Pairwise association of key lifestyle factors and risk of solid cancers - A prospective pooled multi-cohort register study.

Smoking, alcohol consumption, obesity, and physical inactivity are key lifestyle risk factors for cancer. Previously these have been mostly examined singly or combined as an index, assuming independent and equivalent effects to cancer risk. The aim of our study was to systematically examine the joint pairwise and interactive effects of these lifestyle factors on the risk of a first solid primary cancer in a multi-cohort prospective setting. We used pooled data from seven Finnish health survey studies during 1972-2015, with 197,551 participants diagnosed with 16,373 solid malignant primary tumors during follow-up. Incidence of any cancer was analyzed separately without and with lung cancers using Poisson regression with main and interaction effects of key lifestyle factors. When excluding lung cancer, the highest risk of any cancer in men was observed for smokers with a BMI of ≥25 kg/m2 (HR 1.36, 95 % CI 1.25-1.48) and in women for smokers consuming alcohol (HR 1.22, 1.14-1.30). No statistically significant interactions between any studied risk factor pairs were observed. When including lung cancer, the highest HRs among men were observed for smokers who consume alcohol (HR 1.72, 1.57-1.89) and among women for smokers who were physically inactive (HR 1.38, 1.27-1.49). Smoking combined with other lifestyle factors at any exposure level resulted in highest pairwise risks, both in men and women. These results highlight the importance of smoking prevention, but also the importance of preventing obesity and reducing alcohol consumption.

What is wellness? Investigating the importance of different domains of wellness among laypeople and experts: A survey study.

AIMS: Lack of consensus on wellness has led to a vast number of different conceptualisations, which hinder international efforts to monitor individual-level wellness and social progress comparably. This study aimed to aid in the harmonisation of the concept by contributing to the scarce research on laypeople's views on wellness. The study investigates whether the importance of different areas of wellness varies depending on age, gender, education or socio-economic position. Furthermore, considering that wellness models are often constructed by expert panels, this study aimed to shed light on how experts' and laypeople's views on wellness vary. METHODS: Altogether, 1152 laypeople and 23 Finnish experts rated the importance of 61 systematic review-based wellness domains. Each domain received an ordinal number, which, together with the Mann-Whitney U-test or Kruskal-Wallis test, was used to examine the differences between the groups. RESULTS: Thirteen wellness domains were found at the top of the lists, regardless of whether the results were analysed based on gender, age, education or socio-economic position. When looking at the priority order of different domains, we were able to identify several differences between the expert panel and laypeople. CONCLUSIONS: To ensure the relevance of wellness models, it is vital to understand the areas that laypeople consider to be important for their comprehensive wellness. This study offers 13 domains that could be combined with an expert view on wellness and used as a starting point for creating a more comprehensive, inclusive and better-suited wellness instrument.

Building Consensus on Domains of Wellness Using Finnish and International Expert Panels: A Delphi-Method Study.

PURPOSE: The paper investigates whether we can build consensus on wellness domains and create a more universal conceptual framework for wellness. DESIGN: A modified ranking type of Delphi method. PARTICIPANTS: Two separate panels consisting of 23 Finnish and 11 international experts. METHODS: Panels were asked to rate the importance of 61 systematic review-based wellness domains and to eventually form a wellness model in both panels. The similarities between the resulting models were investigated and a new conceptual framework for wellness was created. RESULTS: The Finnish model included 8 themes and 20 domains, and the international model 5 themes and eleven domains. Eight of the eleven domains were an exact match for the Finnish model (namely mental health, cognitive health, exercise, nutrition, community, life satisfaction, meaningfulness, work-life balance). There were also 2 similar domains that could be found in both models (namely self-care and lifestyle habits, social networks). A new conceptual framework for wellness was created based on these ten domains. CONCLUSION: The lack of consensus on the wellness construct has made it difficult to find comparable measures that could assess and improve the level of wellness of individuals, organizations, and society. This study offers a conceptual framework that can be further validated and turned into a more universal measurement instrument.

