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Aim To test (i) whether the harmful effects of average volume of alcohol consumption (AC) and heavy episodic drinking (HED) differ by socio-economic position (SEP), and (ii) if so, to what extent such differential effects can be attributed to an unequal distribution of harmful levels and patterns of drinking, health, life-style and social factors. Design A longitudinal cohort study with baseline in 2002 or 2006, with record-linkage to national registers. Setting Stockholm County, Sweden. Participants A total of 37 484 individuals, aged 25-70 years, responding to the survey in 2002 or 2006. Measurements The outcome of alcohol-related health problems was obtained from the National Patient Register and Cause of Death Register using the Swedish index diagnoses related to alcohol use. Self-reported information on occupational class (measure of SEP), AC, HED as well as other health-related factors were extracted from the surveys. Average follow-up time was 13.3 years. Findings During follow-up, a total of 1237 first-time events of alcohol-related health problems occurred. After initial adjustments, heavy drinking appeared to be more harmful to individuals with low SEP compared with high SEP (P = 0.001). Differences in HED frequency explained the largest part of the differential effect of AC. Engaging in weekly HED was more harmful to individuals with low SEP (P = 0.031) than high SEP. Differences in AC, together with other factors, explained a large part of the differential effect of HED. Conclusions The greater adverse impact of alcohol consumption on health in Sweden on people with lower socio-economic position may be largely attributable to higher prevalence of heavy episodic drinking, as well as other behavioral and social risk factors.

Background The present study aims to investigate the association between educational qualification and early labor market exit among men and to examine the contribution of labor market marginalization measured across the working life on this association. Method A register-linked cohort study was conducted including men who completed military service in 1969/70 (born between 1949 and 1951) and were alive at age 55 and not disability pension beneficiaries (n = 40 761). Information on the highest level of educational qualification and the outcome of early exit (disability pension, sickness absence, unemployment, and early old-age pension) was obtained from Swedish nationwide registers between the ages of 55 and 64 years. Labor market marginalization was defined as periods of long-term unemployment and sickness absence over the working life and up to follow-up. Cox regression analyses were used to obtain hazard ratios (HR) with 95% confidence intervals (CI). Results Low-educated men were more likely to leave the labor force early due to disability pension or sickness absence (HR: 2.48), unemployment (HR: 2.09), and early old-age pension with- (HR:1.25) and without -income (HR: 1.58). Labor market marginalization across the working life explained a large part of the association for the more involuntary early exit routes (disability pensions, sickness absence, unemployment) and explained very little with regards to the more voluntary early exit routes (early old-age pension with and without income). Conclusion Exposure to labor market marginalization across the working life was important in explaining educational differences in early labor market exit due to disability pension or sickness absence and unemployment. This study underscores the importance of identifying and implementing preventive measures in the workplace (e.g. adaptions) to prevent new spells of sickness absence and unemployment, especially among low educated individuals.

Objective:Increased alcohol availability influences drinking behavior; however, little is known about the effect of availability changes on subsequent generations. This study examined whether expos...

Background Social inequalities in labor force participation are well established, but the causes of these inequalities are not fully understood. The present study aims to investigate the association between educational qualification and labor market marginalization (LMM) among mature-aged working men and to examine to what extent the association can be explained by risk factors over the life course. Method The study was based on a cohort of men born between 1949 and 1951 who were examined for Swedish military service in 1969/70 and employed in 2000 (n = 41,685). Data on educational qualification was obtained in 2000 and information on the outcome of LMM (unemployment, sickness absence, and disability pension) was obtained between 2001 and 2008. Information on early health behaviors, cognitive ability, previous employment histories, and mental health was collected from conscription examinations and nationwide registers. Results Evidence of a graded association between years of education and LMM was found. In the crude model, compared to men with the highest level of education men with less than 12 years of schooling had more than a 2.5-fold increased risk of health-related LMM and more than a 1.5-fold increased risk of non-health-related LMM. Risk factors measured across the life course explained a large part of the association between education and health-related LMM (33–61%) and non-health-related LMM (13–58%). Conclusions Educational differences remained regarding LMM among mature-aged workers, even after considering several important risk factors measured across the life course. Previous health problems and disrupted employment histories explained the largest part of the associations.

