Psychosocial conditions during school-age as determinants of long-term labour market attachment: a study of the Northern Swedish Cohort from the 1980s to the 2020s.

BACKGROUND: This study, conducted on a Swedish population cohort, explores how internalized (depressive and functional somatic) and externalized (smoking, drinking, truancy, vandalism, delinquency) mental health symptoms, as well as close interpersonal relations (family climate and school connectedness) reported during adolescence, influence the work-life course up to late midlife. METHODS: We examined repeated measurements of labour market status from age 16 to 56 using sequence analyses. We identified five different labour market attachment (LMA16-56) trajectories, namely 'strong,' 'early intermediate,' 'early weak,' 'late weak,' and 'constantly weak.' Multinomial logistic regressions were employed to relate each of the nine determinants to the identified trajectories. RESULTS: When compared to the risk of 'strong' LMA16-56, adversity in all conditions, except for vandalism, entailed a higher risk of the 'constantly weak' trajectory. Moreover, all conditions, except for functional somatic symptoms, entailed a higher risk of the 'late weak' LMA16-56. The risk of the 'early intermediate' LMA16-56 was non-significant across all the conditions. CONCLUSIONS: This study contributes to existing knowledge through its novel exploration of labour market attachment and the revelation of the significance of proximal interpersonal relationships in attachment outcomes. Additionally, the study reaffirms the importance of externalizing behaviour, while suggesting that internalized symptoms in adolescence might have a less influential, though not negligible, role. These results underscore the importance of addressing acting out behaviour and nurturing human relationships during compulsory basic education, when the entire age group is still within reach. This approach aims not only to reduce frictions in the school-to-work transition but also to prevent midlife labour market attachment problems that may arise with delayed intervention.

Risk factors in adolescence as predictors of trajectories of somatic symptoms over 27 years.

BACKGROUND: Somatic symptoms among adolescents are common, yet little is known about long-term trajectories of somatic symptoms and the factors in adolescence that shape them. We examined individual, family and school-based factors at age 16 as predictors of trajectories of somatic symptoms over 27 years. METHODS: Participants from the Northern Swedish Cohort (n = 1001) responded to questions about individual factors (e.g. health behaviours), family factors (e.g. contact with parents, social and material adversity) and school satisfaction at age 16; as well as 10 somatic symptoms at ages 16, 18, 21, 30 and 43. Teacher assessments at age 16 included overall ability at school and peer relations. Age 16 predictors of somatic symptom trajectory group membership were analysed using multinomial logistic regression. RESULTS: Poor contact with mother and poor school satisfaction were significant predictors of adverse symptom trajectories among both men and women. Low birth weight and low parental academic involvement were contributing factors for women, while smoking and social adversity were more relevant factors for men. CONCLUSIONS: Our findings emphasize the importance of a holistic approach that considers the unique contributions of individual, family and school-based factors in the development of trajectories of somatic symptoms from adolescence to middle age.

Trajectories of musculoskeletal pain from adolescence to middle age: the role of early depressive symptoms, a 27-year follow-up of the Northern Swedish Cohort.

Depression and musculoskeletal pain are associated, but long-term follow-up studies are rare. We aimed to examine the relationship of early depressive symptoms with developmental patterns of musculoskeletal pain from adolescence to middle age. Adolescents ending compulsory school (age 16) in Luleå, Northern Sweden, in 1981 (n = 1083) were studied and followed up in 1986, 1995, and 2008 (age 43) for musculoskeletal pain. Attrition was very low. Indicators for any and severe pain were based on pain in the neck-shoulders, low back, and the extremities. Latent class growth analyses were performed on 563 men and 503 women. Associations of a depressive symptoms score (DSS, range 0.0-2.0) at age 16 with pain trajectory membership were assessed by logistic and multinomial regression, adjusting for parental socioeconomic status, social adversities, smoking, exercise, body mass index, and alcohol consumption at age 16. For any pain, 3 trajectories emerged: high-stable (women 71%, men 61%), moderate (11%, 17%), and low-increasing (18%, 22%). With the low-increasing trajectory as reference, for each 0.1-point increase in the DSS, the odds ratio of belonging to the high-stable trajectory was 1.25 (95% confidence interval 1.11-1.41) in women and 1.23 (1.10-1.37) in men. For severe pain, 2 trajectories were found: moderate-increasing (women 19%, men 9%) and low-stable. For each 0.1-point increase in the DSS, the odds ratio of membership in the moderate-increasing trajectory was 1.14 (1.04-1.25) in women and 1.17 (1.04-1.31) in men in the fully adjusted model. Thus, depressive symptoms at baseline are strongly associated with pain trajectory membership.

