Who stopped smoking? Results from a panel survey of living conditions in Sweden

1905 smokers were investigated from a random sample of 4424 persons among the Swedish population interviewed in 1974 and 1981. On average, 28% of those smoked in 1974 had stopped smoking by 1981. A multivariate method was used to study whether socioeconomic and demographic factors, tobacco consumption level or health contributed to changes in smoking behaviour. Most successful in smoking cessation were senior salaried employees (35% quit), well educated persons (33% quit) and those who smoked less than ten cigarettes per day (36% quit). On the other hand, only 20% of divorced parents with children succeeded in smoking cessation. Tobacco consumption turned out to be the most important variable for explaining the variance. The probability of smoking cessation increased by 40% if one smoked less than 10 cigarettes per day. The low explained variance, 6%, of this multivariate approach indicates, however, that socioeconomic factors have only marginal effects on the decision to stop smoking. It seems more likely that many factors, e.g. demographic, socioeconomic, motivational, self-efficacy, social and therapeutic support, nicotine dependence etc. act together in a complex way.     

Smoking cessation in Texas-Mexico border communities: a quasi-experimental panel study

BACKGROUDd. Smoking-related disease and injury is prominent among the numerous health problems on the U.S.-Mexico border, but little is known about the methods that might help promote smoking cessation among the low-income populations in this region. METHOD. Media campaigns were combined with different forms of intensive and community-wide interpersonal communication to encourage smoking cessation in a border U.S. city and in a Mexican city. Panels of moderate to heavy smokers were followed in four groups to allow quasi-experimental comparison of smoking cessation rates. RESULTS. Over a five-year study period smoking cessation rates of 17% (self-reported) and 8% (verified) were observed in panels in the program community (N = 160). In the comparison community (N = 135) corresponding rates of smoking cessation were 7% (self-reported) and 1.5% (verified). Within the program community, no differences were observed in smoking cessation among smokers exposed to a community-wide program and those assigned to receive personal counseling. DISCUSSION. Although the observed changes in smoking were unexpectedly small in the treatment and comparison groups, the approximately 8% effect size for the community-wide program was close to what was predicted. Results indicate that such programs may yield effects similar to those of more intensive approaches, but further research with greater statistical power will be necessary to confirm that point.     

Changing life expectancy in the 1980s: why was Denmark different from Sweden?

OBJECTIVE: To identify the contribution from specific causes of death to the changes in life expectancy at birth in Denmark relative to Sweden in different age groups during the 1980s and to compare the difference in life expectancy between the two countries in 1990. DESIGN: Mortality data from WHO mortality tapes grouped in smaller series of clinically meaningful categories were used to calculate the contribution of each of these categories at each 10 year age group to the difference in life expectancy at birth in each country between 1979 and 1990 and between the two countries. SETTING: Denmark and Sweden. RESULTS: Between 1979 and 1990 life expectancy increased in both Denmark and Sweden. However, the increase in Sweden was more than two years while that in Denmark was less than one year. In both countries a decrease in cardiovascular disease mortality contributed most to the increase in life expectancy in males as well as females. In both sexes the smaller increase in life expectancy in Denmark was a result of differences in mortality trends in cardiovascular diseases and respiratory and non-respiratory cancers. CONCLUSION: Over a short time two Nordic countries experienced remarkable but different changes in mortality. These findings suggest that mortality rates are sensitive to even minor differences in social and cultural factors across countries and over short time periods.     

The sociodemographic determinants of the tobacco habit and its cessation in the population of Cornellà de Llobregat]

OBJECTIVE: To assess the relationship between socio-demographic factors and smoking status in a population of Barcelona metropolitan area. METHODS: The study included 2,074 questionnaires from the health interview survey carried out in a representative sample of Cornellà during december 1993-november 1994. Only questionnaires of respondents older than 15 were included. A politomic logistic regression was used. Smoking status, classified as never smoker, actual smoker and former smoker, was considered the dependent variable and the sociodemographic factors, the independent variables. Socio-economic status was measured by educational level. RESULTS: The percentage of smokers in men was 46% while in women was only 22%. In men, the probability of smoking was higher in those men whose educational levels were lower (OR: 2.97); in women, no association was found between smoking and education. Unemployment increased the likelihood of being a smoker in both men and women (OR: 1.80). Women did smoke less than men in all age groups and educational levels except for women aged 15-44 with EGB or higher educational level. Educational level was not a significant factor in quitting smoking in either men or women. For both sexes, the greater the age the more likelihood there was of being an ex-smoker. Quitting was not associated with gender in any age or educational group. CONCLUSION: A similar prevalence of smoking in younger women and men of higher educational level suggests that gender differences are diminishing. In men, smoking was associated with educational level. Age is the principal determinant of quitting and neither educational achievement nor gender play a significant role in our study.     

