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  • 1. Agardh, Emilie E.
    et al.
    Lundin, Andreas
    Lager, Anton
    Allebeck, Peter
    Koupil, Ilona
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). Karolinska Institutet, Sweden.
    Andreasson, Sven
    Östenson, Claes-Göran
    Danielsson, Anna-Karin
    Alcohol and type 2 diabetes: The role of socioeconomic, lifestyle and psychosocial factors2019In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 47, no 4, p. 408-416Article in journal (Refereed)
    Abstract [en]

    AIMS: We investigate (a) alcohol consumption in association with type 2 diabetes, taking heavy episodic drinking (HED), socioeconomic, health and lifestyle, and psychosocial factors into account, and (b) whether a seemingly protective effect of moderate alcohol consumption on type 2 diabetes persists when stratified by occupational position.

    METHODS: This population-based longitudinal cohort study comprises 16,223 Swedes aged 18-84 years who answered questionnaires about lifestyle, including alcohol consumption in 2002, and who were followed-up for self-reported or register-based diabetes in 2003-2011. Odds ratios (ORs) with 95% confidence intervals (CIs) were estimated in a multivariable-adjusted logistic regression model for all participants and stratified by high and low occupational position. We adjusted for HED, socioeconomic (occupational position, cohabiting status and unemployment), health and lifestyle (body mass index (BMI), blood pressure, smoking, physical inactivity, poor general health, anxiety/depression and psychosocial (low job control and poor social support) characteristics one by one, and the sets of these factors.

    RESULTS: Moderate consumption was inversely associated with type 2 diabetes after controlling for health and lifestyle (OR=0.47; 95% CI: 0.29-0.79) and psychosocial factors (OR=0.40; 95% CI: 0.22-0.79) when compared to non-drinkers. When adjusting for socioeconomic factors, there was still an inverse but non-significant association (OR=0.59; 95% CI: 0.35-1.00). In those with high occupational position, there was no significant association between moderate consumption and type 2 diabetes after adjusting for socioeconomic (OR=0.67; 95% CI: 0.3-1.52), health and lifestyle (OR=0.70; 95% CI: 0.32-1.5), and psychosocial factors (OR=0.75; 95% CI: 0.23-2.46). On the contrary, in those with low occupational position, ORs decreased from 0.55 (95% CI: 0.28-1.1) to 0.35 (95% CI: 0.15-0.82) when adjusting for psychosocial factors, a decrease that was solely due to low job control. HED did not influence any of these associations.

    CONCLUSIONS: Moderate alcohol consumption is associated with a lower risk of type 2 diabetes, after adjusting for HED, health and lifestyle, and psychosocial characteristics. The association was inverse but non-significant after adjusting for socioeconomic factors. When stratified by occupational position, there was an inverse association only in those with low occupational position and after adjusting for low job control.

  • 2.
    Albrecht, Sophie
    et al.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Kecklund, Göran
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Radboud University, The Netherlands.
    Tucker, Philip
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Swansea University, UK.
    Leineweber, Constanze
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Investigating the factorial structure and availability of work time control in a representative sample of the Swedish working population2016In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 44, no 3, p. 320-328Article in journal (Refereed)
    Abstract [en]

    Aims: Past research has often neglected the sub-dimensions of work time control (WTC). Moreover, differences in levels of WTC with respect to work and demographic characteristics have not yet been examined in a representative sample. We investigated these matters in a recent sample of the Swedish working population. Methods: The study was based on the 2014 data collection of the Swedish Longitudinal Occupational Survey of Health. We assessed the structure of the WTC measure using exploratory and confirmatory factor analysis. Differences in WTC by work and demographic characteristics were examined with independent sample t-tests, one-way ANOVAs and gender-stratified logistic regressions. Results: Best model fit was found for a two-factor structure that distinguished between control over daily hours and control over time off (root mean square error of approximation = 0.06; 95% CI 0.04 to 0.09; Comparative Fit Index (CFI) = 0.99). Women, shift and public-sector workers reported lower control in relation to both factors. Age showed small associations with WTC, while a stronger link was suggested for civil status and family situation. Night, roster and rotating shift work seemed to be the most influential factors on reporting low control over daily hours and time off. Conclusions: Our data confirm the two-dimensional structure underlying WTC, namely the components 'control over daily hours' and 'control over time off'. Women, public-sector and shift workers reported lower levels of control. Future research should examine the public health implications of WTC, in particular whether increased control over daily hours and time off can reduce health problems associated with difficult working-time arrangements.

  • 3.
    Almquist, Ylva B.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    School performance as a precursor of adult health: Exploring associations to disease-specific hospital care and their possible explanations2013In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 41, no 1, p. 81-91Article in journal (Refereed)
    Abstract [en]

    Aims: While past research has shown that school performance is associated with some specific health outcomes in adulthood, few studies have taken a general approach to the link between school performance and adult disease. The aim of the present study was therefore to investigate sixth grade school performance in relation to disease-specific hospital care in adulthood and, moreover, to examine whether other conditions in childhood could account for any such associations. Methods: The data used was the Stockholm Birth Cohort, consisting of 14,294 individuals born in 1953. Associations between school performance and disease-specific hospital care were analysed by means of Cox regression. Results: Poor school performance was shown to be linked to a variety of diseases in adulthood, e.g. drug dependence, stomach ulcer, cerebrovascular diseases, and accidents. Some differences according to gender were found. Most associations, but not all, were explained by the simultaneous inclusion of various family-related and individual factors (e.g. social class, cognitive ability, and behavioural problems). Conclusions: In sum, the results of this study suggest that poor school performance may be an essential part of risk clustering in childhood with important implications for the individual's health career.

  • 4.
    Almquist, Ylva B.
    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).
    Rostila, Mikael
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Edling, Christofer
    Rydgren, Jens
    Stockholm University, Faculty of Social Sciences, Department of Sociology.
    Friendship network characteristics and psychological well-being in late adolescence: Exploring differences by gender and gender composition2014In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 42, no 2, p. 146-154Article in journal (Refereed)
    Abstract [en]

    Aims: The aim of the present study was to examine the association between friendship networks and psychological well-being among 19-year-olds. Methods: The data used was a random sample of Swedish individuals born in 1990 who answered a questionnaire in 2009-2010. Friendship networks were considered in terms of three measures of emotional support. Six statements about the individual's emotional state were used to create a summary measure of psychological well-being. Gender and gender composition were included as potentially moderating factors. The association between friendship networks and psychological well-being was analysed by means of linear regression analysis (n = 1289). Results: The results indicate that males' and females' friendship networks were similar with regard to quality and trust, whereas males' networks were characterized by less self-disclosure and a stronger preference for same-gender friendships. Gender composition did not matter for the support levels. Emotional support was associated with psychological well-being but there were gender differences: females seemed to benefit more health-wise from having high-quality (and trusting) networks. Moreover, whereas self-disclosure among males was positively linked to well-being, this was not the case among females. None of these associations were moderated by gender composition. Conclusions: In sum, friendship networks are beneficial for the psychological well-being among late adolescents, but there are some important differences according to gender.

  • 5.
    Arat, Arzu
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS). Karolinska Institute, Sweden.
    Norredam, Marie
    Baum, Ulrike
    Jónsson, Stefán Hrafn
    Gunlaugsson, Geir
    Wallby, Thomas
    Hjern, Anders
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS). Karolinska Institutet, Sweden.
    Organisation of preventive child health services: Key to socio-economic equity in vaccine uptake?2019In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, article id 1403494819850430Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Measles has made a comeback in Western Europe, with more cases being reported each year. One factor behind this development is low vaccination coverage in socially disadvantaged segments of the population in many countries. This study investigates whether socioeconomic patterns of uptake of the measles, mumps and rubella (MMR) vaccine in the Nordic countries differ by national organisation of preventive health services for children. METHODS: MMR vaccine uptake before the age of two years was analysed in register data from Denmark, Finland, Iceland and Sweden, linked to family indicators of socio-economic status (SES) from national registers. RESULTS: Denmark, a country where child vaccinations are administered by general practitioners, presented the lowest overall coverage of MMR at 83%. It also had the greatest difference between subpopulations of low and high SES at 14 percentage points. Finland, Iceland and Sweden, countries where preschool children are vaccinated in 'well-baby' clinics, had a higher overall coverage at 91-94%, with a more equal distribution between SES groups at 1-4 percentage points. CONCLUSIONS: This study suggests that the organisation of preventive health care in special units, 'well-baby' clinics, facilitates vaccine uptake among children with low SES in a Nordic welfare context.