Snus use during the life-course and risk of the metabolic syndrome and its components.

OBJECTIVE: We aimed to investigate the association between life-course exposure to snus and prevalence of the metabolic syndrome and its components in adulthood. DESIGN AND METHOD: Tobacco habits at baseline (age 16) and three follow-ups (ages 21, 30 and 43) were assessed among 880 participants in a population-based cohort in Northern Sweden. Presence of the metabolic syndrome at age 43 was ascertained using the International Diabetes Federation criteria. Odds ratios and CIs for risk of the metabolic syndrome and its components by snus use at 16, 21, 30 and 43 years were calculated using logistic regression. Cumulative snus use was defined as number of life periods (1-4) with current snus use. RESULTS: At age 43, 164 participants (18.6%) were current snus users. We found no association between exclusive snus use at the ages of 16, 21, 30 and 43 years and the metabolic syndrome at age 43 years. Snus use (among non-smokers) was associated with raised triglycerides and high blood pressure in crude analysis, but not in multivariable models. There was no association between cumulative snus use and risk of the metabolic syndrome. Cumulative snus use was associated with central obesity, raised triglycerides and impaired fasting glucose/diabetes mellitus type 2 in crude analyses, but not after adjustments. CONCLUSIONS: The health consequences of snus exposure from adolescence to mid-adulthood do not seem to include increased risk of the metabolic syndrome or its components. The cardio-metabolic risk of dual exposure to snus and cigarettes may warrant further attention.

Binge drinking and total alcohol consumption from 16 to 43 years of age are associated with elevated fasting plasma glucose in women: results from the northern Swedish cohort study.

BACKGROUND: Studies have indicated that moderate alcohol consumption is associated with lower incidence of diabetes in women. However, not only the amount but also the drinking pattern could be of importance when assessing the longitudinal relation between alcohol and glucose. Also, there is a lack of studies on alcohol use beginning in adolescence on adult glucose levels. The aim was to examine the association between total alcohol consumption and binge drinking between ages 16 and 43 and fasting plasma glucose at age 43. METHODS: Data were retrieved from a 27-year prospective cohort study, the Northern Swedish Cohort. In 1981, all 9th grade students (n = 1083) within a municipality in Sweden were invited to participate. There were re-assessments at ages 18, 21, 30 and 43. This particular study sample consisted of 897 participants (82.8%). Fasting plasma glucose (mmol/L) was measured at a health examination at age 43. Total alcohol consumption (in grams) and binge drinking were calculated from alcohol consumption data obtained from questionnaires. RESULTS: Descriptive analyses showed that men had higher levels of fasting plasma glucose as compared to women. Men also reported higher levels of alcohol consumption and binge drinking behavior. Linear regressions showed that total alcohol consumption in combination with binge drinking between ages 16 and 43 was associated with elevated fasting plasma glucose at age 43 in women (beta = 0.14, p = 0.003) but not in men after adjustment for BMI, hypertension and smoking at age 43. CONCLUSIONS: Our findings indicate that reducing binge drinking and alcohol consumption among young and middle-aged women with the highest consumption might be metabolically favorable for their future glucose metabolism.

Mid-Adolescent Predictors of Adult Drinking Levels in Early Adulthood and Gender Differences: Longitudinal Analyses Based on the South Australian School Leavers Study.

There is considerable public health interest in understanding what factors during adolescence predict longer-term drinking patterns in adulthood. The aim of this study was to examine gender differences in the age 15 social and psychological predictors of less healthy drinking patterns in early adulthood. The study investigates the relative importance of internalising problems, other risky health behaviours, and peer relationships after controlling for family background characteristics. A sample of 812 young people who provided complete alcohol consumption data from the age of 15 to 20 years (5 measurement points) were drawn from South Australian secondary schools and given a detailed survey concerning their psychological and social wellbeing. Respondents were classified into two groups based upon a percentile division: those who drank at levels consistently below NHMRC guidelines and those who consistently drank at higher levels. The results showed that poorer age 15 scores on measures of psychological wellbeing including scores on the GHQ-12, self-esteem, and life-satisfaction as well as engagement in health-related behaviours such as smoking or drug-taking were associated with higher drinking levels in early adulthood. The pattern of results was generally similar for both genders. Higher drinking levels were most strongly associated with smoking and marijuana use and poorer psychological wellbeing during adolescence.