Background Youth unemployment remains at a high stable level in many countries making it a public health problem of importance. The aim was to examine the short-term effect of unemployment at a young age (aged 17–29 years) on self-reported binge drinking and alcohol-related problems. Methods We used data from a cross-sectional national study that took place in 2013, with a follow-up in 2014. A sample of young adults aged 17–29 years (n = 1188, response rate of 46.3%) that completed both surveys served as the study sample in the current study. The same self-reported questionnaire, consisting of questions regarding their alcohol habits and sociodemographic information, was used on both occasions. Information on the outcomes of binge drinking and alcohol-related harm were obtained from the 2014 survey. From the 2013 survey, information on individual and family level covariates were collected. Odds ratios (ORs) with 95% confidence intervals (CIs) with employed individuals as the reference group were estimated by logistic regression analysis. Results At baseline, results indicate that employed individuals reported the greatest prevalence of weekly binge drinking. In the fully adjusted models, unemployment appeared to be associated with an increased risk of alcohol-related problems (OR 1.37, 95% CI 0.77–2.45); however, this was not the case for weekly binge drinking (OR 0. 94, 95% CI 0.45–1.96). Conclusion Unemployment at a young age may be a risk factor for later alcohol-related problems. Thus, targeting youth unemployment could be one element in an effective health policy aimed at reducing rates of alcohol use disorders.

Increased alcohol availability influences drinking behavior; however, little is known about the effect of availability changes on subsequent generations. This study examined whether exposure to increased alcohol availability while pregnant is associated with criminal behavior in subsequent generations.A register-linked study was conducted using data from a natural experiment setting, including 363,207 children born between 1965 and 1971. During 1967/68, strong beer became temporarily available in grocery stores instead of state-owned monopoly stores only, for individuals less than 21 years of age, in two regions of Sweden. Children born in regions exposed to the policy change were compared with children born elsewhere in Sweden (excluding a border area), children born before 1967, and children conceived after 1968. Information on criminal outcomes was obtained from the National Register of Criminal Convictions. Follow-up was from age 15 to 42 years. Hazard ratios with 95% confidence intervals were estimated using Cox regression analysis.Compared with the unexposed cohorts, children conceived by young mothers before the policy change but exposed to the change in utero did not appear to be at an increased risk of being convicted of a violent crime, theft, or drunk driving later in life. Similar patterns of results were found among children conceived by older mothers.Using data from a natural experiment setting, no consistent evidence was found that being exposed to increased alcohol availability while pregnant increased the risk of having a child who would be convicted of a crime later in life.

To test if exposure to unemployment in young adulthood is associated with an increased risk of later alcohol-related morbidity.A nation-wide register-linked longitudinal population-based study.Sweden.A total of 16 490 individuals born between 1967 and 1978, who had participated in the Labour Force Survey between the ages of 16-24 years during 1990-95.Information on the outcome of alcohol-related morbidity was obtained from the National Hospital Discharge Register. The Swedish index of alcohol-related in-patient care was used to define the outcome. Information on sex, age and country of birth, as well as parents' level of education, socio-economic status and alcohol-related health problems, were also obtained. Average follow-up time was 22 years. Cox regression analysis was used to obtain hazard ratios (HR) with 95% confidence intervals (CI).Compared with full-time students, individuals who experienced short- and long-term unemployment spells at a young age were at an increased risk of later alcohol-related morbidity; 3 months (HR = 2.04, 95% CI = 1.35-3.09), 3-6 months (HR = 2.20, 95% CI = 1.29-3.75) and 6 months (HR = 1.99, 95% CI = 1.06-3.71) of unemployment, after adjusting for several important individual and family level covariates.In Sweden, a nation-wide register-based study with a 22-year follow-up suggests that being unemployed in young adulthood is associated with an increased risk of alcohol-related morbidity later in life.

