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  • 1.
    Alexius, Susanna
    et al.
    Stockholm University, Faculty of Social Sciences, Stockholm Centre for Organizational Research (SCORE).
    Cisneros Örnberg, Jenny
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Grossi, Giuseppe
    Logics and mechanisms of board appointment in hybrid organizations2018Conference paper (Other academic)
    Abstract [en]

    The relevance of the paper to the panel topic 

    The management and governance of hybrid organizations involve a range of challenges and critical issues. One such issue concerns the people that embody the hybrid and their capabilities to represent and handle the complex missions and potential value conflicts at stake in a hybrid organization. Looking closer at processes of recruitment and nomination of key actors such as CFOs, managers and board members is relevant as it sheds light on high held ideals for hybrid management and governance and the human resources seen fit to handle complex hybrid missions.

    The significance of the research (why it is distinctive and its contribution to the field)

    Our case gives a micro illustration of the governance challenges involved in attempts to design the nomination process to reflect a wider range of goals and values. We also wish to briefly discuss how this shift in appointment logics – from “political discretion” (PA), over “professionalism as in efficiency and economization” (NPM) to “political correctness” (NPG) may affect the boards and management of the SOEs.

    The research question(s) and method

    The Swedish state has an outspoken aim to be an “active and professional” owner by generating economic value in its 49 state-owned enterprises. At the same time, there is a political ambition for these firms to be seen as national and international “role models”, in the forefront of gender equality and sustainability. In addition, for about 25 SOEs, there are specifically Government commissioned social “public policy assignments” to be taken into consideration. The aim of this paper is to analyse the logics (political vs. professional) in the Swedish Government offices concerning the mechanisms of appointment of board members of Swedish State-owned Enterprises (SOEs) with Government commissioned social public policy assignments.

    Findings are based on qualitative analyses of documents, observations and interviews with key actors. Focusing foremost on the daily work of civil servants responsible for board nomination in the Ministry of Commerce and Innovation the study also acknowledges the role of external head hunters and executive search firms, politically appointed civil servants, politicians and board chairs and members in the nomination process.

    The theoretical/conceptual foundations for the research

    The backdrop to our case story is the historical transition from traditional Public Administration (PA), over new public management (NPM) regimes to the emerging post-NPM era of “New Public Governance” (Osborne, 2010; Almqvist et al., 2003; Ivarsson Westernberg, 2017), their dominant institutional logics and the effects on the appointment of public representatives, such as board members of SOEs.

    The results to be reported

    Our claim is that in the emerging NPG era, the previously dominating professional (and typically economical) logic of NPM-inspired governance of State-owned enterprises is challenged. Public appointment officials now face increasing external pressure to demonstrate that the multiple social values at stake for the hybrid organizations are reflected in the nomination of their board members, without compromising business efficiency, public accountability and the public income derived from SOEs.

  • 2.
    Alm, Susanne
    et al.
    Stockholm University, Faculty of Social Sciences, The Swedish Institute for Social Research (SOFI).
    Brolin Låftman, Sara
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Sandahl, Julia
    Stockholm University, Faculty of Social Sciences, Department of Criminology.
    Modin, Bitte
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    School effectiveness and students' future orientation: A multilevel analysis of upper secondary schools in Stockholm, Sweden2019In: Journal of Adolescence, ISSN 0140-1971, E-ISSN 1095-9254, Vol. 70, p. 62-73Article in journal (Refereed)
    Abstract [en]

    Introduction

    Future orientation (FO) refers to individuals' beliefs and feelings about their future. Earlier research has primarily investigated correlates of FO at the individual and family level, but it seems likely that FO is also shaped by other central agents or institutions, such as the school. Earlier studies have found positive associations between “school effectiveness” and student performance, and negative associations in relation to e.g., bullying, delinquency, and health risk behaviors. The current study investigated three teacher-reported features of school effectiveness - school leadership, teacher cooperation and consensus, and school ethos - and their links with student-reported FO.

    Methods

    Survey data were collected in 2016 among 5131 students (aged 17–18 years) and 1061 teachers in 46 upper secondary schools in Stockholm, Sweden, and merged with school-level register data. Two-level binary logistic regression analyses were performed.

    Results

    The analyses showed that higher teacher ratings of school leadership and school ethos were associated with a greater likelihood of reporting an optimistic FO among students. Teacher cooperation and consensus was however not associated with students' FO.

    Conclusion

    The findings indicate that the school environment contributes to shaping students' beliefs about their future. Thus, enhancing features of school effectiveness may be a way of promoting a positive development and brighter objective future prospects for the young, via pathways such as good student-teacher relations and academic motivation and achievement.

  • 3.
    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 1470-2738, Vol. 72, no 11, p. 997-1002Article 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.

  • 4.
    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.

  • 5. Atkinson, Jo-An
    et al.
    Prodan, Ante
    Livingston, Michael
    Centre for Alcohol Policy Research, La Trobe University, Bundoora, Australia.
    Knowles, Dylan
    O'Donnell, Eloise
    Room, Robin
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. La Trobe University, Australia.
    Indig, Devon
    Page, Andrew
    McDonnell, Geoff
    Wiggers, John
    Impacts of licensed premises trading hour policies on alcohol-related harms2018In: Addiction, ISSN 0965-2140, E-ISSN 1360-0443, Vol. 113, no 7, p. 1244-1251Article in journal (Refereed)
    Abstract [en]

    BACKGROUND AND AIM: Evaluations of alcohol policy changes demonstrate that restriction of trading hours of both 'on'- and 'off'-licence venues can be an effective means of reducing rates of alcohol-related harm. Despite this, the effects of different trading hour policy options over time, accounting for different contexts and demographic characteristics, and the common co-occurrence of other harm reduction strategies in trading hour policy initiatives, are difficult to estimate. The aim of this study was to use dynamic simulation modelling to compare estimated impacts over time of a range of trading hour policy options on various indicators of acute alcohol-related harm.