Irregular eating of meals in adolescence and the metabolic syndrome in adulthood: results from a 27-year prospective cohort.

OBJECTIVE: The objective was to investigate whether irregular eating of meals in adolescence predicts the metabolic syndrome and its components in adulthood, and if any specific meal is of particular importance. DESIGN: Prospective cohort study with 27 years of follow-up. Information on meals (breakfast, school lunch and dinner with family), lifestyle (alcohol consumption, smoking habits, physical activity, consumption of sweets and pastries) at age 16 years was assessed from questionnaires, and presence or not of the metabolic syndrome and its components were defined at age 43 years in 889 participants (82·1% of total cohort). Logistic regression was used to calculate odds ratios and confidence intervals. SETTING: The Northern Swedish Cohort; all school-leavers of the 9th grade in the town Luleå in 1981. SUBJECTS: Adolescents (age 16 years). RESULTS: Irregular eating of meals at age 16 years was associated with higher prevalence of the metabolic syndrome at age 43 years (OR=1·74; 95% CI 1·12, 2·71), but this was explained by concurrent unhealthy lifestyle at age 16 years. Poor breakfast at age 16 years was the only meal associated with the metabolic syndrome at age 43 years, independent of other meals, BMI (kg/m2) and lifestyle at age 16 years (OR=1·67; 95% CI 1·00, 2·80). CONCLUSIONS: Irregular eating of meals in adolescence predicted the metabolic syndrome in adulthood, but not independently of BMI and lifestyle in adolescence. Poor breakfast in adolescence was the only specific meal associated with future metabolic syndrome, even after adjustments. Breakfast eating should be encouraged in adolescence.

Length of unemployment and health-related outcomes: a life-course analysis.

BACKGROUND: Most previous studies on the effects of length of unemployment on health have focused on the duration of continuous spells of unemployment rather than on the cumulative length of intermittent spells. This study analysed the relationship between the cumulative length of intermittent spells of unemployment and different health-related outcomes using data from a longitudinal study of school leavers. METHODS: All pupils who completed compulsory schooling in 1981 in a medium-sized town in northern Sweden (N = 1083) were followed for 14 years with repeated questionnaires including questions about unemployment, health and health behaviour. RESULTS: Men tended to react with a steady state or a levelling off of health symptoms with increased unemployment, whereas women showed deteriorating health symptoms. For health behaviour the reverse occurred. Women's health behaviour was less connected with increased unemployment while men's health behaviour tended to deteriorate. CONCLUSION: Cumulative length of unemployment is correlated with deteriorated health and health behaviour. Long-term unemployment, even as a result of cumulated shorter employment spells over a number of years should be an urgent target for policy makers.

Television viewing over the life course and the metabolic syndrome in mid-adulthood: a longitudinal population-based study.

BACKGROUND: Accumulating evidence suggests that television (TV) viewing is associated with cardio-metabolic risk, but little is known about how this relationship unfolds over the life course. This study employs a life course epidemiological framework by examining the potential cumulative effect of frequent TV viewing during adolescence and young adulthood on the prevalence of metabolic syndrome in mid-adulthood; and whether TV viewing during adolescence constitutes a sensitive period for the development of the metabolic syndrome in mid-adulthood. METHODS: We used data from the Northern Swedish Cohort, a nationally representative cohort comprising 855 participants (80% of the baseline sample). Data were collected during 1981-2008 and analysed in 2013. Logistic regression was applied to examine the associations between TV viewing at ages 16, 21 and 30 years, and the metabolic syndrome at age 43 years. RESULTS: Cumulative frequent TV viewing was associated with subsequent prevalence of the metabolic syndrome after adjustment for potential confounders (p for trend=0.026). Watching 'several shows a day' compared with 'one show/week' or less at age 16 years was associated with the metabolic syndrome at age 43 years after adjustment for later exposure (TV viewing at ages 21 and 30 years) and potential confounders (OR 1.86, 95% CI 1.06 to 3.27). CONCLUSIONS: The number of life periods of frequent TV viewing during adolescence and early adulthood influenced cardio-metabolic risk in mid-adulthood in a dose-dependent manner, corresponding to a cumulative risk life course model. Additionally, TV viewing in adolescence may constitute a sensitive period for the metabolic syndrome in mid-adulthood.

Suboptimal health as a predictor of non-permanent employment in middle age: a 12-year follow-up study of the Northern Swedish Cohort.

