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Previous studies have found that troubled childhood family conditions have long-term detrimental effects on a person’s economic situation in adulthood. However, the mechanisms behind these effects are unclear. The aim of this study was to examine the associations between poor adolescent family relationships and the economic adversity in mid-adulthood and whether different adversities in early adulthood mediate this association. Participants of a Finnish cohort study at 16 years in 1983 were followed up when aged 22, 32 and 42 (N = 1334). Family relationships were measured according to adolescents’ perceived lack of emotional parental support (e.g. My mother is close to me (reversed)), lack of parental support in the individuation process and poor atmosphere at home. We analysed the direct effects of poor family relationships at age 16 on the economic adversity at age 42 and also indirect effects via various adversities at ages 22 and 32. The examined adversities were poor somatic and mental health, lack of an intimate relationship, low education and heavy drinking. Poor adolescent family relationships were associated with economic adversity in mid-adulthood. For women, poor relationships were associated with their economic adversity (42y) through poor mental health and low education in early adulthood. For men, the effect was transmitted via low education, although this was not the case after adjusting for school achievement in adolescence. The quality of family relationships in adolescence is associated with an individual’s economic situation well into mid-adulthood in women. Moreover, this association was not explained by family structure and parental SEP in adolescence. Early promotion of parent-child interaction, as well as health and education of individuals from troubled family conditions, might reduce economic inequality in adulthood.

Background: Long-term sickness absence (LTSA; >10 days) creates huge economic burden for employers and societies. Lifestyle behaviours and quality of sleep may reduce the risk of LTSA, but the possible savings achieved through improving these risk factors have been poorly quantified. We aimed to provide monetary estimates for the association of risk factors with cost of LTSA. Methods: The Helsinki Health Study is a cohort of employees of the City of Helsinki, Finland (n=8960, response rate 67%). In 2007, the participants received a questionnaire that gathered information on their lifestyle and sleep. A sum of the risk factors was calculated: Participants received one point for being a smoker; heavy alcohol user (>7 portions/week for women and >14 portions/week for men); physically inactive (

We examined whether relative occupational social class inequalities in physical health functioning widen, narrow or remain stable among white collar employees from three affluent countries. Health functioning was assessed twice in occupational cohorts from Britain (1997-1999 and 2003-2004), Finland (2000-2002 and 2007) and Japan (1998-1999 and 2003). Widening inequalities were seen for British and Finnish men, whereas inequalities among British and Finnish women remained relatively stable. Japanese women showed reverse inequalities at follow up, but no health inequalities were seen among Japanese men. Health behaviours and social relations explained 4-37% of the magnitude in health inequalities, but not their widening.

BACKGROUND: The purpose of this study is to assess the effects of lifestyle risk factors on the risk of hospitalization for sciatica and to determine whether overweight or obesity modifies the effect of leisure-time physical activity on hospitalization for sciatica. METHODS: We included 4 Finnish prospective cohort studies (Health 2000 Survey, Mobile Clinic Survey, Helsinki Health Study, and Young Finns Study) consisting of 34,589 participants and 1259 hospitalizations for sciatica during 12 to 30 years of follow-up. Sciatica was based on hospital discharge register data. We conducted a random-effects individual participant data meta-analysis. RESULTS: After adjustment for confounding factors, current smoking at baseline increased the risk of subsequent hospitalization for sciatica by 33% (95% confidence interval [CI], 13%-56%), whereas past smokers were no longer at increased risk. Obesity defined by body mass index increased the risk of hospitalization for sciatica by 36% (95% CI 7%-74%), and abdominal obesity defined by waist circumference increased the risk by 41% (95% CI 3%-93%). Walking or cycling to work reduced the risk of hospitalization for sciatica by 33% (95% CI 4%-53%), and the effect was independent of body weight and other leisure activities, while other types of leisure activities did not have a statistically significant effect. CONCLUSIONS: Smoking and obesity increase the risk of hospitalization for sciatica, whereas walking or cycling to work protects against hospitalization for sciatica. Walking and cycling can be recommended for the prevention of sciatica in the general population. (C) 2017 Elsevier Inc. All rights reserved.