    METHODS: An agent-based model of alcohol consumption in New South Wales, Australia was developed using existing research evidence, analysis of available data and a structured approach to incorporating expert opinion. Five policy scenarios were simulated, including restrictions to trading hours of on-licence venues and extensions to trading hours of bottle shops. The impact of the scenarios on four measures of alcohol-related harm were considered: total acute harms, alcohol-related violence, emergency department (ED) presentations and hospitalizations.

    RESULTS: Simulation of a 3 a.m. (rather than 5 a.m.) closing time resulted in an estimated 12.3 ± 2.4% reduction in total acute alcohol-related harms, a 7.9 ± 0.8% reduction in violence, an 11.9 ± 2.1% reduction in ED presentations and a 9.5 ± 1.8% reduction in hospitalizations. Further reductions were achieved simulating a 1 a.m. closing time, including a 17.5 ± 1.1% reduction in alcohol-related violence. Simulated extensions to bottle shop trading hours resulted in increases in rates of all four measures of harm, although most of the effects came from increasing operating hours from 10 p.m. to 11 p.m.

    CONCLUSIONS: An agent-based simulation model suggests that restricting trading hours of licensed venues reduces rates of alcohol-related harm and extending trading hours of bottle shops increases rates of alcohol-related harm. The model can estimate the effects of a range of policy options.

  • 6. Atzendorf, Josefine
    et al.
    Apfelbacher, Christian
    Gomes de Matos, Elena
    Kraus, Ludwig
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. IFT Institut für Therapieforschung, Germany; Eötvös-Loránd-Universität, Hungary.
    Piontek, Daniela
    Patterns of multiple lifestyle risk factors and their link to mental health in the German adult population: a cross-sectional study2018In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 8, no 12, article id e022184Article in journal (Refereed)
    Abstract [en]

    Objectives Lifestyle risk factors, such as drinking or unhealthy diet, can expotentiate detrimental health effects. Therefore, it is important to investigate multiple lifestyle risk factors instead of single ones. The study aims at: (1) identifying patterns of lifestyle risk factors within the adult general population in Germany and (2) examining associations between the extracted patterns and external factors.

    Design Cross-sectional study.

    Setting General German adult population (aged 18–64 years).

    Participants Participants of the 2015 Epidemiological Survey of Substance Abuse (n=9204).

    Primary outcome measures Lifestyle risk factors (daily smoking, at-risk alcohol consumption, unhealthy diet, low physical activity, weekly use of pharmaceuticals, as well as consumption of cannabis and other illicit drugs).

    Results A latent class analysis was applied to identify patterns of lifestyle risk factors, and a multinomial logistic regression was carried out to examine associations between the extracted classes and external factors. A total of four classes were extracted which can be described as healthy lifestyle (58.5%), drinking lifestyle (24.4%), smoking lifestyle (15.4%) and a cumulate risk factors lifestyle (1.7%). Individuals who were male, at younger age and single as well as individuals with various mental health problems were more likely to show multiple lifestyle risk factors.

    Conclusions Healthcare professionals should be aware of correlations between different lifestyle risk factors as well as between lifestyle risk groups and mental health. Health promotion strategies should further focus especially on younger and single men.

    This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

  • 7. Atzendorf, Josefine
    et al.
    Aschenbrenner, Annika Berit
    de Matos, Elena Gomes
    Kraus, Ludwig
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. FT Institut für Therapieforschung, Germany; Eötvös Loránd University, Hungary.
    Kroeger, Christoph
    Delle, Simone
    Piontek, Daniela
    E-Zigaretten: Einschätzung vonGesundheitsgefahren undNutzung zur Tabakentwöhnung2018In: Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz, ISSN 1436-9990, Vol. 61, no 11, p. 1415-1421Article in journal (Refereed)
    Abstract [de]

    BackgroundThe perception that e-cigarettes are less harmful than traditional tobacco products can influence the consumption of e-cigarettes.ObjectivesThree questions were examined: (1)How do different population groups perceive health risks of e-cigarettes? (2)Do sociodemographic variables explain differences in the risk assessment of e-cigarettes? (3)Does the perception of health risks predict the use of e-cigarettes for smoking cessation?MethodsData came from the 2015 Epidemiological Survey of Substance Abuse (ESA) with asample size of n=9204 participants, aged 18 to 64years (response rate 52.2%). Data were collected by telephone, online, or by written questionnaires. Assessments of risk perception of e-cigarettes and conventional cigarettes (more harmful, just as harmful, less harmful, do not know) were compared. Descriptive statistics and logistic regressions were performed.ResultsIndividuals with lower education rated e-cigarettes as more harmful. Older people and women perceived e-cigarettes as just as harmful. Smokers considered e-cigarettes to be more harmful than or just as harmful as conventional tobacco products. The likelihood of using e-cigarettes for smoking cessation was higher if people thought they were less harmful than conventional cigarettes.ConclusionsOnly one-third of the population knows that e-cigarettes are less harmful to health than conventional cigarettes. The perception of health risks is related to the usage of e-cigarettes for smoking cessation.

  • 8. Atzendorf, Josefine
    et al.
    Gomes de Matos, Elena
    Kröger, Christoph
    Kraus, Ludwig
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. IFT Institut für Therapieforschung, Germany; Eötvös-Loránd-Universität, Hungary.
    Piontek, Daniela
    Die Nutzung von E-Zigaretten in der deutschen Bevölkerung – Ergebnisse des Epidemiologischen Suchtsurvey 20152018In: Das Gesundheitswesen, ISSN 0941-3790, E-ISSN 1439-4421Article in journal (Refereed)
    Abstract [en]

    The use of E-Cigarettes in the German Population: Results of the Epidemiological Survey of Substance Abuse 2015

    Aim Estimates of e-cigarette consumption in Germany vary considerably. The use of e-cigarettes for tobacco cessation is critically discussed. Based on current data, the distribution of the consumption of e-cigarettes and their use in the adult general population of Germany will be presented.

    Methods The 2015 Epidemiological Survey of Substance Abuse, a nationwide survey of 18 to 64 year-old people in Germany (n=9,204, response rate: 52,2%), was used as data basis.