PURPOSE: Earlier research on health-related selection in the labour market has concentrated on selection of those with poor health into unemployment. The purpose of the present study was to investigate if suboptimal health also predicts non-permanent employment. METHODS: A population cohort of 517 men and 477 women was surveyed at age 30 and at age 43 about their health and yearly employment. Non-permanent employment during the follow-up was assessed for its occurrence with Cox regression and for the amount (accumulation in months) with generalised linear models. RESULTS: Suboptimal self-rated health, sense functioning and sleep quality in women and suboptimal mood in men predicted high accumulation of non-permanent employment. By contrast, in men, suboptimal self-rated health and sense functioning predicted low accumulation. The gender differences were statistically significant. Smoking predicted high occurrence and accumulation of non-permanent employment equally in men and women, whereas no associations were seen with overweight and alcohol consumption. CONCLUSIONS: Selection into non-permanent employment was shown for several indicators of suboptimal health. A gendered pattern was found, with more health selection among women. The findings of this pioneering study should be tested with further research.

Socio-economic disadvantage and body mass over the life course in women and men: results from the Northern Swedish Cohort.

BACKGROUND: Obesity and body mass in adulthood relate both to current and to childhood socio-economic status, particularly in women, but the underlying life course processes are not known. This study aims at examining whether the life course socio-economic status-body mass association in women and men is explained by the cumulative risk or adolescent sensitive period models whether associations are similar at different life course stages; and whether health behaviours explain the associations. METHODS: A total of 476 women and 517 men participated in this 27-year prospective cohort study (participation rate 93%). Body mass index was assessed at the age of 16 and 43 years and self-reported at the age of 21 and 30 years. Information on socio-economic status by own or parental (age 16 years) occupation, smoking, snuff, alcohol, physical activity and diet was collected at each age. RESULTS: In women, cumulative socio-economic status and socio-economic status in adolescence were related to body mass index at the age of 16, 21, 30 and 43 years and to the 27-year change in body mass, independently of health behaviours and for adolescent socio-economic status also of later socio-economic attainment. Associations were generally stronger for body mass at older age. In men, associations were mostly non-significant, although health behaviours contributed strongly to body mass. CONCLUSIONS: In women, both the sensitive period (in adolescence) and cumulative risk models explain the socio-economic-body mass link. Efforts to reduce the social inequality in body mass in women should be directed at the early life course, but focusing on unhealthy behaviours might not be a sufficient approach.

It's no surprise! Men are not hit more than women by the health consequences of unemployment in the Northern Swedish Cohort.

AIMS: Research often fails to ascertain whether men and women are equally hit by the health consequences of unemployment. The aim of this study was to analyze whether men's self-reported health and health behaviour were hit more by unemployment than women's in a follow-up of the Northern Swedish Cohort. METHODS: A follow-up study of a cohort of all school leavers in a middle-sized industrial town in northern Sweden was performed from age 16 to age 42. Of those still alive of the original cohort, 94% (n = 1,006) participated during the whole period. A sample was made of participants in the labour force and living in Sweden (n = 916). Register data were used to assess the length of unemployment from age 40 to 42, while questionnaire data were used for the other variables. RESULTS: In multivariate logistic regression analyses significant relations between unemployment and mental health/smoking were found among both women and men, even after control for unemployment at the time of the investigation and indicators of health-related selection. Significant relations between unemployment and alcohol consumption were found among women, while few visits to a dentist was significant among men. CONCLUSIONS: Men are not hit more by the health consequences of unemployment in a Swedish context, with a high participation rate of women in the labour market. The public health relevance is that the study indicates the need to take gendered contexts into account in public health research.

Socioeconomic status over the life course and allostatic load in adulthood: results from the Northern Swedish Cohort.

BACKGROUND: Although several studies have reported rather consistent associations between socioeconomic status (SES) and allostatic load (AL), so far no study has examined the influence of SES over the life course on AL. The aim of the present study was to investigate the association between SES over the life course and AL in mid-adulthood, guided by the conceptual models of cumulative risk, critical period and social chain of risk. METHODS: The sample comprises a 27-year prospective cohort (n=1071) from northern Sweden. Participants (n=855, 79.8%) completed questionnaires at the ages of 16, 21, 30 and 43 years. A health examination was performed at age 43 years after an overnight fast, including physical examination and blood sampling, and participants completed 1-day salivary cortisol sampling (four samples). SES was based on parental occupation at age 16 years and participants' own occupation at ages 21, 30 and 43 years. Information on daily smoking, snuff use, high alcohol consumption and physical inactivity was reported by the participants. An AL index was constructed from tertiles of 12 biological parameters. RESULTS: Cumulative socioeconomic disadvantage was related to AL in both women and men. The association was largely explained by health behaviours in men, but was independent of health behaviours in women. In women, an association was observed between AL and SES in adolescence, whereas in men only current SES was related to AL, independently of current health behaviours. CONCLUSIONS: SES over the life course influences the level of multi-systemic dysregulation in mid-adulthood, with the strongest support for the cumulative risk model.

