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  • 1. Berthelsen, Hanne
    et al.
    Muhonen, Tuija
    Toivanen, Susanna
    Mälardalens högskola, Sverige.
    Vad händer med arbetsmiljön när man inför aktivitetsbaserade kontor inom akademin?2017In: Arbetsmarknad & Arbetsliv, ISSN 1400-9692, Vol. 23, no 3, p. 9-23Article in journal (Refereed)
    Abstract [sv]

    Aktivitetsbaserade kontor är fortfarande ovanliga för forskare och lärare inom akademin, men nu verkar flera lärosäten vara igång att införa den här typen av arbetsplatser. Det finns begränsat med kunskap om vad som händer vid flyttprocesser från egna rum till aktivitetsbaserade kontor i akademin och hur personalen upplever arbetsmiljön i denna typ av kontorsmiljöer. I den här artikeln redovisas resultat från en enkätundersökning före och efter flytt till aktivitetsbaserade kontor på en svensk högskola.

  • 2. Bruno Pena Gralle, Ana Paula
    et al.
    Barbosa Moreno, Arlinda
    Lopes Juvanhol, Leidjaira
    de Jesus Mendes da Fonseca, Maria
    Prates Melo, Enirtes Caetano
    Antunes Nunes, Maria Angelica
    Toivanen, Susanna
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Harter Griep, Rosane
    Job strain and binge eating among Brazilian workers participating in the ELSA-Brasil study: does BMI matter?2017In: Journal of Occupational Health, ISSN 1341-9145, E-ISSN 1348-9585, Vol. 59, no 3, p. 247-255Article in journal (Refereed)
    Abstract [en]

    Objective: To assess the association between job strain and binge eating as well as the effect-modifying influence of body mass index (BMI) on this association. Methods: A total of 11,951 active civil servants from the multicenter Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) was included in this cross-sectional analysis. Job strain was assessed using the Demand-Control-Support Questionnaire. Binge eating was defined as eating a large amount of food with a sense of lack of control over what and how much is eaten in less than 2 hours at least twice a week. Multiple logistic regression was used to determine the association between binge eating and job strain as well as its interaction with BMI. Results: After adjustment, and using low-strain job as the reference category, binge eating was associated with high-strain job (high demand/low control: odds ratio [OR]=1.58, 95% confidence interval [CI] 1.26-1.98), active job (high demand/high control: OR=1.35, 95% CI 1.07-1.70), and passive job (low demand/low control: OR=1.24, 95% CI 1.01-1.53). Psychological job demands were positively associated with binge eating (OR=1.04, 95% CI 1.01-1.07), while greater job control and social support at work were each inversely associated with binge eating (OR=0.95, 95% CI 0.92-0.97 and OR=0.96, 95% CI 0.94-0.98, respectively). BMI modified the association between job strain and binge eating: Heavier psychological job demands were associated with higher odds of binge eating among obese participants, while a stronger inverse association between job control and binge eating was seen among slimmer participants. Conclusions: Job strain increases the odds of binge eating and this association is modified by BMI.

  • 3. Canivet, Catarina
    et al.
    Bodin, Theo
    Emmelin, Maria
    Toivanen, Susanna
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Moghaddassi, Mahnaz
    Östergren, Per-Olof
    Precarious employment is a risk factor for poor mental health in young individuals in Sweden: a cohort study with multiple follow-ups2016In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 16, article id 687Article in journal (Refereed)
    Abstract [en]

    Background

    The globalisation of the economy and the labour markets has resulted in a growing proportion of individuals who find themselves in a precarious labour market situation, especially among the young. This pertains also to the Nordic countries, despite their characterisation as well developed welfare states with active labour market policies. This should be viewed against the background of a number of studies, which have shown that several aspects of precarious employment are detrimental to mental health. However, longitudinal studies from the Nordic region that examine the impact of precarious labour market conditions on mental health in young individuals are currently lacking. The present study aims to examine this impact in a general cohort of Swedish young people.

    Methods

    Postal questionnaires were sent out in 1999/2000 to a stratified random sample of the Scania population, Sweden; the response rate was 58 %. All of those who responded at baseline were invited to follow-ups after 5 and 10 years. Employment precariousness was determined based on detailed questions about present employment, previous unemployment, and self-rated risk of future unemployment. Mental health was assessed by GHQ-12. For this study individuals in the age range of 18–34 years at baseline, who were active in the labour market (employed or seeking job) and had submitted complete data from 1999/2000, 2005, and 2010 on employment precariousness and mental health status, were selected (N = 1135).

    Results

    Forty-two percent of the participants had a precarious employment situation at baseline. Labour market trajectories that included precarious employment in 1999/2000 or 2005 predicted poor mental health in 2010: the incidence ratio ratio was 1.4 (95 % CI: 1.1–2.0) when excluding all individuals with mental health problems at baseline and adjusting for age, gender, social support, social capital, and economic difficulties in childhood. The population attributable fraction regarding poor mental health in the studied age group was 18 %.

    Conclusions

    This study supported the hypothesis that precarious employment should be regarded as an important social determinant for subsequent development of mental health problems in previously mentally healthy young people.