    Results E-cigarettes were known to most of the respondents (85,3%, 43,5 Mio.), whereas only 2,9% (1,5 Mio.) used e-cigarettes in the last 30 days. Higher risk of consuming e-cigarettes was seen in younger people (OR=0,95, 95%-KI=(0,93; 0,97)), men (OR=1,45, 95%-KI=(1,02; 2,07)) and smokers (OR=12,53, 95%-KI=(8,71; 18,03)). About a third of smokers and ex-smokers of conventional cigarettes (36,6%) who consumed e-cigarettes used these for tobacco cessation of which one fifth (21,3%) was able to quit smoking.

    Conclusion E-cigarette users seem to be more likely to be male, younger and smokers of conventional cigarettes. In addition to curiosity, the change in smoking behavior is an important motive for consumption. The results indicate that the use of e-cigarettes can contribute to tobacco cessation, the majority of users, however, continue to consume conventional and/or e-cigarettes.

  • 9. Autto, Janne
    et al.
    Törrönen, Jukka
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    ‘Yes, but all responsible Finns want to stop living on credit’: Feeling rules in the Finnish politics of austerity2018In: Citizenship Studies, ISSN 1362-1025, E-ISSN 1469-3593Article in journal (Refereed)
    Abstract [en]

    In 2015, the newly elected government of Finland introduced austerity measures designed to improve the public economy, which had not recovered from the financial crisis of 2007–2008. The article examines how the government sought to secure acceptance for austerity by appealing to citizens’ emotions. We analyse how the measures were emotionally motivated and how, according to the parties in power, citizens should and should not have felt about them. The article shows how the politics of austerity produces various and contradictory feeling rules. These seek to temper citizens’ negative emotions towards austerity, such as dissatisfaction over unfair sharing of pain and distrust towards political authority. Interestingly, the rules evoke hope that a better future lies ahead if citizens follow the proposed measures, yet prompt fears of what will happen if they do not. The government also emphasised its transparency and honesty to prompt empathy and trust from the population.

  • 10.
    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.

  • 11.
    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.

  • 12. Berthelsen, Hanne
    et al.
    Muhonen, Tuija
    Toivanen, Susanna
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. Mälardalen University, Sweden.
    What happens to the physical and psychosocial work environment when activity-based offices are introduced into academia?2018In: Journal of Corporate Real Estate, ISSN 1463-001X, E-ISSN 1479-1048, Vol. 20, no 4, p. 230-243Article in journal (Refereed)
    Abstract [en]

    Purpose There is an increased interest for introducing activity-based offices at universities. The purpose of this study is to contribute to the knowledge about the importance of the built environment for the psychosocial work environment within academia by analyzing how staff at a large Swedish university experienced the physical and psychosocial work environment before and after moving to activity-based offices. Design/methodology/approach A Web-based survey was distributed to all employees at two faculties at a university three months before (2015, n = 217, response rate 51 per cent) and nine months after (2016, n = 200, response rate 47 per cent) relocation to a new activity-based university building. Findings In the new premises, a vast majority (86 per cent) always occupied the same place when possible, and worked also more often from home. The social community at work had declined and social support from colleagues and supervisors was perceived to have decreased. The participants reported a lower job satisfaction after the relocation and were more likely to seek new jobs. No aspects in the physical or psychosocial work environment were found to have improved after the relocation. Research/limitations implications The study had a two-wave cross-sectional design, which does not allow establishing causal relations. Practical implications There is reason to be cautious about relocation to activity-based offices at universities. The potential savings in costs for premises may lead to may be followed by an increase in other costs. The risk that staff cannot concentrate on their work in activity-based university workplaces and lose their sense of community with colleagues are factors, which in the long run may lead to decreased efficiency, more conflicts and poorer well-being. Originality/value This paper contributes with new knowledge concerning changes in the physical and psychosocial work environment when relocating from cell offices to activity-based offices in a university setting.

  • 13. 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.

  • 14.
    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.

  • 15. Cantarero-Arevalo, Lourdes
    et al.
    Pérez-Vicente, Raquel
    Juárez, S
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Ethnic differences in asthma treatment among Swedish adolescents: A multilevel analysis of individual heterogeneity2016In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 44, no 2, p. 184-194Article in journal (Refereed)
  • 16.
    Cisneros Örnberg, Jenny
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Hettne, Jörgen
    The Future Swedish Gambling Market: Challenges in Law and Public Policies2018In: Gambling Policies in European Welfare States: Current Challenges and Future Prospects / [ed] Michael Egerer, Virve Marionneau, Janne Nikkinen, Palgrave Macmillan, 2018, p. 197-216Chapter in book (Refereed)
    Abstract [en]

    Swedish gambling regulation has been questioned from an EU law perspective. While no changes have yet taken place, a reform proposal has during 2017 been submitted and the Government has in April 2018 passed a bill to Parliament based on that proposal. The new Swedish Gambling Act shall be based on a licensing system: anyone who wants to act in the Swedish gambling market must have a designated licence. The proposal underlines that the negative consequences of gambling should be limited and that extensive consumer protection calls for curbs on marketing. This chapter will discuss different aspects of gambling regulation in Sweden, especially in the light of EU law. Particular attention will be paid to the legal scope for reform, differences in taxation including the position held by public interest non-profit organisations, marketing and consumer protection.

