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  • 1. Airaksinen, Jaakko
    et al.
    Aaltonen, Mikko
    Tarkiainen, Lasse
    Martikainen, Pekka
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Latvala, Antti
    Associations Between Cohabitation, Marriage, and Suspected Crime: a Longitudinal Within-Individual Study2023In: Journal of developmental and life course criminology, ISSN 2199-4641, Vol. 9, no 1, p. 54-70Article in journal (Refereed)
    Abstract [en]

    The effects of marriage on criminal behavior have been studied extensively. As marriages today are typically preceded by cohabiting relationships, there is a growing need to clarify how different relationship types are associated with criminality, and how these effects may be modified by relationship duration, partner's criminality, and crime type. We used Finnish longitudinal register data and between- and within-individual analyses to examine how cohabitation and marriage were associated with suspected crime. The data included 638,118 residents of Finland aged 0-14 in 2000 and followed for 17 years for a suspected crime: having been suspected of violent, drug, or any crime. Between-individual analyses suggested that those who were cohabiting or married had a 40-65% lower risk of being suspected of a crime compared to those who were single, depending on the type of crime. The within-individual analysis showed a 25-50% lower risk for suspected crime when people were cohabiting or married compared to time periods when they were single. Those in a relationship with a criminal partner had 11 times higher risk for suspected crime than those in a relationship with a non-criminal partner. Forming a cohabiting relationship with a non-criminal partner was associated with reduced criminality. The risk reduction was not fully explained by selection effects due to between-individual differences. Marriage did not introduce further reduction to criminality. Our findings demonstrate that selection effects partly explain the association between relationship status and criminality but are also compatible with a causal effect of cohabitation on reduced risk of being suspected of a crime.

  • 2. Airaksinen, Jaakko
    et al.
    Aaltonen, Mikko
    Tarkiainen, Lasse
    Martikainen, Pekka
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS). University of Helsinki, Finland; Max-Planck-Institute for Demographic Research, Germany.
    Latvala, Antti
    Associations of neighborhood disadvantage and offender concentration with criminal behavior: Between-within analysis in Finnish registry data2021In: Journal of criminal justice, ISSN 0047-2352, E-ISSN 1873-6203, Vol. 74, article id 101813Article in journal (Refereed)
    Abstract [en]

    The association between neighborhood disadvantage and crime has been extensively studied, but most studies have relied on cross-sectional data and have been unable to separate potential effects of the neighborhood from selection effects. We examined how neighborhood disadvantage and offender concentration are associated with criminal behavior while accounting for selection effects due to unobserved time-invariant characteristics of the individuals. We used a registry-based longitudinal dataset that included all children aged 0-14 living in Finland at the end of year 2000 with follow-up until the end of 2017 for criminal offences committed at ages 18-31 years (n = 510,189). Using multilevel logistic regression with a between-within approach we examined whether neighborhoods differed in criminal behavior and whether within-individual changes in neighborhood disadvantage and offender concentration were associated with within-individual changes in criminal behavior. Our results indicated strong associations of most measures of neighborhood disadvantage and offender concentration with criminal behavior between individuals. The within-individual estimates accounting for selection related to unobserved individual characteristics were mostly non-significant with the exception of higher neighborhood disadvantage being associated with increased risk for violent crimes. Our findings suggest that criminal behavior is better explained by individual characteristics than by causal effects of neighborhoods.

