1.
Axelsson Fisk, Sten, et al.
(författare)
Understanding the complexity of socioeconomic disparities in smoking prevalence in sweden : A cross-sectional study applying intersectionality theory
2021
Ingår i: BMJ Open. - : BMJ. - 2044-6055. ; 11:2
Tidskriftsartikel (refereegranskat) abstract
Objectives Socioeconomic disparities in smoking prevalence remain a challenge to public health. The objective of this study was to present a simple methodology that displays intersectional patterns of smoking and quantify heterogeneities within groups to avoid inappropriate and potentially stigmatising conclusions exclusively based on group averages. Setting This is a cross-sectional observational study based on data from the National Health Surveys for Sweden (2004-2016 and 2018) including 136 301 individuals. We excluded people under 30 years of age, or missing information on education, household composition or smoking habits. The final sample consisted on 110 044 individuals or 80.7% of the original sample. Outcome Applying intersectional analysis of individual heterogeneity and discriminatory accuracy (AIHDA), we investigated the risk of self-reported smoking across 72 intersectional strata defined by age, gender, educational achievement, migration status and household composition. Results The distribution of smoking habit risk in the population was very heterogeneous. For instance, immigrant men aged 30-44 with low educational achievement that lived alone had a prevalence of smoking of 54% (95% CI 44% to 64%), around nine times higher than native women aged 65-84 with high educational achievement and living with other(s) that had a prevalence of 6% (95% CI 5% to 7%). The discriminatory accuracy of the information was moderate. Conclusion A more detailed, intersectional mapping of the socioeconomic and demographic disparities of smoking can assist in public health management aiming to eliminate this unhealthy habit from the community. Intersectionality theory together with AIHDA provides information that can guide resource allocation according to the concept proportionate universalism.
2.
Lindström, Martin
(författare)
The social medicine specialty in southern Sweden
2023
Ingår i: Scandinavian Journal of Public Health. - : SAGE Publications. - 1403-4948 .- 1651-1905. ; 51:4, s. 517-519
Tidskriftsartikel (refereegranskat) abstract
Aims: This article discusses the situation of the social medicine specialty in Skåne, southern Sweden with the aim of understanding the long-term trends of this medical specialty in Skåne and its relation to research in social medicine. Results: In the 1950s to 1980s, there was a balance between clinical and preventive practice, and research. This balance was maintained in the 1980s to early 2000s as the medical specialty and the research moved ‘upstream’ in the chain of causality to psychosocial, socio-economic and contextual determinants of health. The increasingly ‘upstream’ character of the specialty and particularly its new position in the regional organisation since 2010 may have made it more vulnerable to general executive-level reorganisations. Conclusions: The specialty should maintain its ‘upstream’ focus but regain its proximal scope in prevention, epidemiology and health equity. It should regain its place in the health-care system organisation or alternatively become a state-based instead of regional specialty.
3.
Lindström, Martin, et al.
(författare)
Impact of different aspects of social participation and social capital on smoking cessation among daily smokers: a longitudinal study.
2003
Ingår i: Tobacco Control. - : BMJ. - 1468-3318 .- 0964-4563. ; 12:3, s. 274-281
Tidskriftsartikel (refereegranskat) abstract
Objective: To investigate differences in different aspects of social participation and social capital among baseline daily smokers that had remained daily smokers, become intermittent smokers, or stopped smoking at one year follow up. Design/setting/participants/measurements: 12 507 individuals, aged 45–69 years, interviewed at baseline between 1992 and 1994 and at a one year follow up were investigated in this longitudinal study. The three groups of baseline daily smokers were compared to the reference population (baseline intermittent smokers and non-smokers) according to different aspects of social participation and social capital. A multivariate logistic regression model was used to assess differences in different aspects of social participation and social capital. Results: The baseline daily smokers that remained daily smokers at the one year follow up had significantly increased odds ratios of non-participation in study circles in other places than at work, meeting of organisations other than unions, theatre/cinema, arts exhibition, church, sports events, large gatherings of relatives, and private parties compared to the reference population. The baseline daily smokers that had become intermittent smokers at the one year follow up had significantly increased odds ratios of non-participation in church services. The baseline daily smokers that had stopped smoking had increased odds ratios of non-participation in having attended a meeting of organisations other than labour unions during the past year, having been to a theatre or cinema, and of having visited an arts exhibition during the past year. All three categories of baseline daily smokers had significantly decreased odds ratios of non-participation in night club/entertainment. Conclusions: The baseline daily smokers that had remained daily smokers at the one year follow up had particularly high rates of non-participation compared to the reference population in both activities specifically related to social capital, such as other study circles, meetings of organisations other than labour unions, and church attendance and cultural activities such as theatre/cinema and arts exhibition, although significantly lower participation in cultural activities and meetings of other organisations was also observed among daily smokers that had stopped smoking. All three baseline daily smoker groups had higher rates of having visited a night club during the past year.
4.
Merlo, Juan, et al.
