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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: Article 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.
    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.

  • 3.
    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.

  • 4.
    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.

  • 5.
    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.

  • 6. 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.

  • 7.
    Fors, Stefan
    et al.
    Karolinska Institutet.
    B Almquist, Ylva
    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.

  • 8.
    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.

  • 9.
    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.

  • 10.
    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.

  • 11.
    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.

  • 12.
    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.

  • 13. 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.

  • 14. 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.

  • 15.
    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.

  • 16.
    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.

  • 17.
    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.

  • 18.
    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. 

  • 19. 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.

  • 20.
    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.

  • 21. 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.

  • 22. 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.

  • 23.
    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.

  • 24.
    Ramberg, Joacim
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Special Education. 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.

  • 25.
    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.

  • 26.
    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.

  • 27.
    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)
  • 28.
    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.

  • 29.
    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 1476-7392Article 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.

  • 30.
    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 1465-3362Article 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. 

  • 31.
    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.

  • 32.
    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.

  • 33.
    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.

  • 34. Wall-Wieler, Elizabeth
    et al.
    Almquist, Ylva
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Liu, Can
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. Karolinska Institutet, Sweden.
    Vinnerljung, Bo
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. Karolinska Institutet, Sweden.
    Hjern, Anders
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. Karolinska Institutet, Sweden.
    Intergenerational transmission of out-of-home care in Sweden: A population-based cohort study2018In: International Journal of Child Abuse & Neglect, ISSN 0145-2134, E-ISSN 1873-7757, Vol. 83, p. 42-51Article in journal (Refereed)
    Abstract [en]

    The objective of this study is to examine the intergenerational transmission of out-of-home care. This population-based study used data from the Swedish National Registers and included all children born in Sweden between 1990 and 2012 (followed for up to 13 years), whose parents were both born in Sweden between 1973 and 1980 (278 327 children; 145 935 mothers; 146 896 fathers). Cox regression models are used to obtain crude and adjusted hazard ratios (HR) of OHC placement among children based on parents’ history of OHC. Compared with children whose parents both did not have a history of OHC, the risk of being placed in OHC was greater when both parents spent time in OHC (crude HR = 48.70, 95% CI 41.46–57.21; adjusted HR = 3.04, 95% CI = 2.54–3.64), however, children who had only one parent who spent time in care were also at higher risk (mothers only adjusted HR = 2.37, 95% CI = 2.08–2.70; fathers only adjusted HR = 1.33, 95% CI = 1.13–1.55). The crude rate of placement in OHC was highest for children whose parents were placed in care during adolescence, but after adjusting for social and behavioral covariates, children whose parents were in care in early childhood were at greater risk of OHC than children whose parents were in care in adolescence. To reduce this intergenerational transmission of OHC, more supports should be provided to parents who spent time in OHC to ensure a successful transition to parenthood.

  • 35.
    Winter, Katarina
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. SoRAD/Stockholm University.
    Experiences and expertise of codependency: Repetition, claim-coupling, and enthusiasmIn: Public Understanding of Science, ISSN 0963-6625, E-ISSN 1361-6609Article in journal (Refereed)
    Abstract [en]

    Arenas where experts interact with publics are useful platforms for communication and interaction between actors in the field of public health: researchers, practitioners, clinicians, patients, and laypersons. Such coalitions are central to the analysis of knowledge coproduction. This study investigates an initiative for assembling expert and other significant knowledge which seeks to create better interventions and solutions to addiction-related problems, in this case codependency. But what and whose knowledge is communicated, and how? The study explores how processes of repetition, claim-coupling, and enthusiasm produce a community based on three boundary beliefs: (1) victimized codependent children failed by an impaired society; (2) the power of daring and sharing; and (3) the (brain) disease model as the scientific representative and explanation for (co)dependence. These processes have legitimized future hopes in certain suffering actors, certain lived and professional expertise and also excluded social scientific critique, existing interventions, and alternative accounts.

