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  • 1.
    Almquist, Ylva B.
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Jackisch, Josephine
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Forsman, Hilma
    Stockholm University, Faculty of Social Sciences, Department of Social Work.
    Gauffin, Karl
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Vinnerljung, Bo
    Stockholm University, Faculty of Social Sciences, Department of Social Work.
    Hjern, Anders
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Brännström, Lars
    Stockholm University, Faculty of Social Sciences, Department of Social Work.
    A decade lost: does educational success mitigate the increased risks of premature death among children with experience of out-of-home care?2018In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738Article in journal (Refereed)
    Abstract [en]

    Background: Past research has consistently identified children with experience of out-of-home care (OHC) as a high-risk group for premature mortality. While many have argued that educational success is a key factor in reducing these individuals’ excessive death risks, the empirical evidence has hitherto been limited. The aim of the current study was therefore to examine the potentially mitigating role of educational success for the association between OHC experience and premature mortality.

    Methods: Drawing on a Stockholm cohort born in 1953 (n=15,117), we analysed the associations between placement in OHC (ages 0-12), school performance (ages 13, 16, and 19), and premature all-cause mortality (ages 20-56) by means of Cox and Laplace regression analysis.

    Results: The Cox regression models confirmed the increased risk of premature mortality among individuals with OHC experience. Unadjusted Laplace regression models showed that these children died more than a decade, based on median survival time, before their majority population peers. However, among individuals who performed well at school, i.e. scored above-average marks at age 16 (grade 9) and age 19 (grade 12), respectively, the risks of premature mortality did not significantly differ between the two groups.

    Conclusion: Educational success seems to mitigate the increased risks of premature death among children with experience of OHC.

  • 2.
    Almquist, Ylva B.
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Landstedt, Evelina
    Jackisch, Josephine
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Rajaleid, Kristiina
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Westerlund, Hugo
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Hammarström, Anne
    Prevailing over Adversity: Factors Counteracting the Long-Term Negative Health Influences of Social and Material Disadvantages in Youth2018In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 15, no 9, article id 1842Article in journal (Refereed)
    Abstract [en]

    Disadvantaged circumstances in youth tend to translate into poor health development. However, the fact that this is not always the case has been seen as indicative of differential resilience. The current study highlights factors outside the context of the family with the potential to counteract the long-term negative influences of social and material adversity in adolescence on general health status. This study was based on two waves of questionnaire data from the Northern Swedish Cohort. From the wave in 1981 (age 16), indicators of social and material conditions as well as factors related to school, peers, and spare time were derived. From the wave in 2008 (age 43), information about self-rated health was used. Ordinal logistic regression models (n = 908) showed that adversity in youth was associated with poorer self-rated health in midlife among men and women alike, net of health status at baseline. However, having an advantaged situation with regard to school, peers, or spare time appeared to protect against the detrimental influences of disadvantaged circumstances in the family context on subsequent health. This suggests that health-promoting interventions may benefit from focusing on contexts outside the family in their effort to strengthen processes of resilience among disadvantaged youths.

  • 3.
    B. Låftman, Sara
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Alm, Susanne
    Stockholm University, Faculty of Social Sciences, The Swedish Institute for Social Research (SOFI).
    Sandahl, Julia
    Stockholm University, Faculty of Social Sciences, Department of Criminology.
    Modin, Bitte
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Future Orientation among Students Exposed to School Bullying and Cyberbullying Victimization2018In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 15, no 4, article id 605Article in journal (Refereed)
    Abstract [en]

    Future orientation can be defined as an individual’s thoughts, beliefs, plans, and hopes for the future. Earlier research has shown adolescents’ future orientation to predict outcomes later in life, which makes it relevant to analyze differences in future orientation among youth. The aim of the present study was to analyze if bullying victimization was associated with an increased likelihood of reporting a pessimistic future orientation among school youth. To be able to distinguish between victims and bully-victims (i.e., students who are both bullies and victims), we also took perpetration into account. The data were derived from the Stockholm School Survey performed in 2016 among ninth grade students (ages 15–16 years) (n = 5144). Future orientation and involvement in school bullying and in cyberbullying were based on self-reports. The statistical method used was binary logistic regression. The results demonstrated that victims and bully-victims of school bullying and of cyberbullying were more likely to report a pessimistic future orientation compared with students not involved in bullying. These associations were shown also when involvement in school bullying and cyberbullying were mutually adjusted. The findings underline the importance of anti-bullying measures that target both school bullying and cyberbullying.

  • 4.
    Berg, Lisa
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. Stockholm University, Faculty of Social Sciences, The Swedish Institute for Social Research (SOFI).
    Brännström, Lars
    Stockholm University, Faculty of Social Sciences, Department of Social Work.
    Evicted children and subsequent placement in out-of-home care: A cohort study2018In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 13, no 4, article id e0195295Article in journal (Refereed)
    Abstract [en]

    Background

    Evictions may have serious consequences for individuals’ health and wellbeing. Even though an eviction may be experienced as a significant crisis for the family, there is little previous knowledge on consequences for evicted children. This study represents the first attempt to examine to what extent children from evicted households were separated from their parents and placed in out-of-home care (foster family or residential care) using population-based data, net of observed confounding factors related to the socioeconomic and psychosocial circumstances of their parents.

    Methods

    This study takes advantage of information from a Swedish national database, consisting of about 8 000 evicted individuals and a random sample of 770 000 individuals from the national population, linked to individual-level, longitudinal data from Swedish national registers. Our analytical sample consists of information for more than 250 000 children born in 1995–2008, including 2 224 children from evicted households. We used binary logistic regression based on the Karlson/Holm/Breen method to account for observed imbalances at baseline between evicted and non-evicted children.

    Results

    Compared to non-evicted children, the crude odds ratio for placement in out-of-home care in evicted children was 12.10 (95% CI 8.54–17.14). Net of observed confounding factors related to the socioeconomic and psychosocial circumstances of the parents, evicted children had a twofold elevated risk of being placed in out-of-home care (odds ratio 2.26, 95% CI 1.55–3.27). Crude OR for evicted children in comparison with children under threat of eviction (eviction not formally executed) was 1.71 (95% CI 1.17–2.49) and adjusted OR 1.58 (95% CI 1.06–2.35).

    Conclusion

    Children who experience eviction constitute a disadvantaged group and are at significant risk of being separated from their parents and placed in out-of-home care. These results demonstrate the importance of providing support for these children and their parents. Strategies to prevent households with children from being evicted seem to be an important and viable intervention path.

  • 5. Bohman, Hannes
    et al.
    Brolin Låftman, Sara
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Cleland, Neil
    Lundberg, Mathias
    Päären, Aivar
    Jonsson, Ulf
    Somatic symptoms in adolescence as a predictor of severe mental illness in adulthood: a long-term community-based follow-up study2018In: Child and Adolescent Psychiatry and Mental Health, ISSN 1753-2000, E-ISSN 1753-2000, Vol. 12, article id 42Article in journal (Refereed)
    Abstract [en]

    Background: Somatic symptoms are common and costly for society and correlate with suffering and low functioning. Nevertheless, little is known about the long-term implications of somatic symptoms. The objective of this study was to assess if somatic symptoms in adolescents with depression and in their matched controls predict severe mental illness in adulthood by investigating the use of hospital-based care consequent to different mental disorders. Methods: The entire school population of 16-17-year-olds in the city of Uppsala, Sweden, was screened for depression in 1991-1993 (n = 2300). Adolescents with positive screenings (n = 307) and matched non-depressed controls (n = 302) participated in a semi-structured diagnostic interview for mental disorders. In addition, 21 different self-rated somatic symptoms were assessed. The adolescents with depression and the matched non-depressed controls were engaged in follow-up through the National Patient Register 17-19 years after the baseline study (n = 375). The outcome measures covered hospital-based mental health care for different mental disorders according to ICD-10 criteria between the participants' ages of 18 and 35 years. Results: Somatic symptoms were associated with an increased risk of later hospital-based mental health care in general in a dose-response relationship when adjusting for sex, adolescent depression, and adolescent anxiety (1 symptom: OR = 1.63, CI 0.55-4.85; 2-4 symptoms: OR = 2.77, 95% CI 1.04-7.39; >= 5 symptoms: OR = 5.75, 95% CI 1.98-16.72). With regards to specific diagnoses, somatic symptoms predicted hospital-based care for mood disorders when adjusting for sex, adolescent depression, and adolescent anxiety (p<0.05). In adolescents with depression, somatic symptoms predicted later hospital-based mental health care in a dose-response relationship (p<0.01). In adolescents without depression, reporting at least one somatic symptom predicted later hospital-based mental health care (p<0.05). Conclusions: Somatic symptoms in adolescence predicted severe adult mental illness as measured by hospital-based care also when controlled for important confounders. The results suggest that adolescents with somatic symptoms need early treatment and extended follow-up to treat these specific symptoms, regardless of co-occurring depression and anxiety.