The tobacco cessation consultation of the Salah-Azeiz Tunis cancer center: one year results

BackgroundTo reduce tobacco smoking is, in Tunisia, a public health priority. The tobacco cessation consultation is one of the interventions to fight against the tobacco epidemic; it is a new activity developed in the Salah-Azeiz Tunis cancer centre. The objective of this work is to evaluate the impact of the consultation on the smokers after one year of activities and to analyse the prognostic factors of tobacco cessation in order to improve the efficacy of such an activity in the future, in Tunisia.MethodsThe cessation methods were based on cognitive and behavioral therapies associated with nicotine patch, delivered free of charge. During one year (July 2003 to June 2004), 340 smokers were attended. Data on their smoking status and psychological characteristics were collected using a standardized questionnaire.ResultsThe patients were mostly men (79%), these smokers did not present important anxiodepressive troubles, 68% thought that they were able to quit easily. The majority (57%) smoked more than 20 cigarettes a day and was nicotinodependant (Fagenström > 7). Half of this population had already intended to stop, they declared to smoke mostly because of stress. The global cessation rate after a median follow-up of 32 weeks is 27%. The cessation rate lasting six months for 83 patients followed regularly was 23%. The good prognostic factors of cessation, after multivariate analysis, were (when taking out from the model the regular follow-up), to be confidant on the possibility to stop (OR = 0.87 [0.78–0.97]). On the contrary, a high score (>7) for Fagerström test (OR = 1.9 [1.1–3.4), the use of smoking to fight against stress (OR = 1.08 [1.0–1.2) and a smoking environment at home (OR = 4.5 [1.1–18.9]) were prognostic of a failure in quitting smoking.ConclusionThese results show that the cessation rate, which is still too low as compared with the literature, could be increased by a better follow-up of smokers associated with an information campaign on the existing possibilities to quit smoking in Tunisia.     

Gastroenteritis in older people living in the community: results of two Australian surveys

SUMMARY We analysed two large national surveys conducted in 2001 and 2008 to examine incidence and outcomes of gastroenteritis in older Australians. A case was someone reporting ?3 loose stools or ?1 episode of vomiting in 24 h, excluding non-infectious causes. We compared cases arising in the elderly (?65 years) and in other adults (20-64 years). Elderly people experienced 0·33 [95% confidence interval (CI) 0·24-0·42] episodes of gastroenteritis/person per year, compared to 0·95 (95% CI 0·74-1·15) in other adults. Elderly cases reported less stomach cramps, fever and myalgia than younger cases, and were more likely to be hospitalized, although this was not statistically significant. In multivariable analysis, gastroenteritis in elderly people was associated with travelling within the state (odds ratio 1·35, 95% CI 1·07-1·71). Elderly people were less concerned about food safety than other adults. Older Australians were less likely to report gastroenteritis and experienced different symptoms and outcomes from other adults.     

Memory aids in longitudinal health surveys: results from a field experiment.

The use of memory aids to improve respondent recall is becoming increasingly popular in health surveys. In a one-year field experiment involving over 1,200 respondents, people assigned memory aids reported over 50 per cent more symptom episodes than those not assigned memory aids. Differences in reporting levels were particularly striking during the first six to 12 weeks of the survey, for symptoms related to acute, transitory illness, and among minorities and the lower socioeconomic groups. Respondents assigned memory aids were also more likely to report a doctor contact--especially during the fall/winter months. Among respondent who used their memory aids at least once (N = 252), nearly 35 per cent said they were influenced by the information recorded in their memory aids, and most of those who were influenced said that they became more aware of their health. Ten of these people said that they became more worried or depressed because of the information recorded in their memory aids. This constitutes about a four per cent risk among those people who reported using their memory aids at least once. There was no evidence to suggest that the memory aids influenced perceptions of health status.     