  • 3. Alaie, Iman
    et al.
    Brolin Låftman, Sara
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Jonsson, Ulf
    Bohman, Hannes
    Parent-youth conflict as a predictor of depression in adulthood: a 15-year follow-up of a community-based cohort2020In: European Child and Adolescent Psychiatry, ISSN 1018-8827, E-ISSN 1435-165X, Vol. 29, no 4, p. 527-536Article in journal (Refereed)
    Abstract [en]

    Experiencing conflictual relations with one's parents while growing up has been linked to onset, recurrence, and worse treatment outcome of adolescent depression. While this suggests that significant problems in the parent-youth relationship make depressive disorders more relentless, it is not clear whether this effect lasts into adulthood. Our aim was to examine if major and minor conflict with parents while growing up predicts depression in adulthood in youth with and without a history of depression. We utilized data from the Uppsala Longitudinal Adolescent Depression Study. This community-based cohort was assessed with structured diagnostic interviews both at age 16-17 and at follow-up 15 years later. The analyses included 382 individuals (227 with a history of child or adolescent depression; 155 peers without such a history). Binary logistic regression was used, adjusting for sex, disruptive behavior disorders, and additional family-related adversities. Among individuals with adolescent depression, major conflict with parents was strongly associated with adult depression (adjusted OR 2.28, 95% CI 1.07-4.87). While major conflict with parents was rare among non-depressed controls, a non-significant association of similar magnitude was still observed. Minor conflict, on the other hand, was not significantly associated with adult depression. Overall, conflict with parents did not predict adult anxiety disorders, substance use, suicidal behavior, somatoform disorders, or psychotic disorders. In conclusion, major parent-youth conflict during upbringing seems to be linked with an increased risk of depression in adulthood. These findings underscore the need to consider contextual/familial factors in the prevention and clinical management of early-life depression.

  • 4.
    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, Centre for Health Equity Studies (CHESS).
    Bohman, Hannes
    Poor Family Relationships in Adolescence and the Risk of Premature Death: Findings from the Stockholm Birth Cohort Study2019In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 16, no 10, article id 1690Article in journal (Refereed)
    Abstract [en]

    Poor family relationships during childhood have been shown to have long-term negative effects on an offspring’s health. However, few studies have followed the offspring to retirement age, and relatedly, knowledge about the link between poor family relationships and premature death is scarce. The aim of this study was to examine the association between poor family relationships in adolescence and the risk of premature death, even when considering other adverse childhood conditions. Prospective data from the Stockholm Birth Cohort study were used, with 2636 individuals born in 1953 who were followed up until age 65. Information on family relations was based on interviews with the participants’ mothers in 1968. Information on mortality was retrieved from administrative register data from 1969–2018. Cox proportional hazards regressions showed that poor family relationships in adolescence were associated with an increased risk of premature death, even when adjusting for childhood conditions in terms of household social class, household economic poverty, contact with the child services, parental alcohol abuse, and parental mental illness (Hazard Ratio (HR), 2.08, 95% Confidence Interval (CI), 1.40–3.09). The findings show that poor family relationships in adolescence can have severe and long-lasting health consequences, highlighting the importance of early interventions.

  • 5.
    Alm, Susanne
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Criminology.
    Brolin Låftman, Sara
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Bohman, Hannes
    Poor family relationships in adolescence as a risk factor of in-patient somatic care across the life course: Findings from a 1953 cohort2021In: SSM - Population Health, ISSN 2352-8273, Vol. 14, article id 100807Article in journal (Refereed)
    Abstract [en]

    Background: Prior research has shown that poor family relations during upbringing have long-term detrimental effects on mental health. Few previous studies have, however, focused on somatic health outcomes and studies rarely cover the life span until retirement age. The aims of the current study were, firstly, to examine the association between poor family relationships in adolescence and in-patient somatic care across the life course whilst adjusting for confounders at baseline and concurrent psychiatric in-patient care; and secondly, to compare the risks of somatic and psychiatric in-patient care across the life course.

    Methods: Prospective data from the Stockholm Birth Cohort study were used, with 2636 participants born in 1953 who were followed up until 2016. Information on family relationships was collected from the participants' mothers in 1968. Annual information on in-patient somatic and psychiatric care was retrieved from official register data from 1969 to 2016.

    Results: Poisson regressions showed that poor family relationships in adolescence were associated with an increased risk of in-patient somatic care in mid- and especially in late adulthood (ages 44-53 and 54-63 years), even when controlling for the co-occurrence of psychiatric illness and a range of childhood conditions. No statistically significant association was observed in early adulthood (ages 16-43 years), when controlling for confounders. These findings are in sharp contrast to the analyses of inpatient psychiatric care, according to which the association with poor family relations was strongest in early adulthood and thereafter attenuated across the life course.