  • 4.
    Dunlavy, Andrea
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Juárez, Sol
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Toivanen, Susanna
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Rostila, Mikael
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Migration background characteristics and the association between unemployment and suicide2017In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 27, no Suppl. 3Article in journal (Refereed)
    Abstract [en]

    Background

    Persons of foreign-origin have higher rates of unemployment compared to those of native-origin, yet few studies have assessed relationships between unemployment and mental health in persons of foreign-origin relative to the native-origin. This study aims to examine the extent to which generational status, region of origin, age at arrival, and duration of residence modify the relationship between employment status and suicide risk.

    Methods

    Population-based registers were used to conduct a longitudinal, open cohort study of native-origin and foreign-origin Swedish residents of working age (25-64 years) from 1993-2008. Hazard ratios and 95% confidence intervals for suicide mortality were estimated using gender-stratified Cox proportional hazards models.

    Results

    Elevated hazard ratios for suicide were observed among the majority of foreign-origin persons exposed to unemployment. Second generation Swedish men exposed to unemployment demonstrated significantly greater (p < 0.05) excess risk of suicide (HR = 3.63, 95% CI: 2.90-4.54) than that observed among native-origin Swedish men exposed to unemployment (HR = 1.67, 95% CI: 1.29-2.16). In unemployed foreign-born men, younger age at arrival and longer duration of residence were associated with increased risk of suicide, whereas unemployed foreign-born men who arrived as adults and had a shorter duration of residence did not demonstrate excess suicide risk.

    Conclusions

    Analyses indicated that the majority of the foreign-origin exposed to unemployment demonstrated excess risk of suicide that was of a similar magnitude to that observed among their native-origin counterparts. Yet there were notable differences in patterns of association by generational status, region of origin, age at arrival, and duration of residence. The high excess risk observed in unemployed second generation men suggests that ensuring employment among this group may be of particular public health importance.

  • 5. Fernandes Portela, Luciana
    et al.
    Kröning Luna, Caroline
    Rotenberg, Lúcia
    Silva-Costa, Aline
    Toivanen, Susanna
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Araújo, Tania
    Härter Griep, Rosane
    Oswaldo Cruz Institute (IOC/Fiocruz), Brazil.
    Job strain and self-reported insomnia symptoms among nurses: What about the influence of emotional demands and social support?2015In: BioMed Research International, ISSN 2314-6133, E-ISSN 2314-6141, article id 820610Article in journal (Refereed)
    Abstract [en]

    Job strain, derived from high psychological demands and low job control, is associated with insomnia, but information on the role of emotional demands and social support in this relationship is scarce. The aims of this study were (i) to test the association between job strain and self-reported insomnia symptoms, (ii) to evaluate the combination of emotional demands and job control regarding insomnia symptoms, and (iii) to analyze the influence of social support in these relationships. This cross-sectional study refers to a sample of nurses (N = 3,013 and N = 3,035 for Job Strain and Emotional demand-control model, resp.) working at public hospitals in Rio de Janeiro, Brazil. Data were collected through a self-report questionnaire. The prevalence of insomnia symptoms was 34.3%. Job strain was associated with increased odds for insomnia symptoms (OR: 2.20); the same result was observed with the combination of emotional demands and low job control (OR: 1.99). In both models, the inclusion of low social support combined with high demands and low job control led to increased odds for insomnia symptoms, compared to groups with high social support from coworkers and supervisors. Besides job strain, the study of emotional demands and social support are promising with regards to insomnia symptoms, particularly among nurses.

  • 6.
    Gisselmann, Marit
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Hemström, Örjan
    Toivanen, Susanna
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Kön, genus och skillnader i hälsa2012In: Den orättvisa hälsan Om socioekonomiska skillnader i hälsa och livslängd: Om socioekonomiska skillnader i hälsa och livslängd / [ed] Rostila, M.; Toivanen, S., Liber, 2012Chapter in book (Other academic)
  • 7. Gisselmann, Marit
    et al.
    Toivanen, Susanna
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Kön, genus och sociala skillnader i hälsa2013In: Sociala skillnader i unga kvinnors hälsa: en kunskapssammanställning av KvinnorKan, Stockholm: KvinnorKan , 2013, , p. 10 - 19p. 10-19Chapter in book (Other academic)
  • 8.
    Griep Härter, Rosane
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Bastos S., Leonardo
    da Fonseca, Maria de Jesus Mendes
    Silva-Costa, Aline
    Portela, Luciana Fernandes
    Toivanen, Susanna
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Rotenberg, Lucia
    Years worked at night and body mass index among registered nurses from eighteen public hospitals in Rio de Janeiro, Brazil2014In: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 14, p. 603-Article in journal (Refereed)
    Abstract [en]