(författare)
God vård på lika villkor vid hjärtinfarkt i dagens Sverige. Geografiska skillnader i dödlighet utan betyd
2005
Ingår i: Läkartidningen. - 0023-7205. ; 102:1-2, s. 20-23
Tidskriftsartikel (refereegranskat) abstract
It is a known fact that the 1990s brought a decrease in mortality after myocardial infarction in Sweden but that differences in mortality rates following myocardial infarction still remain between the Swedish counties. Unresolved, however, are questions as to what these inter-county differences mean for the individual patient and what role hospital care plays in this context. We analysed all patients aged 64-85 years who were hospitalised following diagnosis of myocardial infarction in Sweden during the period 1993-1996. To gain an understanding of the relevance of geographical differences in mortality after myocardial infarction for the individual patient we applied multi-level regression analysis and calculated county and hospital median odds ratios (MORs) in relation to 28-day mortality. For hospitalised patients with myocardial infarction, being cared for in another hospital with higher mortality would increase the risk of dying by 9% (MOR=1.09) in men and 12% in women. If these patients moved to another county with higher mortality the risk would increase by 7% and 3%, respectively. The small geographical differences in 28-day mortality after myocardial infarction found in Sweden suggest a high degree of equality across the country; however, further improvement could be achieved in hospital care, especially for women - an issue that deserves further analysis.
5.
Ahnquist, Johanna, et al.
(författare)
Social determinants of health - A question of social or economic capital? Interaction effects of socioeconomic factors on health outcomes
2012
Ingår i: Social Science and Medicine. - : Elsevier BV. - 1873-5347 .- 0277-9536. ; 74:6, s. 930-939
Tidskriftsartikel (refereegranskat) abstract
Social structures and socioeconomic patterns are the major determinants of population health. However, very few previous studies have simultaneously analysed the "social" and the "economic" indicators when addressing social determinants of health. We focus on the relevance of economic and social capital as health determinants by analysing various indicators. The aim of this paper was to analyse independent associations, and interactions, of lack of economic capital (economic hardships) and social capital (social participation, interpersonal and political/institutional trust) on various health outcomes. Data was derived from the 2009 Swedish National Survey of Public Health, based on a randomly selected representative sample of 23,153 men and 28,261 women aged 16-84 year, with a participation rate of 53.8%. Economic hardships were measured by a combined economic hardships measure including low household income, inability to meet expenses and lacking cash reserves. Social capital was measured by social participation, interpersonal (horizontal) trust and political (vertical/institutional trust) trust in parliament. Health outcomes included; (i) self-rated health, (i) psychological distress (GHQ-12) and (iii) musculoskeletal disorders. Results from multivariate logistic regression show that both measures of economic capital and low social capital were significantly associated with poor health status, with only a few exceptions. Significant interactive effects measured as synergy index were observed between economic hardships and all various types of social capital. The synergy indices ranged from 1.4 to 2.3. The present study adds to the evidence that both economic hardships and social capital contribute to a range of different health outcomes. Furthermore, when combined they potentiate the risk of poor health. (C) 2012 Elsevier Ltd. All rights reserved.
6.
Lindström, Martin, et al.
(författare)
Parental separation in childhood and self-reported psychological health : A population-based study
2016
Ingår i: Psychiatry Research. - : Elsevier BV. - 0165-1781. ; 246, s. 783-788
Tidskriftsartikel (refereegranskat) abstract
The aim of the present study is to investigate associations between parental separation/divorce during childhood, and self-reported psychological health, adjusting for social capital, social support, civil status and economic stress in childhood. A cross-sectional public health survey was conducted in the autumn of 2012 in Scania, southern Sweden, with a postal questionnaire with 28,029 participants aged 18-80. Associations between parental separation/divorce during childhood and self-reported psychological health (GHQ12) were investigated using logistic regressions. A 16.1% proportion of all men 22.4% of all women reported poor psychological health. Among men, 20.4% had experienced parental separation during childhood until age 18 years, the corresponding prevalence among women was 22.3%. Parental separation/divorce in childhood was significantly associated with poor self-rated psychological health among men who had experienced parental separation/divorce at ages 0-4, and among women with this experience at ages 0-4, 10-14 and 15-18. These significant associations remained throughout the multiple analyses. The results support the notion that the experience of parental separation/divorce in childhood may influence psychological health in adulthood, particularly if it is experienced in the age interval 0-4 years.
7.
Lindström, Martin, et al.