    Conclusion: Poor family relationships in adolescence are associated with an increased risk of severe consequences for somatic health lasting to late adulthood even when controlling for confounders including in-patient psychiatric care, emphasising the potentially important role of early interventions.

  • 6.
    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, Centre for Health Equity Studies (CHESS).
    Sivertsson, Fredrik
    Stockholm University, Faculty of Social Sciences, Department of Criminology.
    Bohman, Hannes
    Poor family relationships in adolescence as a risk factor of in-patient psychiatric care across the life course: A prospective cohort study2020In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 48, no 7, p. 726-732Article in journal (Refereed)
    Abstract [en]

    Background: Previous research has shown that poor family relations in childhood are associated with adverse mental health in adulthood. Yet, few studies have followed the offspring until late adulthood, and very few have had access to register-based data on hospitalisation due to psychiatric illness. The aim of this study was to examine the association between poor family relations in adolescence and the likelihood of in-patient psychiatric care across the life course up until age 55. Methods: Data were derived from the Stockholm Birth Cohort study, with information on 2638 individuals born in 1953. Information on family relations was based on interviews with the participants' mothers in 1968. Information on in-patient psychiatric treatment was derived from administrative registers from 1969 to 2008. Binary logistic regression was used. Results: Poor family relations in adolescence were associated with an increased risk of later in-patient treatment for a psychiatric diagnosis, even when adjusting for other adverse conditions in childhood. Further analyses showed that poor family relations in adolescence were a statistically significant predictor of in-patient psychiatric care up until age 36-45, but that the strength of the association attenuated over time. Conclusions: Poor family relationships during upbringing can have serious negative mental-health consequences that persist into mid-adulthood. However, the effect of poor family relations seems to abate with age. The findings point to the importance of effective interventions in families experiencing poor relationships.

  • 7.
    Almquist, Ylva B.
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Brännström, Lars
    Stockholm University, Faculty of Social Sciences, Department of Social Work.
    Do trajectories of economic, work- and health-related disadvantages explain child welfare clients’ increased mortality risk? A prospective cohort study2019In: BMC Public Health, E-ISSN 1471-2458, Vol. 19, article id 418Article in journal (Refereed)
    Abstract [en]

    Background

    Past research has shown that individuals who have had experiences of out-of-home care (OHC) in childhood have increased risks of premature mortality. Prior studies also suggest that these individuals are more likely to follow long-term trajectories that are characterised by economic, work-, and health-related disadvantages, compared to majority population peers. Yet, we do not know the extent to which such trajectories may explain their elevated mortality risks. The aim of this study is therefore to examine whether trajectories of economic, work-, and health-related disadvantages in midlife mediate the association between OHC experience in childhood and subsequent all-cause mortality.

    Methods

    Utilising longitudinal Swedish data from a 1953 cohort (n = 14,294), followed from birth up until 2008 (age 55), this study applies gender-specific logistic regression analysis to analyse the association between OHC experience in childhood (ages 0–19; 1953–1972) and all-cause mortality (ages 47–55; 2000–2008). A decomposition method developed for non-linear regression models is used to estimate mediation by trajectories of economic, work-, and health-related disadvantages (ages 39–46; 1992–1999), as indicated by social welfare receipt, unemployment, and mental health problems. To account for selection processes underlying placement in OHC, an alternative comparison group of children who were investigated by the child welfare committee but not placed, is included.

    Results

    The results confirm that individuals with experience of OHC have more than a two-fold increased risk of all-cause mortality, for men (OR: 2.10, 95% CI: 1.42–3.11) and women (OR: 2.23, 95% CI: 1.39–3.59) alike. Approximately one-third (31.1%) of the association among men, and one-fourth (27.4%) of the association among women, is mediated by the long-term trajectories of economic, work-, and health-related disadvantages. The group who were investigated but not placed shows similar, yet overall weaker, associations.

