The Impact of the Danish National Smoking Ban From 2007 on the Incidence of Eight Smoking-related Diseases: A Nationwide Register-based Interrupted Time Series Analysis.

BACKGROUND: Previous research has documented the effect of comprehensive smoking bans on preventing various adverse health outcomes in the years post-ban. In 2007, Denmark implemented a national smoking ban that prohibited indoor smoking in workplaces and public settings, although only partial restrictions applied in specific premises such as small bars, one-person offices, and in psychiatric units. We tested the hypothesis that the implementation of the national smoking ban was associated with a decrease in incidence of smoking-related morbidity in the Danish population compared to the pre-ban period. METHODS: Interrupted time series analyses including the entire Danish population (≥30 years) was conducted. Information of hospitalizations and cause-specific mortality due to acute myocardial infarction, heart failure, hemorrhagic stroke, ischemic stroke, chronic obstructive pulmonary disease, cancer in bronchus and lung, cancer in lip, mouth, oral cavity, and pharynx, and bladder cancer were obtained from population-based registers. Poisson regression models accounting for seasonal variations and secular trends quantified immediate changes in incidence rates occurring at the time of the smoking ban as well as changes in the post-ban trend compared to pre-ban levels. RESULTS: Overall, we observed no consistent declines in incidence of cardiovascular diseases, chronic obstructive pulmonary disease, or the specific types of cancer in the post-ban period compared with the pre-ban period. CONCLUSION: No consistent reduction in incidence of smoking-related diseases was observed after the smoking ban was introduced in Denmark. This probably reflects that the Danish smoking ban included several exemptions, resulting in a less comprehensive ban compared to those introduced in other countries. IMPLICATIONS: In this study, we found that the Danish national smoking ban from 2007 did not consistently reduced the incidence of eight smoking-related outcomes in the post-ban period compared to pre-ban levels. We argue that due to the exemptions in the smoking ban, which for example allowed smoking in specific premises of the care and nursing sector, in one-person offices, and small bars, the ban was not sufficiently comprehensive to influence smoking behavior and thereof the incidence of smoking-related morbidity. Our findings highlight the importance of introducing comprehensive legislative measures to yield largest health benefits at a population level.

Mental wellbeing among Danish employees during the COVID-19 pandemic: results from a longitudinal study on the role of industry and working environment.

BACKGROUND: The COVID-19 pandemic has had a profound impact on working life. Previous studies have primarily focused on the mental health and wellbeing of healthcare workers and are mostly based on cross-sectional data from non-representative samples. The aim of this study was to investigate mental wellbeing trajectories among employees from different industries, and to longitudinally identify factors that affect mental wellbeing during the COVID-19 pandemic, including job insecurity, fear of COVID-19, working from home or being discharged with wage compensation and management quality. METHODS: Baseline data were obtained from the Danish Health and Wellbeing Survey in 2019 (September-December), with follow-up in September-November 2020. We included 1995 respondents, who completed the questionnaire in both waves and were employed in 2020 and measured mental wellbeing using the Short Warwick-Edinburgh Mental Well-Being Scale. RESULTS: Mental wellbeing declined among employees in all industries. Employees working from home and employees unsatisfied with management experienced a greater decline in mental wellbeing. We found no differences in mental wellbeing trajectories in relation to fear of infecting others or contracting COVID-19, job insecurity and being discharged with wage compensation. CONCLUSIONS: Mental wellbeing declined among employees in all industries with no difference between industries. Employees working from home may have been particularly vulnerable, and the analyses show that managers play a key role in mitigating the negative consequences of the pandemic by ensuring adequate information and involvement of employees.

Changes in mental well-being during the COVID-19 pandemic: A longitudinal study among Danes from 2019 to 2021.

