Past projects

Here you can find our past projects.
Determinants and correlates of leisure-time physical activity

It is known that many different factors play a role in leisure-time physical activity behavior. However, a consensus of the factors involved in leisure-time physical activity behavior has not been reached. Genetic studies are a new area of physical activity research. Motives for physical activity have been widely studied but longitudinal studies are still missing. The purpose of this project was to quantify longitudinally genetic and environmental influences on leisure-time physical activity and to examine the associations between motives and longitudinal leisure-time physical activity. The results of the latest longitudinal Finnish twin studies point to the existence of age-specific genetic and environmental influences on leisure-time physical activity. Variations in environmental factors seem to explain the observed deterioration in leisure-time physical activity levels. A decline in genetic influences is seen first from adolescence to young adulthood and again from the age of thirty to the mid-thirties. In the Finnish twin participants, mastery, physical fitness, and psychological state were the major motivation factors associated with consistent leisure-time physical activity behavior. The results also indicate that intrinsic motivation factors may be important for engagement in leisure-time physical activity.

Researcher: Sari Aaltonen

Alcohol control and health

Alcohol misuse was ranked in the top three risk factors for global disease burden in 2010. Pricing and availability of alcohol have been regarded as effective tools in reducing harm. Changes in alcohol prices have been documented to be inversely associated with changes in consumption and alcohol-related harm. Much of the evidence on this issue is based on cross-sectional state-level time series data and natural experiments have been called for. The changes in Finnish alcohol legislation that occurred in 2004 can be considered as a natural experiment. In the European context, research on the association between prices of alcohol and alcohol-related harm is scarce or non-existent. The objectives of this study are (i) to estimate the impact of changes in alcohol policy of  2004 in Finland on alcohol-related, cardiovascular and all-cause mortality, hospitalization related to alcohol, and interpersonal violence according to a wide range of socio-demographic indicators and (ii) to estimate effects of affordability of alcohol and minimum prices of alcohol on alcohol-related mortality and morbidity according to different socio-demographic indicators   The analyses are based on the nationwide registration of hospitalization, causes of death and crimes, and information on alcohol prices and socio-demographic indicators in Finland and other EU countries.

Key words: alcohol drinking, alcohol misuse, price of alcohol, natural experiment, mortality, morbidity, socio-demographic inequalities

Researcher: Kimmo Herttua

Adherence to drug therapy

Myocardial infarction (MI) is a common cause of death and the prevalence of risk factors for MI, such as hypertension, hypercholesterolemia and diabetes mellitus, are prevalent and may increase as a result of population ageing and rising obesity rates. Statin drug therapy is an important part of heart disease prevention. Poor adherence both hampers the effectiveness of the medications and increases the risk of recurrence and mortality. The aim is to study the prevalence of poor adherence to statin drug therapy after myocardial infarction and how adherence is affected by household structure and other social factors. The analyses are based on the nationwide registration of drugs and hospitalization in Finland.

Key words: medication adherence, cardiovascular disease, statins, household structure

Researchers: Kimmo Herttua and Riikka Sallinen

Excess mortality among the unemployed

Several individual-level observational follow-up studies have shown that, after adjusting for age, mortality is higher among the unemployed than among the employed, and the effects are especially strong with respect to suicide.  The reasons for this association are not fully established. Strong inferences about the causal effects of unemployment on mortality are still not warranted, because the possibility that individuals with a high risk of mortality might be selected for unemployment cannot be fully ruled out. We estimate the effects of unemployment and establishment downsizing on mortality in periods of low (1989) and high (1994) unemployment.  Unemployment was found to be associated with a notably larger increase in the hazard of mortality during economic boom than in the recession. By showing that, in the context of either a high level of unemployment or rapid downsizing, the effects of unemployment on mortality are modest these studies provides strong evidence of unaccounted confounding. Also, high relative suicide mortality among the unemployed during times of economic boom suggests that selective processes may be responsible for some of the employment status differences in suicide. However, long-term unemployment seems to have causal effects on suicide, which, especially among men, partly stem from low income. Altogether, individual-level studies may overestimate the causal effects of unemployment on mortality.