  • 17. Dams, Judith
    et al.
    Buchholz, Angela
    Kraus, Ludwig
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. IFT Institute for Therapeutic Research Munich, Germany; ELTE Eötvös Loránd University, Hungary.
    Reimer, Jens
    Scherbaum, Norbert
    Konnopka, Alexander
    König, Hans-Helmut
    Excess costs of alcohol-dependent patients in German psychiatric care compared with matched non-alcohol-dependent individuals from the general population: a secondary analysis of two datasets2018In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 8, no 8, article id e020563Article in journal (Refereed)
    Abstract [en]

    Objectives Heavy alcohol use can cause somatic and mental diseases, affects patients' social life and is associated with social isolation, unemployment and reduced quality of life. Therefore, societal costs of alcohol dependence are expected to be high. The aim of this study was to estimate excess costs of patients with alcohol dependence diagnosed using the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition criteria compared with individuals without alcohol dependence in Germany. Design In a secondary analysis, baseline data of patients with alcohol dependence enrolled in a randomised controlled trial (German Clinical Trials Register DRS00005035) were compared with data collected via a telephone survey from individuals without alcohol dependence and that had been matched by entropy balancing. Health service use was evaluated retrospectively for a 6-month period. Settings Four German psychiatric university clinics (patients with alcohol dependence) and the German general adult population (individuals without alcohol dependence). Participants n=236adult patients with alcohol dependence and n=4687adult individuals without alcohol dependence. Primary and secondary outcome measures The excess costs of health service use, absenteeism and unemployment of patients with alcohol dependence were calculated and compared with individuals without alcohol dependence. In subgroup analyses, the associations between excess cost and gender, comorbidities and the duration of disease were investigated. Results Total 6-month excess costs of Euro11839 (95% CI Euro11 529 to Euro12 147) were caused by direct excess costs of Euro4349 (95% CI Euro4129 to Euro4566) and indirect costs of Euro7490 (95% CI Euro5124 to Euro9856). In particular, costs of inpatient treatment, formal long-term care, absenteeism and unemployment were high. Conclusions Alcohol dependence causes substantial direct and indirect excess costs. Cost-effective interventions to prevent and treat alcohol dependence are urgently needed. Trial registration number DRKS00005035.

  • 18. Dauber, Hanna
    et al.
    Pogarell, Oliver
    Kraus, Ludwig
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. IFT Institut für Therapieforschung, Germany; ELTE Eötvös-Loránd-University, Hungary.
    Braun, Barbara
    Older adults in treatment for alcohol use disorders: service utilisation, patient characteristics and treatment outcomes2018In: Substance Abuse Treatment, Prevention, and Policy, ISSN 1747-597X, E-ISSN 1747-597X, Vol. 13, article id 40Article in journal (Refereed)
    Abstract [en]

    Background In western countries demographic changes are leading to an ageing society. Consequently, the number of older adults with alcohol use disorders (AUDs) will rise and the demand of treatment is likely to increase. However, thus far not many older adults with an AUD are seeking treatment and little is known about the efficacy of treatment for older adults. The present study aimed at determining the proportion of older adults with an AUD in addiction treatment, particular characteristics and treatment outcomes of this clientele.

    Methods Using data of 10,860 patients with an AUD aged 60 and over that are documented within the national German addiction care system we conducted exploratory analyses with regard to prevalence, sociodemographic, disorder- and treatment-related variables.

    Results Overall, we found a low proportion of older patients in treatment due to AUDs, but highly positive treatment outcomes. With regard to sociodemographic and disorder-related characteristics, older females and late-onset patients in particular constitute a unique clientele.

    Conclusions The low service utilisation on the one hand but good treatment prognosis on the other emphasise the need to promote treatment seeking among older adults with AUDs. In this context, the special characteristics we found among older patients may contribute to better reach this population and to improve provisions of targeted treatment approaches.

  • 19.
    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 1464-360X, Vol. 28, no 5, p. 891-897Article 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.

  • 20.
    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.
    Toivanen, Susanna
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. Mälardalen University, Sweden.
    Rostila, Mikael
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Suicide risk among native- and foreign-origin persons in Sweden: a longitudinal examination of the role of unemployment status2018In: Social Psychiatry and Psychiatric Epidemiology, ISSN 0933-7954, E-ISSN 1433-9285Article in journal (Refereed)
    Abstract [en]

    PURPOSE: Prior research has documented an association between unemployment and elevated suicide risk. Yet, few Swedish studies have explicitly considered how such risk may vary by different migration background characteristics among persons of foreign-origin, who often experience diverse forms of labor market marginalization. This study examines the extent to which unemployment status may differentially influence suicide risk among the foreign-origin by generational status, region of origin, age at arrival, and duration of residence.

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

    RESULTS: Elevated suicide risk observed among foreign-origin unemployed groups was generally of a similar or lower magnitude than that found in unemployed native-origin, although unemployed second-generation Swedish men demonstrated significantly greater (p < 0.05) excess risk of suicide than that observed among their native-origin counterparts. Unemployed foreign-born men with a younger age at arrival and longer duration of residence demonstrated an increased risk of suicide, while those who arrived as adults, and a shorter duration of residence did not show any increased risk. Among foreign-born women, excess suicide risk persisted regardless of age at arrival and duration of residence in the long-term unemployed.

    CONCLUSIONS: Multiple migration background characteristics should be considered when examining relationships between employment status and suicide among the foreign-origin.

  • 21. Einiö, Elina
    et al.
    Martikainen, Pekka
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. University of Helsinki, Finland; Max Planck Institute for Demographic Research, Germany; Karolinska Institutet, Sweden.
    Risk of Hospitalization for Cancer, Musculoskeletal Disorders, Injuries, or Poisonings Surrounding Widowhood2019In: American Journal of Epidemiology, ISSN 0002-9262, E-ISSN 1476-6256, Vol. 188, no 1, p. 110-118Article in journal (Refereed)
    Abstract [en]

    Psychological distress has been indicated to affect the risk of death from cardiovascular disease, cancer, and external causes. Mortality from these major causes of death is also known to be elevated after widowhood when distress is at a heightened level. Surprisingly little is known about changes in health other than mental and cardiac health shortly before widowhood. We used longitudinal data on widowed (n = 19,185) and continuously married (n = 105,939) individuals in Finland (1996-2002) to assess the risk of hospitalization for cancer and for external and musculoskeletal causes surrounding widowhood or random dates. We fitted population-averaged logit models using longitudinal data of older adults aged 65 years or over. The results show that hospitalization for injuries had already increased prior to widowhood and clearly peaked after it. The increases were largely related to falls. A similar increasing pattern of findings was not found around a random date for a group of continuously married individuals. Hospitalizations for cancer and musculoskeletal disorders appeared to be unrelated to the process of widowhood. Hospitalizations for poisonings increased after widowhood. The results imply that the process of widowhood is multifaceted and that various types of health changes should be studied separately and before the actual loss.