  • 6.
    Brydsten, Anna
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Hammarström, Anne
    San Sebastian, Miguel
    Health inequalities between employed and unemployed in northern Sweden: a decomposition analysis of social determinants for mental health2018In: International Journal for Equity in Health, ISSN 1475-9276, E-ISSN 1475-9276, Vol. 17, article id 59Article in journal (Refereed)
    Abstract [en]

    Background: Even though population health is strongly influenced by employment and working conditions, public health research has to a lesser extent explored the social determinants of health inequalities between people in different positions on the labour market, and whether these social determinants vary across the life course. This study analyses mental health inequalities between unemployed and employed in three age groups (youth, adulthood and mid-life), and identifies the extent to which social determinants explain the mental health gap between employed and unemployed in northern Sweden.

    Methods: The Health on Equal Terms survey of 2014 was used, with self-reported employment (unemployed or employed) as exposure and the General Health Questionnaire (GHQ-12) as mental health outcome. The social determinants of health inequalities were grouped into four dimensions: socioeconomic status, economic resources, social network and trust in institutional systems. The non-linear Oaxaca decomposition analysis was applied, stratified by gender and age groups.

    Results: Mental health inequality was found in all age groups among women and men (difference in GHQ varying between 0.12 and 0.20). The decomposition analysis showed that the social determinants included in the model accounted for 43-51% of the inequalities among youths, 42-98% of the inequalities among adults and 60-65% among middle-aged. The main contributing factors were shown to vary between age groups: cash margin (among youths and middle-aged men), financial strain (among adults and middle-aged women), income (among men in adulthood), along with trust in others (all age groups), practical support (young women) and social support (middle-aged men); stressing how the social determinants of health inequalities vary across the life course.

    Conclusions: The health gap between employed and unemployed was explained by the difference in access to economic and social resources, and to a smaller extent in the trust in the institutional systems. Findings from this study corroborate that much of the mental health inequality in the Swedish labour market is socially and politically produced and potentially avoidable. Greater attention from researchers, policy makers on unemployment and public health should be devoted to the social and economic deprivation of unemployment from a life course perspective to prevent mental health inequality.

  • 7.
    Dunlavy, Andrea C.
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Juárez, Sol
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Rostila, Mikael
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Employment status and risk of all-cause mortality among native- and foreign-origin persons in Sweden2018In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360XArticle in journal (Refereed)
    Abstract [en]

    Background: The association between exposure to unemployment and increased risk of mortality is well established. Yet migrants and their children often experience a number of stressors in the country of residence which could exacerbate the negative effects of job loss or unemployment. This study examined the extent to which region of origin and generational status modified associations between employment status and risk of all-cause mortality. Methods: Using population-based registers, an open cohort of 2 178 321 individuals aged 25-64 years was followed from 1993 to 2008. Hazard ratios for mortality were calculated using Cox regression. Employment status and socio-demographic covariates were included as time-varying variables in all models. Results: Relative to employed native-origin Swedes, excess risk of mortality was found among most groups of unemployed persons. The excess risk of mortality found among African women exposed to long-term unemployment (HR = 3.26, 95% CI: 2.30-4.63), Finnish men exposed to short-and long-term unemployment (HR = 2.74, 95% CI: 2.32-3.24 and HR = 2.39, 95% CI: 2.12-2.69), and second generation Swedish men exposed to short-term unemployment (HR = 2.34, 95% CI: 2.06-2.64) was significantly greater (P < 0.05) than that found among their unemployed native-origin counterparts. Excess risk of mortality among the unemployed in other foreign-origin groups was of a similar or lower magnitude to that found in unemployed native-origin Swedes. A decreased risk of mortality was observed among the employed in nearly all foreign-origin groups. Conclusions: With some exceptions, mortality risk in foreign-origin individuals across all categories of employment status was generally similar to or lower than the risk observed in native-origin Swedes.

  • 8. Elo, Irma T.
    et al.
    Martikainen, Pekka
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. University of Helsinki, Finland; The Max Planck Institute for Demographic Research, Germany.
    Aaltonen, Mikko
    Children's educational attainment, occupation, and income and their parents' mortality2018In: Population Studies, ISSN 0032-4728, E-ISSN 1477-4747, Vol. 72, no 1, p. 53-73Article in journal (Refereed)
    Abstract [en]

    Using data from Finland, this paper contributes to a small but growing body of research regarding adult children's education, occupation, and income and their parents' mortality at ages 50+ in 1970-2007. Higher levels of children's education are associated with 30-36 per cent lower parental mortality at ages 50-75, controlling for parents' education, occupation, and income. This association is fully mediated by children's occupation and income, except for cancer mortality. Having at least one child educated in healthcare is associated with 11-16 per cent lower all-cause mortality at ages 50-75, an association that is largely driven by mortality from cardiovascular diseases. Children's higher white-collar occupation and higher income is associated with 39-46 per cent lower mortality in the fully adjusted models. At ages 75+, these associations are much smaller overall and children's schooling remains more strongly associated with mortality than children's occupation or income.

  • 9.
    Eriksson, Lena
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Edman, Johan
    Stockholm University, Faculty of Social Sciences, Department of Criminology.
    Great expectations: The bureaucratic handling of Swedish residential rehabilitation in the 21st century2018In: Nordic Studies on Alcohol and Drugs, ISSN 1455-0725, E-ISSN 1458-6126, Vol. 35, no 4, p. 257-274Article in journal (Refereed)
    Abstract [en]

    Background and aims: Increasingly, efforts to counteract perceived problems in drug treatment at residential rehabilitation centres have come to rely on measures drawing on evidence-based practice (EBP). However, the Swedish media, government inquiries, and international research have identified a number of problems regarding both residential rehabilitation and EBP. This suggests that caution should be exercised when placing expectations on EBP. The aim of this study is to investigate how the responsible authorities have handled increasing demands for EBP with administrative control while facing critical evaluations of their steering and implementation efforts. The study examines the maturation of a widespread treatment ideology, which aims to be based on evidence, in a country known for its restrictive drug policy and its goal of becoming a drug-free society. Methods: Through a qualitative textual analysis of 17 years (2000-2016) of inquiries, directives, and authority archives we have traced the interplay between problem descriptions, intended goals, and implemented solutions. Findings: The analysis shows that the ambition to provide care and welfare based on EBP is still an ambition. Also, the authorities' control over the care actually provided still leaves room for improvement. Recurring criticism and the empirical material indicate that the expectations have not been met. Conclusions: We would like to suggest that continued frustration can be traced to the misconception that EBP is the opposite of values and ideology, and hence preferable. As drug treatment strives for scientific credibility to give it legitimacy, some types of evidence are preferred above others. We would like to suggest that we need to bring ideology to the fore, and openly discuss our restrictive policy goals and choices of evidence.

  • 10.
    Fors, Stefan
    et al.
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Almquist, Ylva B.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Brännström, Lars
    Stockholm University, Faculty of Social Sciences, Department of Social Work.
    Coexisting Social, Economic, and Health-Related Disadvantages in More than 2.4 Million Swedes: Combining Variable-Centred and Person-Centred Approaches2018In: Social Indicators Research, ISSN 0303-8300, E-ISSN 1573-0921Article in journal (Refereed)
    Abstract [en]

    The notion of coexisting disadvantages has been recognised in social welfare policy and welfare research, not least in the Nordic countries. The prevalence and patterning of coexisting disadvantages in society have far reaching implications for well-being, social policy, and social inequality. Using longitudinal register-based data for the years 1998‒2008 for all Swedish individuals born 1946‒1965 (n > 2.4 million), this exploratory study maps out the occurrence of coexisting disadvantages in the Swedish working-age population, and examines to what extent observed prevalence rates are associated with sex, age, immigrant status, and marital status. Coexisting disadvantages are analysed in terms of four broad register-based indicators intended to capture individuals’ resources in key areas of the society: education, income, labour market, and mental health. The results show that while most individuals are not disadvantaged in these areas, coexisting disadvantages do occur and its prevalence varies according to sex, age, immigrant status, and marital status. This study shows that combinations of person-centred and variable-centred analyses of register-based indicators can play a part when developing effective systems for policy surveillance.

  • 11.
    Forsström, David
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Samuelsson, Eva
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Utbud av stöd och behandling för spelproblem: En studie om utmaningar inför förtydligat ansvar i lagstiftningen2018Report (Other academic)
    Abstract [en]

    On the 1st of January 2018, the Swedish legislation was subject to change due to a need to clarify the responsibility of care givers to prevent and provide support and treatment for gambling problems. The aim of this study has been to review the current situation of available support and treatment for gambling problems in Sweden, before the change in legislation took place. The Public Health Agency of Sweden and the Support Line (a telephone hotline service) has provided relevant information. Interviews have been conducted with sixteen key actors in the gambling treatment field representing municipalities, regional health care, authorities and non-governmental organisations. The interview material was analysed using thematic analysis. Preliminary results were presented for a group of treatment providers to validate the results and to collect further comments. The study showed that support and treatment for people with gambling problems are fragmentary and arbitrary on the national level. Support and treatment is available in some parts of the country but often relying on individual treatment providers’ own engagement, which creates a vulnerable situation in terms of availability and continuity of competence. The treatment offered is mainly cognitive behavioural therapy and there is a need to diversify and integrate various treatment options for different target groups. Non-governmental organisations play an important role by offering complimentary support as such, but also when treatment is not available. The main conclusion was that the municipal social services and the regional healthcare system in general are badly equipped to meet the needs of problem gamblers due to lack of resources and competence. Further efforts to provide education for personnel and implementation of screening routines to facilitate early detection in social services and health care settings are suggested. Despite ongoing development work, the legislative changes are challenging for municipalities and regional health care to accomplish satisfactory cooperation based on the needs of gamblers and their concerned significant others. A follow-up study will take place during 2019/2020 to review the development of support and treatment for gambling problems after the implementation of the new legislation.