Numerous studies have shown that the COVID-19 pandemic had large influence on mental health during the first lockdown, but fewer studies have focused on the long-term influence on mental health. In a national longitudinal study, we examined mental well-being measured just before (fall 2019) and twice during (falls of 2020 and 2021) the COVID-19 pandemic. We utilized the Danish Health and Wellbeing Survey with questionnaires collected in 2019, 2020 and 2021 among the same study population consisting of 8179 persons. The outcome was mental well-being measured by the Short Warwick-Edinburgh Mental Well-Being Scale (SWEMWBS). Linear regression models were conducted to evaluate change in SWEMWBS from 2019 to 2021. The SWEMWBS distribution was similar in 2019, 2020 and 2021, although the distribution moved to lower scores in 2020 compared to 2019 and moved slightly to higher scores in 2021 compared to 2020. Mean SWEMWBS decreased from 24.8 (95%CI 24.7-25.0) in 2019 to 24.1 (24.0-24.2) in 2020 and increased to 24.4 (24.3-24.6) in 2021 (p < 0.001). The mean decrease from 2019 to 2020 and increase from 2020 to 2021 was strongest among women, persons below age 75 years, persons without depression and among persons with higher education and with employment. In conclusion, we find that mental well-being decreased from 2019 to 2020 and slightly increased from 2020 to 2021 without reaching the pre-pandemic level. These changes are statistically significant but small and support that COVID-19 may only have had a small long-term influence on mental health in the general population.

Decreasing mental well-being during the COVID-19 pandemic: A longitudinal study among Danes before and during the pandemic.

The COVID-19 pandemic has had a huge impact on people's lives and may influence mental health in the general population. In a unique representative Danish longitudinal study, we examined mental well-being measured just before and during the COVID-19 pandemic. The Danish Health and Wellbeing Survey is the Danish contribution to the European Health Interview Survey. In this study, we included the wave from autumn 2019, which we re-invited in the autumn 2020. The study population consisted of 4,234 persons. The main outcome was mental well-being measured by the Short Warwick-Edinburgh Mental Well-Being Scale (SWEMWBS). Linear and logistic regression models were conducted to evaluate change in SWEMWBS between 2019 and 2020. The SWEMWBS distribution was similar in 2019 and 2020, although the distribution moved to lower scores in 2020 compared to 2019. Mean SWEMWBS decreased significantly from 25.5 in 2019 to 24.6 in 2020 corresponding to a mean change of -1.0 (95%CI, -1.1. to -0.8). The proportion with low SWEMWBS increased from 16.5% in 2019 to 20.1% in 2020 (p < 0.001). The mean change was similar for men and women and for different age groups. The most negative development was observed among persons without depression or long-standing illnesses at baseline and among persons with higher educational level. Among persons with depression SWEMWBS increased. As expected, mental well-being significantly decreased in the adult Danish population during the COVID-19 pandemic. However, somewhat more unexpectedly, the decrease was most pronounced among persons without depression or long-standing illnesses and among higher educated groups.

'High schools High on life': Development of an Intervention to Reduce Excessive Drinking in Danish High Schools.

Background: Clear documentation of the understanding of the problem, process of development, and content of interventions is essential to enable other researchers to understand why interventions succeed or fail and to enable researcher to build on previous evidence and replicate and adapt findings in other contexts. In this paper we describe the rationale, intervention development, and final design of the 'High schools High on life' intervention; a high school-based, multi-component intervention to reduce excessive drinking among Danish high school students. Methods: The development of the intervention 'High schools High on life' was guided by the planning steps of the Intervention Mapping protocol (IM) in combination with the behavior change wheel and the behavior change techniques, theory, evidence, practice, and new empirical studies of contextual factors in the Danish high school setting. Results: The development process resulted in a multi-component intervention with the following intervention elements: a school environmental component targeting school alcohol policies and norms, a school educational component addressing students' social norms around alcohol, and a parental component encouraging parent-child communication around alcohol. Discussion: Not all steps of IM were followed rigidly. However, IM proved useful as a planning tool in combination with the behavior change wheel and the behavior change techniques, as it provided a systematic approach to the intervention development process. IM forced the research group to be explicit about decisions and choices throughout the planning process. The transparency of the developmental process and theoretical, empirical and practical/contextual foundation of the 'High schools High on life' intervention may enable future intervention studies to build on our findings and accumulate knowledge to reduce excessive drinking among young people. Trial registration: The trial was registered at clinicaltrials.gov (Trial registration number NCT03906500) prior to randomization.