Objective The aim of this study was to examine how changes over time in leisure-time physical activity are associated with subsequent sickness absence. Methods Helsinki Health Study cohort baseline questionnaire survey data were collected in 2000–2002 among 40–60-year-old employees of the City of Helsinki, Finland. A follow-up survey was conducted in 2007. 4182 (83% women) respondents were available for the analyses. Leisure-time physical activity was asked using identical questions in both surveys. Sickness absence data were derived from the employer's registers (mean follow-up time 2.8 years). Associations of changes over time in leisure-time physical activity with self-certified (≤ 3 days) and medically certified (> 3 days) sickness absence spells were examined, using Poisson regression analysis. Results Inactive women and men who increased their physical activity to vigorously active had a significantly lower risk of both self-certified (RR = 0.80, 95% CI 0.65–0.97) and medically certified (RR = 0.63, 95% CI 0.49–0.83) subsequent sickness absence spells compared with the persistently inactive. The persistently active with vigorous intensity had the lowest risk of sickness absence. Adjusting for changes in physical health functioning attenuated but did not abolish the lowered risk found. Conclusions For reducing sickness absence more emphasis should be given to the potential contribution of vigorous physical activity.

Background Social determinants of sleep may prove to be as important as health status. In this study we examined the extent to which persistent and changing economic difficulties are associated with sleep problems in two prospective occupational cohorts. Methods We used data from Finnish (baseline 2000–2002; follow-up 2007; n = 6328) and British (baseline 1997–1999; follow-up 2003–2004; n = 5002) public sector employees. Economic difficulties, sleep problems, and a variety of covariates were assessed at baseline and follow-up. Results Prevalence of frequent sleep problems at follow-up was 27% and 20% among women and men in the Finnish cohort, and 34% and 27% in the British cohort, respectively. Odds for sleep problems were higher among those with persistent economic difficulties (frequent economic difficulties at baseline and follow-up) compared to those with no difficulties. This association remained after multiple adjustments, including parental and current socioeconomic position, in the Finnish (OR 1.72, 95% CI 1.35–2.18) cohort. Increases in economic difficulties were similarly associated with sleep problems in the Finnish and the British cohort. Conclusion Evidence from two occupational cohorts suggests strong associations between economic difficulty and poor sleep. Awareness of this association will help health care professionals identify and prevent sleep problems.

The economic resources available to an individual or a household have been hypothesised to affect health through the direct material effects of living conditions as well as through social comparison and experiences of deprivation. The focus so far has been mainly on current individual or household income, and there is a lack of studies on wealth, a potentially relevant part of household resources. We studied the associations of household wealth and household income with self-rated health, and addressed some theoretical issues related to economic advantage and health. The data were from questionnaire survey of Finnish men and women aged from 45 to 67 years, who were employed by the City of Helsinki from five to seven years before the collection of the data in 2007. We found household wealth to have a strong and consistent association with self-rated health, poor health decreasing with increasing wealth. The relationship was only partly attributable to the association of wealth with employment status, household income, work conditions and health-related behaviour. In contrast, the association of household income with self-rated health was greatly attenuated by taking into account employment status and wealth, and even further attenuated by work conditions. The results suggested a significant contribution of wealth differentials to differences in health status. The insufficiency of current income as the only measure of material welfare was demonstrated. Conditions associated with long-term accumulation of material welfare may be a significant aspect of the causal processes that lead to socioeconomic inequalities in ill health.