  • 12. Giordano, Guiseppe Nicola
    et al.
    Mewes, Jan
    Miething, Alexander
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Trust and all-cause mortality: a multilevel study of US General Social Survey data (1978–2010)2018In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738Article in journal (Refereed)
    Abstract [en]

    Background Within public health research, generalised trust has been considered an independent predictor of morbidity and mortality for over two decades. However, there are no population-based studies that have scrutinised both contextual-level and individual-level effects of generalised trust on all-cause mortality. We, therefore, aim to investigate such associations by using pooled nationally representative US General Social Survey (GSS) data linked to the National Death Register (NDI).

    Methods The combined GSS–NDI data from the USA have 90 contextual units. Our sample consisted of 25 270 respondents from 1972 to 2010, with 6424 recorded deaths by 2014. We used multilevel parametric Weibull survival models reporting HRs and 95% CI (credible intervals for Bayesian analysis). Individual-level and contextual-level generalised trust were the exposures of interest; covariates included age, race, gender, marital status, education and household income.

    Results We found a robust, significant impact of individual-level and contextual-level trust on mortality (HR=0.92, 95% CI 0.88 to 0.97; and HR=0.96, 95% CI 0.93 to 0.98, respectively). There were no discernible gender differences. Neither did we observe any significant cross-level interactions.

    Conclusion High levels of individual and contextual generalised trust protect against mortality, even after considering numerous individual and aggregated socioeconomic conditions. Its robustness at both levels hints at the importance of psychosocial mechanisms, as well as a trustworthy environment. Declining trust levels across the USA should be of concern; decision makers should consider direct and indirect effects of policy on trust with the view to halting this decline.

  • 13.
    Granvik Saminathen, Maria
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Brolin Låftman, Sara
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Almquist, Ylva B.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Modin, Bitte
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Effective schools, school segregation, and the link with school achievement2018In: School Effectiveness and School Improvement, ISSN 0924-3453, E-ISSN 1744-5124Article in journal (Refereed)
    Abstract [en]

    This study examines whether 3 teacher-rated aspects of school effectiveness differ across school segregation profiles in Stockholm, and to what extent these indicators are associated with the academic achievement of 9th-grade students. Analyses were based on 2 cross-sectional data collections performed in 2014 and 2016, respectively (147 school units), one among teachers (= 2,024) and the other among 9th-grade students (= 9,151). Multilevel analysis was applied, estimating 2-level random intercept linear regression models. Results show that teachers’ ratings of school leadership, teacher cooperation, and school ethos, as well as student-reported marks differ across school segregation profiles. Findings further reveal significant associations between these school effectiveness indicators and student performance, even when taking student family background and the school’s student body composition into consideration. In part, these associations are also identified within segregation profiles. Moreover, results show that school ethos acts as a mediator between school segregation profile and student achievement.

  • 14. Hagqvist, Emma
    et al.
    Toivanen, Susanna
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Bernhard-Oettel, Claudia
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Balancing Work and Life When Self-Employed: The Role of Business Characteristics, Time Demands, and Gender Contexts2018In: Social Sciences, ISSN 2076-0760, E-ISSN 2076-0760, Vol. 7, no 8, article id 139Article in journal (Refereed)
    Abstract [en]

    This study explores individual and contextual risk factors in relation to work interfering with private life (WIL) and private life interfering with work (LIW) among self-employed men and women across European countries. It also studies the relationship between interference (LIW and WIL) and well-being among self-employed men and women. Drawing on data from the fifth round of the European Working Conditions Survey, a sample of self-employed men and women with active businesses was extracted. After applying multilevel regressions, results show that although business characteristics are important, the most evident risk factor for WIL and LIW is time demands. Both time demands and business characteristics also seem to be important factors in relation to gender differences in level of interference. There is a relationship between well-being and both WIL and LIW, and time demands is again an important factor. Gender equality in the labor market did not relate to level of interference, nor did it affect the relationship between interference and well-being. However, in gender-separated analyses, LIW and LIW interacted with gender equality in the labor market in different ways for women’s and men’s well-being. In conclusion, gender relations are important in interference and how interference relates to well-being.

  • 15.
    Hellström, Carin
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    The policy process of debates in the Swedish Parliament regarding cigarette smoking- 1971 and 2011:A policy analysis2018Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    In 2003 a WHO treaty presented the use of cigarettes and tobacco as an international tobacco epidemic: a public health concern that needed to be diminished. Decreasing smoking prevalence can be an effect of individual choice, the social context or of governmental interventions. This master thesis originated in an interest in governmental measures aimed at decreasing the population´s smoking prevalence. The data used in this thesis include records of parliamentary and governmental bills as well as the parliamentary debates in the Swedish Parliament 1971 and 2011. Discourse analysis was used to analyse how the hazards of cigarette smoking in a public health perspective were of any interest to the national political arena of the Swedish Parliament. Fivethemes developed from the documents. The essence of the themes evolved to vision, society structure and tools for policy making. To conclude: forty years of policy making resulted in legislation; a smoking ban was put into place and shift of societal norms.The agenda of tobacco policy making expanded, what was politically acceptable and possible to add to the agenda during forty years varied. There were changes in discourse as well as development of new discourse.

  • 16.
    Holmin von Saenger, Isabelle
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Perceived teacher support and student psychosomatic health complaints: Exploring the role of schools' student composition and gender2018Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    Mental health problems have increased among adolescents in Sweden and research suggests that contextual matters could be of importance over and beyond individual socio-demographic characteristics. One such social context is school, where both the student composition of the school and its support can influence student health. This study explored the distribution of psychosomatic health complaints (PHC) and perceived teacher support (PTS) as well as the association between PTS and PHC, across school segregated profiles. It also examined gender differences in these distributions and associations. The study design was cross-sectional, and data came from classroom-surveys within Stockholm municipality of ninth grade students in 2014 (n=4904). Linear regression analyse was applied. Results showed that average levels of PHC varied across school segregation profiles for girls, while PTS varied for both gender. PTS was negatively associated with PHC for all students, while the strength of association varied across school profiles to the benefit of students in the most privileged schools. Gender differences in these associations was also observed. Conclusions were that school context, based on the student composition of the school, and its provided support was linked to psychosomatic health complaints among students in Stockholm and that gender played a role in understanding pathways in these associations.

  • 17.
    Juárez, Sol P.
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. Stockholm University, Faculty of Social Sciences, Department of Sociology.
    Drefahl, Sven
    Stockholm University, Faculty of Social Sciences, Department of Sociology.
    Dunlavy, Andrea
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Rostila, Mikael
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    All-cause mortality, age at arrival, and duration of residence among adult migrants in Sweden: A population-based longitudinal study2018In: SSM - Population Health, ISSN 2352-8273, Vol. 6, p. 16-25Article in journal (Refereed)
    Abstract [en]

    Background: A mortality advantage has been observed among recently arrived immigrants in multiple national contexts, even though many immigrants experience more social disadvantage compared to natives. This is the first study to investigate the combined influence of duration of residence and age at arrival on the association between region of origin and all-cause mortality among the adult immigrant population in Sweden.

    Methods: Using population-based registers, we conducted a follow-up study of 1,363,429 individuals aged 25-64 years from 1990 to 2008. Gompertz parametric survival models were fitted to derive hazard ratios (HR) for all-cause mortality.

    Results: Compared to native Swedes, we observed a health advantage in all group of immigrants, with the exception of individuals from Finland. However, when information on age at arrival and duration of residence was combined, an excess mortality risk was found among immigrants who arrived before age 18, which largely disappeared after 15 years of residence in Sweden. Non-European immigrants over age 18 showed similar or lower mortality risks than natives in all categories of age at arrival, regardless of duration of residence.

    Conclusions: The findings suggest that the mortality advantage commonly observed among immigrants is not universal. Combined information on age at arrival and duration of residence can be used to identify sensitive periods and to identify possible selection bias. The study also suggests that young immigrants are a vulnerable subpopulation. Given the increased number of unaccompanied minors arriving in Europe, targeted health or integration policies should be developed or reviewed.