    Conclusions

    Individuals who come to the attention of the child welfare services, regardless of whether they are placed in out-of-home care or not, continue to be at risk of adverse outcomes across the life course. Preventing them from following trajectories of economic, work-, and health-related disadvantages could potentially reduce their risk of premature death.

  • 8.
    Almquist, Ylva B.
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Rojas, Yerko
    Vinnerljung, Bo
    Stockholm University, Faculty of Social Sciences, Department of Social Work.
    Brännström, Lars
    Stockholm University, Faculty of Social Sciences, Department of Social Work.
    Association of Child Placement in Out-of-Home Care With Trajectories of Hospitalization Because of Suicide Attempts From Early to Late Adulthood2020In: JAMA Network Open, E-ISSN 2574-3805, Vol. 3, no 6Article in journal (Refereed)
    Abstract [en]

    Importance Children placed in out-of-home care (OHC) have higher rates of suicidal behaviors, including suicide attempts, compared with those who grow up in their family of origin. Several studies have shown that this elevated risk persists into young adulthood. Yet, our knowledge about any longer-term associations of OHC with suicide attempts is limited. Objective To examine how childhood experiences of placement in OHC are associated with trajectories of hospitalization because of suicide attempts (HSA) from early into late adulthood. Design, Setting, and Participants This prospective birth cohort study that was conducted in Stockholm, Sweden, and analyzed in March 2020 included 14559 individuals born in 1953 who were living in the greater metropolitan of Stockholm in November 1963 and followed through registers up until December 2016. Exposures Childhood experiences of OHC based on information from the Social Register (age 0-19 years). Main Outcomes and Measures Hospitalization because of suicide attempts based on in-patient care data from the National Patient Register. Group-based trajectory modeling was used to cluster individuals according to their probabilities of HSA across adulthood (age 20-63 years). Results In this cohort of 14559 individuals (7146 women [49.1%]), 1320 individuals (9.1%) had childhood experiences of OHC, whereas 525 individuals ( 3.6%) had HSA. A Cox regression analysis showed a substantially higher risk of HSA among those with childhood experiences of OHC (hazard ratio, 3.58; 95% CI, 2.93-4.36) and after adjusting for a range of adverse childhood living conditions (hazard ratio, 2.51; 95% CI, 2.00-3.15). Those with at least 1 HSA were grouped into 4 trajectories: (1) peak in middle adulthood (66 [12.6%]), (2) stable low across adulthood (167 [31.8%]), (3) peak in early adulthood (210 [40.0%]), and (4) peak in emerging adulthood (82 [15.6%]). A multinomial regression analysis suggested that those with experiences of OHC had higher risks of following any of these trajectories (trajectory 1: relative risk ratio [RRR], 2.91; 95% CI, 1.61-5.26; trajectory 2: RRR, 3.18; 95% CI, 2.21-4.59; trajectory 3: RRR, 4.32; 95% CI, 3.18-5.86; trajectory 4: RRR, 3.26; 95% CI, 1.94-5.46). The estimates were reduced after adjusting for adverse childhood living conditions. Conclusions and Relevance The findings suggest that the elevated risk of suicide attempts among former child welfare clients does not cease after young adulthood, indicating the necessity for clinical attention to childhood experiences of OHC as a risk marker for suicidal behavior across the life span. Question How are childhood experiences of placement in out-of-home care associated with trajectories of hospitalization because of suicide attempts from early into late adulthood? Findings In this cohort study of 14559 individuals, individuals were grouped into 4 trajectories with differential onset of suicide attempts across adulthood. Childhood experiences of placement in out-of-home care were associated with increased risks of following each of these trajectories. Meaning The elevated risk of suicide attempts among former child welfare clients persists into young adulthood, indicating the necessity for clinical attention to childhood experiences of out-of-home care as a risk marker for suicidal behavior across the life span. This cohort study examines the association between childhood experiences of placement in out-of-home care and trajectories of hospitalization because of suicide attempts from early into late adulthood in Sweden.