  • 6.
    Aronsson, Vanda
    et al.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Toivanen, Susanna
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. Mälardalen University, Sweden.
    Leineweber, Constanze
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Nyberg, Anna
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Can a poor psychosocial work environment and insufficient organizational resources explain the higher risk of ill-health and sickness absence in human service occupations? Evidence from a Swedish national cohort2019In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 47, no 3, p. 310-317Article in journal (Refereed)
    Abstract [en]

    Aim: The aim of this study was to investigate differences in burnout, self-rated health (SRH) and sickness absence between human service occupations (HSOs) and other occupations, and whether they can be attributed to differences in psychosocial work environment and organizational resources. Methods: Data were derived from the Swedish Longitudinal Occupational Survey of Health, an approximately representative sample of the Swedish working population (n = 4408). Employment in HSOs, psychosocial work environment and organizational resources in 2012 predicted relative risks of sickness absence, burnout and suboptimal SRH in 2014 using modified Poisson regressions. The psychosocial work factors' and organizational resource variables' relative importance were estimated by adding them to the models one by one, and with population attributable fractions (PAFs). Results: Employment in HSOs was associated with a higher risk of sickness absence and the risk was explained by psychosocial and organizational factors, particularly high emotional demands, low work-time control and exposure to workplace violence. Employment in HSOs was not associated with burnout after sociodemographic factors were adjusted for, and furthermore not with SRH. A lower risk of suboptimal SRH was found in HSOs than in other occupations with equivalent psychosocial work environment and organizational resources. PAFs indicated that psychosocial work environment and organizational resource improvements could lead to morbidity reductions for all outcomes; emotional demands were more important in HSOs. Conclusions: HSOs had higher risks of sickness absence and burnout than other occupations. The most important work factors to address were high emotional demands, low work-time control, and exposure to workplace violence.

  • 7. Auguer, Nathalie
    et al.
    Le Serbon, Emelie
    Rostila, Mikael
    Stockholm University, Faculty of Social Sciences, Department of Sociology.
    Leaving Sweden behind: gains in life expectancy in Canada2015In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 43, no 4, p. 340-347Article in journal (Refereed)
    Abstract [en]

    Aims: Sweden and Canada are known for quality of living and exceedingly high life expectancy, but recent data on how these countries compare are lacking. We measured life expectancy in Canada and Sweden during the past decade, and identified factors responsible for changes over time. Methods: We calculated life expectancy at birth for Canada and Sweden annually from 2000 to 2010, and determined the ages and causes of death responsible for the gap between the two countries using Arriaga's method. We determined how population growth, ageing, and mortality influenced the number of deaths over time. Results: During 2000-2010, life expectancy in Canada caught up with Sweden for men, and surpassed Sweden by 0.4 years for women. Sweden lost ground owing to a slower reduction in circulatory and tumour mortality after age 65 years compared with Canada. Nonetheless, population ageing increased the number of deaths in Canada, especially for mental and nervous system disorders. In Sweden, the number of deaths decreased. Conclusions: In only one decade, life expectancy in Canada caught up and surpassed Sweden due to rapid improvements in circulatory and tumour mortality. Population ageing increased the number of deaths in Canada, potentially stressing the health care system more than in Sweden.

  • 8.
    Barclay, Kieron J.
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Sociology.
    Scot, Kirk
    Stockholm University, Faculty of Social Sciences, Department of Sociology. Lund University, Sweden.
    Workplace sex composition and ischaemic heart disease: A longitudinal analysis using Swedish register data2014In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 42, no 6, p. 525-533Article in journal (Refereed)
    Abstract [en]

    Aims: The aim of this study is to follow-up on previous research indicating that the sex composition of workplaces is related to a number of health outcomes, including sickness absenteeism and mortality. We test two hypotheses. The first is Kanter's theory of tokenism, which suggests that minority group members suffer from an increased risk of stress. Secondly, we test the hypothesis that workplaces with a higher proportion of men will have a higher incidence rate of ischaemic heart disease (IHD), as men are more likely to engage in negative health behaviours, and through peer effects this will result in a workplace culture that is detrimental to health over the long term. Methods: Large-scale, longitudinal Swedish administrative register data are used to study the risk of overnight hospitalization for IHD amongst 67,763 men over the period 1990 to 2001. Discrete-time survival analyses were estimated in the form of logistic regression models. Results: Men have an elevated risk of suffering from IHD in non-gender-balanced workplaces, but this association was only statistically significant in workplaces with 61-80% and 81-100% males. However, after adjusting for occupation no clear pattern of association could be discerned. No pattern of association was observed for women. Conclusions: This study suggests that the gender composition of workplaces is not strongly associated with the risk of suffering from IHD.

  • 9.
    Bergström, Malin
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS). Karolinska Institutet, Sweden.
    Fransson, Emma
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Wells, Michael B.
    Köhler, Lennart
    Hjern, Anders
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS). Karolinska Institutet, Sweden.
    Children with two homes: Psychological problems in relation to living arrangements in Nordic 2- to 9-year-olds2019In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 47, no 2, p. 137-145Article in journal (Refereed)
    Abstract [en]

    Aim: Joint physical custody, children spending equal time in each parents’ respective home after a parental divorce, is particularly common in Nordic compared with other Western countries. Older children have been shown to fare well in this practice but for young children there are few existing studies. The aim of this paper is to study psychological problems in 2- to 9-year-old Nordic children in different family forms. Methods: Total symptom score according to the Strengths and Difficulties Questionnaire as well as scores showing externalizing problems were compared among 152 children in joint physical custody, 303 in single care and 3207 in nuclear families through multiple linear regression analyses. Results: Children in single care had more psychological symptoms than those in joint physical custody (B = 1.08; 95% CI 0.48 to 1.67) and those in nuclear families had the least reported symptoms (B = −0.53; 95% CI −0.89 to −0.17). Externalizing problems were also lower in nuclear families (B = −0.28, 95% CI −0.52 to −0.04) compared with joint physical custody after adjusting for covariates. Conclusions: Young children with non-cohabiting parents suffered from more psychological problems than those in intact families. Children in joint physical custody had a lower total problem score than those in single care after adjusting for covariates. Longitudinal studies with information on family factors before the separation are needed to inform policy of young children’s post-separation living arrangements.

  • 10.
    Bernhard-Oettel, Claudia
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Work and organizational psychology.
    Canivet, Catarina
    Aronsson, Gunnar
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Work and organizational psychology.
    Stengård, Johanna
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Work and organizational psychology.
    Östergren, P-O
    The role of social embeddedness for remaining in non-desired workplaces and mental health consequences: Results from Scania Public Health Cohort2019In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 47, no 3, p. 334-343Article in journal (Refereed)
    Abstract [en]

    Aims: The aim of the study was to investigate the role of social embeddedness on and off the job in relation to remaining in non-desired workplaces (NDWs) and the development of mental health. Method: The study used questionnaire data from the Scania Public Health cohort (N=2410) that were collected in 2000 (T1), 2005 (T2) and 2010 (T3). Logistic regression models were calculated to probe how NDWs and social embeddedness factors measured at baseline (T1) related to NDWs five years later (T2), and to investigate how NDWs and social embeddedness factors at T2 related to poor mental health at T3. Synergy indices were calculated in both analyses to test for additive v. interactive effects between NDWs and social embeddedness factors on the outcomes. Results: NDWs at baseline and low social embeddedness on and off the job was associated with NDWs at T2. For those in a desired workplace, low support from co-workers as well as low workplace affinity increased the risk to be in an NDW at T2. NDWs and low social embeddedness also associated with impaired mental health (T3). For those in an NDW, low support from co-workers as well as low workplace affinity increased the risk of poor mental health at T3. Conclusions: This study underlines the importance of social embeddedness for NDWs and the development of poor mental health over time. Particularly low social support from co-workers and low workplace affinity seem to be risk factors for future experience of an NDW and impaired mental health.

  • 11. Borsch, Anne Sofie
    et al.
    De Montgomery, Christopher Jamil
    Gauffin, Karl
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Eide, Ketil
    Heikkilä, Elli
    Smith Jervelund, Signe
    Health, Education and Employment Outcomes in Young Refugees in the Nordic Countries: A Systematic Review2018In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905Article, review/survey (Refereed)
    Abstract [en]

    OBJECTIVES: Since 2000, approximately 500,000 refugees have settled in the Nordic countries, about a third of them being children and young people. To identify general trends, and to detect gaps in the existing knowledge about the socioeconomic and health status of these young refugees, this review discusses the literature regarding three key areas related to welfare policy: health, education and employment.

    METHODS: A systematic search in PubMed, Scopus, SocINDEX, Sociological Abstracts, Embase and Cochrane, and a search for publications from relevant institutions were undertaken. All publications had to be original quantitative studies published since 1980. The total number of studies identified was 1353, 25 publications were included.

    RESULTS: Young refugees had poorer mental health than ethnic minority and native-born peers. Mental health problems were related to pre-migration experiences but also to post-migration factors, such as discrimination and poor social support. Refugees performed worse in school than native-born and few progressed to higher education. Experiencing less discrimination and having better Nordic language proficiency was associated with higher educational attainment. A higher proportion of refugees were unemployed or outside the labour force compared with other immigrants and native-born. Assessment instruments varied between studies, making comparisons difficult.

    CONCLUSIONS: The study suggests pre-migration factors but also post-migration conditions such as perceived discrimination, social support and Nordic language proficiency as important factors for the mental health, education and employment outcomes of young refugees in the Nordic countries. Further Nordic comparative research and studies focusing on the relationship between health, education and employment outcomes are needed.