Objectives The aim of this study was to examine the overall and cause-specific mortality of DUI arrestees compared to a reference population with no history of DUI and to recognize the risk factors of premature death. Methods The data used were a register of all DUI arrestees between April 1988 and December 2006. All drivers with drug-positive samples were excluded. DUI arrestees were compared to a reference population with no previous history of DUI. Overall and cause-specific hazard ratios were calculated and risk factors were estimated. Results Alcohol causes, diseases of the circulatory system and accidents constituted the most common causes of death among DUI arrestees. Suspected DUI was linked with higher mortality in every observed cause of death. The risk of death by alcohol-related or external cause was especially high. Among women DUI arrests caused sharper increase to the risk of death than increase found among male arrestees. Within the group of DUI arrestees the risk of death was affected by age, sex, marital status, education, multiple arrests as well as time and observed blood alcohol level of the arrest. Half of the suspected DUI cases and one in five of the references had alcohol as a contributing factor to death. Conclusions Arrest on suspicion of drunk-driving is an indicator for elevated risk of death. Alcohol is often related to deaths of DUI arrestees. Drunk-drivers should be efficiently guided with respect to evaluations and treatments for harmful drinking.

Objective To examine whether physical activity contributes to physical health functioning five to seven years later among middle-aged employees. Methods Baseline data were collected in 2000–2002 by questionnaire surveys among 40–60-year-old employees of Helsinki City. A follow-up survey was conducted among baseline respondents in 2007 (n = 7330, response rate 83%). Physical activity during leisure time or commuting within the previous 12 months was asked at baseline. Physical health functioning was measured by physical component summary (PCS) of the Short-Form 36 questionnaire. PCS mean scores were examined, as were poor and good PCS scores. Results Vigorously active and conditioning exercisers had better subsequent physical health functioning than did the inactive and moderately active. Baseline health and functioning explained a major part of the differences found. Smoking, alcohol use and BMI further explained some of the differences. No clear differences in physical health functioning mean scores emerged during follow-up. In good physical health functioning, however some differences between conditioning and inactive women remained after adjustments. Conclusions Prospective associations between physical activity and physical health functioning were relatively weak, but high physical activity may help in maintaining good physical health functioning. Vigorous activity may be more beneficial than moderate activity.

This study aims to examine social class differences in smoking, heavy drinking, unhealthy food habits, physical inactivity and obesity, and work-related psychosocial factors as explanations for these differences. This is done by comparing employee cohorts from Britain, Finland and Japan. Social class differences in health behaviours are found in the two western European countries, but not in Japan. The studied psychosocial factors related to work, work-family interface and social relationships did not explain the found class differences in health behaviours.

This study examined whether trust predicted subsequent self-rated health over time at 3 years follow-up among aging people, and whether changes in trust were associated with self-rated health. Longitudinal, questionnaire-based data were collected from three age cohorts (born in 1926–1930, 1936–1940, and 1946–1950) living in the Province of Paijat-Hame, southern Finland. The response rate at the baseline in 2002 was 66% ( n = 2815). The follow-up was carried out in 2005, with 79% of eligible individuals participating ( n = 2216). Logistic regression analyses were used to derive the results. High trust was a strong predictor for good self-rated health at the follow-up. Adjusting for background variables, however, attenuated the association. In addition, good self-rated health was most common among men with sustained high trust, among women the association was somewhat weaker. Among men improvement in trust was associated with good self-rated health, but this correlation weakened after multiple adjustments. Thus, longitudinally trust is an important contributor to self-rated health among aging people. Moreover, improvement of trust but also the stability of high trust especially among men indicate better self-rated health. Trust has a positive effect on health and should therefore be seen as a significant element in health promotion.