    Background: Employees working night shifts are at a greater risk of being overweight or obese. Few studies on obesity and weight gain analyze the years of exposure to night work. The aim of this study was to determine the relationship between the years of exposure to night work and body mass index (BMI) among registered nurses. Methods: A cross-sectional analysis was performed in 18 largest public hospitals in Rio de Janeiro, Brazil. A total of 2,372 registered nurses ( 2,100 women) completed a comprehensive questionnaire concerning sociodemographic, professional, lifestyle, and health behavioral data. Current and past exposures to night shifts as well as BMI values were measured as continuous variables. A gamma regression model was used with an identity link function to establish the association. Results: The association between years of exposure to night work and BMI was statistically significant for both women and men after adjusting for all covariates [beta = 0.036; CI95% = 0.009-0.063) and beta = 0.071 (CI95% = 0.012-0.129), respectively]. The effect of night work was greater among men than women. For example, for those women who have worked at night for 20 years the estimated average BMI was 25.6 kg/m(2) [range, 25.0-26.2]. In relation to men, after 20 years of exposure to night work the estimated average BMI was 26.9 kg/m(2) [range, 25.6-28.1]. Conclusions: These findings suggest that night shift exposure is related to BMI increases. Obesity prevention strategies should incorporate improvements in work environments, such as the provision of proper meals to night workers, in addition to educational programs on the health effects of night work.

  • 9. Griep, Rosane Haerter
    et al.
    Nobre, Aline Araujo
    de Mello Alves, Marcia Guimaraes
    Mendes da Fonseca, Maria de Jesus
    Cardoso, Letcia de Oliveira
    Giatti, Luana
    Prates Melo, Enirtes Caetano
    Toivanen, Susanna
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Chor, Dora
    Job strain and unhealthy lifestyle: results from the baseline cohort study, Brazilian Longitudinal Study of Adult Health (ELSA-Brasil)2015In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 15, article id 309Article in journal (Refereed)
    Abstract [en]

    Background: Unhealthy lifestyle choices, such as smoking and sedentary behavior, are among the main modifiable risk factors for chronic non-communicable diseases. The workplace is regarded as an important site of potential health risks where preventive strategies can be effective. We investigated independent associations among psychosocial job strain, leisure-time physical inactivity, and smoking in public servants in the largest Brazilian adult cohort. Methods: We conducted a cross-sectional analysis of baseline data from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil)-a multicenter prospective cohort study of civil servants. Our analytical samples comprised 11,779 and 11,963 current workers for, respectively, analyses of job strain and leisure-time physical activity and analyses of job strain and smoking. Job strain was assessed using the Brazilian version of the Swedish Demand-Control-Support Questionnaire; physical activity was evaluated using a short form of the International Physical Activity Questionnaire. We also examined smoking status and number of cigarettes smoked per day. The association reported in this paper was assessed by means of multinomial and logistic regression, stratified by sex. Results: Among men, compared with low-strain activities (low demand and high control), job strain showed an association with physical inactivity (odds ratio [OR] = 1.34; 95% confidence interval [CI] = 1.09-1.64) or with the practice of physical activities of less than recommended duration (OR = 1.44; 95% CI = 1.15-1.82). Among women, greater likelihood of physical inactivity was identified among job-strain and passive-job groups (OR = 1.47; 95% CI = 1.22-1.77 and OR = 1.42; 95% CI = 1.20-1.67, respectively). Greater control at work was a protective factor for physical inactivity among both men and women. Social support at work was a protective factor for physical inactivity among women, as was smoking for both genders. We observed no association between demand or control dimensions and smoking. Conclusions: Job strain, job control, and social support were associated with physical activity. Social support at work was protective of smoking. Our results are comparable to those found in more developed countries; they provide additional evidence of an association between an adverse psychosocial work environment and health-related behaviors.

  • 10. Hagqvist, Emma
    et al.
    Toivanen, Susanna
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Vinberg, Stig
    The gender time gap: Time use among self-employed women and men compared to paid employees in Sweden2017In: Time & Society, ISSN 0961-463X, E-ISSN 1461-7463Article in journal (Refereed)
    Abstract [en]

    In this article, the authors set out to study the time use of men and women in Sweden, comparing self-employed and employed individuals. Previous studies indicate that there are reasons to believe that both gendered time use and mechanisms related to time use might differ between the self-employed and employees. Employing time use data, the aim was to study whether there are differences in gendered time use between self-employed individuals and employees in Sweden, and furthermore, which mechanism relates to gendered time use among self-employed individuals and employees. The results show that self-employed men and women distribute their time in a more gender-traditional manner than employees. In addition, relative resources are found to be an important factor related to gendered time use among the self-employed. For employees, gender relations tend to be a mechanism related to gendered time use. The conclusion is that working conditions are important for gendered time use and should be considered in future studies.

  • 11.
    Hagqvist, Emma
    et al.
    Mittuniversitetet, Sverige.
    Toivanen, Susanna
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Vinberg, Stig
    Mittuniversitetet, Sverige.
    Time strain among self-employed women and men compared to employees in Sweden2015In: Society, Health & Vulnerability, ISSN 2002-1518, Vol. 6, no 22 decArticle in journal (Refereed)
    Abstract [en]

    Dual-earner families are common in Sweden, and most women are involved in the labour market. It has been shown that employees and self-employed individuals perceive their working conditions differently: self-employed individuals are more likely to experience an imbalance between work and family, higher job demands, and the feeling that they must be ‘‘always on.’’ Thus, there may also be a difference between employees and self-employed individuals in terms of perceived time strain. Previous studies have identified differences in time-use patterns among men and women who are employed and self-employed. This study uses time-use data to examine potential gender differences among men and women who are self-employed and those who are employees with regard to time strain effects related to time spent on paid and unpaid work in Sweden. The results show that self-employed individuals, particularly self-employed women, report the highest levels of time strain. For self-employed women, an increase in the time spent on paid work reduces perceived time strain levels, whereas the opposite is true for employees and self-employed men. It is primarily individual and family factors, and not time use, that are related to time strain. The results provide evidence that gender differences in time strain are greater among self-employed individuals than among employees.