The Joint Contributions of Overweight/Obesity and Physical and Mental Working Conditions to Short and Long Sickness Absence among Young and Midlife Finnish Employees: A Register-Linked Follow-Up Study.

INTRODUCTION: Overweight/obesity and strenuous working conditions are associated with work disability, but their joint contributions to sickness absence (SA) are unknown. We aimed to examine their joint contributions to SA periods of 1-7 and ≥8 days. METHODS: Self-reported data on body mass index and working conditions, including perceived physically and mentally strenuous work and hours per day spent in heavy physical work, were linked to the employer's SA register for the City of Helsinki, Finland, employees (n = 4,323, women 78%) who were 19-39 years old at baseline. We calculated rate ratios (RRs) and 95% confidence intervals (CIs) for SA periods using negative binomial regression models among participants with healthy weight and overweight/obesity, with and without exposure to strenuous working conditions. The mean follow-up time was 2.1 years. RESULTS: Participants with overweight/obesity and exposure to physically strenuous working conditions had the highest age- and gender-adjusted RRs for SA periods of both 1-7 and ≥8 days (physically strenuous work: RR: 1.38, CI: 1.25-1.52, and RR: 1.87, CI: 1.60-2.18, respectively; ≥3 h per day spent in physical work: RR: 1.40, CI: 1.26-1.55 and 2.04, CI: 1.73-2.40, respectively). The interaction between overweight/obesity and physically strenuous working conditions was additive for SA periods of 1-7 days and weakly synergistic for SA periods of ≥8 days. For mentally strenuous work, participants with overweight/obesity and exposure to mentally strenuous work had the highest age-adjusted RRs for SA periods of ≥8 days, and the interaction was additive. CONCLUSION: The joint contributions of overweight/obesity and exposure to strenuous working conditions to SA should be considered when aiming to reduce employees' SA. Employers might benefit from providing employees adequate support for weight management and adherence to healthy lifestyles while improving employees' working conditions.

Pairwise association of key lifestyle factors and risk of colorectal cancer: a prospective pooled multicohort study.

BACKGROUND: Several lifestyle factors are associated with an increased risk of colorectal cancer (CRC). Although lifestyle factors co-occur, in most previous studies these factors have been studied focusing upon a single risk factor or assuming independent effects between risk factors. AIM: To examine the pairwise effects and interactions of smoking, alcohol consumption, physical inactivity, and body mass index (BMI) with risk of subsequent colorectal cancer (CRC). METHODS AND RESULTS: We used METCA cohort data (pooled data from seven population-based Finnish health behavior survey studies during years 1972-2015) consisting of 171 063 women and men. Participants' smoking, alcohol consumption, physical inactivity and BMI measures were gathered, and participants were categorized into those exposed and those not exposed. The incidence of CRC was modeled by Poisson regression with main and interaction effects of key lifestyle factors. The cohort members were followed-up through register linkage to the Finnish Cancer Registry for first primary CRC case until the end of 2015. Follow-up time was 1715, 690 person years. The highest pairwise CRC risk was among male smokers who had overweight (BMI ≥ 25 kg/m2 ) (HR 1.75, 95% CI 1.36-2.26) and women who had overweight and consumed alcohol (HR 1.45, 95% CI 1.14-1.85). Overall, among men the association of lifestyle factors and CRC risk was stronger than among women. In men, both having overweight and being a smoker combined with any other adverse lifestyle factor increased CRC risk. Among women, elevated CRC risks were observed for those who were physically inactive and who consumed alcohol or had overweight. No statistically significant interactions were detected between pairs of lifestyle factors. CONCLUSIONS: This study strengthens the evidence of overweight, smoking, and alcohol consumption as CRC risk factors. Substantial protective benefits in CRC risk can be achieved by preventing smoking, maintaining BMI to <25 kg/m2 and not consuming alcohol.

Weight change among normal weight, overweight and obese employees and subsequent diagnosis-specific sickness absence: A register-linked follow-up study.