Objectives To examine nonparticipation to a questionnaire survey and occupational health check-ups by sociodemographic variables and health status, measured by medically confirmed sickness absence, and whether the associations between other study variables and participation were affected by health status. Study Design and Setting Questionnaire surveys and health check-ups were conducted among the City of Helsinki employees. Sample information was derived from the employer's personnel register and analyzed by participation and giving consent to link the data to external administrative registers. Results Participation to the questionnaire survey was more common among the older, higher occupational classes, those with higher income, permanent employment, and those with no absence due to medically confirmed sickness. Among women in particular, the differences were small. Consent giving followed generally similar patterns than survey response. Nonparticipation to health check-ups was related to low income and temporary employment contract. In both questionnaire survey and health check-ups, associations between other study variables and participation were not affected by health status. Conclusions Questionnaire surveys and health check-ups were broadly representative of the target population. Associations between other study variables and participation did not differ by health status. This suggests that even when the data are not fully representative associations between the study variables need not to be biased.

Background The aim of this prospective longitudinal study of adolescents was to investigate socioeconomic differences in adult depression and in the domain of social support from adolescence to adulthood. We also studied the modifying effect of social support on the relationship between socioeconomic status (SES) and depression. Methods All 16-year-old ninth-grade school pupils of one Finnish city completed questionnaires at school ( n = 2194). Subjects were followed up using postal questionnaires when aged 22 and 32 years. Results At 32 years of age there was a social gradient in depression, with a substantially higher prevalence among subjects with lower SES. Low parental SES during adolescence did not affect the risk of depression at 32 years of age, but the person's lower level of education at 22 years did. Lower level of support among subjects with lower SES was found particularly in females. Some evidence indicated that low level of social support had a greater impact on depression among lower SES group subjects. However, this relationship varied depending on the domain of social support, life stage and gender. On the other hand, the results did not support the hypothesis that social support would substantially account for the variation in depression across SES groups. Limitations The assessments and classifications of social support were rather brief and crude, particularly in adolescence and early adulthood. Conclusions It is important to pay attention to social support resources in preventive programs and also in the treatment settings, with a special focus on lower SES group persons.

Objective To examine the relationship between work–family conflicts and drinking behaviours among women and men, and to discover whether the relationship remains the same after taking into account family structure and socio-economic status. Method Cross-sectional surveys were carried out by postal questionnaires in 2001 and 2002 among female and male municipal employees aged 40–60, of Helsinki, Finland; 4228 women and 1043 men participated, with a response rate of 66%. Dependent variables were heavy drinking—for men >12 standard portions per week and for women >9 portions per week; weekly binge drinking including 6 or more portions per occasion; and problem drinking, as measured by the CAGE questionnaire. Independent variables were work-to-family conflicts and family-to-work conflicts. Covariates were age, family structure, education, income, and occupational class. Results Work–family conflicts were strongly related to problem drinking among both women and men and also associated with heavy drinking among women. Taking family structure and socio-economic status into account did not markedly change the relationship between work–family conflicts and heavy drinking among women, but strengthened slightly the association with problem drinking among both women and men. Conclusions Work–family conflicts are particularly important issues in problem drinking among men and women and also in heavy drinking among women. Improving the balance between work and family may be a way to prevent problem drinking.

The aim of this study was to examine the associations of parental education and specific childhood circumstances with adult physical and mental functioning. Self-reported data were collected in 2000, 2001 and 2002 among middle-aged women ( n = 7171 ) and men ( n = 1799 ) employed by the City of Helsinki. Functioning was measured by the physical and mental component summaries of the Short-Form 36 Health Survey (SF-36). The lowest quartile of the scores on each component summary was considered to indicate limited functioning. Adult socio-economic circumstances were measured by their own education. Among women parental education was inversely associated with physical functioning. The association remained after adjusting for specific childhood circumstances but disappeared after adjustment for own education. In contrast, parental education was positively associated with mental functioning among women, and the association remained after adjusting for specific childhood circumstances and the own education. Among women childhood adversities such as own chronic disease, parental mental problems, economic difficulties and having been bullied in childhood were associated with both physical and mental functioning. Parental drinking problems were associated with adult mental functioning among women. Among men, chronic disease, economic difficulties and having been bullied in childhood were associated with physical functioning. Parental mental problems, economic difficulties and having being bullied in childhood were also associated with mental functioning among men. These results suggest that the effect of parental education on physical functioning is mediated through one's own education. The association between parental education and mental functioning and the effects of several specific childhood circumstances may suggest a latency effect. Some evidence of cumulative effects of childhood and adulthood circumstances were found among women in physical functioning. Specific childhood circumstances are therefore important determinants of adult functioning. These circumstances provide detailed information on the association of childhood circumstances with adult functioning over and above parental education.