Key words: unemployment, mortality, suicide, selection, causal effects, economic boom, recession

Researchers: Netta Mäki and Pekka Martikainen

Key publications:

Mäki, N., & Martikainen, P. (2012). A register-based study on excess suicide mortality among unemployed men and women during different levels of unemployment in Finland. Journal of Epidemiology & Community Health, 66(4), 302-307.

Widowhood and health

The death of a spouse is one of the biggest emotional shocks in life, and it is known to have a major effect on health. This study will expand our previous work on the effects of widowhood by studying short-term hospitalizations before and after the death of a spouse. We will use panel data and methods to examine the risks of being hospitalized due to various diseases and accidents. Our research contributes to the debate on adverse consequences of stressful life events. 

Key words: widowhood, bereavement, hospital use 

Researcher: Elina Einiö 

Promoting mental well-being and healthy ageing in cities (MINDMAP)

The overall aim of this EU Horizon2020 funded comparative project is to identify the opportunities offered by the urban environment for the promotion of mental wellbeing and cognitive function of older individuals in Europe. To achieve this, the project will advance understanding by bringing together longitudinal studies across cities in Europe, the US and Canada to unravel the causal pathways and multi-level interactions between the urban environment and the individual determinants of mental wellbeing in older age. The project will examine the causes of variation in mental wellbeing and disorders in old age both within as well as between cities and identify national and urban policies for the prevention and early diagnosis of mental conditions and disorders of older people. This knowledge will contribute to the establishment of preventive strategies in urban settings to promote the mental dimension of healthy ageing, reduce the negative impact of mental disorders on co-morbidities and preserve cognitive function in old age. The specific objectives of MINDMAP are:

  1. To assess the impact of the urban environment on the mental wellbeing and disorders associated with ageing, and estimate the extent to which exposure to specific urban environmental factors and policies explain differences in ageing-related mental and cognitive disorders both within as well as between European cities. The project will assemble and harmonize data from 10 ongoing longitudinal ageing studies across more than 16 cities in Europe, Canada and the United States. This will be complemented by registry data on mortality and hospital discharge, as well as international longitudinal surveys of ageing.
  2. To assess the causal pathways and interactions between the urban environment and the individual determinants of mental health and cognitive ageing in older adults. We will test the hypothesis that mental health and cognitive capacity in old age are shaped by the interaction between specific characteristics of the urban environment and social, biological, behavioural, and psychosocial characteristics. Our study will also asses the interaction between the urban environment and the genetic make-up.
  3. To use agent-based modelling to simulate the effect of prevention and early identification policies specific to urban environments on the trajectories of mental health and cognitive ageing across cities in Europe. Integrating findings from the first two aims into a novel agent-based model, we will use a systems approach to simulate the potential impact of multiple policy and intervention scenarios on the mental and cognitive wellbeing of older populations in European cities.

To achieve these aims, we adopt an interdisciplinary approach that integrates insights and methodological approaches from mental health and psychiatry, biology, epidemiology, epigenetics, geriatrics, geography and social sciences. To achieve impact, we model the impact of concrete features of the urban environment, policies and interventions on common mental health disorders in European cities. We involve a wide number of stakeholders at the regional, national and European level to translate knowledge into practice. A major legacy of the project will be a research infrastructure of harmonized international urban cohort studies of ageing and mental health. This infrastructure will advance the study of the interactions between contextual exposures in the urban environment and individual determinants of mental health and cognitive ageing within and beyond the MINDMAP project.

MINDMAP projet homepage

Researchers: Lasse Tarkiainen, Kaarina Korhonen, Heta Moustgaard

Social consequences of parental and childhood illness (SCOPE)

Parental and childhood health may have significant consequences for educational and labour market outcomes. Acute health shocks and chronic conditions are known to affect employment careers among middle-aged adults, but less is known about the social consequences of illness for children and youth.

We use large, internationally exceptional register-based data on families with annual repeated measurements on parents and children over several decades to quantify the social consequences of parental and childhood health problems and to clarify the causal mechanisms through which they may affect educational and employment trajectories in youth.

Health-related marginalization in youth may have long-term consequences in terms of unemployment and labour market exclusion. These present a major strain on both the individual and the social protection system. By identifying key mechanisms of health related selection the results will inform policy interventions aiming at reducing such harm.