  • 12. Harter Griep, R
    et al.
    Rotenberg, L
    Chor, D.
    Toivanen, Susanna
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Landsbergis, P.
    Beyond simple approaches to studying the association between work characteristics and absenteeism: Combining the DCS and ERI models2010In: Work & Stress, ISSN 0267-8373, E-ISSN 1464-5335, Vol. 24, no 2, p. 179-195Article in journal (Refereed)
    Abstract [en]

    The Demand-Control-Support (DCS) and the Effort-Reward Imbalance (ERI) models assess different psychosocial factors. This study investigates whether a combination of these models increases their ability to predict sickness absence, as compared to results based on each model separately. A cross-sectional study with nursing personnel (N = 1307) in Brazil was performed. Regression analyses were conducted in three stages: analysis of each scale of the models and sickness absences; assessment of the independent association of each model with sickness absences; assessment of the associations of three combinations of models/scales with sickness absences: DC and social support (SS), ERI and overcommitment, and DC and ERI. As regards comparisons between the stress models, ERI was shown to be independently associated with short (up to 9 days) and long (10 days or more) spells of absenteeism. The same result held true for low social support. The combinations DC-ERI and DC-SS were better predictors for short spells than each model/scale separately, whereas for long spells, the combination DC-SS was the best predictor. ERI seems to be a good instrument for predicting absenteeism if used alone, whereas DC performed better when combined with ERI or SS. An improved risk estimation of sickness absences by combining information from the two models was observed.

  • 13. Härter Griep, Rosane
    et al.
    Toivanen, Susanna
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Santos, Itamar S.
    Rotenberg, Lucia
    Juvanhol, Leidjaira Lopes
    Goulart, Alessandra C.
    Aquino, Estela M.
    Benseñor, Isabela
    Work-family conflict, lack of time for personal care and leisure, and job strain in migraine: Results of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil)2016In: American Journal of Industrial Medicine, ISSN 0271-3586, E-ISSN 1097-0274, Vol. 59, no 11, p. 987-1000Article in journal (Refereed)
    Abstract [en]

    Background

    Work-family conflict and time scarcity may affect health. We investigated the association between these issues and migraine, taking into account job strain.

    Methods

    Baseline data from ELSA-Brasil (6,183 women; 5,664 men) included four indicators of work-family conflict: time- and strain-based interference of work with family (TB-WFC, SB-WFC), interference of family with work (FWC) and lack of time for personal care and leisure (LOT). Migraine was classified according to International Headache Society criteria.

    Results

    Among women, definite migraine was associated with SB-WFC (odds ratio [OR] = 1.28; 95% confidence interval [CI] 1.06–1.55), FWC (OR = 1.32; 1.00–1.75), and LOT (OR = 1.30; 1.08–1.58). Probable migraine was associated with SB-WFC (OR = 1.17; 1.00–1.36). High psychological job demands and low social support interacted with LOT in association with definite migraine. Among men, probable migraine was associated with LOT (OR = 1.34; 1.09–1.64), and there were interactions between job strain and WFC for probable migraine.

    Conclusions

    Balancing the demands of professional and domestic spheres could be highly relevant in the management of migraines.

  • 14.
    Härter Griep, Rosane
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). Oswaldo Cruz Foundation, Brazil.
    Toivanen, Susanna
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    van Diepen, Cornelia
    Guimarães, Johanna M. N.
    Camelo, Lidyane V.
    Lopes Juvanhol, Leidjaira
    Aquino, Estela M.
    Chor, Dóra
    Work–family conflict and self-rated health: the role of gender and educational level. Baseline data from the Brazilian longitudinal study of adult health (ELSA-Brasil)2016In: International Journal of Behavioral Medicine, ISSN 1070-5503, E-ISSN 1532-7558, Vol. 23, no 3, p. 372-382Article in journal (Refereed)
    Abstract [en]

    Purpose

    This study examined gender differences in the association between work–family conflict and self-rated health and evaluated the effect of educational attainment.

    Method

    We used baseline data from ELSA-Brasil, a cohort study of civil servants from six Brazilian state capitals. Our samples included 12,017 active workers aged 34–72 years. Work–family conflict was measured by four indicators measuring effects of work on family, effects of family in work and lack of time for leisure and personal care.

    Results

    Women experienced more frequent work–family conflict, but in both genders, increased work–family conflict directly correlated with poorer self-rated health. Women’s educational level interacted with three work–family conflict indicators. For time-based effects of work on family, highly educated women had higher odds of suboptimal self-rated health (OR = 1.54; 95 % CI = 1.19–1.99) than less educated women (OR = 1.14; 95 % CI = 0.92–1.42). For strain-based effects of work on family, women with higher and lower education levels had OR = 1.91 (95 % CI 1.48–2.47) and OR = 1.40 (95 % CI 1.12–1.75), respectively. For lack of time for leisure and personal care, women with higher and lower education levels had OR = 2.60 (95 % CI = 1.95–3.47) and OR = 1.11 (95 % CI = 0.90–1.38), respectively.