Objective. To examine the association between smoking and general health as measured by the Short-Form Health Survey (SF-36) questionnaire. Methods. Data derived are from three cross-sectional surveys conducted in 2000, 2001 and 2002. Respondents to the postal surveys were middle-aged employees of the City of Helsinki (1799 men and 7171 women, response rate 67%). Smoking status was divided into current heavy and moderate smokers, ex-smokers and never smokers. Health status was measured by the eight SF-36 subscales and the physical and mental component summaries. Results. On the physical subscales, current smokers reported poorer health than non-smokers on general health and physical functioning in men. On the mental subscales, current smokers had consistently poorer health than non-smokers. However, often only heavy smokers differed from non-smokers. No differences were found between ex-smokers and never smokers on any subscale or the component summaries of the SF-36. Conclusions. Differences between smoking categories were found on some physical and all mental subscales of the SF-36. The differences were slightly larger among men. As heavy smokers more often report limitations with daily activities as well as loss of well-being, these impairments potentially provide valuable incentives for non-smoking to be used in health education messages and interventions.

Smoking is more prevalent among lower socioeconomic status groups, among those who perceive economic difficulties and among lone mothers. Less is known of how these factors contribute to smoking independently. The aim of this study was first to examine the association between smoking and both economic difficulties and lone parenthood. We then also studied to what extent smoking among people experiencing economic difficulties and lone parenthood is due to other factors such as socioeconomic status and social relations. The data derive from surveys conducted among the employees of the City of Helsinki, Finland, in 2000 and 2001 including 6243 respondents aged 40-60 yr (response rate 68%). The measures were daily smoking, economic difficulties and family type, as well as socioeconomic status (education, occupational social class, household income, housing tenure) and social relations. The more had respondents experienced economic difficulties, the more prevalent was their smoking. Smoking among lone parents was more common than among parents living together; this was true for both men and women. After controlling for socioeconomic status and housing tenure, the association between smoking and economic difficulties, as well as that between smoking and lone parenthood, attenuated but remained statistically significant. However, after controlling for social relations the associations became stronger. Both economic difficulties and lone parenthood were associated with smoking independent of education, occupational social class, household disposable income, housing tenure or social relations for both men and women.

Background . Working conditions influence health, but previous studies on the associations between work-related factors and health behaviours are scarce. The aim of this study was to analyse whether unfavourable working conditions are associated with diet, physical activity, alcohol consumption, and smoking. Methods . The data derive from postal questionnaires collected in 2000–2001 from 40- to 60-year-old employees of the City of Helsinki ( n = 6243, response rate: 68%). Logistic regression analysis was used to examine health behaviours as outcomes. Job demands and job control, physically and mentally strenuous work, work fatigue, working overtime and satisfaction with work–home interface were independent variables, adjusted for age, education, occupational social class and marital status. Results . Most of the examined associations between working conditions and health behaviours were not statistically significant. Among women, mentally strenuous work and high job control were associated with a healthy diet. Work fatigue was associated with physical inactivity, whereas physically strenuous work and satisfaction with work–home interface were more often reported by physically active women. Work fatigue was associated with high drinking among men. Low job strain was reported by nonsmoking women, whereas working overtime was associated with nonsmoking among men. Conclusions . Working conditions were only weakly associated with health behaviours, and the associations varied for different health behaviours.