  • 36.
    Åhlin, Julia K.
    et al.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Rajaleid, Kristiina
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Jansson-Fröjmark, Markus
    Westerlund, Hugo
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Magnusson Hanson, Linda L.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Job demands, control and social support as predictors of trajectories of depressive symptoms2018In: Journal of Affective Disorders, ISSN 0165-0327, E-ISSN 1573-2517, Vol. 235, p. 535-543Article in journal (Refereed)
    Abstract [en]

    Background: Job demands, job control and social support have been associated with depressive symptoms. However, it is unknown how these work characteristics are associated with different trajectories of depressive symptoms, which this study aimed to examine. Methods: We included 6679 subjects in the Swedish Longitudinal Occupational Survey of Health (SLOSH), who completed biennial questionnaires in 2006-2016. Group-based trajectory models identified groups with similar development of depressive symptoms. Multinomial logistic regression estimated associations between baseline demands, control, social support and trajectories of depressive symptoms. Results: We identified six depression trajectories with varying severity and stability across four measurements. High job demands and low social support, but not low control, were associated with higher probability of belonging to subsequent trajectories with higher symptom level compared to very low symptom level. Adjusted risk ratios ranged from 1.26, 95% CI = 1.06-1.51 (low symptom trajectory) to 2.51, 95% CI = 1.43-4.41 (persistent severe symptom trajectory). Results also indicated that onset of high demands, low control and low social support increases depressive symptoms over time. Limitations: The results were based on self-reported data and all individuals did not have complete data in all waves. Conclusions: The results indicated that especially perceptions of high job demands and low social support are associated with higher or increasing levels of depressive symptoms over time. This support the supposition that high job demands, and low social support may have long-term consequences for depressive symptoms and that interventions targeting job demands and social support may contribute to a more favourable course of depression.

  • 37.
    Östberg, Viveca
    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.
    Modin, Bitte
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Lindfors, Petra
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Work and organizational psychology.
    Bullying as a Stressor in Mid-Adolescent Girls and Boys–Associations with Perceived Stress, Recurrent Pain, and Salivary Cortisol2018In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 15, no 2, article id 364Article in journal (Refereed)
    Abstract [en]

    Bullying involves repeated exposure to negative actions while also invoking a power asymmetry between the involved parties. From a stress perspective, being bullied can be seen as a severe and chronic stressor, and an everyday social-evaluative threat, coupled with a shortage of effective social resources for dealing with this particular stressor. The aim of this study was to investigate whether exposure to bullying among mid-adolescent girls and boys is associated with subjective and objective stress-related outcomes in terms of perceived stress, recurrent pain, and salivary cortisol. The data came from the School Stress and Support Study (TriSSS) including students in grades 8–9 in two schools in Stockholm, Sweden, in 2010 (study sample n = 392; cortisol subsample n = 198). Bullying was self-reported and measured by multiple items. The statistical analyses included binary logistic and linear (OLS) regression. Being bullied was associated with greater perceived stress and an increased risk of recurrent pain, among both boys and girls. Also, bullied students had lower cortisol output (AUCG) and lower cortisol awakening response (CARG) as compared to those who were not bullied. Gender-stratified analyses demonstrated that these associations were statistically significant for boys but not for girls. In conclusion, this study demonstrated that being bullied was related to both subjective and objective stress markers among mid-adolescent girls and boys, pointing to the necessity of continuously working against bullying.

  • 38.
    Östergren, Olof
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Educational inequalities in mortality are larger at low levels of income: A register-based study on premature mortality among 2.3 million Swedes, 2006–20092018In: SSM - Population Health, ISSN 2352-8273, Vol. 5, p. 122-128Article in journal (Refereed)
    Abstract [en]

    Education develops skills that help individuals use available material resources more efficiently. When material resources are scarce, each decision becomes comparatively more important. Education may also protect from health-related income decline, since the highly educated tend to work in occupations with lower physical demands. Educational inequalities in health may, therefore, be more pronounced at lower levels of income. The aim of this study is to assess whether the shape of the income gradient in premature mortality depends on the level of education.

    Total population data on education, income and mortality was obtained by linking several Swedish registers. Income was defined as five-year average disposable household income for ages 35–64 and mortality follow-up covered the period 2006–2009. The final population comprised 2.3 million individuals, 6.2 million person-years and 14,362 deaths. Income was modeled using splines in order to allow variation in the functional form of the association across educational categories. Poisson regression with robust standard errors was used.

    The curvilinear shape of the association between income and mortality was more pronounced among those with a low education. Both absolute and relative educational inequalities in premature mortality tended to be larger at low levels of income. The greatest income differences in mortality were observed for those with a low education and the smallest for the highly educated.

    Education and income interact as predictors of mortality. Education is a more important factor for health when access to material resources is limited.

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