  • 9.
    Almquist, Ylva B
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Östberg, Viveca
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Modin, Bitte
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Is there a peer status gradient in mortality? Findings from a Swedish cohort born in 1953 and followed to age 672023In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 33, no 2, p. 184-189Article in journal (Refereed)
    Abstract [en]

    Background Similar to having a less advantaged socioeconomic position, children in lower peer status positions typically experience a situation characterized by less power, influence and command over resources, followed by worse health outcomes. The aim of this study was to examine whether peer status position is further associated with increased risks for premature all-cause mortality. Methods Data were drawn from a 1953 cohort born in Stockholm, Sweden. Peer status positions were established through survey data on peer nominations within the school class at age 13, whereas national registers were used to identify all-cause mortality across ages 14-67. Differences in hazard rates and median survival time, according to peer status position, were estimated with Cox regression and Laplace regression, respectively. Results Although differences in hazard rates were not large, they were consistent and clear, also after taking childhood socioeconomic status into account. Regarding median survival time, the number of years lost increased gradually as peer status decreased, with a difference of almost 6 years when comparing individuals in the lowest and highest positions. Conclusions Children's positions in the peer status hierarchy play a role for their chances of health and survival, pointing to the relevance of addressing opportunities for positive peer interaction and mitigating any adverse consequences that may stem from negative experiences within the peer context.

  • 10.
    Aradhya, Siddartha
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Sociology. Lund University, Sweden.
    Katikireddi, Srinivasa Vittal
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS). University of Glasgow, Glasgow, UK.
    Juárez, Sol Pia
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Immigrant ancestry and birthweight across two generations born in Sweden: an intergenerational cohort study2022In: BMJ Global Health, E-ISSN 2059-7908, Vol. 7, no 4, article id e007341Article in journal (Refereed)
    Abstract [en]

    Introduction Differences in birthweight are often seen between migrants and natives. However, whether migrant-native birthweight inequalities widen, narrow or remain persistent across generations when comparing the descendants of immigrants and natives remains understudied. We examined inequalities in birthweight of mothers (G2) and daughters (G3) of foreign-born grandmothers (G1) compared with those of Swedish-born grandmothers.

    Methods We used population registers with multigenerational linkages to identify 314 415 daughters born in Sweden during the period 1989–2012 (G3), linked to 246 642 mothers (G2) born in Sweden during 1973–1996, and to their grandmothers (G1) who were Swedish or foreign-born. We classified migrants into non-western, Eastern European, the rest of Nordic and Western. We used multivariable methods to examine mean birthweight and low birthweight (<2500 g; LBW).

    Results Birthweight between individuals with Swedish background (G1) and non-western groups increased from -80 g to -147 g between G2 (mothers) and G3 (daughters), respectively. Furthermore, the odds of LBW increased among the G3 non-western immigrants compared with those with Swedish grandmothers (OR: 1.38, 95% CI 1.12 to 1.69). Birthweight increased in both descendants of Swedes and non-western immigrants, but less so in the latter (83 g vs 16 g).

    Conclusion We observed an increase in birthweight inequalities across generations between descendants of non-western immigrants and descendants of Swedes. This finding is puzzling considering Sweden has been lauded for its humanitarian approach to migration, for being one of the most egalitarian countries in the world and providing universal access to healthcare and education.

