The associations among educational level, occupational status, and atherosclerosis were investigated during 1992-1994 in a general population sample of 4,176 Swedish men and women. Carotid artery intima-media thickness (IMT) and carotid stenosis were determined by B-mode ultrasound. Socioeconomic differences in mean carotid IMT and odds ratios for carotid stenosis prevalence were estimated. In women, the associations among educational level, occupational status, and IMT were weak. In men, there was no association between education and IMT, while low occupational status was associated with a thicker IMT. Women with low education had an increased odds of carotid stenosis compared with women with high education (odds ratio (OR) = 2.04, 95% confidence interval (CI): 1.53, 2.73), while this pattern was weaker among men. Women in manual occupations had an increased odds of carotid stenosis compared with women in high- or medium-level nonmanual occupations (OR = 1.75, 95% CI: 1.29, 2.36), which could not be seen among men. After adjustment for risk factors, the association between IMT and occupational status in men disappeared, while the associations among educational level, occupational status, and carotid stenosis in women persisted. The results imply that the atherosclerotic process is associated with socioeconomic status in both sexes, and they also indicate the possibility of sex differences in the mechanisms connecting socioeconomic status to atherosclerosis.

The reliability and validity of methods to assess social networks, social support and control were investigated in a population of 12,009 females and males born between 1926 and 1945 (the "Malmö Shoulder and Neck Study"). This study demonstrated an overall reliability with kappa coefficients between 0.70 and 0.47, but the reliability was more varying among females and lower in the youngest age group. The analysis of the construct validity indicated that the different indices measure different aspects of the psychosocial environment, but both theoretical and methodological problems were identified, when the validity of multidimensional concepts are to be determined. The validity of such indices can best be judged by combining quantitative and qualitative methods. Potential validity problems must be kept in mind when these indices are used in epidemiological research. The results from the reliability analysis call for repeated assessments and the sample size must be adjusted vis-a-vis the reliability.

Study objective -To test the stress hypothesis by characterising women during their first pregnancy who continue to smoke in early pregnancy in comparison with women who quit smoking, with special reference to psychosocial factors like social network, social support, demands, and control in work and daily life. Design -The study is based on a cohort of primigravidas followed during pregnancy. Data were collected by self administered questionnaires during the pregnant womens' first antenatal visit at about 12 weeks.Setting -The study was performed in the antenatal clinics in the city ofMalmo, Sweden.Participants -The participants were all primigravidas living in the city of Malmo, Sweden, over a one year period, 1991-92.A total of 872 (87.7%) of the 994 invited women agreed to participate. The population of this study on smoking includes all primigravidas who at the time of conception were smoking (n=404, 46.3%).Main results -At the first antenatal visit (63-6% (n =257) of the prepregnancy smokers were still smoking (a total smoking prevalence of 29-5%). The pregnant smokers were on average younger and had a lower educational level. The highest relative risk (RR) of continued smoking was found among unmarried women RR 2-7 (95% confidence interval) (1.5, 4.8), women having unplanned pregnancies RR 2-2 (1-2, 4.0) and those with a low social participation RR 1-6 (1.0, 2-7), low instrumental support RR 2-6 (1.2, 6.0), low support from the child's father RR 2-1 (1.0, 4.2) and those exposed to job strain RR= 2-3 (1.1,4-8). The In recent years great attention has been paid to the dangers of smoking during pregnancy. In spite ofthis, many pregnant women continue to smoke. In Sweden the prevalence of smoking among all pregnant women was 21 8% in 1992 (Swedish Medical Birth Registry -personal communication). A study from two big cities in Denmark showed a prevalence of 44% in 1987, and 81% ofthese women were still smoking at the end of pregnancy.9 One Norwegian study in 1989 showed a smoking prevalence of 46% 3 months before pregnancy, and 84% of the women were still smoking at the time of the first medical check up. '0 In a Swedish study, 32% of the pregnant women in one big city were daily smokers at the time of conception and by the time oftheir antenatal visit, 2 months later, 77% reported that they were still smoking."1 Women's smoking has been seen as related to social deprivation, stress, and disadvantage.2 13 Persistent smoking during pregnancy is found to be related to low household incomes, living in rented accommodation, being unmarried, and having a husband or partner in manual employment.'4 High parity number, not living with the infant's father, and daily passive smoking at home are also associated with an increased risk for continued smoking.'5 Other important predictors of unsuccessful smoking cessation are a high level of smoking before pregnancy and high coffee consumption.9Women experiencing depression and those with psychosocial difficulties in daily domestic roles also have higher rates of pe...