Life course origins of the metabolic syndrome in middle-aged women and men: the role of socioeconomic status and metabolic risk factors in adolescence and early adulthood.

PURPOSE: To assess whether body mass index (BMI), blood pressure, and socioeconomic status in adolescence and early adulthood are independently related to the metabolic syndrome in adult women and men. METHODS: We based our work on a Swedish prospective cohort study that recruited participants at 16 years of age (N = 1083 at age 16; 403 women and 429 men at age 43, 78% of those still alive [N = 1071]). Blood pressure (BP) and BMI were assessed when participants were 16 and 21 years of age. At age 43, the metabolic syndrome was defined according to the International Diabetes Federation guidelines. Socioeconomic status (SES) was operationalized by the participant (age 21 and 43) or parent's (age 16) occupational status. Information on smoking, snuff, alcohol, and inactivity was collected at age 43. RESULTS: In women, SES at age 16 was independently related to the risk of metabolic syndrome. In women and men, BMI at age 16 was related to metabolic syndrome but was attenuated by BMI at age 21, which was significant in the final model; in women systolic BP displayed similar patterns. CONCLUSIONS: Our data seem to suggest two independent life course pathways for metabolic syndrome: one metabolic pathway for both women and men operating through BMI (for women also systolic BP) in adolescence and early adulthood, and for women, an apparently independent pathway through adolescent socioeconomic disadvantage.

Fetal and life course origins of serum lipids in mid-adulthood: results from a prospective cohort study.

BACKGROUND: During the past two decades, the hypothesis of fetal origins of adult disease has received considerable attention. However, critique has also been raised regarding the failure to take the explanatory role of accumulation of other exposures into consideration, despite the wealth of evidence that social circumstances during the life course impact on health in adulthood. The aim of the present prospective cohort study was to examine the contributions of birth weight and life course exposures (cumulative socioeconomic disadvantage and adversity) to dyslipidemia and serum lipids in mid-adulthood. METHODS: A cohort (effective n = 824, 77%) was prospectively examined with respect to self-reported socioeconomic status as well as stressors (e.g., financial strain, low decision latitude, separation, death or illness of a close one, unemployment) at the ages of 16, 21, 30 and 43 years; summarized in cumulative socioeconomic disadvantage and cumulative adversity. Information on birth weight was collected from birth records. Participants were assessed for serum lipids (total cholesterol, low- and high-density lipoprotein cholesterol and triglycerides), apolipoproteins (A1 and B) and height and weight (for the calculation of body mass index, BMI) at age 43. Current health behavior (alcohol consumption, smoking and snuff use) was reported at age 43. RESULTS: Cumulative life course exposures were related to several outcomes; mainly explained by cumulative socioeconomic disadvantage in the total sample (independently of current health behaviors but attenuated by current BMI) and also by cumulative adversity in women (partly explained by current health behavior but not by BMI). Birth weight was related only to triglycerides in women, independently of life course exposures, health behaviors and BMI. No significant association of either exposure was observed in men. CONCLUSIONS: Social circumstances during the life course seem to be of greater importance than birth weight for dyslipidemia and serum lipid levels in adulthood.

Inequalities in smoking: influence of social chain of risks from adolescence to young adulthood: a prospective population-based cohort study.

BACKGROUND: The pathway between socioeconomic disadvantages and smoking is a process that requires an understanding of life-course influence. PURPOSE: This study investigated pathways of social risks at different life stages that are linked to adolescent smoking and maintenance of smoking through to young adulthood. METHOD: A cohort consisting of all pupils (n = 1083) from one Swedish city were followed from age 16 to age 30 (1981-1995), with a 96.4% response rate. RESULT: Odds ratios of being a smoker at age 30 among low educated were 2.54 for men and 2.53 for women. Using structural equation model analysis for men and women, a strong chain of risks was found from age 16 linking to smoking at age 30: adolescents with adverse socioeconomic status (SES) were more likely from a divorced family. Being from a divorced family and having poor contact with their parents influenced their smoking directly and through peers. Adolescents with adverse SES were also likely to be unpopular in school, which affected their smoking behavior directly and through peers. These socially disadvantaged participants, who were smokers at age 16, continued smoking until age 30 years. The risk pathways were similar for both men and women. CONCLUSIONS: Adult smoking reflects the cumulative influence of multiple socioeconomic and psychosocial chains of risks experienced during upbringing. The programs that are addressed to reduce smoking among socially disadvantaged adolescents would have an impact in reducing smoking inequalities in adults.