    Conclusion

    Women’s education level affects the relationship between work–family conflict and self-rated health. The results may contribute to prevention activities.

  • 15.
    Hélio, Manhica
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Toivanen, Susanna
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Hjern, Anders
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Rostila, Mikael
    Stockholm University, Faculty of Social Sciences, Department of Sociology. Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Mortality in adult offspring of immigrants: a Swedish national cohort study2015In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 10, no 2, article id e0116999.Article in journal (Refereed)
  • 16. Hökerberg, Yara Hahr Marques
    et al.
    Reichenheim, Michael Eduardo
    Faerstein, Eduardo
    Lambert Passos, Sonia Regina
    Fritzell, Johan
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Toivanen, Susanna
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Westerlund, Hugo
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Cross-cultural validity of the demand-control questionnaire: Swedish and Brazilian workers2014In: Revista de Saude Publica, ISSN 0034-8910, E-ISSN 1518-8787, Vol. 48, no 3, p. 486-496Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE

    To evaluate the cross-cultural validity of the Demand-Control Questionnaire, comparing the original Swedish questionnaire with the Brazilian version.

    METHODS

    We compared data from 362 Swedish and 399 Brazilian health workers. Confirmatory and exploratory factor analyses were performed to test structural validity, using the robust weighted least squares mean and variance-adjusted (WLSMV) estimator. Construct validity, using hypotheses testing, was evaluated through the inspection of the mean score distribution of the scale dimensions according to sociodemographic and social support at work variables.

    RESULTS

    The confirmatory and exploratory factor analyses supported the instrument in three dimensions (for Swedish and Brazilians): psychological demands, skill discretion and decision authority. The best-fit model was achieved by including an error correlation between work fast and work intensely (psychological demands) and removing the item repetitive work (skill discretion). Hypotheses testing showed that workers with university degree had higher scores on skill discretion and decision authority and those with high levels of Social Support at Work had lower scores on psychological demands and higher scores on decision authority.

    CONCLUSIONS

    The results supported the equivalent dimensional structures across the two culturally different work contexts. Skill discretion and decision authority formed two distinct dimensions and the item repetitive work should be removed.

  • 17. Klingelschmidt, J.
    et al.
    Milner, A.
    Khireddine-Medouni, I.
    Witt, K.
    Alexopoulos, E. C.
    Toivanen, Susanna
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    La Montagne, A. D.
    Chastang, J. -F.
    Niedhammer, I.
    Suicide among agricultural, forestry, and fishery workers: a systematic literature review and meta-analysis2018In: Scandinavian Journal of Work, Environment and Health, ISSN 0355-3140, E-ISSN 1795-990X, Vol. 44, no 1, p. 3-15Article, review/survey (Refereed)
    Abstract [en]

    Objectives This review aimed to quantify suicide risk among agricultural, forestry, and fishery workers and study potential variations of risk within this population.

    Methods We conducted a systematic literature review and meta-analysis from 1995 to 2016 using MEDLINE and following the PRISMA guidelines. A pooled effect size of suicide risk among the population of interest was calculated using meta-analysis. Subgroup analyses were conducted to investigate whether effect size differed according to population or study characteristics. Meta-regression was used to identify sources of heterogeneity.

    Results The systematic review identified 65 studies, of which 32 were included in the meta-analysis. Pooled effect size was 1.48 [95% confidence interval (CI) 1.30–1.68] representing an excess of suicide risk among the population of interest. Subgroup analysis showed that this effect size varied according to geographic area, with a higher effect size in Japan. The following study characteristics were found to contribute to the between-study variance: reference group, measure of effect size, and study design.

    Conclusions Our findings suggest an excess of suicide risk among agricultural, forestry, and fishery workers and demonstrated that this excess may be even higher for these groups in Japan. This review highlights the need for suicide prevention policies focusing on this specific population of workers. More research is also needed to better understand the underlying factors that may increase suicide risk in this population.

  • 18.
    Lundberg, Olle
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Toivanen, Susanna
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Sense of coherence and social structure2011In: Encyclopaedia of Environmental Health / [ed] Nriagu, J.O., Oxford: Elsevier , 2011Chapter in book (Other academic)
  • 19.
    Mellner, Christin
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Toivanen, Susanna
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Framtidens arbetsliv – utmaningar för morgondagens ledare2013In: Chefstidningen, ISSN 2000-3498, no 5, p. 48-51Article in journal (Other academic)
  • 20.
    Modin, Bitte
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Östberg, Viveca
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Toivanen, Susanna
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Sundell, Knut
    Psychosocial working conditions, school sense of coherence and subjective health complaints: A multilevel analysis of ninth grade pupils in the Stockholm area2011In: Journal of Adolescence, ISSN 0140-1971, E-ISSN 1095-9254, Vol. 34, no 1, p. 129-139Article in journal (Refereed)
    Abstract [en]

    This study explores the psychosocial working conditions of 7930 Swedish 9th grade students, distributed over 475 classes and 130 schools, in relation to their subjective health using multilevel modeling. At the individual level, students with “strained” working conditions in school (i.e. those experiencing a high level of demands in combination with a low level of control) demonstrated significantly worse health compared to students in “low-strain” situations. “Strained” conditions in combination with a weak school-related sense of coherence were especially unfavourable for health. These findings remained significant when support from teachers, school marks, norm-breaking behaviours, family-relations and certain class- and school-contextual conditions were adjusted for. Thus, while demands are an essential part of school work, this study suggests that high levels of control and a strong school-related sense of coherence can protect against the more detrimental effects on health that high demands at school may cause.