The objective of this study was to determine whether there is an association of all-cause mortality with different aspects of social network, social support, and social influence. The study sample (n = 621) was a random half of all male residents of Malmö, Sweden, born in 1914, of whom 500 (80.5%) were interviewed and examined in 1982-1983. On the basis of a model with carefully defined and well-differentiated concepts integrated in a theoretic framework of social resources, an instrument was developed to measure different aspects of social network, social support, and social influence. During the follow-up period from September 1982 to November 1987, 67 (13.4%) of the 500 participants died. In univariate analysis, a higher mortality risk was found among men with low availability of emotional support and low adequacy of social participation and among men living alone (crude relative risk = 2.3, 2.3, and 1.7, respectively). These relative mortality risks changed little after adjustments for social class, health status at baseline, cardiovascular risk factors, alcohol intake, physical activity, and body mass index in the multivariate analysis (adjusted relative mortality risk = 2.5, 2.2, and 2.0 for men with low availability of social support and low adequacy of social participation and for men living alone, respectively). These findings are consistent with the existence of a general effect of social network and social support on mortality among elderly men.

The proportions of the population with obesity and overweight increased significantly between 1986 and 1994 for both men and women. The increasing prevalence of physical inactivity seems to be an important explanation.

No abstract

The specific hypothesis that high job demands interact synergistically with low decision latitude in the development of carotid atherosclerosis could not be supported in this study, neither in men nor in women. Instead a more complex pattern of interaction between job demands and decision latitude was shown.

SUMMARY Base line data together with data in public registers and a structured phone interview of 94 of the 121 non-attenders was used for an assessment of factors influencing participation in the prospective population study 'Men born in 1914' in Malmo, Sweden. The overall attendance rate was 80 5% but varied among areas in the city from 27% to 100%. The lower participation rate among single men remained, when correcting for social class, significant only for single men in social class III. Men who did not feel well and/or had been admitted to hospital during the last 12 months had a lower participation rate. A negative attitude towards health surveys in general was the most common reason for non-participation. The phone interview turned out to be a feasible method to reach non-attenders to assess whether the sample was representative of the population and to learn more about reasons for non-participation.A low participation rate in a population survey may seriously invalidate the results due to the selection bias caused by non-response. In order to avoid this problem we should try to reduce the number of non-attenders to an absolute minimum. . The aim of the present part of the study, which is based on the results from the base line study together with information in public registers and a telephone interview of non-attenders, was to assess whether the study population was representative and to assess reasons for non-participation. Material and methodsThe study population consisted of all men living in Malmo who were born in an even month in 1914. The study group was defined every fourth month starting in August 1982. This procedure was adopted to reduce the risk of mailing the invitation to someone who had died or left town after the study population had been defined. The majority of this cohort of 621 men had participated in a health survey in 1969-70 focusing on arteriosclerotic leg disease and its relation to smoking habits, hypertension, and hyperlipidaemia.4The purpose of the study, the examinations and interviews included, and data handling was described in a letter. This letter was followed up a couple of weeks later by a phone call from our secretary to confirm consent to participate and to make the necessary appointments.The purpose and design of the study were also described in a letter mailed to all doctors in the city.Men who refused to participate in the study were called by one of the physicians in the study programme. Those who could not be persuaded to 174