  • 12.
    Brolin Låftman, Sara
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Bergström, Malin
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Modin, Bitte
    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).
    Joint physical custody, turning to parents for emotional support, and subjective health: a study of adolescents in Stockholm, Sweden2014In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 42, no 5, p. 456-462Article in journal (Refereed)
    Abstract [en]

    Aims: Among children with separated parents, the arrangement of joint physical custody, i.e. children living equally much in both parents’ homes, has increased substantially during the last decades in Sweden. To date, empirical research on the living conditions of this group is limited. This study analyses family type differences in turning to parents for emotional support and in subjective health among adolescents. The focus of the study is adolescents in joint physical custody, who are compared with those living with two original parents in the same household; those living (only) in a single-parent household; and those living (only) in a reconstituted family. Methods: The data come from the Stockholm School Survey of 2004, a total population survey of students in grade 9 (15–16 years) in Stockholm (n=8,840). Ordinary least squares (OLS) regressions were conducted. Results: Turning to both parents about problems is most commonly reported by adolescents in intact families, followed by those in joint physical custody. Adolescents in non-traditional family types report worse subjective health than adolescents in intact families, but the difference is smaller for those in joint physical custody than for those living with a single parent. The slightly poorer health of adolescents in joint physical custody than those in intact families is not explained by their lower use of parents as a source of emotional support. Conclusions: The study suggests that joint physical custody is associated with a higher inclination to use parents as a source of emotional support and better subjective health than other post-divorce family types.

  • 13.
    Brolin Låftman, Sara
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Magnusson, Charlotta
    Stockholm University, Faculty of Social Sciences, The Swedish Institute for Social Research (SOFI).
    Do health complaints in adolescence negatively predict the chance of entering tertiary education in young adulthood?2017In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 45, no 8, p. 878-885Article in journal (Refereed)
    Abstract [en]

    Background: Self-reported psychological and psychosomatic health complaints, such as nervousness, sadness, headache and stomach-ache, are common among adolescents, particularly among girls, and studies suggest that the prevalence has risen among adolescent girls during the last few decades. However, only a limited number of studies have investigated the potential long-term consequences of such health complaints. The aim of the current study was to assess whether psychological and psychosomatic health complaints in adolescence predict the chance of entering tertiary education in young adulthood among women and men. Methods: The data used are from the Swedish Young-LNU, which is based on a nationally representative sample with self-reported survey information from adolescents aged 10–18 years in 2000 and from the same individuals at ages 20–28 in 2010 (n=783). Information was also collected from parents and from official registers. Results: Linear probability models showed that self-reported psychological complaints in adolescence were associated with a lower chance of having entered tertiary education 10 years later. This association was accounted for by differences in grade point average (GPA), suggesting that GPA may mediate the association between psychological complaints and later education. The pattern was similar for both genders. Furthermore, among men, psychosomatic complaints in adolescence were significantly associated with a lower likelihood of having entered tertiary education 10 years later when adjusting for GPA and social class in adolescence. A similar but non-significant tendency was found among women. Conclusions: The findings suggest that health complaints in adolescence may have long-term consequences in terms of lower educational attainment.

  • 14.
    Brolin Låftman, Sara
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Modin, Bitte
    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).
    Hoven, Hanno
    Plenty, Stephanie
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Effort-reward imbalance in the school setting: associations with Somatic pain and self-rated health2015In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 43, no 2, p. 123-129Article in journal (Refereed)
    Abstract [en]

    Aims: According to the workplace theory of effort-reward imbalance (ERI), individuals who perceive a lack of reciprocity between their effort spent at work and the rewards received in turn are at an increased risk of stress-related ill-health. It is also assumed that being overcommitted to work is linked to an increased risk of stress-related ill-health. This study applies the effort-reward imbalance model to the school setting. It aims to analyse the associations that effort-reward imbalance and overcommitment share with somatic pain and self-rated health among adolescents. Methods: Data are from the School Stress and Support Study (TriSSS), involving students in grades 8 and 9 (ages 14-16 years) in two schools in Stockholm, Sweden, during 2010 (n=403). Information on effort-reward imbalance and health outcomes was gathered from self-report questionnaires. An adjusted short version of ERI was used. Factor analysis showed that extrinsic effort, reward and overcommitment constitute three distinct dimensions. The designed measures demonstrated sound psychometric properties both for the full sample and for subgroups. Ordered logistic regressions were conducted. Results: The analyses showed that low reward and higher overcommitment were associated with greater somatic pain and poorer self-rated health. Furthermore, effort-reward imbalance was linked with an elevated risk of somatic pain and poorer self-rated health. Conclusions: Students are more likely to experience stress-related ill-health when they perceive an imbalance between their effort and rewards. In addition, high overcommitment is associated with an increased risk of ill-health among students.

  • 15.
    Bryngelson, Anna
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Long-term sickness absence and social exclusion2009In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 37, no 8, p. 839-845Article in journal (Refereed)
    Abstract [en]

    Background: In previous research, ill-health and marginalization from the labour market have been pointed out as potential triggers for being marginalized from other spheres of society as well, e.g. economic, political and social, i.e. social exclusion. However, very few studies have examined the consequences of long-term sickness absence. Aim: The research question raised here is therefore to examine the relationship between long-term sickness absence (≥60 days) and social exclusion among individuals. Methods: The logistic regression analyses are based on longitudinal data (n = 3,144) from the Swedish Level of Living Survey linked to register data. Results: The results suggest that both women and men have higher odds of having no excess cash (‘‘cash margins’’) after their long-term sickness absence, compared with people with no such sickness absence. Women seem more likely to have no cash margins combined with being single/unmarried and having no close friends after long-term sickness absence, than do women without such sick-listing. The results indicate a slight mediating effect of employment status on the odds ratios for these economic and social conditions. Conclusions: The present study suggests that long-term sickness absence increases the risk of adverse economic and social conditions among individuals. That these conditions can be seen as indicators of social exclusion is more doubtful.

  • 16.
    Bryngelson, Anna
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). Karolinska Institutet, Sweden.
    Bacchus Hertzman, Jennie
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Fritzell, Johan
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). Institute for Futures Studies, Sweden.
    The relationship between gender segregation in the workplace and long-term sickness absence in Sweden2011In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 39, no 6, p. 618-626Article in journal (Refereed)
    Abstract [en]

    Background: The aim of the study is to investigate whether the gender composition in workplaces is related to long-term sickness absence (LSA). We start off with Kanter’s theory on ‘‘tokenism,’’ suggesting an increased risk of stress among minority groups (tokens), which, in turn, might increase the risk of ill health and LSA. Methods: The dataset consists of information obtained from the Swedish level of Living Survey (LNU) and the Swedish Establishment Survey (APU), linked to register-based data from the Swedish Social Insurance Agency. The longitudinal data is representative for the Swedish population and consists of 496 women and 566 men, aged 20—55 at baseline. Our study group consisted of employed persons in 1991 and we analyze, by means of piecewise constant intensity regressions, the first entry into LSA with a follow-up period of nine years. Results: Compared with women in gender-integrated workplaces, women’s risk of LSA is most elevated at both extremely male-dominated (0—20% females) and extremely female-dominated workplaces (80—100% females), although the result among women in the most male-dominated group did not reach statistical significance at the 5% level. Men’s risk seems less varied by gender composition. Conclusions: The present study suggests that the gender composition in the workplace has an impact on the risk of LSA, especially among women. Our findings lend no support for Kanter’s theory on the effects of being a token. Most likely, women’s and men’s different status positions have an impact on the different associations found.

  • 17.
    Bygren, Magnus
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Sociology. Linköping University, Sweden.
    Szulkin, Ryszard
    Stockholm University, Faculty of Social Sciences, Department of Sociology.
    Using register data to estimate causal effects of interventions: An ex post synthetic control-group approach2017In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 45, no 17, p. 50-55Article in journal (Refereed)
    Abstract [en]

    Aims: It is common in the context of evaluations that participants have not been selected on the basis of transparent participation criteria, and researchers and evaluators many times have to make do with observational data to estimate effects of job training programs and similar interventions. The techniques developed by researchers in such endeavours are useful not only to researchers narrowly focused on evaluations, but also to social and population science more generally, as observational data overwhelmingly are the norm, and the endogeneity challenges encountered in the estimation of causal effects with such data are not trivial. The aim of this article is to illustrate how register data can be used strategically to evaluate programs and interventions and to estimate causal effects of participation in these. Methods: We use propensity score matching on pretreatment-period variables to derive a synthetic control group, and we use this group as a comparison to estimate the employment-treatment effect of participation in a large job-training program. Results: We find the effect of treatment to be small and positive but transient. Conclusions: Our method reveals a strong regression to the mean effect, extremely easy to interpret as a treatment effect had a less advanced design been used (e.g. a within-subjects panel data analysis), and illustrates one of the unique advantages of using population register data for research purposes.