  • 11.
    Arat, Arzu
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS). Karolinska Institute, Sweden.
    Norredam, Marie
    Baum, Ulrike
    Jónsson, Stefán Hrafn
    Gunlaugsson, Geir
    Wallby, Thomas
    Hjern, Anders
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS). Karolinska Institute, Sweden; Sachsska Children’s Hospital, Sweden.
    Organisation of preventive child health services: Key to socio-economic equity in vaccine uptake?2020In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 48, no 5, p. 491-494Article in journal (Refereed)
    Abstract [en]

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

  • 12. Arpin, Emmanuelle
    et al.
    Gauffin, Karl
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Kerr, Meghan
    Hjern, Anders
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS). Karolinska Institutet, Sweden.
    Mashford-Pringle, Angela
    Barros, Aluisio
    Rajmil, Luis
    Choonara, Imti
    Spencer, Nicholas
    Climate Change and Child Health Inequality: A Review of Reviews2021In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 18, no 20, article id 10896Article, review/survey (Refereed)
    Abstract [en]

    There is growing evidence on the observed and expected consequences of climate change on population health worldwide. There is limited understanding of its consequences for child health inequalities, between and within countries. To examine these consequences and categorize the state of knowledge in this area, we conducted a review of reviews indexed in five databases (Medline, Embase, Web of Science, PsycInfo, Sociological Abstracts). Reviews that reported the effect of climate change on child health inequalities between low- and high-income children, within or between countries (high- vs low–middle-income countries; HICs and LMICs), were included. Twenty-three reviews, published between 2007 and January 2021, were included for full-text analyses. Using thematic synthesis, we identified strong descriptive, but limited quantitative, evidence that climate change exacerbates child health inequalities. Explanatory mechanisms relating climate change to child health inequalities were proposed in some reviews; for example, children in LMICs are more susceptible to the consequences of climate change than children in HICs due to limited structural and economic resources. Geographic and intergenerational inequalities emerged as additional themes from the review. Further research with an equity focus should address the effects of climate change on adolescents/youth, mental health and inequalities within countries.

  • 13. Axelsson Fisk, Sten
    et al.
    Alex-Petersen, Jesper
    Rostila, Mikael
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS). Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Liu, Can
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Juárez, Sol Pia
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Social inequalities in the risk of giving birth to a small for gestational age child in Sweden 2010–16: a cross-sectional study adopting an intersectional approach 2024In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 34, no 1, p. 22-28Article in journal (Refereed)
    Abstract [en]

    Background: Well-established associations exist between the risk of small for gestational age (SGA) and unidimensional sociodemographic factors. We investigated social inequalities in SGA risk and adopted an intersectional approach that simultaneously considers different social categories. By doing so, we could assess heterogeneities in SGA risk within unidimensional sociodemographic categories.

    Methods: We included all live 679 694 singleton births in Sweden between 2010 and 2016. The outcome was SGA, and the exposures were age, maternal educational level, dichotomous migration status and civil status. Thirty-six possible combinations of these factors constituted the exposure in an intersectional model. We present odds ratios (ORs) with 95% confidence intervals (95% CIs) and the area under the receiver operating characteristic curve (AUC)—a measurement of discriminatory accuracy (i.e. the ability to discriminate the babies born SGA from those who are not).

    Results: Women with low education and women born outside Sweden had ORs of 1.46 (95% CI 1.38–1.54) and 1.50 (95% CI 1.43–1.56) in unidimensional analyses, respectively. Among women aged under 25 with low education who were born outside Sweden and unmarried, the highest OR was 3.06 (2.59–3.63). The discriminatory accuracy was low for both the unidimensional model that included all sociodemographic factors (AUC 0. 563) and the intersectional model (AUC 0.571).

    Conclusions: The intersectional approach revealed a complex sociodemographic pattern of SGA risk. Sociodemographic factors have a low accuracy in identifying SGA at the individual level, even when quantifying their multi-dimensional intersections. This cautions against interventions targeted to individuals belonging to socially defined groups to reduce social inequalities in SGA risk.

  • 14.
    B. Almquist, Ylva
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Bishop, Lauren
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Gustafsson, Nina-Katri
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Berg, Lisa
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Intergenerational transmission of alcohol misuse: mediation and interaction by school performance in a Swedish birth cohort2020In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 74, no 7, p. 598-604Article in journal (Refereed)
    Abstract [en]

    Background Children whose parents misuse alcohol have increased risks of own alcohol misuse in adulthood. Though most attain lower school marks, some still perform well in school, which could be an indicator of resilience with protective potential against negative health outcomes. Accordingly, the aim of this study was to examine the processes of mediation and interaction by school performance regarding the intergenerational transmission of alcohol misuse.