  • 21. Niedhammer, Isabelle
    et al.
    Milner, Allison
    Witt, Katrina
    Klingelschmidt, Justine
    Khireddine-Medouni, Imane
    Alexopoulos, Evangelos C.
    Toivanen, Susanna
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Chastang, Jean-Francois
    LaMontagne, Anthony D.
    Response to letter to the editor from Dr Rahman Shiri: The challenging topic of suicide across occupational groups2018In: Scandinavian Journal of Work, Environment and Health, ISSN 0355-3140, E-ISSN 1795-990X, Vol. 44, no 1, p. 108-110Article in journal (Refereed)
  • 22.
    Rostila, Mikael
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Toivanen, Susanna
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Den orättvisa hälsan: Om socioekonomiska skillnader i hälsa och livslängd2012Book (Other academic)
    Abstract [sv]

    I vilken utsträckning är hälsan ojämlikt fördelad i Sverige och i övriga världen? Varför lever människor med högre social position längre än andra? Hur kan hälsan fördelas mer rättvist?Dessa är några av de frågor som denna unika svenska bok önskar besvara och klargöra. Boken handlar om hur människors position i samhällets hierarkiska strukturer är nära förknippad med systematiska skillnader i hälsa. Var vi råkar födas i världen, men även den sociala position vi har i ett givet samhälle, har stor betydelse för vår hälsa och livslängd. Trots att en jämlik hälsa borde vara en mänsklig rättighet har hälsans ojämlika fördelning ofta stått långt ned på den politiska dagordningen.

  • 23.
    Rostila, Mikael
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Toivanen, Susanna
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Inledning: Den orättvisa ohälsan2012In: Den orättvisa hälsan: om socioekonomiska skillnader i hälsa och livslängd. / [ed] Rostila, M.; Toivanen, S., Stockholm: Liber, 2012, p. 13-26Chapter in book (Other academic)
  • 24.
    Rostila, Mikael
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Toivanen, Susanna
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Vägar mot en rättvis hälsa2012In: Den orättvisa hälsan: Om socioekonomiska skillnader i hälsa och livslängd / [ed] Rostila, M.; Toivanen, S., Liber, 2012Chapter in book (Other academic)
  • 25.
    Toivanen, Susanna
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Exploring the Interplay Between Work Stress and Socioeconomic Position in Relation to Common Health Complaints: The Role of Interaction2011In: American Journal of Industrial Medicine, ISSN 0271-3586, E-ISSN 1097-0274, Vol. 54, no 10, p. 780-790Article in journal (Refereed)
    Abstract [en]

    Background This study explored the interplay between work stress and socioeconomic position and investigated if the interaction of work stress and low socioeconomic position is associated with poorer health. Methods A representative sample of the Swedish working population, including 2,613 employees (48.7% women) aged 19-64 years, was analyzed. The health outcomes were poor self-rated health, psychological distress, and musculoskeletal pain. Work stress was operationalized as job strain and effort-reward imbalance, and socioeconomic position as occupational class. Interaction analysis was based on departure from additivity as criterion, and a synergy index (SI) was applied, using odds ratios (ORs) from logistic regressions for women and men. Results/Conclusions In fully adjusted models, work stress, and in a lesser extent also socioeconomic position, was associated with higher odds for the three health complaints. The prevalence of poorer health was highest among those individuals jointly exposed to high work stress and low occupational class, with ORs ranging from 1.94 to 6.77 (95% CI 1.01-18.65) for poor self-rated health, 2.42-8.44 (95% CI 1.28-27.06) for psychological distress and 1.93-3.93 (95% CI 1.11-6.78) for musculoskeletal pain. The joint influence of work stress and low socioeconomic position on health was additive rather than multiplicative.

  • 26.
    Toivanen, Susanna
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Forskning om framtidens hälsofrämjande arbetsplatser - ett postdokprojekt i näringslivet2012In: Svepet: Medlemsblad för Svensk Epidemiologisk Förening, ISSN 1101-4385, Vol. 30, no 1, p. 6-7Article in journal (Other (popular science, discussion, etc.))
  • 27.
    Toivanen, Susanna
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Framtidens kontor2011In: TAM-Revy, no 1, p. 4-6Article in journal (Other academic)
  • 28.
    Toivanen, Susanna
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Income differences in cardiovascular disease prevalence: the contribution of job control and physical work demands2004In: International Journal of Behavioral Medicine, ISSN 1070-5503, E-ISSN 1532-7558, Vol. 11(Suppl), p. 73-74Article in journal (Refereed)
  • 29.
    Toivanen, Susanna
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Income differences in stroke mortality: a follow-up study of the Swedish working population2009In: International Journal of Occupational Medicine and Environmental Health, Vol. 22(Suppl), p. 81-Article in journal (Refereed)
  • 30.
    Toivanen, Susanna
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Income differences in stroke mortality: a follow-up study of the Swedish working population2011In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 39, no 8, p. 797-804Article in journal (Refereed)
    Abstract [en]

    Aims: This study explored the association between income and stroke mortality in the total working population in Sweden and examined whether the associations differ by gender or for stroke subtypes intracerebral haemorrhage (ICH) or brain infarction (BI).