  • 18. Celeste, Roger Keller
    et al.
    Nadanovsky, Paulo
    Fritzell, Johan
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Trends in socioeconomic disparities in the utilization of dental care in Brazil and Sweden2011In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 39, no 6, p. 640-648Article in journal (Refereed)
    Abstract [en]

    Aims: To describe trends in socioeconomic disparities in utilization of dental care. Methods: We obtained cross-sectional data from Sweden in the period 1968-2000 and from Brazil in 1986 and 2002 for 16 state capitals. The outcome was the percentage of people who reported that they had visited the dentist in the last 12 months, calculated for a higher and a lower income group and stratified by sex, age (two groups: young and adults) and dental status. Adjusted prevalence differences and prevalence ratios were produced using Poisson regression. Results: In Brazil, there was a decline in use of dental care among the 15-19 year olds in the period 1986-2002, but not among the 35-44 year olds. In Sweden, there was a decline among the young and adults between 1991 and 2000. Overall, socioeconomic disparities in use of dental services between the higher and the lower economic groups showed a decline in both countries. The reduction in disparities among young Brazilians was 1.1 percentage points per year (p < 0.01), but among the other age groups the decline was not significant (p>0.01). In the last surveys, the gap remained in both countries and age groups (p < 0.01). Conclusions: The recent decline in utilization of dental care and in the socioeconomic gap may mirror improvements in oral health. However, there are still relevant and persistent disparities in utilization of dental care in both countries, with a higher proportion of people of higher socioeconomic status visiting the dentist.

  • 19.
    Chaparro, M. Pia
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    De Luna, Xavier
    Haggstrom, Jenny
    Ivarsson, Anneli
    Lindgren, Urban
    Nilsson, Karina
    Koupil, Ilona
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). Karolinska Institutet, Sweden.
    Childhood family structure and women's adult overweight risk: A longitudinal study2017In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 45, no 5, p. 511-519Article in journal (Refereed)
    Abstract [en]

    Aim: The aim of this study was to investigate whether women's adult overweight and obesity risk was associated with their childhood family structure, measured as their mothers' marital status history, during the women's first 18 years of life. Methods: Using linked register data, we analyzed 30,584 primiparous women born in Sweden in 1975 who were between 19-35 years of age when their height and pre-pregnancy weight was recorded. The outcomes were women's overweight/ obesity (body mass index (BMI) >= 25 kg/m(2)) and obesity (BMI >= 30 kg/m(2)) and the predictor was mothers' marital status history, which was summarized using sequence analysis. We carried out nested logistic regression models adjusting for women's age and maternal sociodemographic characteristics. Results: Mothers' marital status history was summarized into six clusters: stable marriage, stable cohabitation, married then divorcing, cohabiting then separating, varied transitions, and not with father. In fully adjusted models and compared with women whose mothers belonged to the stable marriage cluster: (1) women whose mothers belonged to the other marital status clusters had higher odds of overweight/obesity (odds ratio (OR) ranging 1.15-1.19; p < 0.05); and (2) women whose mothers belonged to the stable cohabitation (OR = 1.31; 95% confidence interval (CI) = 1.14-1.52), cohabiting then separating (OR = 1.23; 95% CI = 1.01-1.49), varied transitions (OR = 1.24; 95% CI = 1.11-1.39), and not with father (OR = 1.24; 95% CI = 1.00-1.54) clusters had higher odds of obesity. Conclusions: Women whose mothers were not in stable marriage relationships had higher odds of being overweight or obese in adulthood. The finding that even women raised in the context of stable cohabitation had higher odds of being overweight or obese is intriguing as these relationships are socially accepted in Sweden.

  • 20.
    Chaparro, Pia
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Ivarsson, A.
    Koupil, Illona
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Nilsson, K.
    Häggström, J.
    de Luna, X.
    Lindgren, U.
    Regional inequalities in pre-pregnancy overweight and obesity in Sweden, 1992, 2000, and 20102015In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 43, no 5, p. 534-539Article in journal (Refereed)
    Abstract [en]

    Aims: To investigate regional differences and time trends in women's overweight and obesity in Sweden. Methods: Using data from the Swedish Medical Birth Register (women aged 18 years, first pregnancy only) and the Total Population Register accessed through the Umea SIMSAM Lab, age-standardized prevalence of pre-pregnancy overweight/obesity (BMI 25 kg/m(2)) and obesity (BMI 30 kg/m(2)) were estimated by county for the years 1992, 2000, and 2010. Maps were created using ArcMap v10.2.2 to display regional variations over time and logistic regression analyses were used to assess if the observed trends were significant. Results: The prevalence of pre-pregnancy overweight/obesity and obesity increased significantly in all Swedish counties between 1992, and 2010. In 2010, Sodermanland and Gotland exhibited the highest age-standardized overweight/obesity (39.7%) and obesity (15.1%) prevalence, respectively. The sharpest increases between 1992 and 2010 were observed in Vasterbotten for overweight/obesity (75% increase) and in Gotland for obesity (233% increase). Across the years, Stockholm had the lowest prevalence of overweight/obesity (26.3% in 2010) and obesity (7.3% in 2010) and one of the least steep increases in prevalence of both between 1992 and 2010. Conclusions: Substantial regional differences in pre-pregnancy overweight and obesity prevalence are apparent in Sweden. Further research should elucidate the mechanisms causing these differences.

  • 21.
    Danielsson, Maria
    et al.
    Swedish National Board of Health and Welfare, Stockholm, Sweden.
    Heimerson, Inger
    Swedish National Board of Health and Welfare, Stockholm, Sweden.
    Lundberg, Ulf
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Perski, Aleksander
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Stefansson, Claes-Göran
    Swedish National Board of Health and Welfare, Stockholm, Sweden.
    Åkerstedt, Torbjörn
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Psychosocial stress and health problems: Health in Sweden: The National Public Health Report 2012. Chapter 62012In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 40, no 9 suppl, p. 121-134Article in journal (Other academic)
    Abstract [en]

    Stress can be defined as an imbalance between demands placed on us and our ability to manage them. The body’s stress system is adapted to confront sudden physical threats. Today, however, we are increasingly exposed to prolonged mental and psychosocial stress. Prolonged stress can give rise to a range of problems: poor performance, chronic fatigue, disinterest, dejection, memory disturbances, sleep problems, numbness and diffuse muscle pains. These symptoms may eventually be followed by depression, post-traumatic stress disorder and chronic fatigue syndrome, and ultimately chronic pain conditions, cardiovascular disease and diabetes. Sleep is a vital counterbalance to stress as it enables the body to recover properly. Good sleep is thus essential to our ability to cope with stress and stay healthy.

    The decline in the mental wellbeing of the population since the 1980s has been accompanied by a rise in the number of pain complaints. A similar development in respect of symptoms such as anxiousness, nervousness and anxiety, constant fatigue and neck and shoulder pain and sleeping problems has been observed in the population. This increase, which continued throughout the 1990s and culminated in 2001, was followed by a slight fall. However, there was no decline among young people in the early 2000s. Rather, the number of complaints continued to increase.

    Since the mid-1990s, the proportion of people suffering from stress symptoms has risen and fallen in step with employment levels. Since the beginning of the 1980s, growing numbers of people in gainful employment have experienced their work as hectic and mentally taxing. This may indicate that the balance between healthy and unhealthy factors impacting the actively employed has tilted towards less favourable conditions. Mental stress at work has increased among women and men, particularly among county council employees. Repeated organisational restructuring may explain why hectic and mentally taxing work has become more commonplace. Mental ill-health along with musculoskeletal disorders are the most frequent diagnoses in connection with newly granted disability pensions. Sickness absence trends largely reflect the trend in stress symptoms.

  • 22.
    Erikson, Robert
    et al.
    Stockholm University, Faculty of Social Sciences, The Swedish Institute for Social Research (SOFI).
    Torssander, Jenny
    Stockholm University, Faculty of Social Sciences, The Swedish Institute for Social Research (SOFI).
    Clerics die, doctors survive - A note on death risks among highly educated professionals2009In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 37, p. 227-231Article in journal (Refereed)
    Abstract [en]

    Aims: Mortality is strongly associated with education. We present relative death risks of men and women in 12 educational/ occupational groups in Sweden today, with a focus on individuals with higher education. Methods: Results from Cox regressions are reported for 12 educational groups with special emphasis on those with professional education, e.g. clerics, physicians, people with medical PhDs, and university teachers. The study is based on register data of the total Swedish population in the age group of 30–64 (n¼3,734,660). Results: There is a considerable variation in mortality between educational groups. Men with compulsory education run a risk that is more than three times higher than that of professors outside medicine, and other educational groups fall in between. Medical doctors and physicians have relatively low death risks compared to those with compulsory education – less than 50% among men and less than 60% among women – although professors in medicine deviate by having higher risks than their colleagues in other subjects. Those with a theological exam show higher risks of dying during the follow-up period compared to others of a similar educational level. Professors outside medicine experience the lowest death risks of all identified groups. Conclusions: Men and women with a professional education have comparatively low death risks, particularly low among medical doctors and university employees, while the clergy seems to experience relatively higher death risks than others with a similar level of education. These patterns may reflect the effects of education as well as the selection of men and women to higher education.