This study examined changes over time in relative health inequalities among men and women in four Nordic countries, Denmark, Finland, Norway and Sweden. A serious economic recession burst out in the early 1990s particularly in Finland and Sweden. We ask whether this adverse social structural development influenced health inequalities by employment status and educational attainment, i.e. whether the trends in health inequalities were similar or dissimilar between the Nordic countries. The data derived from comparable interview surveys carried out in 1986/87 and 1994/95 in the four countries. Limiting long-standing illness and perceived health were analysed by age, gender, employment status and educational attainment. First, age-adjusted overall prevalence percentages were calculated. Second, changes in the magnitude of relative health inequalities were studied using logistic regression analysis. Within each country the prevalence of ill-health remained at a similar level, with Finns having the poorest health. Analysing all countries together health inequalities by employment status and education showed no major changes. There were slightly different tendencies among men and women in inequalities by both health indicators, although these did not reach statistical significance. Among men there was a suggestion of narrowing health inequalities, whereas among women such a suggestion could not be discerned. Looking at particular countries some small changes in men's as well as women's health inequalities could be found. Over a period of deep economic recession and a large increase in unemployment, particularly in Finland and Sweden, health inequalities by employment status and education remained broadly unchanged in all Nordic countries. Thus, during this fairly short period health inequalities in these countries were not strongly influenced by changes in other structural inequalities, in particular labour market inequalities. Institutional arrangements in the Nordic welfare states, including social benefits and services, were cut during the recession but nevertheless broadly remained, and are likely to have buffered against the structural pressures towards widening health inequalities.

The common wisdom about gender differences in illhealth has been encapsulated in the phrase "women are sicker, but men die quicker". Recently this wisdom has been increasingly questioned. The purpose of this study is first to analyse the patterns and magnitude of gender differences across various indicators of illhealth; second to examine changes over time in these differences and third to assess whether sociodemographic and socioeconomic, family status and social network determinants have any bearing on the differences. The data derive from nationally representative 1986 and 1994 Surveys on Living Conditions in Finland. Women showed poorer health for five out of eight indicators analysed; that is somatic symptoms, mental symptoms, disability among those 50 years or older, long-standing illness and limiting long-standing illness were more prevalent among women than men. Male excess was found for perceived health below good and extremely limiting long-standing illness among those 50 years or older. However, the male excess was statistically significant only for poor perceived health among those 50 years or older. Adjusting for a number of suggested determinants of health had a negligible effect on gender differences. Further analyses showed that gender differences in illhealth remained largely stable over the eight year study period which saw a steep increase of unemployment for both genders. Only in the case of mental and somatic symptoms have gender differences declined, with a simultaneous increase in the prevalence of such symptoms. Otherwise gender differences in illhealth turned out to be resistant to the deep labour market crisis over this relatively short period of time. Although women had poorer health than men for a number of health indicators, we also find gender equality and even male excess for some indicators. Furthermore, the results suggest that a male excess in illhealth is likely to be found with more severe domains of illhealth among elderly people.

Background. The aim of the present study was to examine the association between smoking status and relative body weight at different educational levels in Finland during 1978–1995. Methods. The data for the study were derived from separate cross-sectional health behavior surveys conducted annually by the National Public Health Institute (n= 3,418–5,037, response rate 68–84%). Relative weight was compared among current smokers, ex-smokers, and never smokers. Mean body mass index (BMI) was used as the measure of relative weight. Educational level was measured by the number of school years. Results. During 1978–1995, relative weight increased in all smoking categories. Among men, ex-smokers weighed most, irrespective of study year or educational level, whereas among women ex-smokers showed a mean BMI comparable with that of never smokers. Among current and never smokers, both men and women, the association between smoking status and mean BMI varied according to educational level: current smokers weighed less than never smokers at the lowest educational level, whereas at the highest educational level they weighed more than never smokers. Conclusions. The association between smoking status and relative weight varied according to educational level. The finding suggests that the association between smoking status and relative weight is modified by social and behavioral factors.