  • 22.
    Elling, Devy
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. Karolinska Institutet, Sweden.
    Surkan, Pamela J.
    Enayati, Sahba
    El-Khatib, Ziad
    Sex differences and risk factors for diabetes mellitus - an international study from 193 countries2018In: Globalization and Health, ISSN 1744-8603, E-ISSN 1744-8603, Vol. 14, article id 118Article in journal (Refereed)
    Abstract [en]

    Background: Increases in overweight and obesity among youths have resulted in the diagnosis of Type 2 diabetes mellitus (T2DM) at earlier ages. The impact of lifestyle-related factors has been implicated; however, its relation to morbidity and mortality and sex differences remain unclear. We aimed to document the changes in risk factors and sex differences associated with T2DM-related morbidity and mortality during 1995-2015.

    Method: We used mortality rates and morbidity estimates from the Global Burden of Diseases Study 2016 using Disability-Adjusted Life Years (DALY). Multiple linear regression analyses were used to determine associations between T2DM-related mortality and related risk factors. DALYs were grouped by country income level, and were stratified by sex.

    Results: Increases in mortality were observed for both sexes, and females tended to have higher mortality rates per 100,000 persons. Body mass index (BMI) continued to be the leading risk factor for T2DM-related mortality, and increases in BMI were more common in low- and middle-income countries (LIC and MIC). Low physical activity was strongly associated with mortality rates, followed by dietary risks and smoking (2.4; 1.4; 0.8 per 100,000 persons, respectively). Similar patterns were observed after adjustments for income level, sex, and age. DALYs continued to show increasing trends across all income levels during 1995-2015 (high-income (HIC):16%; MIC: 36%; LIC: 12%). Stratification by sex showed similar results; males had fewer T2DM DALYs than females, though a greater increase was observed among males.

    Conclusion: Overall, T2DM related mortality was higher among females. Compared to in HIC, there appeared to be a considerable increase in the burden of T2DM in MIC and LIC, where BMI is the leading risk factor for T2DM-related mortality. Prevention programs should emphasize related risk factors according to the existing standard of care.

  • 23. 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.

  • 24.
    Eriksson, Charli
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Kimber, Birgitta
    Skoog, Therése
    Design and implementation of RESCUR in Sweden for promoting resilience in children: a study protocol2018In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 18, article id 1250Article in journal (Refereed)
    Abstract [en]

    Background: This research program aims to investigate the implementation and effects of a theoretically promising prevention method. It is being developed in a European research collaboration within a Comenius project (2012-2015) between 6 European universities (in Malta, Italy, Greece, Croatia, Portugal and Sweden) with the purpose of enhancing European children's resilience.

    Methods/design: RESCUR in Sweden consists in a RCT study of the Resilience Curriculum (RESCUR) that is taking place in Sweden 2017-2019. The study is being performed by Junis, IOGT-NTO's Junior Association, part of IOGT International, in conjunction with researchers at Goteborg, Umea and Stockholm universities, and is being funded by the Public Health Agency of Sweden.Around 1000 children of the ages 7-12 will, through their schools and associations, or via groups in social services, be acquainted with the material. Children will learn and practice mindfulness, storytelling, group discussions and much more, all designed to strengthen protective factors and increase their resilience. The program also involves parents, who are taking part in the work to reinforce children's protective factors.Based on the work with groups of children, an effectiveness study including children aged 7-12 in school classes, with randomized and controlled pre- and post-measurements, self-rating questionnaires and group observations is being performed. The program will also be implemented in a non-governmental organization and in groups in social services. The study also investigates forms of implementation.

    Discussion:The design of the study will enable the researchers to answer five research questions by using a mixed-methods approach. Implementation will be studied, which is a necessary prerequisite for an effect study. Moreover, the research procedure has been tailored to the target group, with age-appropriate measures as well as multiple informants, which will produce high-quality data for analysis. A special ethical challenge is the study of young children, and efforts to give children a voice have been included in the program. This project is regarded as having good potential to benefit children in general, and particularly children in vulnerable positions.

  • 25.
    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.

  • 26.
    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.

  • 27.
    Fors, Stefan
    et al.
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Torssander, Jenny
    Stockholm University, Faculty of Social Sciences, The Swedish Institute for Social Research (SOFI).
    B. Almquist, Ylva
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Is childhood intelligence associated with coexisting disadvantages in adulthood? Evidence from a Swedish cohort study2018In: Advances in Life Course Research, ISSN 1569-4909, E-ISSN 1879-6974, Vol. 38, p. 12-21Article in journal (Refereed)
    Abstract [en]

    Intelligence has repeatedly been linked to a range of different outcomes, including education, labour market success and health. Lower intelligence is consistently associated with worse outcomes. In this study, we analyzed the associations between intelligence measured in childhood, and the risk of experiencing a range of different configurations of coexisting disadvantages in adulthood. We also examined the role of educational achievements in shaping the associations. The analyses are based on the Stockholm Birth Cohort, a data material that encompasses more than 14,000 individuals born in 1953, with follow up until 2008. Latent class analysis was used to identify four different outcome configurations characterized by varying levels of disadvantages, measured in terms of unemployment, social assistance recipiency, and mental health problems. The results show that those who scored lower on an intelligence test in childhood were at an increased risk of experiencing all configurations characterized by increased levels of disadvantages during adulthood. However, these associations were contingent on educational achievement. Once the models were adjusted for school marks and educational attainment, no association between intelligence and disadvantages remained. These findings highlight the importance of developing strategies to facilitate optimal educational opportunities for all children, at all levels of cognitive performance.

  • 28.
    Forsström, David
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Jenny, Cisneros Örnberg
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Responsible gambling in practice: A case study of views and practices of Swedish oriented gambling companies2018In: Nordic Studies on Alcohol and Drugs, ISSN 1455-0725, E-ISSN 1458-6126, p. 1-17Article in journal (Refereed)
  • 29.
    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.

  • 30. 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)2019In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 73, no 1, p. 50-55Article 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.