  • 18. Järbrink-Sehgal, M. Ellionore
    et al.
    Schmidt, Peter T.
    Sköldberg, Filip
    Hemmingsson, Tomas
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. Karolinska Institutet, Sweden.
    Hagström, Hannes
    Andreasson, Anna
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Karolinska Institutet, Sweden; Macquarie University, Australia.
    Lifestyle Factors in Late Adolescence Associate With Later Development of Diverticular Disease Requiring Hospitalization2018In: Clinical Gastroenterology and Hepatology, ISSN 1542-3565, E-ISSN 1542-7714, Vol. 16, no 9, p. 1474-1480Article in journal (Refereed)
    Abstract [en]

    BACKGROUND & AIMS: The burden of diverticular disease on society is high and is increasing with an aging population. It is therefore important to identify risk factors for disease development or progression. Many lifestyle behaviors during adolescence affect risk for later disease. We searched for adolescent lifestyle factors that affect risk of diverticular disease later in life. METHODS: We performed a retrospective analysis of data from 43,772 men (age, 18-20 y) conscripted to military service in Sweden from 1969 through 1970, with a follow-up period of 39 years. All conscripts underwent an extensive mental and physical health examination and completed questionnaires covering alcohol consumption, smoking, and use of recreational drugs; cardiovascular fitness was assessed using an ergometer cycle at the time of conscription. Outcome data were collected from national registers to identify discharge diagnoses of diverticular disease until the end of 2009. We performed Cox regression analysis to determine whether body mass index, cardiovascular fitness, smoking, use of recreational drugs, alcohol consumption, and risky use of alcohol, at time of conscription are independent risk factors for development of diverticular disease. RESULTS: Overweight and obese men had a 2-fold increased risk of diverticular disease compared to normal-weight men (hazard ratio, 2.00; P < .001). A high level of cardiovascular fitness was associated with a reduced risk of diverticular disease requiring hospitalization (P = .009). Smoking (P = .003), but not use of recreational drugs (P = .11), was associated with an increased risk of diverticular disease requiring hospitalization. Risky use of alcohol, but not alcohol consumption per se, was associated with a 43% increase in risk of diverticular disease requiring hospitalization (P = .007). CONCLUSIONS: In a retrospective analysis of data from 43,772 men in Sweden, we associated being overweight or obese, a smoker, a high-risk user of alcohol, and/or having a low level of cardiovascular fitness in late adolescence with an increased risk of developing diverticular disease requiring hospitalization later in life. Improving lifestyle factors among adolescents might reduce the economic burden of diverticular disease decades later.

  • 19.
    Karimi, Najmeh
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Injury and migration in Sweden: Risk of death and hospitalization due to car accidents among foreign-born compared to Swedish-born individuals2018Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    Aim: To compare risk of death and hospitalization due to car accidents among foreign-born individuals to Swedish-born.Method: The study cohort (2,404,710 individuals; 11% foreign-born) established by linkage between Swedish national registers. The main exposure was migration status, and duration of residence and age at migration considered as secondary exposures. The cohort was 18-39 years old and followed from 2005-2012. Hazard ratios (HR) with 95% confidence intervals (CI) adjusted for birth year, gender, family income, area of residence, and country of birth were calculated by Cox proportional hazard model.Results: 588 death (8% among foreign-born) and 17,969 hospitalization (11% among foreign-born) due to car accidents recorded. While, adjusted risk of hospitalization was higher among foreign-born than that among Swedish-born individuals, we found lower risk (HR: 0.92; CI: 0.85-0.996) among females and higher risk (HR: 1.17; CI: 1.10-1.24) among males. Risk of hospitalization was higher among foreign-born individuals who immigrated to Sweden at ages younger than 18 years or lived in Sweden 5 years or longer.Conclusions: Gender is acting as an effect modifier for the risk of hospitalization due to car accidents. We recommend further research to examine factors underlying excess risk impact of duration of residence in host country.

  • 20.
    Karlsson, Henrik
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Examining sources of heterogeneity between studies of mental-health outcomes in children with experience of foster care – a meta-analytical approach2018Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    Systematic reviews of the effect of foster care on mental-health outcomes have consistently indicated a zero-sum game, which makes it unclear whether the intervention is suitable for children in need of out-of-home placements. This thesis took on a meta-analytical approach to examine sources of heterogeneity between studies evaluating the effect of foster care on adaptive functioning, cognitive functioning, externalizing behavior, internalizing behavior, and total problems behavior. The bulk of studies came from two recently published systematic reviews. The searches were replicated to cover studies published until March 31, 2018. From 2943 studies assessed for eligibility, 240 were selected for the analysis covering 25 085 children. A choice of study-related covariates was abstracted, and potential sources of heterogeneity were hypothesized and tested by means of meta-regression. The findings indicated that both the choice of study design and measurement instrument were significantly associated with the variation in effect sizes. These associations were even stronger in child protection-oriented welfare regimes while insignificant in family service-oriented regimes, which instead showed significant associations for outcome type and publication year. The results imply a need to standardize effect studies of foster care, and to further research on sources of heterogeneity in different child welfare regimes.

  • 21. Karriker-Jaffe, Katherine J.
    et al.
    Room, Robin
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. La Trobe University, Australia.
    Giesbrecht, Norman
    Greenfield, Thomas K.
    Alcohol's Harm to Others: Opportunities and Challenges in a Public Health Framework2018In: Journal of Studies on Alcohol and Drugs, ISSN 1937-1888, E-ISSN 1938-4114, Vol. 79, no 2, p. 239-243Article in journal (Refereed)
    Abstract [en]

    The emergent and growing body of research on alcohol's harm to others (AHTO), or secondhand effects of drinking, has important implications for prevention, intervention, and policy. Those victimized by other drinkers tend to favor effective alcohol policies more than their nonvictimized peers, but often a community's impulse will be to combat AHTO by targeting and stigmatizing individual heavy drinkers, rather than taking a public health approach to reducing harm. Here we discuss opportunities and challenges in selecting ways of reducing AHTO. We make a case for adopting joint public health and individual approaches to reduce AHTO.

  • 22. Korhonen, Kaarina
    et al.
    Einiö, Elina
    Leinonen, Taina
    Tarkiainen, Lasse
    Martikainen, Pekka
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. University of Helsinki, Finland; Max Planck Institute for Demographic Research, Germany.
    Time-varying effects of socio-demographic and economic factors on the use of institutional long-term care before dementia-related death: A Finnish register-based study2018In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 13, no 6, article id e0199551Article in journal (Refereed)
    Abstract [en]

    Objectives The effects of socio-demographic and economic factors on institutional long-term care (LTC) among people with dementia remain unclear. Inconsistent findings may relate to time varying effects of these factors as dementia progresses. To clarify the question, we estimated institutional LTC trajectories by age, marital status and household income in the eight years preceding dementia-related and non-dementia-related deaths. Methods We assessed a population-representative sample of Finnish men and women for institutional LTC over an eight-year period before death. Deaths related to dementia and all other causes at the age of 70+ in 2001-2007 were identified from the Death Register. Dates in institutional LTC were obtained from national care registers. We calculated the average and time-varying marginal effects of age, marital status and household income on the estimated probability of institutional LTC use, employing repeated-measures logistic regression models with generalised estimating equations (GEE). Results The effects of age, marital status and household income on institutional LTC varied across the time before death, and the patterns differed between dementia-related and non-dementia-related deaths. Among people who died of dementia, being of older age, non-married and having a lower income predicted a higher probability of institutional LTC only until three to four years before death, after which the differences diminished or disappeared. Among women in particular, the probability of institutional LTC was nearly equal across age, marital status and income groups in the last year before dementia-related death. Among those who died from non-dementia-related causes, in contrast, the differences widened until death. Conclusions We show that individuals with dementia require intensive professional care at the end of life, regardless of their socio-demographic or economic resources. The results imply that the potential for extending community living for people with dementia is likely to be difficult through modification of their socio-demographic and economic environments.

  • 23.
    Kraus, Ludwig
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. IFT Institut für Therapieforschung, Germany; ELTE Eötvös Loránd University, Hungary .
    Seitz, Nicki-Nils
    Piontek, Daniela
    Molinaro, Sabrina
    Siciliano, Valeria
    Guttormsson, Ulf
    Arpa, Sharon
    Monshouwer, Karin
    Leifman, Hakan
    Vicente, Julian
    Griffiths, Paul
    Clancy, Luke
    Feijao, Fernanda
    Florescu, Silvia
    Lambrecht, Patrick
    Nociar, Alojz
    Raitasalo, Kirsimarja
    Spilka, Stanislas
    Vyshinskiy, Konstantin
    Hibell, Bjorn
    'Are The Times A-Changin'? Trends in adolescent substance use in Europe2018In: Addiction, ISSN 0965-2140, E-ISSN 1360-0443, Vol. 113, no 7, p. 1317-1332Article in journal (Refereed)
    Abstract [en]

    Aims To estimate temporal trends in adolescents' current cigarette, alcohol and cannabis use in Europe by gender and region, test for regional differences and evaluate regional convergence. Design and Setting Five waves of the European School Survey Project on Alcohol and Other Drugs (ESPAD) from 28 countries between 1999 and 2015. Countries were grouped into five regions [northern (NE), southern (SE), western (WE), eastern Europe (EE) and the Balkans (BK)]. Participants A total of 223 814 male and 211 712 female 15-16-year-old students. Measurements Daily cigarette use, weekly alcohol use, monthly heavy episodic drinking (HED) and monthly cannabis use. Linear and quadratic trends were tested using multi-level mixed-effects logistic regression; regional differences were tested using pairwise Wald tests; mean absolute differences (MD) of predicted prevalence were used for evaluating conversion. Findings Daily cigarette use among boys in EE showed a declining curvilinear trend, whereas in all other regions a declining linear trend was found. With the exception of BK, trends of weekly drinking decreased curvilinear in both genders in all regions. Among girls, trends in WE, EE and BK differed from trends in NE and SE. Monthly HED showed increasing curvilinear trends in all regions except in NE (both genders), WE and EE (boys each). In both genders, the trend in EE differed from the trend in SE. Trends of cannabis use increased in both genders in SE and BK; differences were found between the curvilinear trends in EE and BK. MD by substance and gender were generally somewhat stable over time. Conclusions Despite regional differences in prevalence of substance use among European adolescents from 1999 to 2015, trends showed remarkable similarities, with strong decreasing trends in cigarette use and moderate decreasing trends in alcohol use. Trends of cannabis use only increased in southern Europe and the Balkans. Trends across all substance use indicators suggest no regional convergence.