  • 23.
    Ferdous, Tamanna
    et al.
    Department of Public Health and Caring Sciences, Uppsala University.
    Cederholm, Tommy
    Department of Public Health and Caring Sciences, Uppsala University.
    Razzaque, Abdur
    Knowledge for Global Lifesaving Solutions, Dhaka, Bangladesh.
    Wahlin, Åke
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Kabir, Zarina Nahar
    Karolinska Institutet.
    Nutritional status and self-reported and performance-based evaluation of physical function of elderly persons in rural Bangladesh2009In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 37, no 5, p. 518-524Article in journal (Refereed)
    Abstract [en]

    Aim: To investigate the impact of nutritional status on self-reportedas well as performance-based indicators of physical functionin a rural elderly population in Bangladesh. Methods: A cross-sectionalstudy conducted in Matlab, Bangladesh, included 457 randomlyselected community-living elderly persons aged 60 years or more(60—92 years; 69 ± 7 years). Mobility, activitiesof daily living (ADL), performance tests, handgrip strength,the Mini Nutritional Assessment (MNA) and a structured questionnairewere used to assess physical function, nutritional status, socioeconomicstatus and health status, respectively. Descriptive and linearhierarchical regression analyses were applied. Results: Sevenper cent of the participants reported limitations in mobility,and 8% reported limitations in ADL. However, more than halfof the participants had difficulties in performing one or moreitems in the performance tests. According to the MNA, 26% ofthe participants were undernourished and 62% were at risk ofmalnutrition. More undernourished participants than well-nourishedparticipants reported limited mobility, impaired ADL and difficultiesin the performance tests. A corresponding reduction in gripstrength was observed in the undernourished group. Accordingly,higher MNA scores, indicating better nutritional status, weresignificantly associated with higher mobility index, higherADL index, higher performance tests index, and higher scoresin handgrip strength. These associations remained after adjustingfor demographic, socioeconomic and health status differences.Conclusions: Good nutritional status is important for the physicalfunction of elderly people, even after controlling for possibleconfounders. Performance tests indicated a higher degree offunctional impairment than that observed by self-reported estimation.

  • 24.
    Ferrarini, Tommy
    et al.
    Stockholm University, Faculty of Social Sciences, The Swedish Institute for Social Research (SOFI).
    Nelson, Kenneth
    Stockholm University, Faculty of Social Sciences, The Swedish Institute for Social Research (SOFI).
    Sjöberg, Ola
    Stockholm University, Faculty of Social Sciences, The Swedish Institute for Social Research (SOFI). Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Decomposing the effect of social policies on population health and inequalities: An empirical example of unemployment benefits2014In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 42, no 7, p. 635-642Article in journal (Refereed)
    Abstract [en]

    Aim: The purpose of this study is to discuss and empirically contrast different conceptualizations and operationalizations of social policies in analysing health and educational differences in health cross-nationally. Methods: Country-level institutional and expenditure data on unemployment benefit schemes and individual-level data from the EU-SILC for 23 countries were used to analyse the association between unemployment benefits and self-assessed health for individuals with different educational attainment. Results: The analyses indicate that higher coverage rate (i.e. the proportion of the relevant population eligible for benefits) is associated with better self-related health among both low- and high-educated individuals, but is not linked to smaller educational differences in health. In contrast, replacement rate (i.e. the amount of benefits received) in isolation is not related to self-assessed health. However, in countries where coverage rates are high, higher replacement rates are associated with better health among both low- and high-educated individuals and smaller educational differences in health. Conclusions: Decomposing unemployment benefit programmes into two main dimensions – the proportion in the labour force covered by such programmes and the replacement rate received in case of unemployment – may present further insights into institutional mechanisms linking macro-level social policies to individual-level health outcomes.

  • 25.
    Fors, Stefan
    et al.
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). Stockholm University, Faculty of Social Sciences, Department of Social Work.
    Agahi, Neda
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Shaw, Benjamin A.
    Paying the price? The impact of smoking and obesity on health inequalities in later life2012In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 41, no 2, p. 134-141Article in journal (Refereed)
    Abstract [en]

    Aims: The aims of the study are twofold: (i) to explore the impact of socioeconomic position, as measured 13 years earlier, on cognitive functioning and mobility impairment in later life, and (ii) to explore the extent to which obesity and smoking status can explain socioeconomic inequalities in cognitive and mobility impairments in later life. Methods: Data from a nationally representative sample of Swedish adults aged 56-76 in 1991 who were re-interviewed 13 years later in 2004, was analysed to explore the impact of socioeconomic position, smoking, and obesity on cognitive and physical functioning in late life. Results: The results showed that both smoking and obesity in late mid-life were stratified by socioeconomic position. Moreover, the results showed significant associations between socioeconomic position and both cognitive and physical functioning in later life. However, these inequalities in late life function could only partially be explained by the socioeconomic differences in smoking and obesity. Conclusions: The findings of this study suggest that socioeconomic differences in the rates of smoking and obesity may explain some, but not all, of the socioeconomic inequalities in physical and cognitive functioning during old age.

  • 26.
    Fors, Stefan
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Social Work. Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Lennartson, Carin
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Lundberg, Olle
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Live long and prosper? Childhood living conditions, marital status, social class in adulthood and mortality during mid-life: A cohort study2011In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 39, no 2, p. 179-186Article in journal (Refereed)
    Abstract [en]

    Aims: The aim of the present study was to investigate the impact of childhood living conditions, marital status, and social class in adulthood on the risk of mortality during mid-life. Two questions were addressed: Is there an effect of childhood living conditions on mortality risk during mid-life and if so, is the effect mediated or modified by social class and/or marital status in adulthood? Methods: A nationally representative, Swedish, level of living survey from 1968 was used as baseline. The study included those aged 25—69 at baseline (n = 4082). Social conditions in childhood and adulthood were assessed using self-reports. These individuals were then followed for 39 years using registry data on mortality. Results: The results showed associations between childhood living conditions, marital status, social class in adulthood and mortality during mid life. Social class and familial conditions during childhood as well as marital status and social class in adulthood all contributed to the risk of mortality during mid-life. Individuals whose father’s were manual workers, who grew up in broken homes, who were unmarried, and/or were manual workers in adulthood had an increased risk of mortality during mid life. The effects of childhood conditions were, in part, both mediated and modified by social class in adulthood. Conclusions: The findings of this study suggest that there are structural, social conditions experienced at different stages of the life course that affect the risk of mortality during mid-life.

  • 27.
    Fransson, Emma
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Turunen, Jani
    Stockholm University, Faculty of Social Sciences, Department of Sociology.
    Hjern, Anders
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). Karolinska Institutet, Sweden.
    Östberg, Viveca
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Bergström, Malin
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Psychological complaints among children in joint physical custody and other family types: Considering parental factors2016In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 44, no 2, p. 177-183Article in journal (Refereed)
    Abstract [en]

    Aims: Increasing proportions of Scandinavian children and children in other Western countries live in joint physical custody, moving between parents’ homes when parents live apart. Children and parents in non-intact families are at risk of worse mental health. The potential influence of parental ill-health on child well-being in the context of differing living arrangements has not been studied thoroughly. This study investigates the psychological complaints of children in joint physical custody in comparison to children in sole parental care and nuclear families, while controlling for socioeconomic differences and parental ill-health. Methods: Data were obtained from Statistics Sweden’s yearly Survey of Living Conditions 2007–2011 and child supplements with children 10–18 years, living in households of adult participants. Children in joint physical custody (n=391) were compared with children in sole parental care (n=654) and children in nuclear families (n=3,639), using a scale of psychological complaints as the outcome measure. Results: Multiple regression modelling showed that children in joint physical custody did not report higher levels of psychological complaints than those in nuclear families, while children in sole parental care reported elevated levels of complaints compared with those in joint physical custody. Adding socioeconomic variables and parental ill-health only marginally attenuated the coefficients for the living arrangement groups. Low parental education and parental worry/anxiety were however associated with higher levels of psychological complaints. Conclusions: Psychological complaints were lower among adolescents in joint physical custody than in adolescents in sole parental care. The difference was not explained by parental ill-health or socioeconomic variables.

  • 28.
    Fridlund, Veronika
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Sociology.
    Stenqvist, Karin
    Nordvik, Monika K.
    Condom use: the discrepancy between practice and behavioral expectations2014In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 42, no 8, p. 759-765Article in journal (Refereed)
    Abstract [en]

    Aim: The overall aim of this paper is to examine sexually active young people’s behavioral expectations of condom use.

    Methods: We collected data at nine youth clinics and one sexually transmitted infections (STI) clinic in Sweden. We included participants whom had been sexually active during the past 12 months: A total of 1022 participants between the ages of 15 and 31 were included. We analyzed the data separately, for different types of sexual practices and types of sexual partners. Multinomial logistic regression was used to analyze age and gender differences for discrepancies.

    Results: The behavioral expectation of condom use differed, depending on the type of sexual practice and the type of partner. For all types of sex, the overall pattern showed that the participants were most likely to use a condom with a casual unknown partner, followed by a casual known partner, regular partner and lastly, a main partner. Our results also demonstrated that there is a discrepancy between the behavioral expectation of condom use and the self-reported condom use. The lowest discrepancy was for oral sex, especially with a main partner, and the largest discrepancy was for anal sex and vaginal sex with a casual partner.

    Conclusions: Our results imply that the participants had a greater expectation of condom use than actually occurs, especially for casual unknown partners. There is a lack of knowledge about the risks associated with oral sex, which is evident in the results of the participants’ behavioral expectations of condom use under those conditions.