  • 31.
    Goisis, Alice
    et al.
    Department of Social Policy, London School of Economics and Political Science, London, UK.
    Remes, Hanna
    Center for Population, Health and Society (CPHS), University of Helsinki, Finland.
    Barclay, Kieron
    Stockholm University, Faculty of Social Sciences, Department of Sociology. London School of Economics and Political Science, UK; Max Planck Institute for Demographic Research, Germany.
    Martikainen, Pekka
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. University of Helsinki, Finland; Max Planck Institute for Demographic Research, Germany; Karolinska Institutet, Sweden.
    Myrskylä, Mikko
    Max Planck Institute for Demographic Research, Germany.
    Paternal age and the risk of low birth weight and preterm delivery: a Finnish register-based study2018In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 72, no 12, p. 1104-1109Article in journal (Refereed)
    Abstract [en]

    Background Based on existing studies, there is no conclusive evidence as to whether and why paternal age matters for birth outcomes. Methods We used Finnish population registers on 106652 children born 1987-2000. We first document the unadjusted association between paternal age and the risk of low birth weight (LBW; <2500g) and preterm birth (<37 weeks' gestation). Second, we investigate whether the unadjusted association is attenuated on adjustment for child's, maternal and parental socioeconomic characteristics. Third, by adopting a within-family design which involves comparing children born to the same father at different ages, we additionally adjust for unobserved parental characteristics shared between siblings. Results The unadjusted results show that being born to a father aged 40+, as opposed to a father aged 30-34, is associated with an increased risk of LBW of 0.96% (95%CI 0.5% to 1.3%) and to a younger father (<25) with a 1% (95%CI 0.6% to 1.3%) increased risk. The increased risk at younger paternal ages is halved on adjustment for the child's characteristics and fully attenuated on adjustment for child/parental characteristics. The increased risk at paternal ages 40+ ispartially attenuated on adjustment for maternal characteristics (=0.62%; 95%CI 0.13% to 1.1%). Adjustment for unobserved parental characteristics shared by siblings further attenuates the 40+ coefficient (=0.4%; 95%CI -0.5% to -1.2%). Results for preterm delivery are similar. Conclusions The results underscore the importance of considering paternal age as a potential risk factor for adverse birth outcomes and of expanding research on its role and the mechanisms linking it to birth outcomes.

  • 32.
    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 1744-5124, Vol. 29, no 3, p. 464-484Article 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.

  • 33. Griswold, Max G.
    et al.
    Room, Robin
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Gakidou, Emmanuela
    Alcohol use and burden for 195 countries and territories, 1990-2016: a systematic analysis for the Global Burden of Disease Study 20162018In: The Lancet, ISSN 0140-6736, E-ISSN 1474-547X, Vol. 392, no 10152, p. 1015-1035Article in journal (Refereed)
    Abstract [en]

    Background

    Alcohol use is a leading risk factor for death and disability, but its overall association with health remains complex given the possible protective effects of moderate alcohol consumption on some conditions. With our comprehensive approach to health accounting within the Global Burden of Diseases, Injuries, and Risk Factors Study 2016, we generated improved estimates of alcohol use and alcohol-attributable deaths and disability-adjusted life-years (DALYs) for 195 locations from 1990 to 2016, for both sexes and for 5-year age groups between the ages of 15 years and 95 years and older.

    Methods

    Using 694 data sources of individual and population-level alcohol consumption, along with 592 prospective and retrospective studies on the risk of alcohol use, we produced estimates of the prevalence of current drinking, abstention, the distribution of alcohol consumption among current drinkers in standard drinks daily (defined as 10 g of pure ethyl alcohol), and alcohol-attributable deaths and DALYs. We made several methodological improvements compared with previous estimates: first, we adjusted alcohol sales estimates to take into account tourist and unrecorded consumption; second, we did a new meta-analysis of relative risks for 23 health outcomes associated with alcohol use; and third, we developed a new method to quantify the level of alcohol consumption that minimises the overall risk to individual health.

    Findings

    Globally, alcohol use was the seventh leading risk factor for both deaths and DALYs in 2016, accounting for 2·2% (95% uncertainty interval [UI] 1·5–3·0) of age-standardised female deaths and 6·8% (5·8–8·0) of age-standardised male deaths. Among the population aged 15–49 years, alcohol use was the leading risk factor globally in 2016, with 3·8% (95% UI 3·2–4·3) of female deaths and 12·2% (10·8–13·6) of male deaths attributable to alcohol use. For the population aged 15–49 years, female attributable DALYs were 2·3% (95% UI 2·0–2·6) and male attributable DALYs were 8·9% (7·8–9·9). The three leading causes of attributable deaths in this age group were tuberculosis (1·4% [95% UI 1·0–1·7] of total deaths), road injuries (1·2% [0·7–1·9]), and self-harm (1·1% [0·6–1·5]). For populations aged 50 years and older, cancers accounted for a large proportion of total alcohol-attributable deaths in 2016, constituting 27·1% (95% UI 21·2–33·3) of total alcohol-attributable female deaths and 18·9% (15·3–22·6) of male deaths. The level of alcohol consumption that minimised harm across health outcomes was zero (95% UI 0·0–0·8) standard drinks per week.

    Interpretation

    Alcohol use is a leading risk factor for global disease burden and causes substantial health loss. We found that the risk of all-cause mortality, and of cancers specifically, rises with increasing levels of consumption, and the level of consumption that minimises health loss is zero. These results suggest that alcohol control policies might need to be revised worldwide, refocusing on efforts to lower overall population-level consumption.

    Funding

    Bill & Melinda Gates Foundation.

  • 34. 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, Work and organizational 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.

  • 35.
    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.