Key words: childhood health, parental health, educational outcomes, employment outcomes, intergenerational transmission

Researchers: Heta Moustgaard, Hanna Remes, Niina Metsä-Simola, Janne Mikkonen and Mikko Aaltonen

Longitudinal birth cohort and family-based studies of morbidity, mortality and social disadvantage (BIRTHFAM)

In the BIRTHFAM consortium (Population Research Unit & Institute for Molecular Medicine Finland) funded by the Academy of Finland we aim to gain a fuller understanding of the social and genetic determinants of poor health and social disadvantage. To achieve this we will build a cluster of family cohorts and develop novel, interdisciplinary study designs and methodology. Family data encompass a broader range of exposures within and across generations than data on individuals only, providing a more comprehensive view of life-course epidemiology. Furthermore, family data enable stronger causal inference by allowing for comparisons of family members with differing degrees of shared genetic and environmental exposures.

Building on existing data and expertise, we bring together two complementary types of data: 1) family-based register data with long follow-ups of large cohorts and 2) twin data with in-depth information of participants and their genetic makeup. We will develop and document family cohorts for three research initiatives that rely on the internationally unique linked Finnish data: 1) a multigenerational data set of up to five generations for examining intergenerational associations in health and social disadvantage; 2) a data set of participants with different degrees of relatedness (twins, siblings, cousins etc.) for estimating heritability and familial clustering of ill health; 3) harmonised data sets of family cohorts born over 50 years apart for assessing changes in the importance of early life circumstances on adult health.
We will also adapt and share new study designs and methods, organise training and build an international research network for sharing expertise and facilitate access to these exceptional data for top scientists around the world.

The consortium builds research infrastructure with diversity and flexibility for long-term research needs and innovative ideas yet to surface. Understanding how families transmit ill health and social disadvantage across generations highlight new opportunities for improving population health.

Researchers: Hanna Remes, Heta Moustgaard

Sociodemographic determinants of criminal careers in Finland 1987–2015 (CRIMCAR)

Finnish criminal policy places a strong emphasis on the premise that preventing social exclusion reduces crime. Although existing register-based analyses demonstrate a strong association between measures of social disadvantage and crime, we don't currently know how these associations have changed during the recent past. The aim of this Academy of Finland -funded project (2018-2022) is to provide a comprehensive assessment of how criminal careers and sociodemographic backgrounds of persistent offenders have changed during 1987–2015. We analyze long-term conviction trajectories of different birth cohorts to see how lifetime conviction risks and criminal careers have changed. Next, we examine if sociodemographic factors associated with persistent offending and imprisonment have changed in this time frame, and whether offenders are becoming a more marginalized group. Finally, we provide new evidence on the effects of macroeconomic changes on the employment rates of offenders, and assess their vulnerability to such shocks.

Sociodemographic determinants of criminal careers in Finland 1987–2015 (CRIMCAR)

Key words: crime, violence, violent victimization, socioeconomic status

Researchers: Mikko Aaltonen, Joonas Pitkänen

Welfare state life courses: Social inequalities in the co-evolution of employment, health and critical life events (WELLIFE)

This is a NordForsk-funded comparative research project on the social inequalities in health and well-being using unique register information on socioeconomic conditions, social security and health, available in Denmark, Finland, Norway and Sweden. It is a follow-up project implementing research made possible by the data infrastructure project C-LIFE. In the WELLIFE project we set to study three themes. First, we will study whether social policies, including labour market policies, modify the extent to which the onset of illness affects living conditions, in particular employment. For example, health data on cancer incidence and hospitalisation will be used to indicate types of ‘health shocks’. Second, we investigate the role of social policy in the extent to which ‘critical life events’, such as job loss, divorce or health shocks within the close family, translate into poor health and worse living conditions for parents and children. This part of the project will have a special interest in health and employment, but including other outcomes is important to understand the mechanisms at work. While these two objectives will provide new insights into the role of the welfare state in shaping the health-employment relationship, a key ambition is also to provide better understanding of the mechanisms at play in a life course and gender perspective on social inequality formation. The third objective is to analyse prevailing social trajectories experienced by people who fall ill, lose their job or experience divorce, etc. in different welfare settings.