Aims: Obesity and weight change are associated with sickness absence; however, less is known about the diagnoses for sickness absence. We examined the association between stable and changing weight by body mass index groups with sickness absence due to any, musculoskeletal and mental diagnoses among midlife female and male employees. Methods: The Finnish Helsinki Health Study phase 1 survey took place in 2000-2002 (response rate 67%) and phase 2 in 2007 (response rate 83%). Based on self-reported body mass index, we calculated the weight change between phases 1 and 2 (body mass index change ⩾5%). The data were linked with registers of the Social Insurance Institution of Finland, including information on diagnoses (ICD-10) for sickness absence >9 days. We used a negative binom ial model to examine the association with sickness absence among 3140 women and 755 men during the follow-up (2007-2013). Results are presented as rate ratios. Covariates were age, sociodemographic factors, workload, health behaviors and prior sickness absence. Results: Weight-gain (rate ratio range=1.27-2.29), overweight (rate ratio range=1.77-2.02) and obesity (rate ratio range=2.16-2.29) among women were associated with a higher rate of sickness absence due to musculoskeletal diseases, compared to weight-maintaining normal-weight women. Similarly, obesity among men was associated with sickness absence due to musculoskeletal diseases (rate ratio range=1.55-3.45). Obesity among women (rate ratio range=1.54-1.72) and weight gain among overweight men (rate ratio=3.67; confidence interval=1.72-7.87) were associated with sickness absence due to mental disorders. Conclusions: Obesity and weight gain were associated with a higher rate of sickness absence, especially due to musculoskeletal diseases among women. Preventing obesity and weight gain likely helps prevent sickness absence.

Lifestyle and cancer-a joint pairwise association of lifestyle habits with subsequent cancer diagnosis.

BACKGROUND: Unhealthy behaviours increase cancer risk. However, lifestyle habits co-occur and their joint association with cancer is not known. METHODS: A survey among midlife employees included data on lifestyle habits and covariates (N = 8960, response rate 67%, 80% women). The joint variables of lifestyle habits were prospectively linked with register data on cancer diagnosis (mean follow-up time 12.1 years). Cox proportional hazard model was used to calculate hazard ratios (HR), and their 95% confidence intervals. RESULTS: Smoking was associated with subsequent cancer risk and the association was strengthened by inactivity (HR 1.94, 1.46-2.59) and unhealthy diet (HR 1.92, 1.43-2.57). Smoking combined with both low (HR 1.70, 1.19-2.41) and moderate (HR 1.68, 1.27-2.23) alcohol consumption was also associated with increased cancer risk, as was unhealthy diet combined with moderate alcohol consumption (HR 1.55, 1.17-2.06) and inactivity (HR 1.44, 1.10-1.88). Inactivity combined with either low (HR 1.44, 1.06-1.96) or moderate (HR 1.47, 1.11-1.95) alcohol use was associated with subsequent cancer risk. CONCLUSIONS: Key unhealthy behaviours have additive effects. Preventive measures should be targeted to especially smokers and those having several adverse lifestyle habits.

The joint associations of smoking and obesity with subsequent short and long sickness absence: a five year follow-up study with register-linkage.

BACKGROUND: Both smoking and obesity are separately associated with sickness absence. Unhealthy lifestyle habits and health conditions may occur concurrently yet studies focusing on their joint association are few. This study examined the joint associations of smoking and obesity with sickness absence (SA). METHODS: A mail survey among employees of the City of Helsinki, Finland, during 2000-2002 included data on obesity, smoking and covariates (N = 8960, response rate 67%, 80% women). These data were prospectively linked with register data on self- (1-3 days) and medically certified (4 days or longer) SA among those consenting to the linkage (n = 6986). Pregnant, underweight and those with missing data on key variables were excluded (n = 138). The total number of participants included in the analyses was 6847. The follow-up time was 5 years. Poisson regression was used to calculate rate ratios (RR). RESULTS: Among women and men smoking and obesity were associated with self-certified SA. Among women there was a joint association with self-certified SA (obese smokers RR 1.81, 95% CI 1.59-2.07). Among women and men smoking and obesity were jointly associated with medically certified SA (for obese smoking women RR 2.23, 95% CI 1.93-2.57, for obese smoking men RR 2.69, 95% CI 2.03-3.55). Associations remained after adjustments for socioeconomic position, working conditions, health behaviours and self-rated health. CONCLUSION: Both smoking and obesity are jointly associated with all lengths of sickness absence. Support measures for smoking cessation and prevention of obesity could likely to reduce SA.