  • 36.
    Hiyoshi, Ayako
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. Örebro University, Sweden.
    Kondo, Naoki
    Rostila, Mikael
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Increasing income-based inequality in suicide mortality among working-age women and men, Sweden, 1990-2007: is there a point of trend change?2018In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 72, no 11, p. 1009-1015Article in journal (Refereed)
    Abstract [en]

    Background Income inequalities have risen from the 1990s to 2000s, following the economic recession in 1994, but little research has investigated socioeconomic inequalities in suicide mortality for working-age men and women (aged between 30 and 64 years) over the time using longitudinal data in Sweden. Methods Using Swedish national register data between 1990 and 2007 as a series of repeated cohort studies with a 3-year follow-up (sample sizes were approximately 3.7 to 4.0million in each year), relative and slope indices of inequality (RII and SII respectively) based on quintiles of individual disposable income were calculated and tested for temporal trends. Results SII for the risk of suicide mortality ranged from 27.6 (95% CI 19.5 to 35.8) to 44.5 (36.3 to 52.6) in men and 5.2 (0.2 to 10.4) to 16.6 (10.7 to 22.4) in women (per 100000 population). In men, temporal trends in suicide inequalities were stable in SII but increasing in RII by 3% each year (p=0.002). In women, inequalities tended to increase in both RII and SII, especially after the late-1990s, with 10% increment in RII per year (p<0.001). Conclusions Despite universal social security and generous welfare provision, income inequalities in suicide were considerable and have widened, especially in women. The steeper rise in women may be partially related to higher job insecurity and poorer working conditions in the female dominated public sector after the recession. To reduce health consequences following an economic crisis and widened income inequalities, additional measures may be necessary in proportion to the levels of financial vulnerability.

  • 37.
    Hjern, Anders
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. Karolinska Institutet, Sweden.
    Health of refugee and migrant children: Technical guidance2018Report (Other academic)
    Abstract [en]

    Around one million asylum-seeking children were registered in the European Union(EU) during 2015–2017, of whom 200 000 (one in five) arrived unaccompanied by acaregiver. This technical guidance focuses on the initial response of the health careservices to the needs of these and other refugee and migrant children.All countries in the WHO European Region have signed and ratified the United Nation’sConvention on the Rights on the Child (CRC) and have agreed to the obligationscontained in this. This technical guidance identifies a number of areas where the healthsituation for migrant children would be improved if countries adhered more closely tothese obligations.Medical care for chronic disorders and rehabilitation for disabilities are often themost pressing needs of migrant children, with needs for dental care being the mostcommon. In addition, migrant children from low- and middle-income countries have ahigher burden of chronic infectious disorders compared with those from high-incomecountries, and these disorders need to be identified and treated. Lack of access topreventive health care in the countries of origin make vaccination programmes a highpriority to prevent outbreaks of measles and other vaccine-preventable disorders.To address mental health needs, a holistic and family-oriented public health strategyfor promoting mental health and psychological well-being is needed. This shouldinclude collaboration between many different sectors of society, with education inschools and pre-schools being particularly important. There is some evidence alsoto support the effectiveness of more specific interventions to promote well-being, forexample psychoeducational approaches to cope with psychological trauma, culturallysensitive parent-support programmes and interventions in the school environment.A general finding in the literature is that differences in health status between childrenin different migrant groups are greater than the differences between migrant childrenand local populations in Europe. Country of origin is an important predictor here, butalso the social background of the family in the country of origin and the living conditionsin the destination country. Consequently, health assessment/screening proceduresshould be individualized. A comprehensive individualized health assessment by apaediatric nurse or clinician, preferably as soon as possible after the child arrivesin the country of destination, can identify health care needs that might otherwisego undetected for prolonged periods of time. It also allows screening for potentiallycommunicable disorders and updating of vaccinations. Such an approach would savecosts by coordinating health care use in an informed manner. The provision of medicalinterpreters and cultural mediators is important to make care provision for migrantchildren more equitable with that for the host population.

    The evidence presented in this technical guidance is primarily based on observationalreports and theory, plus individual evaluative studies. This reflects the lack of evaluativeresearch of policy and specific interventions on how to facilitate health, well-beingand positive development in migrant children in Europe. There are large knowledgegaps in research regarding pathways to resilience and for assessing the impact ofspecific interventions that may be likely to be effective in improving outcomes. Longterm follow-up is required to evaluate interventions intended to enhance well-being,educational outcomes, employment and social inclusion. Close collaboration withpolicy-makers and key service providers is essential to ensure optimal translation offindings into sustainable practice.

  • 38.
    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.

  • 39.
    Honkaniemi, Helena
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Rostila, Mikael
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Kauppi, M.
    Virtanen, P.
    Lipiäinen, L.
    Pentti, J.
    Kivimäki, M.
    Vahtera, J.
    Trajectories of Antidepressant Use before and after the Loss of a Family Member: Evidence from the Finnish Public Sector Study2018In: Psychotherapy and Psychosomatics, ISSN 0033-3190, E-ISSN 1423-0348, Vol. 87, no 4, p. 246-248Article in journal (Refereed)
  • 40. Hu, Yaoyue
    et al.
    Leinonen, Taina
    University of Helsinki, Finland.
    Myrskylä, Mikko
    Martikainen, Pekka
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. University of Helsinki, Finland; Max Planck Institute for Demographic Research, Germany; Karolinska Institutet, Sweden.
    Changes in Socioeconomic Differences in Hospital Days With Age: Cumulative Disadvantage, Age-as-Leveler, or Both?2019In: The journals of gerontology. Series B, Psychological sciences and social sciences, ISSN 1079-5014, E-ISSN 1758-5368Article in journal (Refereed)
    Abstract [en]

    Objectives: Length of hospital stay is inversely associated with socioeconomic status (SES). It is less clear whether socioeconomic disparities in numbers of hospital days diverge or converge with age.

    Method: Longitudinal linked Finnish registry data (1988-2007) from 137,653 men and women aged 50-79 years at the end of 1987 were used. Trajectories of annual total hospital days by education, household income, and occupational class were estimated using negative binomial models.

    Results: Men and women with higher education, household income, and occupational class had fewer hospital days in 1988 than those with lower SES. Hospital days increased between 1988 and 2007. For some age groups, higher SES was associated with a faster annual rate of increase, resulting in narrowing rate ratios of hospital days between SES groups (relative differences); the rate ratios remained stable for other groups. Absolute SES differences in numbers of hospital days appeared to diverge with age among those aged 50-69 years at baseline, but converge among those aged 70-79 years at baseline.