Aim: The purpose of the present study is to examine the prevalence of active commuting and factors associated with participation in active commuting in the municipality of Karlskrona, Sweden. Active commuting is defined here as walking or cycling to and from school/work for at least 15 minutes one-way. Method: A cross-sectional study was carried out, which included baseline data from parents-to-be. Pregnant females and their partners were invited to participate in the study when they contacted either of the municipality’s two antenatal clinics. Data collection ran from March 2008 to February 2009. When completing the questionnaire, the participants were asked to reflect on their situation one month before the female became pregnant. The final sample consisted of 432 participants (response rate 51.9% for females and 85.0% for males). Results: The main mode of commuting was motor vehicle (63.0%), with active commuters forming a minority (8.3%). The main facilitating factor for active commuting was living in an urban as opposed to a rural area. Regular participation in outdoor recreational physical activity was significantly positively associated with active commuting. Being Swedish and being surrounded by a green space environment were significantly negatively associated with active commuting. Conclusions: This study found that the number of people who are active commuters is modest and other modes of transportation are preferred. Several facilitating and impeding factors associated with active commuting were also found, indicating the importance of applying a broad health-promoting approach to encouraging active commuting.

Aim To test if being exposed to increased alcohol availability during adolescence is associated with an increased risk of receiving disability pension due to all-cause, alcohol use disorders and mental disorders. Design Register-based population-based study using a natural experiment setting, the alcohol policy change in Sweden (1967-1968), with increased access to strong beer in a narrow time window and geographical area. The individuals exposed to the policy change were compared with non-exposed individuals living in the rest of Sweden, excluding a border area. Setting Sweden Participants A total of 518 810 individuals (70 761 in the intervention group; 448 049 in the control group) born 1948-1953, aged 14-20 years old during the policy change. Measurements Date and diagnosis of the outcome variable of disability pension due to all-cause, alcohol use disorders and mental disorders were obtained from the Swedish National Social Insurance Agency database from 1971 to 2013. Individual and family level sociodemographic and health related covariates, as well as a regional level covariate were included. Findings Compared with the control group, adolescents exposed to the alcohol policy change were at an increased risk of receiving disability pension due to all-causes (HR 1.09, 95% CI 1.07-1.11), alcohol use disorders (HR 1.17, 95% CI 1.05-1.30) and mental disorders (HR 1.19, 95% CI 1.15-1.23). Conclusion In Sweden, a natural experiment with a 43-year follow-up suggests that exposure to increased alcohol availability during adolescence is associated with an increased risk of receiving a disability pension due to all-cause, alcohol use disorder and mental disorder diagnoses. This article is protected by copyright. All rights reserved.

Background: A strict high legal age limit for alcohol purchases decreases adolescents’ access to alcohol, but little is known about long-term health effects. The aim was to estimate the effect of increased alcohol availability during adolescence on alcohol-related morbidity and mortality.Methods: A nationwide register-based study using data from a natural experiment setting. In two regions of Sweden, strong beer (4.5%–5.6% alcohol by volume) became temporarily available for purchase in grocery stores for individuals 16 years or older (instead of 21) in 1967/1968. The intervention group was defined as all individuals living in the intervention area when they were 14–20 years old (n=72 110). The remaining Swedish counties excluding bordering counties, without the policy change, were used as the control group (n=456 224). The outcomes of alcohol-related morbidity and mortality were collected from the Hospital Discharge Register and Cause of Death Register, in which average follow-up times were 38 years and 41 years, respectively. HRs with 95% CIs were obtained by Cox regression analysis.Results: In the fully adjusted model, no clear evidence of an association between increased alcohol availability during adolescence and alcohol-related morbidity (HR: 0.99, 95% CI 0.96 to 1.02) or mortality (HR: 1.02, 95% CI 0.95 to 1.10) was found.Conclusion: The initial elevated risk of alcohol-related morbidity and mortality later in life among adolescents exposed to increased access to strong beer in Sweden vanished when a regional measure population density of locality was included in the model, which is important to consider in future research.

Background: In order to increase the current levels of physical activity new strategies have been suggested where it is incorporated into daily routines, such as commuting to and from school/work. ...