    Methods: This was a register-based study among nearly 3 million working women and men (30–64 years in 1990) with a 12-year follow up (1991–2002) for mortality from stroke (4886 deaths). Income was measured as annual registered income from work in 1990. Gender-specific Cox regressions were applied with adjustments for sociodemographic covariates.

    Results: The age-adjusted hazard ratio (95% confidence interval) of lowest versus highest income quartile was 1.80 (1.482.19) for any stroke, 1.68 (1.292.17) for ICH and 2.23 (1.533.22) for BI in women, and the corresponding figures for men were 2.12 (1.922.34), 2.02 (1.772.31), and 2.09 (1.772.46). Adjustment for covariates attenuated these associations to 1.69 (1.332.15) for any stroke and 1.56 (1.142.14) for ICH in women and to 1.98 (1.742.24) for any stroke and 1.77 (1.442.19) for BI in men. In contrast, adjustment for covariates amplified the estimates to 2.36 (1.523.66) for BI in women and to 2.05 (1.732.44) for ICH in men.

    Conclusions: Risk of stroke mortality was highest in the lowest income group, with a gradient for the intermediate groups, in both women and men. The risk of mortality from BI was highest in women with the lowest income and the risk of ICH was highest in men with the lowest income. 

  • 31.
    Toivanen, Susanna
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Job Control and Risk of Incident Stroke in the Working Population in Sweden: a Register-Based Cohort Study2008Conference paper (Refereed)
  • 32.
    Toivanen, Susanna
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Social Determinants of Stroke as Related to Stress at Work among Working Women: A Literature Review2012In: Stroke Research and Treatment, ISSN 2090-8105, E-ISSN 2042-0056, Vol. 2012, article id 873678Article, review/survey (Refereed)
    Abstract [en]

    In adult life, many of the social determinants of health are connected to working life. Yet, our knowledge of the role of work-related factors for the risk of stroke is fairly limited. In contemporary occupational health research, the Demand-Control Model (DCM) is frequently used to measure work stress. Previous literature reviews of the association of work stress and cardiovascular disease (CVD) do not include stroke as a specific outcome. Results regarding work stress and the risk of CVD are less evident in working women. With the focus on working women, the purpose of the present paper was to review the current research into the DCM in relation to stroke and to scrutinize potential gender differences. A literature search was performed and eight studies from three countries were identified. Based on the reviewed studies, there is some evidence that high psychological demands, low job control, and job strain are associated with increased stroke risk in women as well as in men. Any major reduction in deaths and disability from stroke is likely to come from decreasing social inequalities in health, and reducing work stress has a potential to contribute to a reduced risk of stroke in working populations.

  • 33.
    Toivanen, Susanna
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Stress at work and risk of stroke among working women - a literature study2010In: Gender & Development / [ed] Sahaya, A., Kaishta, S., and Patel, V., New Delhi: The Women Press , 2010, p. 216-241Chapter in book (Other academic)
  • 34.
    Toivanen, Susanna
    Stockholm University, Faculty of Social Sciences, Department of Sociology.
    Work stress and health: Is the association moderated by sense of coherence?2007In: Health Inequalities and Welfare Resources: Continuity and Change in Sweden / [ed] Johan Fritzell and Olle Lundberg, Bristol: Policy Press, 2007, p. 87-107Chapter in book (Other academic)
  • 35.
    Toivanen, Susanna
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Workplaces of the future: how are they studied? A literature study of Foresight and Delphi methods2011In: Nordic Journal of Working Life Studies, Vol. 1, no 1, p. 161-167Article in journal (Refereed)
  • 36.
    Toivanen, Susanna
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Bodin Danielsson, C
    Framtidens arbetsrum2011In: Framtider, no 1, p. 29-Article in journal (Other academic)
  • 37.
    Toivanen, Susanna
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Gisselmann, Marit
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Lindfors, Petra
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Kön, genus och hälsa: socioekonomiska skillnader i hälsa bland kvinnor och män: Ett diskussionsunderlag framtaget för Kommission för ett socialt hållbart Malmö2012Report (Other academic)
    Abstract [sv]

    Syftet med denna rapport är att beskriva socioekonomiska skillnaderna i hälsa mellan kvinnor och män och föreslå åtgärder för Malmökommissionen för att minska dessa skillnader bland befolkningen i Malmö. Rapporten inleds med att presentera några teoretiska perspektiv för att utforska skillnader i hälsa bland kvinnor och män, med huvudfokus på det genusteoretiska perspektivet. Sedan beskrivs några av de centrala sociala bestämningsfaktorerna för kvinnors och mäns hälsa och könsskillnader i dessa. Därefter diskuteras hälsoskillnader bland kvinnor och män utifrån socioekonomisk position. Ojämlikhet i hälsa exemplifieras utifrån den institutionaliserade vardagen i skolan, arbetslivet och ålderdomen. Avslutningsvis granskar vi ett urval tidigare förslag för att minska socioekonomiska skillnader i hälsa mellan könen. Utifrån denna genomgång ger vi slutligen några förslag på strategier som på sikt kan tänkas minska skillnader i hälsa mellan kvinnor och män. Några centrala begrepp som förekommer i denna rapport förklaras mer utförligt i bilaga.