  • 24.
    Lindfors, Petra
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Work and organizational psychology.
    Folkesson Hellstadius, Lisa
    Östberg, Viveca
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Perceived stress, recurrent pain and salivary cortisol in mid-adolescent girls and boys2016Conference paper (Other academic)
  • 25.
    Lithner, Ellinor
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Association between work-time control and sickness absence: A longitudinal study among the Swedish working population2018Independent thesis Advanced level (degree of Master (Two Years)), 80 credits / 120 HE creditsStudent thesis
    Abstract [en]

    In Sweden, sickness absence due to mental disorder is increasing for both men and women, although more among women. The psychosocial work environment is acknowledged as an important predictor for sickness absence. Employee based work-time control is beneficial for the balance between job stress and recovery and could therefore be of interest when aiming to prevent sickness absence. The aim is to investigate the association between control over daily hours (CoDH) and control over time off (CoT), respectively, and sickness absence. The study also examine whether the association differ by gender and if burnout or depression mediates the associations. Data was derived from two waves of the Swedish Longitudinal Occupational Survey of Health (SLOSH) which is an approximate representation of the Swedish working population (n=8418, of which 4936 were females). Binary logistic regression was used as method of analysis. After adjustment for possible confounders, no association between CoDH and sickness absence was found. Low CoT was significantly associated with sickness absence among men (OR=0.90 [0.84, 0.96]), but not among women. Neither burnout nor depression mediates the associations. CoT is stronger associated with sickness absence than CoDH. CoT with regard to sickness absence is of greater importance for men than women.

  • 26.
    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.

  • 27.
    Lutters, Marie-Claire
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Explaining the Occupational Class Gradient in Health Among Swedish Employees: Physical and Psychosocial Work-Related Stressors2018Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    The work environment constitutes a key social determinant of health, yet previous research is relatively limited vis-à-vis the contribution of both physical and psychosocial work-related stressors on occupational class differences in health among Swedish employees. This study used cross-sectional data from the Swedish Level of Living Survey 2010 to assess the mediating effect of physical and psychosocial work-related stressors to occupational class differences in physical and mental ill health in Sweden. Disparities between gender were also considered. A sub-sample of 2,624 full- and part-time employed individuals aged 18-65 was analysed using logistic regression. Employees who belonged to higher occupational classes had a lower risk of physical ill health compared to employees from lower occupational classes when age, gender and part-time work is accounted for – but there was no evidence of an occupational class gradient in mental ill health. Similar results were observed among men and women. In line with previous research, differential exposure to physical work-related stressors explained most of the occupational class gradient in physical ill health, yet certain psychosocial work-related stressors were also influential. Future research should further examine what other work-related factors – or social determinants of health – can help explain the association between occupational class and mental health. 

  • 28. Mikkonen, Janne
    et al.
    Moustgaard, Heta
    Remes, Hanna
    Martikainen, Pekka
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. University of Helsinki, Finland; The Max Planck Institute for Demographic Research, Germany.
    The Population Impact of Childhood Health Conditions on Dropout from Upper-Secondary Education2018In: Journal of Pediatric Surgery Case Reports, ISSN 0022-3476, E-ISSN 2213-5766, Vol. 196, p. 283-290.e4Article in journal (Refereed)
    Abstract [en]

    Objectives To quantify how large a part of educational dropout is due to adverse childhood health conditions and to estimate the risk of dropout across various physical and mental health conditions. Study design A registry-based cohort study was conducted on a 20% random sample of Finns born in 1988-1995 (n = 101 284) followed for school dropout at ages 17 and 21. Four broad groups of health conditions (any, somatic, mental, and injury) and 25 specific health conditions were assessed from inpatient and outpatient care records at ages 10-16 years. We estimated the immediate and more persistent risks of dropout due to health conditions and calculated population-attributable fractions to quantify the population impact of childhood health on educational dropout, while accounting for a wide array of sociodemographic confounders and comorbidity. Results Children with any health condition requiring inpatient or outpatient care at ages 10-16 years were more likely to be dropouts at ages 17 years (risk ratio 1.71, 95% CI 1.61-1.81) and 21 years (1.46, 1.37-1.54) following adjustment for individual and family sociodemographic factors. A total of 30% of school dropout was attributable to health conditions at age 17 years and 21% at age 21 years. Mental disorders alone had an attributable fraction of 11% at age 21 years, compared with 5% for both somatic conditions and injuries. Adjusting for the presence of mental disorders reduced the effects of somatic conditions. Conclusions More than one fifth of educational dropout is attributable to childhood health conditions. Early-onset mental disorders emerge as key targets in reducing dropout.

  • 29. Mishra, Gita D.
    et al.
    Moss, Katrina
    Loos, Colleen
    Dobson, Annette J.
    Davies, Peter S. W.
    Loxton, Deborah
    Hesketh, Kylie D.
    Koupil, Ilona
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. Karolinska Institutet, Sweden.
    Bower, Carol
    Sly, Peter
    Tooth, Leigh
    MatCH (Mothers and their Children's Health) Profile: Offspring of the 1973-78 Cohort of the Australian Longitudinal Study on Women's Health2018In: Longitudinal and life course studies, ISSN 1124-9064, E-ISSN 1757-9597, Vol. 9, no 3, p. 351-375Article in journal (Refereed)
    Abstract [en]

    MatCH (Mothers and their Children's Health) is a nationwide Australian study to investigate the links between the history of health, wellbeing and living conditions of mothers and the health and development of their children. MatCH builds on the Australian Longitudinal Study on Women's Health (ALSWH), which began in 1996 and has surveyed more than 58,000 women in four nationally representative age cohorts. MatCH focuses on the three youngest offspring of the cohort of ALSWH participants randomly sampled from all women in Australia born in 1973-78 (N=5780 children of N=3039 mothers). These women, who had completed up to seven postal or online surveys since 1996, were invited in 2016-17 to complete surveys about the health and development of their three youngest children aged under 13. The mothers reported on their children's health conditions and symptoms, diet, anthropometric measures, childcare, screen time, physical activity, temperament, behaviour, language development, motor development and health service utilisation, as well as household and environmental factors. These data are being linked with each child's records from official sources including the Australian Early Development Census (collected at age five to six), the National Assessment Program-Literacy and Numeracy (collected at age eight, 10, 12 and 14) and other external datasets. MatCH will combine 20 years of maternal data with all the information on her children, taking into account the family setting. MatCH offers an unprecedented opportunity to advance our understanding of the relationship between maternal health and wellbeing and child health and development.

  • 30. Moustgaard, Heta
    et al.
    Avendano, Mauricio
    Martikainen, Pekka
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. University of Helsinki, Finland; Max Planck Institute for Demographic Research, Germany.
    Parental Unemployment and Offspring Psychotropic Medication Purchases: A Longitudinal Fixed-Effects Analysis of 138,644 Adolescents2018In: American Journal of Epidemiology, ISSN 0002-9262, E-ISSN 1476-6256, Vol. 187, no 9, p. 1880-1888Article in journal (Refereed)
    Abstract [en]

    Parental unemployment is associated with worse adolescent mental health, but prior evidence has primarily been based on cross-sectional studies subject to reverse causality and confounding. We assessed the association between parental unemployment and changes in adolescent psychotropic medication purchases, with longitudinal individual-level fixed-effects models that controlled for time-invariant confounding. We used data from a large, register-based panel of Finnish adolescents aged 13-20 years in 1987-2012 (n = 138,644) that included annual measurements of mothers' and fathers' employment and offspring psychotropic medication purchases. We assessed changes in the probability of adolescent psychotropic medication purchases in the years before, during, and after the first episode of parental unemployment. There was no association between mother's unemployment and offspring psychotropic purchases in the fixed-effects models, suggesting this association is largely driven by unmeasured confounding and selection. By contrast, father's unemployment led to a significant 15%-20% increase in the probability of purchasing psychotropic medication among adolescents even after extensive controls for observed and unobserved confounding. This change takes at least 1 year to emerge, but it is long-lasting; thus, policies are needed that mitigate the harm of father's unemployment on offspring's mental well-being.

  • 31.
    Paquette, Elodie
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Social determinants of contraceptive use among young women in Kenya2018Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    Contraceptive use has far-reaching social and health benefits for women in low and middle-income countries. While socioeconomic factors are known to be associated with contraceptive use, few studies on this topic have focused specifically on young women, whose reproductive health is a target of the Sustainable Development Goals and the Family Planning 2020 agenda. This study used the Kenya Demographic and Health Survey to examine the association between three social determinants (wealth, education, and residence) and two contraceptive outcomes (modern method use and long-acting reversible contraceptive [LARC] use) in women ages 15-24 in 2008-09 (n=3,211 women) and 2014 (n=4,982 women). Results showed increases in the prevalence of modern method use and of LARC use. Low wealth was associated with non-use of LARC methods, and the same wealth pattern emerged for all modern method use between the two timepoints. An education gradient was observed for both outcomes. This study provides some evidence that the urban-rural gap is closing for contraception; however, rural residence continues to be a strong predictor of non-use of LARC methods. Results indicate that continued work is needed to ensure equitable progress in contraceptive use and method choice to contribute to improved reproductive health for young Kenyan women.