    Discussion: The hypotheses that socioeconomic disparities in health diverge or converge with age may not be mutually exclusive; we demonstrated convergence/maintenance in relative differences for all age groups, but divergence or convergence in absolute differences depending on age.

  • 41. Jiang, Heng
    et al.
    Xiang, Xiaojun
    Hao, Wei
    Room, Robin
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. La Trobe University, Australia.
    Zhang, Xiaojie
    Wang, Xuyi
    Measuring and preventing alcohol use and related harm among young people in Asian countries: a thematic review2018In: Global health research and policy, ISSN 2397-0642, Vol. 3, article id 14Article in journal (Refereed)
    Abstract [en]

    Background: The paper reviews alcohol consumption patterns and alcohol-related social and health issues among 15-29-year old young people in Asian countries, and discusses strategies for preventing and controlling alcohol use and related harms.

    Methods: We searched Google Scholar, PubMed, and Web of Science for reports, reviews and journal articles published in English between 1st Jan 1990 and 31st August 2016.

    Results: Forty-one reports, reviews and journal papers were identified and included in the final review. The current drinking levels and prevalence among young people are markedly different between eight included Asian countries, ranging from 4.2% in Malaysia to 49.3% in China. In a majority of the selected Asian countries, over 15% of total deaths among young men and 6% among young women aged 15-29 years are attributable to alcohol use. Alcohol use among young people is associated with a number of harms, including stress, family violence, injuries, suicide, and sexual and other risky behaviours. Alcohol policies, such as controlling sales, social supply and marketing, setting up/raising a legal drinking age, adding health warning labels on alcohol containers, and developing a surveillance system to monitor drinking pattern and risky drinking behaviour, could be potential means to reduce harmful use of alcohol and related harm among young people in Asia.

    Conclusions: The review reveals that drinking patterns and behaviours vary across eight selected Asian countries due to culture, policies and regional variations. The research evidence holds substantial policy implications for harm reduction on alcohol drinking among young people in Asian countries -- especially for China, which has almost no alcohol control policies at present.

  • 42.
    Juárez, Sol
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Mussino, Eleonora
    Stockholm University, Faculty of Social Sciences, Department of Sociology.
    Hjern, Anders
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. Karolinska Institute, Sweden.
    Being a refugee or having a refugee status? Birthweight and gestational age outcomes among offspring of immigrant mothers in Sweden2018In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905Article in journal (Refereed)
  • 43.
    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.

  • 44.
    Juárez, Sol
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Small, Rhonda
    Hjern, Anders
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. Karolinska Institute, Sweden.
    Schytt, Erica
    Length of residence and caesarean section in migrant women in Sweden: A population-based study.2018In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 28, no 6, p. 1073-1079Article in journal (Refereed)
    Abstract [en]

    Background

    Prior studies have reported substantial differences in caesarean rates between migrant and non-migrant women. In this study we investigate whether the association between maternal country of birth and caesarean section is modified by length of residence in Sweden.

    Methods

    Population-based register study. A total of 106 760 migrant and 473 881 Swedish-born women having singleton, first births were studied using multinomial multiple regression models to estimate odds ratios (OR) and 95% confidence intervals for mode of birth. Random effect meta-analyses were conducted to assess true heterogeneity between categories of length of residence.

    Results

    Longer duration of residence was associated with an increased overall risk of both unplanned and planned caesarean section among migrant women. This pattern was more pronounced among countries grouped as having higher prevalence (compared to Swedes) of unplanned: OR≤1=1.41 (1.32–1.50); OR>1–<6=1.49 (1.42–1.57); OR6–<10=1.61 (1.50–1.72); OR≥10=1.71 (1.64–1.79) and planned caesarean section [OR≤1=1.14 (0.95–1.36); OR>1–<6=1.30 (1.13–1.51); OR6–<10=1.97 (1.64–2.37]; OR≥10=1.82 (1.67–1.98)]. The results were robust to social, obstetric and health adjustments. There were some country-of-origin-specific findings.

    Conclusions

    The fact that the risk of unplanned and planned caesarean section tended to increase with length of residence, even with adjustment for social, obstetric and health factors, suggests that receiving country-specific factors are playing an important role in caesarean section.

  • 45.
    Juárez, Sol
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Wagner, Philippe
    Merlo, Juan
    Applying measures of discriminatory accuracy to revisit traditional risk factors for being small for gestational age in Sweden: a national cross-sectional study2014In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 30, no 4, p. e005388-Article in journal (Refereed)
  • 46. 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.

  • 47.
    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.

  • 48.
    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.

  • 49. 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.

  • 50. Kataja, Kati
    et al.
    Törrönen, Jukka
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Hakkarainen, Pekka
    Tigerstedt, Christoffer
    A virtual academy of polydrug use: Masters, novices and the art of combinations2018In: Nordic Studies on Alcohol and Drugs, ISSN 1455-0725, E-ISSN 1458-6126, Vol. 35, no 6, p. 413-427Article in journal (Refereed)
    Abstract [en]

    Aims: Information technology has become an essential part of drug culture, providing a platformfor lay knowledge concerning drug use. Due to the co-effects of different substances, makingsubstance “combos” requires advanced skills to enhance pleasures and manage risks. In this study,we  focussed  on  Finnish  and  Swedish online  discussions  as  a  context  for  learning  and  sharing experiences of combining substances. Methods: Taking influences from positioning theory, weused qualitative methods to map what kinds of mutual interactive positions related to the expertisein polydrug use online discussants take and how these positions are negotiated and reformulated inthe online setting. We reflect these results through Howard S. Becker’s theory of social learning, according to which becoming a drug user is a process that occurs in interaction with other users, asthe beginners need a model and advice from experienced users in order to claim their place in theusers’ community.Results:In online forums, users discuss the risks and pleasures of combiningdrugs – on the one hand, in relation to different situations and, on the other hand, in relation todifferent competence positions. This occurs by asking for advice, presenting one’s knowledge challenging others, repositioning oneself, defending one’s position or proving one’s competence. Conclusion: Online discussion forums constitute a kind of virtual academy where knowledge ofthe pleasures and risks of combining substances is produced and circulated, and where experienced masters mediate their expertise to less experienced novices.

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