NordForsk - WELLIFE

Researchers: Kaarina Korhonen, Heta Moustgaard, Lasse Tarkiainen, Niina Metsä-Simola

Poor health and union instability

Across societies, poor mental and physical health and excess mortality are consistently linked to union dissolution. External and alcohol-related excess mortality is most pronounced immediately after separation, particularly among men, suggesting that psychological support during the separation process is needed to avoid high-risk health behaviors, such as alcohol use as a coping mechanism. Poor mental health explains excess suicide mortality after separation, but particularly among men, separation is a risk factor for suicide even without pre-existing mental health problems. The findings of the project also suggest that mental health is more closely linked to union stability than to whether the union is marital or not. Poor mental health seems to put strain on unions and even hinder the formation of long-term unions. At the moment the main focus of the project is in examining the effects of physical health conditions on subsequent separation risk, and the role of socio-economic disadvantage in shaping these associations. 

Key words: mental health, divorce, marriage, marital transitions, non-marital transitions, cohabitation, separation, psychotropic medication, mortality, physical health

Researchers: Niina Metsä-Simola, Elina Einiö

Contingent Life Courses (C-LIFE)

This NordForsk funded project facilitates the investigation of welfare, health and employment in the Nordic countries by aiming to establish a register-based comparative dataset that is to be made available to social scientists within public health and welfare research assessing health inequality in Denmark, Finland, Norway and Sweden.

The project title, Contingent Life Courses, reflects that people’s lives and life chances are structured by important features of the social context, and notably, the welfare state. The database will enable rigorous analyses of how life courses are shaped by social policy, and assessments of the importance of social policy and welfare reform for health, welfare and social.

An attractive feature of the proposed database is that it will make possible comparative research on the living conditions and life courses of marginal social groups and how these groups are affected by social policy. Marginal groups, such as school drop-outs, adolescents in poor health or who live in poor or socially disadvantaged households, long-term social assistance recipients, lone mothers, cancer survivors and immigrants, are all small groups that are often difficult to reach, identify and analyse in conventional comparative survey data. Using comparative national register data will hence bring the trajectories and conditions of such marginal groups to light.

Simultaneously, the data will allow studying important population trends such as the development of health inequality, labour market exclusion, use of welfare benefits and social mobility patterns, in a comparative perspective. Nordic register data are pivotal to such an aim, as survey data may be biased or have incomplete time-series, and national register-based studies may not be sufficiently comparable. The higher prevalence and variance in social policy reforms obtained by assembling data from four different national settings constitute a much richer set of data than could have been obtained for one single country.

In sum, the project represents a promising and ground-breaking initiative that – if successful – will foster novel research and scientific excellence, and significantly improve the position of Nordic social scientists and public health researchers internationally. Furthermore, the knowledge that can be produced from the C-LIFE project will be of significant value for policy makers, and may also serve as an instrument for evaluation of new policy interventions and welfare reforms in the years to come.

NordForsk - C-life

Researchers: Lasse Tarkiainen, Kaarina Korhonen, Heta Moustgaard

De­vel­op­ing meth­od­o­lo­gies to re­duce in­equal­it­ies in the de­term­in­ant of health (DE­MET­RIQ)

Social inequalities in health are a major challenge to public health in Europe and reducing them is a priority for the European Union. The objectives of DEMETRIQ are (i) to develop, evaluate and refine methodologies for assessing the effects of social, economic and health policies on the pattern and magnitude of health inequalities among socioeconomic groups, (ii) to assess the differential health effects by socioeconomic group of ‘natural policy experiments’ in the fields of unemployment and poverty reduction; tobacco and alcohol control; and access to education and preventive health care, and (iii) to synthesize the evidence from the findings of objectives 1-2, and to actively engage users in the research to promote effective exchange of knowledge for policy and practice. In our work package, we will examine population-wide behavioral change in terms of alcohol control. We will collect information on relevant aspects of alcohol control policies in EU countries, and carry out time series analyses of the impact of these variations on inequalities in alcohol consumption and related mortality and morbidity.