  • 32. Piontek, Daniela
    et al.
    Kraus, Ludwig
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. FT Institut für Therapieforschung, Germany; Eötvös Loránd University, Hungary.
    Trends in alcohol-related mortality in East and West Germany, 1980-2014: age, period and cohort variations2018In: Addiction, ISSN 0965-2140, E-ISSN 1360-0443, Vol. 113, no 5, p. 836-844Article in journal (Refereed)
    Abstract [en]

    Background and aims Several indicators suggest that the extent and trends of alcohol-related mortality differ between East and West Germany. Regional drinking patterns and differences in health-care systems are assumed to affect the risk of dying from an alcohol-induced disease. The study addresses two questions: (1) what are the unbiased and independent age, period and cohort effects on alcohol-related mortality trends in Germany; and (2) do these trends differ between East and West Germany? Methods Data on alcohol-related mortality for East and West Germany came from the national causes of death register for the years 1980-2014. Analyses included all deaths fully attributable to alcohol based on the International Classification of Diseases (ICD-9 and ICD-10). Gender-stratified age-period-cohort analyses were conducted using the intrinsic estimator model. Results Age effects showed a concave pattern with a peak at ages 55-64years in both regions. Incidence rate ratios (IRR) in East Germany were highest in the years 1990-1994 (men and women: IRR=1.52) and declined thereafter. In West Germany, IRR were lowest in 1980-1984 (men: IRR=0.81, women: IRR=0.75) and stabilized at approximately 1.10 since 1995-1999. Cohort effects showed continuously lower IRR for those born after 1955-1959 in the East and those born after 1945-1949 in the West. Patterns for males and females were comparable. Conclusions The results suggest that alcohol-related mortality showed different trends in East and West Germany, which can be explained partly by different drinking patterns before and changes in the health-care system after the reunification.

  • 33. Quilter, Julia
    et al.
    McNamara, Luke
    Seear, Kate
    Room, Robin
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. La Trobe University, Australia.
    The significance of 'intoxication' in Australian criminal law2018In: Trends and Issues in Crime and Criminal Justice, ISSN 1836-2206, no 546, p. 1-16Article in journal (Refereed)
    Abstract [en]

    This study explores how the state of 'intoxication' from the consumption of alcohol or other drugs is treated by the criminal justice system in Australia. The authors analysed more than 500 statutory provisions which attach significance to a person's 'intoxication' for a variety of purposes, and 327 appellate court decisions handed down in Australia between 2010 and 2014 in which the court considered evidence that the accused, the victim or a witness was 'intoxicated' at the time of the alleged offence. The study found that 'intoxication' has multiple purposes in the criminal law, but there is a widespread problem of under-definition. In the absence of clear definition, intoxication is often assessed on the basis of highly subjective criteria-in contexts as diverse as public order policing and assessments of victim credibility in sexual assault trials. The authors recommend that consideration be given to the standardising the definition of 'intoxication', consistent with society's expectation that criminal law should mark a clear line between ` sobriety' and 'intoxication' if the latter state is to carry penal consequences.

  • 34.
    Ramberg, Joacim
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Brolin Låftman, Sara
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    B. Almquist, Ylva
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Modin, Bitte
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    School effectiveness and students' perceptions of teacher caring: A multilevel study2018In: Improving Schools, ISSN 1365-4802, E-ISSN 1475-7583Article in journal (Refereed)
    Abstract [en]

    The effective schools literature has shown that school-contextual aspects matter for students’ academic and social outcomes. A potential link here may be the quality of the relationships between teachers and students, but few studies have investigated whether features of school effectiveness are in fact associated with students’ perceptions of teacher caring, which is the main purpose of this study. Based on recently collected data from 150 senior-level school units in Stockholm, school effectiveness in terms of teacher-assessed ‘school leadership’, ‘teacher cooperation and consensus’, and ‘school ethos’ (n = 2073) was analyzed in relation to perceived teacher caring as reported by students (n = 8022). Two-level linear regression analyses showed that all three aspects of school effectiveness were predictive of higher levels of perceived teacher caring among students. The findings suggest that these features of school effectiveness constitute an important foundation for promoting the quality of teachers’ relationships with their students.

  • 35.
    Ramberg, Joacim
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Brolin Låftman, Sara
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Fransson, Emma
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Modin, Bitte
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    School effectiveness and truancy: a multilevel study of upper secondary schools in Stockholm2018In: International Journal of Adolescence and Youth, ISSN 0267-3843, E-ISSN 2164-4527Article in journal (Refereed)
    Abstract [en]

    Truancy is a problem associated with a range of negative consequences at the individual and societal level, both in the short and the long term. Few earlier studies have investigated the association between school effectiveness and truancy. The aim of this study is to examine the links between three teacher-rated features of school effectiveness – school leadership, teacher cooperation and consensus, and school ethos – and student-reported truancy. Data were collected in 2016 among 4,956 students and 1,045 teachers in 46 upper secondary schools in Stockholm. Results from two-level binary logistic regression analyses show that higher teacher ratings of the school leadership and of the school ethos (but not of teacher cooperation and consensus) are associated with a lower likelihood of truancy at the student-level, even when adjusting for student- and school-level sociodemographic characteristics. The findings indicate that effective school characteristics may contribute to reducing students’ inclination to play truant.

  • 36.
    Reitan, Therese
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. Södertörns högskola, Sverige.
    Lagen eller magen? Förvaltningsrätten och LVM-mål rörande gravida kvinnor2017In: Retfærd. Nordisk Juridisk Tidsskrift, ISSN 0105-1121, Vol. 40, no 3-4, p. 132-150Article in journal (Refereed)
    Abstract [en]

    According to the Swedish Substance Abuse (Special Provisions) Act a person may be sentenced to compulsory care for a maximum of six months by an administrative court if she has a serious ongoing substance abuse and needs care which cannot be provided through voluntary measures. The person must also risk seriously harming her physical or mental health, destroying her life, or harming herself or a next of kin. The latter does not include an unborn child and the courts are only to assess whether the grounds for commitment are sufficient in terms of the woman’s needs and risk for harm. The legislation does, however, leave ample scope for so called fairness arguments (“reella hänsyn”). This article studies the extent to which the pregnancy is accentuated in court rulings and in what way – with a special focus on fairness arguments.

  • 37.
    Reitan, Therese
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Substance abuse during pregnancy: a 5-year follow-up of mothers and children2018In: Drugs: education prevention and policy, ISSN 0968-7637, E-ISSN 1465-3370Article in journal (Refereed)
    Abstract [en]

    Introduction: The study investigates health and social conditions among pregnant substance abusers and the children that were born from these pregnancies, and analyses outcomes in relation to type of substance abuse.

    Methods: Register data concerning 97 pregnant substance abusers and 104 children, at birth and 5 years on, were analysed with descriptive statistics and chi square tests.

    Results: The women presented a multitude of problems, including low education, substance abusing partners, and elevated smoking rates. Compared with the population, more children were born prematurely and average birth weight was almost 350 g lower. About 14% were diagnosed as being affected by maternal substance abuse. During follow-up, 5 women died and 88% showed continued substance-related mental and health problems. All children survived and 85% experienced placement in out-of-home care. Purchase of psychotropic drugs and mental health problems were more common among women with alcohol as one drug of preference.

    Conclusions: Parenthood did not represent a turning point for pregnant substance abusers. Comprehensive and persistent support is necessary, but in the short-term, efforts should be made to curb excessive smoking rates. The children faced several disadvantages at birth, but a longer follow-up is required to assess the impact of maternal substance abuse properly.

  • 38.
    Room, Robin
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. La Trobe University, Australia.
    Relevant to all disciplines and professions but central to none: How may social alcohol and drug research flourish?2018In: Nordic Studies on Alcohol and Drugs, ISSN 1455-0725, E-ISSN 1458-6126, Vol. 35, no 2, p. 104-107Article in journal (Refereed)
  • 39.
    Rostila, Mikael
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Maki, Netta
    Martikainen, Pekka
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). University of Helsinki, Finland; Max Planck Institute of Demographic Research, Germany.
    Does the death of a child influence parental use of psychotropic medication? A follow-up register study from Finland2018In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 13, no 5, article id e0195500Article in journal (Refereed)
    Abstract [en]

    Background Several studies have found that the loss of a child is associated with psychiatric health problems, yet few studies examined whether child loss influences psychotropic medication use. This study examined short-and long-term use of psychotropic medication, both before and after the death of a child, and its potential effect modifiers. Methodology/Principal findings A random sample of 205,456 parents, including 902 bereaved parents, were selected from a Finnish total population registry. The analyses were based on linear regressions using generalised estimation equations (GEE) and adjusted for sociodemographic factors. Annual psychotropic use was defined as having purchased prescribed psychotropic medication between 1996 and 2012. Bereaved parents were followed for four years prior to and up to four years after the death of their child. An increase in the use of antidepressants and anxiolytics was found in parents following their loss. The highest percentage of use was found around one year after bereavement, followed by a steady decrease although this remained higher than the level of use among non-bereaved four years after the death. Between 20-25% of bereaved mothers and 10-15% of bereaved fathers used antidepressants or anxiolytics one year after bereavement while the corresponding number in non-bereaved was 5-10%. An increase in psychotropic medication was also found several years before the disease-related loss of a child. Conclusions/Significance The use of psychotropic medication is markedly higher among parents after losing a child. Patterns of use leading up to and following the death of a child should be further examined in relation to clinical risk factors so as to identify at risk populations.