  • 29.
    Halvarsson, Veronika
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Sociology.
    Ström, Sara
    Stockholm University, Faculty of Social Sciences, Department of Sociology.
    Liljeros, Fredrik
    Stockholm University, Faculty of Social Sciences, Department of Sociology.
    The prescription of oral contraceptives and its relation to the incidence of chlamydia and abortion in Sweden 1997-20052012In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 40, no 1, p. 85-91Article in journal (Refereed)
    Abstract [en]

    Aims: The aim of this study is to examine the association between the prescription of oral contraceptives and the incidence of chlamydia, and between the prescription of oral contraceptives and the number of abortions in a population-based ecological study. Methods: For this study we used register data from the Swedish Institute for Infectious Disease Control (chlamydia incidence), the Swedish National Board of Health and Welfare (number of abortions), Statistics Sweden (population data), and Apoteket (Swedish pharmacy) (prescriptions for oral contraceptives). We conducted ordinary least squares regression analysis of the association between chlamydia or abortions and the prescription of oral contraceptives. Results: The prescription of oral contraceptives has a positive association on both the incidence of chlamydia and the numbers of abortion. Our best model predicts that prescription of 100 yearly doses of oral contraceptives increase the abortions by 3.3 cases among 16-year-old women and 0.7 cases among 29-year-old women, while cases of chlamydia increase by 6.7 among 16-year-old women and 1.5 among 29-year-old women. Conclusions: Our findings indicate that the use of oral contraceptives among young people and young adults is positively associated with the chlamydia incidence and the abortion rate in these populations in Sweden.

  • 30. Hellevik, Per
    et al.
    Överlien, Carolina
    Stockholm University, Faculty of Social Sciences, Department of Social Work. Norwegian Centre for Violence and Traumatic Stress Studies, Norway.
    Teenage intimate partner violence: Factors associated with victimization among Norwegian youths2016In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, no 44, p. 702-708Article in journal (Refereed)
    Abstract [en]

    Objective: The aim of the present study was threefold: (1) learn more about factors associated with teenage intimate partner violence (IPV) victimization; (2) explore aspects of digital media use in connection with teenage IPV; (3) and compare the impact IPV victimization has on boys and girls. Method: Survey data from 549 Norwegian students, mean age 15.2 years, who had experience(s) with being in intimate relationship(s), were examined. Experiences with psychological, physical, digital, and sexual violence were analyzed. Results: In total, 42.9% of the participants had experienced some form of IPV: 29.1% had experienced digital violence; 25.9% had experienced psychological violence; 18.8% had experienced sexual violence; and 12.8% had experienced physical violence. Factors significantly associated with teenage IPV victimization were female gender, older partners, domestic violence, bullying victimization, low academic achievements, and sending sexual messages via digital media. Girls reported to be significantly more negatively impacted by the victimization than boys. Conclusions: Some teenagers experience victimization in their intimate relationships, and for many digital media seems to play a central role in this violence. Teenagers who experience victimization outside their relationships or have risky lifestyles have a higher risk of experiencing IPV victimization. A focus on teenage IPV, and especially digital media’s role in this violence, is needed if this public health issue is to be combated.

  • 31.
    Heshmati, Amy
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Chaparro, M. Pia
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). Tulane University, USA.
    Goodman, Anna
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). London School of Hygiene and Tropical Medicine, UK.
    Koupil, Ilona
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). Karolinska Institutet, Sweden.
    Early life characteristics, social mobility during childhood and risk of stroke in later life: findings from a Swedish cohort2017In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 45, no 4, p. 419-427Article in journal (Refereed)
    Abstract [en]

    Aims: To investigate if early life characteristics and social mobility during childhood are associated with incident thrombotic stroke (TS), haemorrhagic stroke (HS) and other stroke (OS). Methods: Our study population consists of all live births at Uppsala University Hospital in 1915-1929 (Uppsala Birth Cohort; n = 14,192), of whom 5532 males and 5061 females were singleton births and lived in Sweden in 1964. We followed them from 1 January 1964 until first diagnosis of stroke (in the National Patient Register or Causes of Death Register), emigration, death, or until 31 December 2008. Data were analysed using Cox regression, stratifying by gender. Results: Gestational age was negatively associated with TS and OS in women only. Women had increased risk of TS if they were born early preterm (<35 weeks) (HR 1.54 (95% CI 1.02-2.31)) or preterm (35-36 weeks) (HR 1.37 (95% CI 1.03-1.83)) compared to women born at term. By contrast, only women who were early preterm (HR 1.98 (95% CI 1.27-3.10) had an increased risk of OS. Men who were born post-term (42 weeks) had increased risk of HS (HR 1.45 (95% CI 1.04-2.01)) compared with men born at term, with no association for women. TS was associated with social mobility during childhood in women: women whose families were upwardly or downwardly mobile had increased risk of TS compared to women who were always advantaged during childhood. Conclusions: Gestational age and social mobility during childhood were associated with increased risk of stroke later in life, particularly among women, but there was some heterogeneity between stroke subtypes.

  • 32.
    Hjern, Anders
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Children's health: Health in Sweden: The National Public Health Report 2012. Chapter 22012In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 40, no Suppl. 9, p. 23-41Article in journal (Refereed)
  • 33.
    Hjern, Anders
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Migration and public health: Health in Sweden: The National Public Health Report 2012. Chapter 13.2012In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 40, no 9 suppl, p. 255-267Article in journal (Refereed)
  • 34. Høj Jørgensen, Terese Sara
    et al.
    Fors, Stefan
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Juul Nilsson, Charlotte
    Enroth, Linda
    Aaltonen, Mari
    Sundberg, Louise
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Brønnum-Hansen, Henrik
    Heine Strand, Bjørn
    Chang, Milan
    Jylhä, Marja
    Ageing populations in the Nordic countries: Mortality and longevity from 1990 to 20142019In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 47, no 6, p. 611-617Article in journal (Refereed)
    Abstract [en]

    Aims: Cross-country comparisons of mortality and longevity patterns of Nordic populations could contribute with novel insights into the compositional changes of these populations. We investigated three metrics of population ageing: the proportion of the population aged 75+ and 90+ years, the proportion of birth cohorts reaching 75 and 90 years, and life expectancy (LE) at age 75 and 90 years in Sweden, Norway, Iceland, Denmark and Finland, in the period 1990-2014.

    Methods: Demographic information was collected from national statistical databases and the Human Mortality Database.

    Results: All metrics on population ageing increased during the study period, but there were some cross-country variations. Finland experienced a notably steep increase in the proportion of 75+ and 90+ year olds compared to the other countries. Regarding the proportion reaching old ages, the Finnish lagged behind from the beginning, but females decreased this difference. The Danes were more similar to the other countries at the beginning, but did not experience the same increase over time. Gender-specific LE at age 75 and 90 years was similar overall in the five countries.

    Conclusions: Developments in cross-country variation suggest that survival until old age has become more similar for Finnish females and more different for Danish males and females compared with the other countries in recent decades. This provides perspectives on the potential to improve longevity in Denmark and Finland. Similarities in LE in old age suggest that expected mortality in old age has been more similar throughout the study period.

  • 35. Jansson, Catarina
    et al.
    Alexanderson, Kristina
    Kecklund, Göran
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Åkerstedt, Torbjörn
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Clinically diagnosed insomnia and risk of all-cause and diagnosis-specific sickness absence: a nationwide Swedish prospective cohort study.2013In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 41, no 7, p. 712-721Article in journal (Refereed)
    Abstract [en]

    Aims: Insomnia is a large health problem. In some prior studies, positive associations between insomnia symptoms and sickness absence have been observed. There is, however, no previous nationwide cohort study of clinically diagnosed insomnia and risk of incident sickness absence. Methods: Prospective nationwide cohort study based on Swedish population-based registers including all 4,956,358 individuals registered as living in Sweden on 31 December 2004/2005, aged 17-64 years, not on disability pension, old-age pension or on-going sickness absence. Those having insomnia inpatient or outpatient care, defined as having at least one admission/specialist visit with a main or secondary diagnosis of disorders of initiating and maintaining sleep [insomnias] (ICD-10: G47.0) during 2000/2001-2005, were compared to those with no such care. All-cause and diagnosis-specific incident sickness absence were followed during 2006-2010. Incidence rate ratios (IRRs) and 95% confidence intervals (CIs) were estimated by Cox proportional hazards regression. Results: In models adjusted for prior sickness absence, socio-demographic factors and inpatient and specialized outpatient care, associations between insomnia and increased risks of all-cause sickness absence (IRR 1.18, 95% CI 1.04-1.35) and sickness absence due to mental diagnoses (IRR 1.75, 95% CI 1.36-2.25) were observed. After further adjustment for insomnia medications these associations disappeared. No associations between insomnia and risk of sickness absence due to cancer, circulatory or musculoskeletal diagnoses, or injuries, were observed. Conclusions: In this nationwide cohort study, we observed increased risks of all-cause sickness absence and sickness absence due to mental diagnoses after adjustment for several potential confounders that disappeared after further adjustment for insomnia medications.