(författare)
Parental separation/divorce in childhood and tobacco smoking in adulthood: A population-based study
2020
Ingår i: Scandinavian Journal of Public Health. - : SAGE Publications. - 1403-4948 .- 1651-1905. ; 48:6, s. 657-666
Tidskriftsartikel (refereegranskat) abstract
Aims:The aim was to investigate associations between the experience of parental separation/divorce in childhood and tobacco smoking in adulthood, adjusting for economic stress in childhood and adulthood and psychological health (General Health Questionnaire GHQ12).Methods: The 2012 public-health survey in Skane, southern Sweden, is a cross-sectional postal questionnaire population-based study with 28,029 participants aged 18-80 (51.7% response rate). Associations between parental separation/divorce in childhood and tobacco smoking were investigated in multiple logistic regression models, with adjustments for economic stress in childhood and adulthood and psychological health.Results: A 17.6% weighted prevalence of men and 17.1% of women reported tobacco smoking. Significantly higher odds ratios of tobacco smoking were observed for men who had experienced parental separation/divorce in childhood at ages 0-4, 5-9 and 15-18 years and for women with this experience in childhood at ages 0-4, 5-9, 10-14 and 15-18 years, even after inclusion of economic stress in childhood in the final multiple models. No effect modification was observed for parental separation and psychological health and for parental separation and economic stress in childhood with regard to smoking.Conclusions:Experience of parental separation/divorce in childhood was significantly associated with tobacco smoking in adulthood for both sexes. There seems to be no specific critical period.
8.
Lindström, Martin, et al.
(författare)
Health locus of control and all-cause, cardiovascular, cancer and other cause mortality: A population-based prospective cohort study in southern Sweden
2022
Ingår i: Preventive Medicine. - : Elsevier BV. - 0091-7435. ; 161
Tidskriftsartikel (refereegranskat) abstract
The aim was to investigate associations between health locus of control (HLC) and all-cause, cardiovascular (CVD), cancer and other cause mortality. A public health postal questionnaire was distributed in the autumn of 2008 to a stratified random sample of the 18-80 year old adult population in Scania in southernmost Sweden. The participation rate was 54.1%, and 25,517 participants were included in the present study. Baseline 2008 survey data was linked to cause of death register data to create a prospective cohort with 8.3-year follow-up. Associations between health locus of control and mortality were investigated in survival (Cox) regression models. Prevalence of internal HLC was 69.0% and external HLC 31.0% among women. Internal HLC was 67.6% and external HLC 32.4% among men. In the models with women and men combined, external HLC had significantly higher all-cause, CVD, cancer and other cause mortality even after adjustments for sociodemographic factors and chronic disease at baseline, but after the introduction of health-related behaviors, external HLC only displayed higher cancer mortality compared to internal HLC. External HLC displayed higher all-cause, cancer and other cause mortality for men in the final model adjusted for health-related behaviors, but not for women. Other pathways than health-related behaviors may exist for the association between external HLC and cancer mortality, particularly among men.
9.
Lindström, Martin
(författare)
Populism and health inequality in high-income countries
2020
Ingår i: SSM - Population Health. - : Elsevier BV. - 2352-8273. ; 11
Tidskriftsartikel (refereegranskat) abstract
The rise of populist parties and movements in general and right-wing populist parties in particular has been noted also in the public health literature. While economic and other factors behind the populist surge have been systematically analyzed in the political and social science literature, the understanding of this political phenomenon seems weak in important parts of the public health literature. The lack of analysis of economic effects on health inequity of immigration of people with low levels of work skills to many high-income countries is given with the WHO Commission on Social Determinants of Health report as an example. Public health scholars should be able to fully analyze all effects on health inequity within countries. Public health scholars and professionals may lose credibility if they do not fully assess all relevant determinants, and the investigation of health inequity within countries should consider all systemic roots. Health inequity between countries is a crucial issue and should be addressed through international cooperation between countries, regions and international organizations. The approach from political science and social science should be adopted.
10.
Lindström, Martin, et al.
(författare)
Social capital, the miniaturization of community, traditionalism and mortality: A population-based prospective cohort study in southern Sweden
2021
Ingår i: Ssm-Population Health. - : Elsevier BV. - 2352-8273. ; 16
Tidskriftsartikel (refereegranskat) abstract
Objectives: To investigate associations between social capital, miniaturization of community and traditionalism and all-cause, cardiovascular (CVD), cancer and other causes mortality. Study design: Prospective cohort study. Methods: The 2008 public health survey in Scania in the southernmost part of Sweden was conducted with a postal questionnaire posted to a stratified random sample aged 18-80. The response rate was 54.1%. The baseline survey was linked to 8.3-year prospective public death register data. Analyses were conducted with survival analyses, adjusting for relevant factors. Results: Among women 37.9% had low social participation and 37.8% low trust. Among men 40.9% had low social participation and 35.7% low trust. Low social capital (low social participation/low trust) and traditionalism (low social participation/high trust) have significantly higher total and cardiovascular mortality among women and men combined and among men, but not among women in the final models. The results for women are not significant in the full models for all-cause, CVD, cancer and all other causes mortality. Miniturization of community (high social participation/low trust) displays no statistically significant associations in the adjusted models. Social participation and trust, respectively, and total mortality show consistent Schoenfeld residuals over 8.3 years. Conclusions: The associations between low social capital, traditionalism and mortality are stronger for men than for women, and may be partly mediated by health-related behaviors.