  • 40. Rozental, Alexander
    et al.
    Bennett, Sophie
    Forsström, David
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Ebert, David D.
    Shafran, Roz
    Andersson, Gerhard
    Carlbring, Per
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology. University of Southern Denmark, Denmark.
    Targeting Procrastination Using Psychological Treatments: A Systematic Review and Meta-Analysis2018In: Frontiers in Psychology, ISSN 1664-1078, E-ISSN 1664-1078, Vol. 9, article id 1588Article in journal (Refereed)
    Abstract [en]

    Background: Procrastination can be stressful and frustrating, but it seldom causes any major distress. However, for some people, it can become problematic, resulting in anxiety, lowered mood, physical complaints, and decreased well-being. Still, few studies have investigated the benefits of targeting procrastination. In addition, no attempt has previously been made to determine the overall efficacy of providing psychological treatments.

    Methods: A systematic review and meta-analysis was conducted by searching for eligible records in Scopus, Proquest, and Google Scholar. Only randomized controlled trials comparing psychological treatments for procrastination to an inactive comparator and assessing the outcomes by a self-report measure were included. A random effects model was used to determine the standardized mean difference Hedge's g at post-treatment. Furthermore, test for heterogeneity was performed, fail-safe N was calculated, and the risk of bias was explored. The study was pre-registered at Prospero: CRD42017069981.

    Results: A total of 1,639 records were identified, with 12 studies (21 comparisons, N = 718) being included in the quantitative synthesis. Overall effect size g when comparing treatment to control was 0.34, 95% Confidence Interval [0.11, 0.56], but revealing significant heterogeneity, Q(20) = 46.99, p < 0.00, and I2 = 61.14%, 95% CI [32.83, 84.24]. Conducting a subgroup analysis of three out of four studies using cognitive behavior therapy (CBT) found an effect size g of 0.55, 95% CI [0.32, 0.77], and no longer showing any heterogeneity, Q(4) = 3.92, p = 0.42, I2 = 0.00%, 95% CI [0.00, 91.02] (N = 236). Risk of publication bias, as assessed by the Egger's test was not significant, z = −1.05, p = 0.30, fail-safe N was 370 studies, and there was some risk of bias as rated by two independent researchers. In terms of secondary outcomes, the self-report measures were too varied to present an aggregated estimate.

    Conclusions: Psychological treatments seem to have small benefits on procrastination, but the studies isplayed significant between-study variation. Meanwhile, CBT was associated with a moderate benefit, but consisted of only three studies. Recommendations for future research are provided, including the use of more valid and reliable outcomes and a screening interview at intake.

  • 41. Rozental, Alexander
    et al.
    Kottorp, Anders
    Forsström, David
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Månsson, Kristoffer N. T.
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Boettcher, Johanna
    Andersson, Gerhard
    Furmark, Tomas
    Carlbring, Per
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Measuring adverse and unwanted events in psychotherapy2018Conference paper (Refereed)
    Abstract [en]

    Background: Psychotherapy offers many benefits, but research also indicate that negative effects sometimes occur. The Negative Effects Questionnaire (NEQ) was therefore developed to help researchers and clinicians determine the occurrence and characteristics of such incidents. 

    Method: The NEQ was evaluated in two studies, using data from both clinical trials and a survey distributed among individuals in the general population (Ns 653 and 564). 

    Results: The results from an exploratory factor analysis suggest that six factors could be relevant to retain: symptoms, quality, dependency, stigma, hopelessness, and failure, with poor treatment quality and therapeutic relationship having the highest self-rated negative effects. Further, the results from a Rasch analysis, a modern test theory application, suggest that the self-report measure exhibits fairness in testing across sociodemographics and that it is suitable for monitoring items with regard to their frequencies or levels of impact. Overall, 18.8% of the patients experienced more stress, 12.6% reported the resurfacing of unpleasant memories, and 12.2% were more anxious during treatment, implying that adverse and unwanted events are not uncommon in psychotherapy and may have to be monitored. 

    Conclusion: The NEQ could be a useful self-report measure to investigate negative effects in both research and clinical practice.

  • 42.
    Samuelsson, Eva
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Sundqvist, Kristina
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Binde, Per
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Configurations of gambling change and harm: qualitative findings from the Swedish longitudinal gambling study (Swelogs)2018In: Addiction Research and Theory, ISSN 1606-6359, E-ISSN 1476-7392, Vol. 26, no 6, p. 514-524Article in journal (Refereed)
    Abstract [en]

    Background: Gambling participation and problems change over time and are influenced by a variety of individual and contextual factors. However, gambling research has only to a small extent studied gamblers’ own perceptions of transitions in and out of problem gambling.

    Method: Qualitative telephone interviews were made with 40 gamblers who had repeatedly participated in the Swelogs Swedish Longitudinal Gambling Study. The framework approach was used for analyses, resulting in a multiple-linkage typology.

    Results: Our analyses revealed four configurations of gambling: (a) stable low frequency with no or minor harm, (b) decreasing high frequency with occasional harm, (c) fluctuating with moderate harm, and (d) increasing high frequency with substantial harm. Natural recovery and return to previous levels of gambling intensity were common. Change occurred either gradually, as a result of adjustment to altered personal circumstances, or drastically as a consequence of determined decisions to change. Personal and contextual factors such as psychological well-being, supportive relationships, and meaningful leisure activities played a part in overcoming harmful gambling and keeping gambling on a non-problematic level. Gambling advertising was commonly perceived as aggressive and triggering.

    Conclusions: The experience of harm is highly subjective, which should be taken into account when developing preventive measures. Considering the fluid character of gambling problems, help and support should be easily accessible and diversified. To repeatedly be interviewed about gambling and its consequences can contribute to increased reflection on, and awareness of, one’s own behaviours and the societal impacts of gambling.

  • 43.
    Storbjörk, Jessica
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    One model to rule them all? Governing images in the shadowof the disease model of addiction2018In: Drug and Alcohol Review, ISSN 0959-5236, E-ISSN 1465-3362, Vol. 37, no 6, p. 726-728Article in journal (Other academic)
    Abstract [en]

    Treatment providers demonstrate a quite strong support for a disease model of addiction, particularly so in the United States. However, conceptions vary and the problems may be perceived as primarily a disease, moral or social problems, or a combination of these (Barnett et al. in press). This commentary discusses the ongoing and dynamic process of defining addiction problems and notes that non-medical perspectives often appear in the shadow of and tend to oppose the disease model that stands quite inviolable – i.e., like the One Ring to rule them all by citing The Lord of the Rings. Recent changes in the Swedish Addiction treatment system, well known for its social perspective on the nature and handling of addiction problems, are highlighted to demonstrate that the world may be changing, or not. It is argued that there cannot be just one model. 

  • 44.
    Storbjörk, Jessica
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Stenius, Kerstin
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    The new privatized market: A question of ideology or pragmatism within the Swedish addiction treatment system?2018In: Social Policy & Administration, ISSN 0144-5596, E-ISSN 1467-9515Article in journal (Refereed)
    Abstract [en]

    Given its traditions of universal welfarism and social democracy, Sweden had already scored unexpectedly high on New Public Management by the 1980s. Health and welfare services remain primarily tax‐funded, but the production of care is increasingly transferred to a competitive quasi-market. To what extent can this development be understood in terms of right‐wing governments, and to what extent in terms of other, socioeconomic and pragmatic factors? We examined this question through official statistics on providers of institutional addiction care since 1976, and through the total expenditure and purchases by local‐level municipal social services of interventions for substance users in Sweden in 1999, 2004, 2009, and 2014. We have analyzed the distribution across publicand private providers within the addiction treatment system, and whether national developments and local differences across the 290 municipalities—which bear the major treatment responsibility—can be understood in terms of local‐level political majority, population size, and local wealth. The share of purchased services has remained stable, but the treatment system shows increasing financial turnover and an increasing share of for‐profit providers among producers of purchased care, especially in outpatient treatment. While venture capital enterprises emerged as a new actor, non‐governmental organizations lost out in importance. Bourgeois government correlated with larger shares of purchasing and purchases from for‐profit providers. However, purchasing on a market dominated by for‐profit providers has also become the “newnormal”, regardless of ideology, and recent years have shown a reversed effect of left‐wing municipalities purchasing more services than right‐wing governments. Pragmatic reasons also influence local‐level purchasing.