During the imputation of missing data, a number of additional participants from Whitehall phase 5 were included by mistake. The correct number in the analyses should have been 4350, not 5002. Re-running the analyses excluding these additional participants from the imputation did not affect the results. Thus the associations remained very similar to those reported. Complete case analysis reported in the ‘Discussion’ was done with the correct number of participants in the first instance. Corrected tables are available from the first author on request.

Gender and social class differences in illness among young people have been a neglected area in research on social inequities in health. It has been assumed that the illness differentials among adults persist throughout their lives. Only recently have social class health differentials among young people become a topic for research. The aim of this study is, first, to examine gender and social class differences in self-reported illness among young Finns; secondly, to determine whether the relationship between social class and limiting long-standing illness is similar among young men and women. In addition to the two main aims, we also examined whether several background variables have any impact on the relationship between class and illness or, directly, on illness. The data were derived from a nationwide Finnish 'Level of Living Survey', which was carried out by the Central Statistical Office of Finland in 1986. This interview material represents the noninstitutional Finnish population aged 15 years old or older. The number of respondents were 12,057, and the response rate was 87%. In the present study we only examined those who were 15-24-year-olds (N = 2238); i.e. 1101 men and 1137 women; the response rates were 91% and 92% respectively. Young women reported a limiting long-standing illness more often than young men. The prevalence of limiting long-standing illness increased with age. Cross-tabulation analyses showed virtually no relationship between social class and limiting long-standing illness. This held true irrespective of the various measures of social class that were used. Controlling the impact of several background variables in the logistic regression analyses did not alter this general result.

Introduction Insomnia symptoms are associated with several health outcomes such as somatic and mental health, sickness absence and disability retirement. However, studies on the association between insomnia symptoms and mortality are few and their results inconsistent. In some studies frequent symptoms are associated with higher mortality risk, some others have found no or even reverse associations. Our aim was to examine the association of insomnia symptoms with all-cause mortality among ageing employees. Materials and methods The Helsinki Health Study baseline questionnaire survey data on 40–60-year-old City of Helsinki employees were collected in 2000–2002 (response rate 67%). These data were linked with register data on mortality until the end of 2011 ( n = 188 deaths) for those with written consent for such linkages (74%; N = 6,464). Insomnia symptoms included difficulties initiating and maintaining sleep, and non-restorative sleep (none, occasional, i.e. 1–14 nights per month, and frequent, i.e. 15 + nights per month). Baseline covariates included age, sex, education, marital status, obesity, alcohol drinking, physical inactivity, and mental health. Cox regression analysis was used to calculate hazard ratios (HR) and their 95% confidence intervals (CI). Results At baseline, 21% of women and 17% of men reported frequent insomnia symptoms. The summary measure examining any insomnia symptoms was not associated with all-cause mortality among men or women. However, difficulties in initiating sleep were strongly associated with mortality among men (HR 4.46, 95% CI 2.03–9.77). After adjusting for all covariates, the association attenuated but remained (HR 2.78, 95% CI 1.19–6.48). No associations could be confirmed among women or for difficulties maintaining sleep and non-restorative sleep. Conclusion Difficulties initiating sleep were associated with mortality among men. Otherwise insomnia symptoms were unassociated with mortality. Studies need to examine insomnia symptoms separately, especially as they may have contrasting associations with mortality. Health care should emphasise early detection and prevention of insomnia symptoms, especially difficulties initiating sleep. Acknowledgements Funding from the Academy of Finland, Finnish Work Environment Fund and University of Helsinki.