  • 38.
    Toivanen, Susanna
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Härter Griep, Rosane
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). Oswaldo Cruz Institute, Brazil.
    Mellner, Christin
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Work and organizational psychology.
    Vinberg, Stig
    Eloranta, Sandra
    Mortality differences between self-employed and paid employees: a 5-year follow-up study of the working population in Sweden2016In: Occupational and Environmental Medicine, ISSN 1351-0711, E-ISSN 1470-7926, Vol. 73, p. 627-636Article in journal (Refereed)
    Abstract [en]

    Objectives: Analyse mortality differences between self-employed and paid employees with a focus on industrial sector, educational level and gender using Swedish register data.

    Methods: A cohort of the total working population (4 776 135 individuals; 7.2% self-employed; 18–100 years of age at baseline 2003) in Sweden with a 5-year follow-up (2004–2008) for all-cause and cause-specific mortality (57 743 deaths). Self-employed individuals were categorised as sole proprietors or limited liability company (LLC) owners according to their enterprise’s legal form. Cox proportional hazards models were applied to compare mortality rates between sole proprietors, LLC owners and paid employees, adjusted for sociodemographic confounders.

    Results: Mortality from cardiovascular diseases was 16% lower and from suicide 26% lower among LLC owners than among paid employees, adjusted for confounders. Within the industrial category, all-cause mortality was 13–15% lower among sole proprietors and LLC owners compared with employees in manufacturing and mining (MM) as well as personal and cultural services (PCS), and 11–20% higher in sole proprietors in trade, transport and communication and the welfare industry (W). A significant three-way interaction indicated 17–23% lower all-cause mortality among male LLC owners in MM and female sole proprietors in PCS, and 50% higher mortality in female sole proprietors in W than in employees in the same industries.

    Conclusions: Mortality differences between selfemployed individuals and paid employees vary by the legal form of self-employment, across industries, and by gender. Differences in work environment exposures and working conditions, varying market competition across industries and gender segregation in the labour market are potential mechanisms underlying these findings.

  • 39.
    Toivanen, Susanna
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Landsbergis, Paul
    Lean och arbetstagarnas hälsa2013In: Lean i arbetslivet / [ed] Per Sederblad, Stockholm: Liber, 2013, p. 84-97Chapter in book (Other academic)
  • 40.
    Toivanen, Susanna
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Mellner, Christin
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Vinberg, Stig
    Self-employed persons in Sweden: mortality differentials by industrial sector and enterprise legal form : a five-year follow-up study2015In: American Journal of Industrial Medicine, ISSN 0271-3586, E-ISSN 1097-0274, Vol. 58, no 1, p. 21-32Article in journal (Refereed)
    Abstract [en]

    Objectives: This study investigated mortality differentials between self-employed persons in Sweden, considering industrial sector, enterprise characteristics and socio-demographic factors.

    Methods: Data on 321,274 self-employed persons were obtained from population registers in Sweden. Cox proportional hazards models were used to compare all-cause and cause-specific mortality rate ratios by industrial sector and enterprise legal form, adjusted for confounders.

    Results: All-cause mortality was 10–32% higher in self-employed persons in Manufacturing and Mining, Trade and Communication, and Not Specified and Other sectors than in Agriculture, Forestry, and Fishing. Mortality from cardiovascular disease was 23% higher in Trade and Communication, and from neoplasms 17–51% higher in Manufacturing and Mining, Not Specified, and Other. Mortality from suicide was 45–60% lower in Personal and Cultural Services, and in Not Specified. Mortality was 8–16% higher in sole proprietorship than limited partnership.

    Conclusions: Further research of working conditions is warranted, considering industry and enterprise legal form.

  • 41.
    Toivanen, Susanna
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Vinberg, Stig
    Arbete och ojämlikhet i hälsa i vuxenlivet2012In: Den orättvisa hälsan: Om socioekonomiska skillnader i hälsa och livslängd / [ed] Rostila, M.; Toivanen, S., Liber, 2012Chapter in book (Other academic)
  • 42. Toivanen, Tuire
    et al.
    Toivanen, Susanna
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Utsatt för tortyr: att möta och rehabiliteratraumatiserade flyktingar2014Book (Other academic)
  • 43. Vinberg, S
    et al.
    Toivanen, Susanna
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Arbetslivet : en bortglömd arena för jämlika hälso- och arbetsvillkor?2011In: Socialmedicinsk Tidskrift, ISSN 0037-833X, Vol. 88, no 4, p. 328-337Article in journal (Other academic)
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