  • 45.
    Toivanen, Susanna
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Harter Griep, Rosane
    Mellner, Christin
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Work and organizational psychology.
    Nordenmark, Mikael
    Vinberg, Stig
    Eloranta, Sandra
    Hospitalization due to stroke or myocardial infarction: are there any differences between self-employed individuals and employees?2016Conference paper (Other academic)
    Abstract [en]

    The aim was to examine hospitalization due to stroke and acute myocardial infarction, respectively, and to analyze differences between the self-employed and paid employees in the same industries. Data and methods: Data from Statistics Sweden's population register (2003) was linked to National Board of Health and Welfare’s hospital admission register and cause of death register (2004-2008). More than 4.7 million people (7% self-employed) were included in the analyses. Individuals were classified on the basis of their occupational status as self-employed persons or employees. The self-employed were further classified as sole proprietors or limited liability company owners according to the legal form of self-employment. Based on the Swedish Standard Industrial Classification (SNI 2002) eight industries were distinguished. Diagnoses of hospitalization were classified as stroke (intracerebral hemorrhage I61, cerebral infarction I63, and unspecified acute cerebrovascular disease I64) and acute myocardial infarction (I21) based on the international classification of diseases (ICD-10). Stroke and Myocardial Infarction (MI) hospitalization incidence rate ratios (IRR) and 95% confidence intervals (CI) were estimated using negative binomial regression models adjusted for pre-specified potential confounding covariates. Effect modification by occupational status, industrial sector, and gender was investigated with two and three-way interaction terms.

  • 46.
    Toivanen, Susanna
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. Mälardalen University, Sweden.
    Härter Griep, Rosane
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. Oswaldo Cruz Foundation (Fiocruz), Brazil.
    Mellner, Christin
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Nordenmark, Mikael
    Vinberg, Stig
    Eloranta, Sandra
    Hospitalization due to stroke and myocardial infarction in self-employed individuals and small business owners compared with paid employees in Sweden—a 5-year study2018In: Small Business Economics, ISSN 0921-898X, E-ISSN 1573-0913Article in journal (Refereed)
    Abstract [en]

    Analysing Swedish population register data, the aim of the present study is to investigate differences in acute cardiovascular disease (CVD) in terms of stroke and myocardial infarction incidence between self-employed individuals and paid employees and to study whether the associations vary by gender or across industrial sectors. A cohort of nearly 4.8 million employed individuals (6.7% self-employed in 2003) is followed-up for hospitalization due to stroke and myocardial infarction (2004–2008). Self-employed individuals are defined as sole proprietors and limited liability company owners according to legal type of their enterprise. Negative binomial regression models are applied to compare hospitalization rates between the self-employed and paid employees, adjusted for socioeconomic and demographic confounders. Two- and three-way interaction are tested between occupational group, industrial sector, and gender. Limited liability company owners have significantly lower hospitalization for myocardial infarction than paid employees. Regarding two-way interaction, sole proprietors have higher myocardial infarction hospitalization in trade, transport and communication, and lower in agriculture, forestry, and fishing than paid employees. Limited liability company owners have lower hospitalization rate for myocardial infarction than employees in several industries. The results highlight the importance of enterprise legal type and industrial sector for CVD among self-employed individuals.

  • 47.
    Törrönen, Jukka
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Using vignettes in qualitative interviews as clues, microcosms or provokers2018In: Qualitative research journal, ISSN 1443-9883, Vol. 18, no 3, p. 276-286Article in journal (Refereed)
    Abstract [en]

    Purpose - Recent studies have introduced new productive theoretical orientations to the vignette studies. There is not, however, sufficient analytical discussion on how the vignettes can be used in qualitative interviews for different functions. The paper aims to discuss this issue.

    Design/methodology/approach - Whatever theoretical framing the researcher decides to apply in qualitative interviews using vignettes, the paper proposes that it is always important to consider in what way the chosen vignettes refer to the object under examination, whether they represent it as clues (metonyms, symptoms, enigmatic traces), as microcosms (icons, metaphors, totems, ideal types, homologies) or as provokers (anomalies, taboos, controversies).

    Findings - When vignettes are used as clues in interviews, they can be introduced as puzzling traces, tracks or indexes which together with the interview questions carry out the interviewees to metonymic reasoning. When vignettes are used in interviews as microcosms, the interview questions are built so that they encourage the interviewees to consider the vignettes as icons that mimic reality or realities, their actors, situations, acts, events and processes. And when vignettes are used as provokers, they are selected and produced so that they challenge the forms, boundaries, meanings and habits of the well-known and plausible realities of the interviewees.

    Originality/value - The paper demonstrates with examples how vignettes function in the interviews as clues, microcosms or provokers and shows why it is important to pay attention to this.

  • 48.
    Törrönen, Jukka
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Tigerstedt, Christoffer
    Following the moving and changing attachments and assemblages of 'addiction': Applying the actor network approach to autobiographies2018In: International journal on drug policy, ISSN 0955-3959, E-ISSN 1873-4758, Vol. 54, p. 60-67Article in journal (Refereed)
    Abstract [en]

    The article applies actor network theory (ANT) to autobiographical data on alcohol dependence to explore what ANT can offer to the analysis of 'addiction stories'. By defining 'addiction' as a relational achievement, as the effect of elements acting together as a configuration of human and non-human actors, the article demonstrates how the moving and changing attachments of addiction can be dynamically analyzed with concepts of 'assemblage', 'mediator', 'tendency', 'translation', 'trajectory', 'immutable mobile', 'fluid' and 'bush fire'. The article shows how the reduction of alcohol dependence simply to genetic factors, neurobiological causes, personality disorders and self-medication constitutes an inadequate explanation. As 'meta theories', they illuminate addiction one-sidedly. Instead, as ANT pays attention to multiple heterogeneous mediators, it specifies in what way the causes identified in 'meta theories' may together with other actors participate in addiction assemblages. When following the development of addiction assemblages, we focus on situational sequences of action, in which human and non-human elements are linked to each other, and we trace how the relational shape of addiction changes from one sequence to another as a transforming assemblage of heterogeneous attachments that either maintain healthy subjectivities or destabilize them. The more attachments assemblages of addiction are able to make that are flexible and durable from one event to another, the stronger also the addiction-based subjectivities. Similarly, the fewer attachments that assemblages of addiction are able to keep in their various translations, the weaker the addiction-based subjectivities also become. An ANT-inspired analysis has a number of implications for the prevention and treatment of addiction: it suggests that in the prevention and treatment of addiction, the aim should hardly be to get rid of dependencies. Rather, the ambition should be the identification of attachments and relations that enable unhealthy practices and the development of harm as part of specific actor networks.

  • 49.
    Vitcheva, Tereza
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Can Effort-reward Imbalance explain Differences in Burnout and Sickness Absence between Strata of Occupational Gender Composition?: A Prospective Cohort Study2018Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    Aims: This study examined the prospective association between male-female ratio in occupations and levels of effort-reward imbalance, burnout and sickness absence. Specifically, we examined whether levels of effort-reward imbalance, burnout and sickness absence differed by strata of occupational gender composition, and whether effort-reward imbalance explained these differences. Methods: Data from two waves of the Swedish Longitudinal Occupational Survey of Health (SLOSH) was used, forming a sample of 9051 participants. Chi-square test and one-way ANOVA were used to estimate differences in variables between strata of occupational gender composition, and multiple logistic regression analyses were performed to analyse if effort-reward imbalance explained differences in outcomes between five strata of occupational gender composition. The analyses were stratified by gender and level of education. Results: Levels of effort-reward imbalance, burnout and sickness absence varied by strata of occupational gender composition. Effort-reward imbalance was the most consistent predictor, while few significant associations were found between occupational gender composition and the outcomes. Effort-reward imbalance mediated some, but not all of the significant associations between occupational gender composition and the outcomes. Conclusions: There was no strong support for an association between occupational male-female ratio and burnout or sickness absence. Effort-reward imbalance was prospectively associated with all outcomes.

  • 50. Wallin, Alma Sörberg
    et al.
    Allebeck, Peter
    Gustafsson, Jan-Eric
    Hemmingsson, Tomas
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. Karolinska Institutet, Sweden.
    Childhood IQ and mortality during 53 years' follow-up of Swedish men and women2018In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 72, no 10, p. 926-932Article in journal (Refereed)
    Abstract [en]

    BackgroundThe association between childhood cognitive ability measured with IQ tests and mortality is well documented. However, studies on the association in women are few and conflicting, and the mechanisms underlying the association are unclear.MethodsData on IQ were collected at school at age 13 among 19 919 men and women born in 1948 and 1953. Information on childhood socioeconomic position, the participants' socioeconomic and social circumstances in middle age and mortality up to 2013 was collected through national registers.ResultsLower IQ was associated with an increased risk of all-cause mortality among men (1070 cases, HR 1.31, 95% CI 1.23 to 1.39 for one SD decrease in IQ) and among women (703 cases, HR 1.16, 95%CI 1.08 to 1.25). IQ was associated with mortality from several causes of death in men, and cancer and cardiovascular disorder mortality in women. Adjustment for socioeconomic factors in childhood and, in particular, in adulthood attenuated the associations considerably in men and near completely in women.ConclusionLower IQ was associated with an increased risk of mortality in men and women. The explanatory effects of socioeconomic factors in adulthood suggest that they constitute an important pathway in the association between IQ and mortality, especially in women.

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