Enabling and sustaining the activities of lay health influencers: lessons from a community-based tobacco cessation intervention study

The authors present findings from a community-based tobacco cessation project that trained lay health influencers to conduct brief interventions. They outline four major lessons regarding sustainability. First, participants were concerned about the impact that promoting cessation might have on social relationships. "Social risk" must be addressed during training to ensure long-term sustainability. Second, formal training provided participants with an increased sense of self-efficacy, allowed them to embrace a health influencer identity, and aided in further reducing social risk. Third, material resources functioned to mediate social tensions during health intervention conversations. A variety of resources should be made available to health influencers to accommodate type of relationship, timing, and location of the interaction. Finally, project design must be attentive to the creation of a "community of practice" among health influencers as an integral part of project sustainability. These lessons have broad implications for successful health promotion beyond tobacco cessation.     

Mortality pattern among pulp and paper mill workers in Sweden: a case-referent study.

The mortality pattern among Swedish pulp and paper mill workers was evaluated in a case-referent study encompassing 4,070 men decreased during the period 1950-1987. The subjects were identified from the register of deaths and burials in six parishes. A significantly increased mortality was seen for diabetes mellitus and for secondary tumors of the lung and liver among the pulp and paper mill workers. Indications of excess risks were also found for obstructive lung disorders, pulmonary emboli, accidents, and pneumonia, as well as for malignant lymphomas, leukemias, and cancer of the pancreas and stomach. In the only parish where a sulfite process was exclusively used, cancer of the digestive tract and especially of the rectum was found to be in excess. Except for this parish, the sulfate process predominated in the plants included. The mortality pattern found in this study is in reasonable agreement with findings in various studies from this type of industry.     

Impediment profiling for smoking cessation: results of a pilot study

OBJECTIVE: To test the effectiveness of a smoking cessation program based on "impediment profiling," the elucidation of an individual participant's personal barriers, with provision of tailored interventions accordingly. METHODS: A literature search was conducted to identify established impediments to smoking cessation. A long impediment profiler (LIP) was developed from validated survey instruments and used as a screening tool to identify individuals' barriers to quitting. Once barriers were identified, participants were assigned to up to seven interventions. Self-reported smoking cessation was confirmed with measurements of carbon monoxide concentrations in expired air of < or = 10 ppm. RESULTS: Nineteen adults participated in the pilot program. At the year 1 mark, 63.2% of the study population was smoke-free. The mean number of impediments of the study population was 3.5 +/- 1.5. There was a negative association between subjects' quit status and the following impediments: stress (p = .0061), anxiety (p = .0445), and depression (p < .001). No single impediment was predictive of quit status. CONCLUSIONS: Impediment profiling as a basis for tailored smoking cessation intervention is associated with a high quit rate in this initial study, and it appears promising. Long-term follow-up is warranted, as is replication in a larger cohort with a concurrent control group.     

New estimates of the number of children living with substance misusing parents: results from UK national household surveys

Background  

The existing estimates of there being 250,000 - 350,000 children of problem drug users in the UK (ACMD, 2003) and 780,000 - 1.3 million children of adults with an alcohol problem (AHRSE, 2004) are extrapolations of treatment data alone or estimates from other countries, hence updated, local and broader estimates are needed.     

The industrial safety professionals: a comparative analysis from World War I until the 1980s.

The birth of industrial society produced demand for the services of professionals specialized in matters related to industrial safety. Three professions--safety engineering, industrial medicine, and ergonomics--are examined. These professions are observed to either submit to single sets of demands, to integrate contradictory demands, or to experience scission. Until the late 1960s their growth appears to have been relatively peaceful and uncontroversial. From this period onward, controversy breaks out over questions related to industrial safety, and professions and government administrations grow. Increasingly, the traditional approach of safety professionals is called into question, and they adopt new orientations. These changes are mapped through the examination of data drawn principally from the United States, France, Great Britain, and to a lesser extent Brazil. The traditional standards approach competes with cost-benefit analysis and with systemic safety for influence; in addition, an emergent approach that analyzes accident causes in terms of social relations of work is detected. From Bhopal to Chernobyl, new technologies subject civilian populations to risks of catastrophic accidents, and the action of safety professionals comes under the spotlight. The analysis constructed permits new understandings of the past and the future of these professions.     