Obesity, change of body mass index and subsequent physical and mental health functioning: a 12-year follow-up study among ageing employees.

BACKGROUND: Studies suggest an association between weight change and subsequent poor physical health functioning, whereas the association with mental health functioning is inconsistent. We aimed to examine whether obesity and change of body mass index among normal weight, overweight and obese women and men associate with changes in physical and mental health functioning. METHODS: The Helsinki Health Study cohort includes Finnish municipal employees aged 40 to 60 in 2000-02 (phase 1, response rate 67%). Phase 2 mail survey (response rate 82%) took place in 2007 and phase 3 in 2012 (response rate 76%). This study included 5668 participants (82% women). Seven weight change categories were formed based on body mass index (BMI) (phase 1) and weight change (BMI change ≥5%) (phase 1-2). The Short Form 36 Health Survey (SF-36) measured physical and mental health functioning. The change in health functioning (phase 1-3) score was examined with repeated measures analyses. Covariates were age, sociodemographic factors, health behaviours, and somatic ill-health. RESULTS: Weight gain was common among women (34%) and men (25%). Weight-gaining normal weight (-1.3 points), overweight (-1.3 points) and obese (-3.6 points) women showed a greater decline in physical component summary scores than weight-maintaining normal weight women. Among weight-maintainers, only obese (-1.8 points) women showed a greater decline than weight-maintaining normal weight women. The associations were similar, but statistically non-significant for obese men. No statistically significant differences in the change in mental health functioning occurred. CONCLUSION: Preventing weight gain likely helps maintaining good physical health functioning and work ability.

Educational differences in disability retirement among young employees in Helsinki, Finland.

BACKGROUND: Disability retirement (DR) among young employees is an increasing problem affecting work life and public health, given the potential major loss of working time. Little is known about educational differences in the risk of DR among young employees, despite the need for such knowledge in targeting preventive measures. We examined the association between education and DR due to any cause and to mental and non-mental causes among young employees. METHODS: Personnel register data of the City of Helsinki from the years 2002-2013 for 25-to-34-year-old employees (n= 41225) were linked to register data from the Finnish Centre for Pensions on DR (n= 381), and from Statistics Finland on education. Education was categorised into four hierarchical groups. The mean follow-up time was 5.7 years. Cox regression analysis was used. RESULTS: There were 381 DR events and of the events, over 70% were due to mental disorders and 72% were temporary. A consistent educational gradient was found. Those with a basic education were at the highest risk of DR due to any cause (HR 4.64, 95% CI 3.07, 7.02), and to mental (HR 4.79, 95% CI 2.89, 7.94) and non-mental causes (HR 4.32, 95% CI 2.10, 8.91). CONCLUSIONS: DR due to any cause, and to mental and non-mental causes, followed a clear educational gradient. Early intervention, treatment and rehabilitation with a view to maintaining work ability are needed among young employees, especially those with low education. Adapting working conditions to their health and work ability may also help to avoid premature exit from work.

Weight change and sickness absence--a prospective study among middle-aged employees.

BACKGROUND: Obesity is associated with an increased risk of work disability, but studies concerning weight change are few. We examined the associations of weight change with subsequent sickness absence. METHODS: Weight status data of 4164 (83% women) employees of the City of Helsinki were gathered from the Helsinki Health Study baseline survey in 2000-2002 and follow-up survey in 2007. Data were linked prospectively with the employer's sickness absence registers. Employees were categorized according to their baseline Body Mass Index (normal weight, overweight, obese) as well as weight change (weight gainer, weight loser, weight maintainer) between the two surveys. The association of weight change with sickness absence spells was analysed with Poisson regression. RESULTS: Among women, those who maintained normal weight had the lowest risk for sickness absence. Weight loss, weight gain and stable obesity increased the risk for sickness absence spells of all lengths. Adjustments for covariates attenuated the association only slightly. Among men, the achieved results were mostly not statistically significant. CONCLUSIONS: Preventing obesity and weight gain is important for employee well-being and work ability. Early support measures in occupational health care could benefit obese employees and those with weight gain to maintain work ability. The association between weight loss and sickness absence should be corroborated in further studies.