Introduction Sleep disturbances have been associated with increased risk of cardiovascular disease outcomes. The associations of insomnia with hypertension and dyslipidemia, the main modifiable cardiovascular disease risk factors, are less studied. We aimed to examine associations of insomnia symptoms with subsequent prescribed medication for hypertension and dyslipidemia. Materials and methods Baseline questionnaire surveys among 40–60-year-old employees of the City of Helsinki, Finland, were conducted in 2000–2002 (N = 6,477, response rate 67%, 78% women) and linked to a national register on prescribed reimbursed medication 5–7 years prior to and 5 years after baseline. The associations between the frequency of insomnia symptoms (difficulties in initiating and maintaining sleep, non-restorative sleep) and hypertension and dyslipidemia medication during the follow-up were analysed using logistic regression analysis (odds ratios (OR) with 95% confidence intervals (CI)). Analyses were adjusted for pre-baseline medication, sociodemographic and work-related factors, health, and health behaviours. Results Frequent insomnia symptoms were reported by 20%. During the 5-year follow-up 32% had hypertension medication and 15% dyslipidemia medication. Adjusting for age, gender, and pre-baseline medication, frequent insomnia symptoms were associated with hypertension medication (OR 1.57, 95% CI 1.23–2.00) and dyslipidemia medication (OR 1.59, 95% CI 1.19–2.12). Occasional insomnia symptoms were also associated with cardiovascular medication, though less strongly. Further adjustments had negligible effects. Conclusion Insomnia should be taken into account in the prevention and management of cardiovascular disease and related risk factors. Acknowledgements The authors have no conflicts of interests to report. This study has been funded with grants from Academy of Finland, Finnish Work Environment Fund, Juho Vainio Foundation, Emil Aaltonen Foundation, and Doctoral Programs in Public Health.

The aim of the study was to describe the consumption of foods known as indicators of the total sucrose intake, and the distribution of the use of these foods. Three samples (N=4140, 3734 and 3354) of Finnish 12 to 18-year-old boys and girls participated in a mailed survey in 1981, 1983 and 1985. The proportions of frequent users of sweet pastries and sugared coffee decreased clearly during the follow-up time, but socio-economic and regional differences in consumption patterns remained unchanged. Throughout the period of study adolescents from farm families used sweet pastries and sugared coffee significantly more often than did urban adolescents from white-collar families. Consumption of sweetened yogurt increased and was higher in urban areas than in farm families. For sweets, soft drinks and sugared tea, no changes occurred, and father's occupation or educational level were not significant determinants of consumption. The Finnish adolescents are replacing the traditional sugar sources by new ones and changes in the consumption of sugar-containing foods follow the same logic as described in cultural and historical studies.

Five samples (N=2900−4300) of Finnish 12 to 18-year-old boys and girls participated in a postal survey on health habits in 1977, 1979, 1981, 1983 and 1985. The proportions of high-fat milk and butter users decreased during the follow-up time, but the socio-economic and regional differences in consumption patterns remained unchanged. Both in 1977 and 1985, children in eastern and northern provinces, and the children of farmers and lower socio-economic and educational groups, more frequently used butter and high-fat milk than children of higher social and educational groups living in urbanized areas.

The suggestion that coffee may have negative health effects has made coffee-drinking habits medically interesting. This paper reports upon coffee use among young people and describes how coffee-users differ from non-users. Data comes from questionnaires from representative nationwide samples of 12–18-year-old Finnish youth in 1977–1985. Their coffee use decreased from 1977 to 1985, and the decrease could be seen in all age and socio-demographic groups studied. In 1981, 35% of the girls and 45% of the 12-year-old boys drank coffee daily. For 18-year-olds the corresponding percentages were 67 and 75, and the mean number of cups consumed per day was 2.3 and 3.1. Compared to the non-users, the coffee-users were from lower social classes, lived more often in the countryside, and had poorer school achievement. Health-damaging habits such as smoking were more common among the coffee-users, their perceived health was somewhat poorer, and they seemed to mature earlier. The difference in regard to health disappeared after adjusting for differences in socio-demographic background and health habits. The heavy users (four cups or more a day) usually differed more from the non-users than did the moderate users (one to three cups daily).