Does occupational gender segregation influence the association of effort-reward imbalance with myocardial infarction in the SHEEP study?

The objective of this study was to investigate whether occupational gender segregation moderates the association between job stress in terms of effort-reward imbalance and the risk of myocardial infarction. This analysis was conducted in 1,381 cases and 1,697 referents of the Swedish SHEEP case control study aged 45-70 years. Information on myocardial infarction and biological coronary risk factors (e.g. hypertension, blood lipids) was achieved from clinical screenings. Information on socio-demographic variables, effort-reward imbalance, behavioral coronary risk factors (e.g., smoking), and additional coronary risk factors (e.g., diabetes, family history of coronary heart disease) was derived from well-tested standardized questionnaires. After adjustment for confounders the strongest association between overcommitment (the intrinsic component of effort-reward imbalance) and risk of belonging to the myocardial infarction group was found among women in male-dominated jobs (odds ratio [OR] = 2.71, 95% CI = 1.13-6.52) as compared to the remaining group (OR = 1.52, 95% CI = 1.01-2.31). Moreover, a significant interaction between pronounced overcommitment and male domination in relation to myocardial infarction was observed among women (OR = 2.44, 95% CI = 1.05-5.67). In men, an association between the ratio of effort and reward (the extrinsic component of the model) and risk of myocardial infarction was found for the majority, that is the group not working in women-dominated jobs (OR = 1.39, 95% CI = 1.04-1.86). Despite methodological limitations, this study gives preliminary evidence of a moderating effect of occupational gender segregation on the association of effort-reward imbalance (i.e., the intrinsic model component overcommitment) with acute myocardial infarction risk among women, but not among men.

The influence of factors identified in adolescence and early adulthood on social class inequities of musculoskeletal disorders at age 30: a prospective population-based cohort study.

BACKGROUND: Social class inequities have been observed for most measures of health. A greater understanding of the relative importance of different explanations is required. In this prospective population-based cohort study we explored the contribution of factors, ascertained at different stages between adolescence and early adulthood, to social class inequities in musculoskeletal disorders (MSD) at age 30. METHODS: We used data from 547 men and 497 women from a town in north Sweden who were baseline examined at age 16 and followed up to age 30. Using logistic regression models, we estimated the unadjusted odds ratios (OR) for MSD for blue-collar versus white-collar workers in men and women separately. We assessed the contribution of different factors identified between adolescence and early adulthood by comparing the unadjusted OR for social class differences with OR adjusted for these explanatory factors. RESULTS: We found significant class differences at age 30 with higher MSD among blue-collar workers (OR = 2.03 in men [95% CI: 1.42, 2.90] and 1.98 in women [95% CI: 1.29, 3.02]). After adjustment for explanatory factors, class differences decreased and were no longer significant, with OR of 1.20 in men (95% CI: 0.76, 1.95) and 1.18 in women (95% CI: 0.69, 2.03). School grades at age 16; being single and alcohol consumption at age 21; having children, restricted financial resources, physical activity, alcohol consumption, smoking, and working conditions at age 30 were important for men; parents' social class, school grade, smoking and physical activity at age 16; being single at age 21; and working conditions at age 30 were important for women. CONCLUSION: The accumulation of adverse behavioural and social circumstances from adolescence to early adulthood may be an explanation for the class differences in MSD at age 30. Interventions aimed at reducing health inequities need to consider exploratory factors identified at early and later stages in life, also including structural determinants of health.

Unemployment -- an important predictor for future smoking: a 14-year follow-up study of school leavers.

AIMS: To analyse predictors among pupils leaving compulsory school for smoking and high alcohol consumption as adults. METHODS: A prospective cohort study in which all pupils (N = 1083) in the last year of compulsory school were followed for 14 years. The data were collected through repeated comprehensive self-administered questionnaires. RESULTS: Smoking was better predicted than alcohol intake. The best predictors were earlier high alcohol intake and earlier smoking. Among other predictors, low grades, poor teachers' prognoses and early unemployment pointed to unfavourable health habits, mainly smoking. CONCLUSIONS: It is possible already at school to identify risk groups for future smoking and high alcohol consumption.