Key words: public health, social inequalities, Europe, alcohol control, policy, change, time series analysis

Researchers: Kimmo Herttua and Pekka Martikainen

Formal care and voting

Finland was the first country in Europe to achieve universal suffrage in 1906. In principle, men and women from all social classes had the right to vote in parliamentary elections. However, the poor who were continuously receiving poor relief from their local municipality were excluded from the national vote. The extent to which these voting restrictions affected the elderly and women is still unknown. Because the elderly were more at risk of earning less income because of a failing capacity to work, it is likely that they were more often politically excluded. This study will assess the proportion of those who were excluded from the vote because they had received poor relief at the beginning of the 1910s. The historic statistics needed in the study are held at the National Archives of Finland. The results of the study will enhance our understanding of the age discriminatory nature of Finland’s universal suffrage.

Key words: vote, universal suffrage, elderly, care, socioeconomic position

Researcher: Elina Einiö

In­equal­it­ies in health ex­pect­ancy across Europe: EURO-GBD-SE -pro­ject

Healthy life expectancy is a composite measure of length and quality of life and thus an important indicator of health in aging populations. In this study, we estimated educational differences in disability-free life expectancy (DFLE) for eight countries from all parts of Europe in the early 2000s.  Long-standing severe disability was measured as a Global Activity Limitation Indicator (GALI) derived from the European Union Statistics on Income and Living Conditions (EU-SILC) survey. Census-linked mortality data were collected by a project comparing health inequalities between European countries (the EURO-GBD-SE project). The lowest DFLE was found among Lithuanians, the highest among Italians. Both life expectancy and DFLE were longer the higher the education, but educational differences were much larger in the latter in all countries. Highly educated Europeans cannot only expect to live longer, but they also spend more years in better health than those with lower education. However, the size of the educational difference in DFLE varies significantly between countries: the smallest differences appear to be in Southern Europe and the largest in Eastern and Northern Europe.

Key words: educational differences, Europe, disability-free life expectancy, long-standing activity limitation, Sullivan’s method, Census-linked mortality data, EU-SILC survey data

Researchers: Netta Mäki and Pekka Martikainen

Socioeconomic factors, health, and the length of working lives

Information on factors influencing the length of working lives and the distribution of life years between work and retirement is crucial for policy development in ageing societies. We found that both working life expectancy at age 50 and the share of remaining life spent in work have increased across periods following the recession of the early 1990s, and across successive cohorts. The trends were similar across the social classes, but there were large differences in the numbers of years spent in various states: compared with upper non-manual employees, male and female manual workers were expected to spend fewer years in both work and statutory retirement, but more years in other forms of non-employment. The likelihood of retirement through any route at age 63–64 was higher among people who became subject to the new flexible statutory pension age between 63 and 68 than among people who were subject to the old system with a fixed statutory pension age at 65. The reform led to increased retirement at age 63–64 regardless of health status, but the change was more pronounced among people with better health. In absolute terms, however, people with poorer health still retire a little bit earlier. After the reform, high levels of education, social class, and income were associated with a longer time spent in employment either in the form of later retirement or participation in post-retirement employment. Otherwise, economic constraints including high debt, low wealth, and renting one’s home were associated with continued employment both before and after retirement.

Keywords: socioeconomic factors, health, working life expectancy, labour market participation, timing of retirement, post-retirement employment, pension reform

Researcher: Taina Leinonen

Key Publications:

Leinonen T, Laaksonen M, Chandola T, Martikainen P. Health as a predictor of early retirement before and after introduction of a flexible statutory pension age in Finland. Soc Sci Med 2016;158:149–57.

Leinonen T, Martikainen P, Myrskylä M. Working Life and Retirement Expectancies at Age 50 by Social Class: Period and Cohort Trends and Projections for Finland. J Gerontol B Psychol Sci Soc Sci published online 11 November 2015.

Determinants of institutional care

With growing pressure from an ageing population on social and health-care expenditure, it is of major policy importance to analyze the reasons for admission to institutional care at older ages. This study focuses on how different chronic medical conditions, socio-economic factors, living with a spouse, and the death of a spouse are associated with admission among people aged 65 years or older. The findings in this study imply that the future need for institutional care will depend not only on the increasing numbers of older people but also on the development of the prevalence and severity of chronic medical conditions associated with admission, and on older people’s income, housing conditions and access to informal care from their spouse.

Key words: nursing home, institution, long-term care, elderly, socioeconomic position, widowhood, bereavement

Researcher: Elina Einiö