Working conditions and major weight gain-a prospective cohort study.

The objective of this study was to examine the associations of working conditions with major weight gain. Three different groups of work-related factors were examined: (i) work arrangements, (ii) physical working conditions, and (iii) psychosocial working conditions. The data are based on the Helsinki Health Study (HHS) questionnaire surveys. A baseline mail survey was made among middle-aged employees of the City of Helsinki in 2000-2002. A follow-up survey was made in 2007. Regression analyses with odds ratios and 95% confidence intervals were calculated. During the 5- to 7-year follow-up, 26% of women and 24% of men gained in weight 5 kg or more. Working conditions were mostly unassociated with weight gain. However, nighttime shift work, physical threat at work, and hazardous exposures at work were moderately associated with weight gain. More attention should be devoted to the prevention of weight gain in general and among risk groups in particular.

Relative weight and disability retirement: a prospective cohort study.

OBJECTIVES: The aims of this study were to examine (i) the association of relative weight with subsequent disability retirement due to any diagnosis and also in two major diagnostic groups (ie, musculoskeletal diseases and mental disorders) and (ii) whether diagnosed diseases, physical and mental functioning, and working conditions explain these associations. METHODS: This prospective study comprised a cohort of 6542 middle-aged employees of the City of Helsinki, Finland. Questionnaire data were linked with register data on disability retirements, with a mean follow-up time of 7.8 years. RESULTS: Adjusting for age, body mass index (BMI) was associated with all-cause disability retirement among men and women, the highest risk being for the severely obese and the obese [hazard ratio (HR) 3.45, 95% confidence interval (95% CI) 2.53-4.69; HR 1.94, 95% CI 1.52-2.46, respectively]. Adjusting for age, relative weight was also strongly associated with the main retirement diagnoses, especially musculoskeletal diseases among the severely obese (HR 4.76, 95% CI 3.06-7.40) and obese (HR 2.35, 95% CI 1.62-3.39). The association was attenuated when adjusting for self-reported diseases and physical and mental functioning at baseline. Working conditions had negligible effects on the associations. CONCLUSIONS: Maintenance of normal weight is likely to reduce the risk of disability retirement. Among obese employees, the focus should be on the improvement of physical functioning and the effective treatment of obesity and its co-morbidities to counteract the heightened risk of disability retirement.

Different measures of body weight as predictors of sickness absence.

AIMS: Excessive weight is associated with increased sickness absence from work due to obesity-linked health problems. However, it is not known which obesity measure best predicts sickness absence. First, we aimed to compare body mass index (BMI), waist circumference (WC), and waist-to-hip ratio (WHR) as predictors of sickness absence spells of various lengths. Second, we aimed to compare BMI based on self-reported and measured weight and height as a predictor of sickness absence to assess the validity of self-reported BMI. METHODS: The participants were 5750 employees of the City of Helsinki, aged 40-60 years, who were followed up on average for 4.8 years using the employer's register. Sickness absence spells were classified as self-certified short (1-3 days), medically certified medium length (4-14 days), and long (>14 days) absence spells. RESULTS: All measures of body weight predicted sickness absence. The relative rates of long sickness absence in the highest quintile as compared to the lowest quintile varied in women from 1.62 (95% CI 1.35-1.94) to 1.89 (95% CI 1.62-2.23) and in men from 1.40 (95% CI 0.76-2.59) to 2.33 (95% CI 1.32-4.11). Differences in the predictive power of BMI and WC were small: both were more strongly associated with sickness absence than WHR. Self-reported BMI performed equally well as measured BMI. CONCLUSIONS: BMI - measured or self-reported - is a valid anthropometric indicator of body weight and predictor of obesity-associated health-risks. Its use is feasible for research purposes as well as for the assessment of weight-related risks to work ability.