The making of a risk object: AIDS, gay citizenship and the meaning of blood donation in Sweden in the early 1980s

In the early 1980s acquired immune deficiency syndrome (AIDS) presented a danger to the blood supply, the extent of which was difficult to ascertain before a reliable test became available in 1985. In a situation of uncertainty, the major Swedish gay organisation in early 1983 recommended voluntary exclusion from blood donation by their members, while internationally gay organisations protested and Swedish medical authorities hesitated about the appropriate action to take. At stake were definitions of gay citizenship, risk and the gift of blood. The article uses three sociological approaches to understand the controversies around blood from men-who-have-sex-with-men as a risk to public health. An institutional approach is used to situate the symbolic meaning of blood donation within the specific Swedish blood collection regime, and thus the possible stigma of exclusion from donation practices. The article then details the evolution of different risk objects, based on different actors' situated knowledge of the danger, and discusses the different framing conditions influencing decision-making by the various actors involved. The analysis uses extensive archival and secondary material to trace decisions taken in the gay movement, medical authorities and blood centres, and to assess their outcome on the spread of AIDS via the blood supply.     

The THEMA study: a sociodemographic survey of hypercholesterolaemic individuals

Background: Hypercholesterolaemia is estimated to affect 20% of the population, although little sociodemographic information is available on affected individuals. The present study aimed to gather relevant information and investigate social determinants of dietary compliance. Methods: A telephone survey was carried out on a representative population sample. Quotas were applied for gender, geography and degree of urbanisation. Individuals were eligible if they were hypercholesterolaemic, and were being followed by a doctor. Sociodemographic, socioeconomic and health data were collected, as well as information about the individuals’ perception of the disease, their relationship and beliefs surrounding food, and their food behaviour (shopping, cooking, eating‐out, deviation from prescribed diet). The association between compliance with diet and medication was investigated. Results: Overall, 802 individuals were included, representing 8% of those contacted, as opposed to the expected 20%. Mean (SD) age was 60 (14.2) years, with 51% of individuals living as a couple; 48% had a good level of physical activity; 44% considered that the hypercholesterolaemia was inherited; 31% felt that the disease was normal beyond the age of 45 years. The functional and convivial aspects of eating were of more importance than that of health maintenance. Cheese was particularly likely to be eaten in dietary lapses. Of a subgroup of 729 individuals, 476 (65%) took medication; of these 476 individuals, 51% complied with dietary recommendations (P < 0.05). Conclusions: The key factors associated with dietary compliance in hypercholesterolaemic individuals were identified: age, sex, the perceptions of hypercholesterolaemia, and the sociocultural aspects of food. By contrast to general assumptions, both dietary and medicinal measures are practised fairly well by a large proportion of these individuals.     

An intersectional analysis of sociodemographic disparities in Covid-19 vaccination: A nationwide register-based study in Sweden

BackgroundStudies on sociodemographic disparities in Covid-19 vaccination uptake in the general population are still limited and mostly focused on older adults. This study examined sociodemographic differences in Covid-19 vaccination uptake in the total Swedish population aged 18–64 years.MethodsNational Swedish register data within the SCIFI-PEARL project were used to cross-sectionally investigate sociodemographic differences in Covid-19 vaccination among Swedish adults aged 18–64 years (n = 5,987,189) by 12 October 2021. Using logistic regression models, analyses were adjusted for sociodemographic factors, region of residence, history of Covid-19, and comorbidities. An intersectional analysis approach including several cross-classified subgroups was used to further address the complexity of sociodemographic disparities in vaccination uptake.FindingsBy 12 October 2021, 76·0% of the Swedish population 18–64 years old had received at least two doses of Covid-19 vaccine, an additional 5·5% had received only one dose, and 18·5% were non-vaccinated. Non-vaccinated individuals were, compared to vaccinated, more often younger, male, had a lower income, were not gainfully employed, and/or were born outside Sweden. The social patterning for vaccine dose two was similar, but weaker, than for dose one. After multivariable adjustments, findings remained but were attenuated indicating the need to consider different sociodemographic factors simultaneously. The intersectional analysis showed a large variation in vaccine uptake ranging from 32% to 96% in cross-classified subgroups, reflecting considerable sociodemographic heterogeneity in vaccination coverage.InterpretationOur study, addressing the entire Swedish population aged 18–64 years, showed broad sociodemographic disparities in Covid-19 vaccine uptake but also wide heterogeneities in coverage. The intersectional analysis approach indicates that focusing on specific sociodemographic factors in isolation and group average risks without considering the heterogeneity within such groups will risk missing the full variability of vaccine coverage.FundingSciLifeLab / Knut & Alice Wallenberg Foundation, Swedish Research Council, Swedish government ALF agreement, FORMAS.