  • 36.
    Jansson, Fredrik
    Stockholm University, Faculty of Humanities, Department of Archaeology and Classical Studies, Centre for the Study of Cultural Evolution. Mälardalen University, Sweden; Linköping University, Sweden.
    Using register data to deduce patterns of social exchange2017In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 45, p. 56-61Article in journal (Refereed)
    Abstract [en]

    This paper presents a novel method for deducting propensities for social exchange between individuals based on the choices they make, and based on factors such as country of origin, sex, school grades and socioeconomic background. The objective here is to disentangle the effect of social ties from the other factors, in order to find patterns of social exchange. This is done through a control-treatment design on analysing available data, where the treatment' is similarity of choices between socially connected individuals, and the control is similarity of choices between non-connected individuals. Structural dependencies are controlled for and effects from different classes are pooled through a mix of methods from network and meta-analysis. The method is demonstrated and tested on Swedish register data on students at upper secondary school. The results show that having similar grades is a predictor of social exchange. Also, previous results from Norwegian data are replicated, showing that students cluster based on country of origin.

  • 37.
    Juárez, Sol
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Sociology. Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Mussino, Eleonora
    Stockholm University, Faculty of Social Sciences, Department of Sociology.
    Hjern, Anders
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS). Karolinska Institute, Sweden.
    Being a refugee or having a refugee status? Birthweight and gestational age outcomes among offspring of immigrant mothers in Sweden2018In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905Article in journal (Refereed)
    Abstract [en]

    Aims: to evaluate whether the information on refugee status based on the residence permit is a useful source of information for perinatal health surveillance. Methods: using the Swedish population registers (1997-2012), we use multinomial regression models to assess the associations between migration status (refugee and non-refugee) and birth outcomes derived from birthweight and gestational age: low birthweight (lBW) (<2500 g), macrosomia (≥4000 g); preterm: (<37 w) and post-term (≥42 w). The Swedish-born population was used as a reference group. Results: Compared to the Swedish-born population, an increased OR (odds ratio) of lBW and post-term was found among migrants with and without refugee status (respectively: OR for refugees: 1.47 [95% CI: 1.33-1.63] and non-refugees:1.27 [95% CI: 1.18-1.38], for refugees: 1.41 [95% CI: 1.35-1.49] and non-refugees:1.04 [95% CI: 1.00-1.08]) with statistically significant differences between these two migrant categories. However, when looking at specific regions of origin, few regions show differences by refugee status. Compared to Swedes, lower or equal ORs of preterm and macrosomia are observed regardless of migratory status. Conclusions: Small or no differences were observed in birth outcomes among offspring of women coming from the same origin with different migratory status, compared to their Swedish counterparts. This suggests that information on migration status is not a relevant piece of information to identify immigrant women at higher risk of experiencing adverse reproductive outcomes. Our results however might be explained by the large proportion of women coming to Sweden for family reunification who are classified as non-refugee migrants.

  • 38.
    Kelfve, Susanne
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Sociology. Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Lennartsson, Carin
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Agahi, Neda
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Modig, Karin
    Do postal health surveys capture morbidity and mortality in respondents aged 65 years and older? A register-based validation study2015In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 43, no 4, p. 348-355Article in journal (Refereed)
    Abstract [en]

    Aims: Non-response to population surveys is a common problem in epidemiological and public health research. Systematic non-response threatens the validity of results. Researchers rarely evaluate the magnitude of systematic non-response because of limited access to population data. This study explores how well morbidity and mortality in postal survey respondents aged 65 years and older represented that of the target population. Methods: The 2010 Stockholm Public Health Survey and the Swedish Population Register were linked to the Cause of Death Register and the National Patient Register in Sweden. Differences were analysed between the response group and the corresponding population in mortality, hospital admission, days spent in hospital and number of diagnoses. Finally, data were weighted for non-response to see if this improved generalizability. Results: Non-response increased with age, and this increase was more pronounced among women than men. Respondents were marginally less often admitted to hospital, hospitalized fewer days and had slightly fewer diagnoses than the population, in particular after age 80. Significantly fewer women died in the response group than in the population as a whole. In terms of mortality among men and in terms of hospitalizations for most age groups, the respondents represented the population fairly well. Non-response weighting adjustment did not improve generalizability. Conclusions: Postal questionnaires are likely to capture morbidity (hospitalization) among women and men aged 65-80 years old and mortality among men, while morbidity after age 80 and mortality in women are likely to be underestimated.

  • 39. Källmén, Håkan
    et al.
    Wennberg, Peter
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). Karolinska Institutet, Sweden.
    Ramstedt, M.
    Hallgren, M.
    Changes in alcohol consumption between 2009 and 2014 assessed with the AUDIT2015In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 43, no 4, p. 381-384Article in journal (Refereed)
    Abstract [en]

    Background: Alcohol habits in Sweden, assessed as sales and estimates of unrecorded consumption, have changed since joining the EU. Earlier studies using the Alcohol Use Disorders Identification Test (AUDIT) showed that reported consumption is consistent with sales data, which makes it possible to assess consumption according to sex and age. Aims: This study reports the changes in alcohol habits between 2009 and 2014, a period starting a couple of years after Sweden joined the EU. Method: The AUDIT was sent to a random sample of the Swedish population aged between 17 and 80 years old. Results: No statistically significant changes were shown in six age and sex groups. Conclusions: Alcohol habits have stabilised in Sweden but on a higher consumption level than before.

  • 40.
    Lager, Anton
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Berlin, Marie
    Heimerson, Inger
    Danielsson, Maria
    Young people’s health: Health in Sweden: The National Public Health Report 2012. Chapter 32012In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 40, no Suppl 9, p. 42-71Article in journal (Refereed)
    Abstract [en]

    The present chapter discusses trends in public health among 16-24-year-olds – young people who are poised precariously between childhood and adult-hood. The group includes upper-secondary school pupils and young people who have gone on to higher education or work.

  • 41.
    Lager, Anton
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Fossum, Bjöörn
    Rörvall, Göran
    Bremberg, Sven G.
    Children's overweight and obesity: Local and national monitoring using electronic health records2009In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 37, no 2, p. 201-205Article in journal (Refereed)
    Abstract [en]

    Aim: To test the feasibility of a system for monitoring children's obesity and overweight based on data from electronic health records in the school health services. Methods: Data on weight and height from electronic health records at school health services were collected for 10-year-olds in 2003—2004, 2004—2005 and 2005—2006. School health personnel extracted group-level data with a simple program installed on the computer containing the health records. Four Swedish municipalities were included in the study: Karlstad, Umeå, Västerås, and Ystad. Results: The system achieved coverage of 92—96% of all children in 2005—2006. The overall prevalence rates were 4.2% (3.8—4.7%) obese and 22.0% (21.1—23.0%) overweight, including obesity. Conclusions: A system based on electronic health records from the school health services can successfully provide data. The system has practical, economical and ethical strengths.

  • 42. Lagergren, Mårten
    et al.
    Johnell, Kristina
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). Stockholm Gerontology Research Center, Sweden.
    Schon, Par
    Danielsson, Maria
    Towards a postponement of activities of daily living dependence and mobility limitations: Trends in healthy life years in old age in Sweden2017In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 45, no 5, p. 520-527Article in journal (Refereed)
    Abstract [en]

    Aims: To investigate the development of healthy life expectancy from 65 years (HLE65) in Sweden in the period 1980-2011 using the health indicators activities of daily living (ADL) and mobility limitations within the framework of the postponement, compression and expansion theories. Methods: Sources of data for the HLE computations were Swedish national mortality statistics and the nationwide Swedish Surveys of Living Conditions, conducted biennially by Statistics Sweden since 1974. We used the Sullivan method for calculations of HLE and a decomposition into mortality and disability effects was made. Results: Life expectancy at age 65 (LE65) increased by 3.1 years for women and 4.0 years for men from 1980-1985 to 2006-2011. HLE65 calculated according to ADL and mobility limitations increased more rapidly than LE65 for both men and women (p<0.05). Conclusions: Our results for trends in the Swedish LE65 and HLE65, computed on the basis of ADL and mobility limitations and using the Swedish Surveys of Living Conditions study, are in line with the postponement hypothesis and there is also a tendency for compression. Thus the years with ADL dependence and mobility limitations are postponed to a higher age and the numbers of these years have decreased.

  • 43. Lagergren, Mårten
    et al.
    Johnell, Kristina
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). Stockholm Gerontology Research Centre, Sweden.
    Schön, Pär
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). Stockholm Gerontology Research Centre, Sweden .
    Danielson, Maria
    Healthy life years in old age: Swedish development 1980-2010 according to different health indicators2016In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 44, no 1, p. 55-61Article in journal (Refereed)
    Abstract [en]

    Aims: To investigate the development of healthy life expectancy from 65 years (HLE65) in Sweden in the period 1980 and 2010 by using two different health indicators: self-rated health and the global activity limitation indicator (GALI).

    Methods: Sources of data for the HLE computations were Swedish national mortality statistics and the nationwide Swedish Survey of Living Conditions (SSLC), which have been conducted biennially by Statistics Sweden since 1974. We used the Sullivan method for calculations of HLE. A decomposition into mortality and disability effect has been made in accordance with the method devised by Nusselder.

    Results: Life expectancy at age 65 (LE65) increased by 3.1 years for women and 4.0 years for men from 1980/85 to 2006/11. Regardless of which health measure investigated - self-rated health or GALI - HLE65 increased between the periods 1980/85 to 2006/2011 more rapidly than LE65 and as a consequence the years with bad self-rated health and years with activity limitations decreased. These increases as well as the decreases were significant (p<0.05).

    Conclusions: The Swedish LE65 and HLE65 development, as judged by the SSLC study, are compatible with the postponement hypothesis and there is even a clear tendency for compression. Thus, the years with bad self-rated health and years with activity limitations are postponed to a higher age and the number of those years have decreased. From this respect, the Swedish development looks positive. The need of old age care in 2010 would have been much higher if it had been expansion - not postponement - of bad self-rated health and years with activity limitations during the time period.

  • 44.
    Lennartsson, Carin
    et al.
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Heimerson, Inger
    Elderly people’s health: Health in Sweden: The National Public Health Report 2012. Chapter 52012In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 40, no 9 suppl, p. 95-120Article in journal (Refereed)
  • 45.
    Lindahl, B. I. B.
    Stockholm University, Faculty of Humanities, Department of Philosophy.
    Health and Evolution2000In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 28, p. 309-311Article in journal (Refereed)
    Abstract [en]

    Darwinian medicine may shed new light on the notion of health and many current health problems. In this paper, health, as an ability to realize one’s own welfare, is compared with health as an ability — either being developed or actually present — to perform a reproductive function of one’s species. It is argued that knowledge about the conditions for health in the latter sense may enhance our efforts to promote health in the former sense.

  • 46.
    Lindahl, B. I. B.
    et al.
    Karolinska Institutet.
    Johansson, Lars Age
    Statistics Sweden.
    Multiple Cause-of-Death Data as a Tool for Detecting Artificial Trends in the Underlying Cause Statistics: A Methodological Study1994In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 22, no 2, p. 145-158Article in journal (Refereed)
    Abstract [en]

    The aims of the study were: (i) to identify trends in the underlying cause-of-death statistics that are due to changes in the coders’ selection and coding of causes, and (ii) to identify changes in the coders’ documented registration principles that can explain the observed trends in the statistics.

    31 Basic Tabulation List categories from the Swedish national cause-of-death register for 1970-1988 were studied. The coders’ tendency to register a condition as the underlying cause of death (the underlying cause ratio) was estimated by dividing the occurrence of the condition as underlying cause (the underlying cause rate) with the total registration of the condition (the multiple cause rate). When the development of the underlying cause rate series followed more closely the underlying cause ratio series than the multiple cause rate series, and a corresponding change in the registration rules could be found, rhe underlying cause rate trend was concluded to be due to changes in the coders’ tendency to register the condition.

    For thirteen categories (fourteen trends), the trends could be explained by changes in the coders’ interpretation practice: five upward, four insignificant, and five downward trends. In addition, for three categories the trends could be explained by new explicit ICD-9 rules.

  • 47. Lindner, Helen
    et al.
    Montgomery, Scott
    Hiyoshi, Ayako
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. Örebro University, Sweden.
    Risk of depression following traumatic limb amputation-a general population-based cohort study2019In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905Article in journal (Refereed)
    Abstract [en]

    Background: Individuals with traumatic limb amputation (TLA) may be at risk of depression, but evidence of increased depression after TLA from longitudinal studies has been limited. It is also unknown whether physical function, cognitive function, and employment prior to amputation affects depression risk. We aimed to examine longitudinal associations between TLA and depression in working age men, and to explore the role of pre-amputation occupational and individual characteristics. Methods: A Swedish national register-based cohort of 189,220 men born between 1952 and 1956, and who attended conscription assessments in adolescence, was followed from 1985 to 2009. Physical, cognitive, and psychological characteristics were measured at the conscription examination, and occupational information was obtained from the 1985 census. Main outcome measures were hospital inpatient and outpatient admissions for depression. Results: In total, 401 men underwent TLA; mean age at amputation was 42.5 years (SD 7.4). Cox regression produced an unadjusted hazard ratio (95% confidence interval) of 2.61 (1.62-4.21) for risk of subsequent depression associated with TLA compared with the general population. Adjustment for occupational, physical, cognitive, and psychological characteristics did not change the association much, producing a hazard ratio of 2.53 (1.57-4.08). Conclusions: TLA is associated with an increased risk of depression in men over more than two decades of follow up. Occupational and individual characteristics prior to amputation did not greatly change depression risk following amputation. We speculate that a coordinated combination of social support and medical management may help reduce persistent depression risk in men who experience amputation.

  • 48.
    Lundberg, Olle
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    The next step towards more equity in health in Sweden: how can we close the gap in a generation?2018In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 46, p. 19-27Article in journal (Refereed)
    Abstract [en]

    In 2015, a national Commission for Equity in Health was appointed by the Swedish Government. In this paper, some key lines of thought from the three reports published by the Commission are summarised. First, the theories and principles for the Commission's work are outlined, in particular regarding the views taken on how health inequalities arise. Second, the importance of process is discussed in relation to cross-sectorial efforts to reduce inequalities in health. More specifically, this brings up some of the proposals made for how to redesign the public health policy framework for cross-sectorial work. Third, the proposed content of cross-sectorial work for more equal health is presented in three steps, namely: (1) overarching recommendations, (2) more equal conditions and opportunities, and (3) general problems of governance. Regarding people's conditions and opportunities, the Commission submitted a number of proposals for the general direction of work that needs to be taken in order to reduce health inequalities, as well as some examples of more specific policy changes or reforms on the basis of each of these general directions, which are summarised here. Finally, some challenges and difficulties that may prevent Sweden from taking the next step towards more equity in health are discussed.

  • 49.
    Magnusson Hanson, Linda L.
    et al.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Westerlund, Hugo
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Leineweber, Constanze
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Rugulies, Reiner
    Osika, Walter
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Theorell, Töres
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Bech, Per
    The Symptom Checklist-core depression (SCL-CD6) scale: Psychometric properties of a brief six item scale for the assessment of depression2014In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 42, no 1, p. 82-88Article in journal (Refereed)
    Abstract [en]

    Aims: Major depressive disorders are common, with substantial impact on individuals/society. Brief scales for depression severity, based on a small number of characteristics all of which are necessary for diagnosis, have been recommended in self-reported versions for clinical work or research when aiming to quickly and accurately measure depression. We have examined psychometric properties of a brief 6-item version of the Symptom Checklist (SCL), the Symptom Checklist core depression scale (SCL-CD6) and aimed to identify a cut-point for epidemiological research. Methods: The psychometric evaluation of the SCL-CD6 was mainly performed by a Mokken analysis of unidimensionality in a random sample of 1476 residents in the Stockholm County, aged 18-64 years. The standardization of SCL-CD6 was based on ROC analysis, using the Major Depression Inventory as index of validity. Predictive validity was subsequently assessed using register data on hospital admissions and purchases of prescribed medications linked to a sample of 5985 participants in the Swedish Longitudinal Occupational Survey of Health (SLOSH). Results: The SCL-CD6 obtained a coefficient of homogeneity of 0.70 by Mokken analysis, which indicates high unidimensionality and a meaningful dimensional measure of depression severity. By ROC we identified a score of 17 or higher (total range 0-24) as the best cut-point for major depression (sensitivity 0.68, specificity 0.98) which predicted subsequent purchases of antidepressants as well as hospitalisations with a depressive episode. Conclusions: The SCL-CD6 was found a valid depression scale with higher unidimensionality than longer epidemiological instruments and thus particularly suitable for assessment in larger population surveys.

  • 50. Malmberg, Gunnar
    et al.
    Nilsson, Lars-Goran
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Weinehall, Lars
    Longitudinal data for interdisciplinary ageing research. Design of the Linnaeus Database2010In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 38, no 7, p. 761-767Article in journal (Refereed)
    Abstract [en]

    Rationale: To allow for interdisciplinary research on the relations between socioeconomic conditions and health in the ageing population, a new anonymized longitudinal database - the Linnaeus Database - has been developed at the Centre for Population Studies at Umea University. This paper presents the database and its research potential. Design: Using the Swedish personal numbers the researchers have, in collaboration with Statistics Sweden and the National Board for Health and Welfare, linked individual records from Swedish register data on death causes, hospitalization and various socioeconomic conditions with two databases - Betula and VIP (Vasterbottens Intervention Programme) - previously developed by the researchers at Umea University. Whereas Betula includes rich information about e. g. cognitive functions, VIP contains information about e. g. lifestyle and health indicators. Population and sample size: The Linnaeus Database includes annually updated socioeconomic information from Statistics Sweden registers for all registered residents of Sweden for the period 1990 to 2006, in total 12,066,478. The information from the Betula includes 4,500 participants from the city of Umea and VIP includes data for almost 90,000 participants. Both datasets include cross-sectional as well as longitudinal information. Potential: Due to the coverage and rich information, the Linnaeus Database allows for a variety of longitudinal studies on the relations between, for instance, socioeconomic conditions, health, lifestyle, cognition, family networks, migration and working conditions in ageing cohorts. Conclusions: By joining various datasets developed in different disciplinary traditions new possibilities for interdisciplinary research on ageing emerge.

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