    Methods Data were drawn from a prospective Swedish cohort study of children born in 1953 (n=14 608). Associations between parental alcohol misuse (ages 0–19) and participants' own alcohol misuse in adulthood (ages 20–63) were examined by means of Cox regression analysis. Four-way decomposition was used to explore mediation and interaction by school performance in grade 6 (age 13), grade 9 (age 16) and grade 12 (age 19).

    Results Mediation and/or interaction by school performance accounted for a substantial proportion of the association between parental alcohol misuse and own alcohol misuse in adulthood (58% for performance in grade 6, 27% for grade 9 and 30% for grade 12). Moreover, interaction effects appeared to be more important for the outcome than mediation.

    Conclusion Above-average school performance among children whose parents misused alcohol seems to reflect processes of resilience with the potential to break the intergenerational transmission of alcohol misuse. Four-way decomposition offers a viable approach to disentangle processes of interaction from mediation, representing a promising avenue for future longitudinal research.

  • 15.
    B. Almquist, Ylva
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Grotta, Alessandra
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Vågerö, Denny
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Stenberg, Sten-Åke
    Stockholm University, Faculty of Social Sciences, The Swedish Institute for Social Research (SOFI).
    Modin, Bitte
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Cohort Profile Update: The Stockholm Birth Cohort Study2020In: International Journal of Epidemiology, ISSN 0300-5771, E-ISSN 1464-3685, Vol. 49, no 2, p. 367-367eArticle in journal (Refereed)
  • 16. Barmpas, Petros
    et al.
    Tasoulis, Sotiris
    Vrahatis, Aristidis G.
    Georgakopoulos, Spiros V.
    Anagnostou, Panagiotis
    Prina, Matthew
    Ayuso-Mateos, José Luis
    Bickenbach, Jerome
    Bayes, Ivet
    Bobak, Martin
    Caballero, Francisco Félix
    Chatterji, Somnath
    Egea-Cortés, Laia
    García-Esquinas, Esther
    Leonardi, Matilde
    Koskinen, Seppo
    Koupil, Ilona
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS). Karolinska Institutet, Sweden.
    Paja̧k, Andrzej
    Prince, Martin
    Sanderson, Warren
    Scherbov, Sergei
    Tamosiunas, Abdonas
    Galas, Aleksander
    Haro, Josep Maria
    Sanchez-Niubo, Albert
    Plagianakos, Vassilis P.
    Panagiotakos, Demosthenes
    A divisive hierarchical clustering methodology for enhancing the ensemble prediction power in large scale population studies: the ATHLOS project2022In: Health Information Science and Systems, E-ISSN 2047-2501, Vol. 10, no 1, article id 6Article in journal (Refereed)
    Abstract [en]

    The ATHLOS cohort is composed of several harmonized datasets of international groups related to health and aging. As a result, the Healthy Aging index has been constructed based on a selection of variables from 16 individual studies. In this paper, we consider additional variables found in ATHLOS and investigate their utilization for predicting the Healthy Aging index. For this purpose, motivated by the volume and diversity of the dataset, we focus our attention upon data clustering, where unsupervised learning is utilized to enhance prediction power. Thus we show the predictive utility of exploiting hidden data structures. In addition, we demonstrate that imposed computation bottlenecks can be surpassed when using appropriate hierarchical clustering, within a clustering for ensemble classification scheme, while retaining prediction benefits. We propose a complete methodology that is evaluated against baseline methods and the original concept. The results are very encouraging suggesting further developments in this direction along with applications in tasks with similar characteristics. A straightforward open source implementation for the R project is also provided (https://github.com/Petros-Barmpas/HCEP).

  • 17.
    Berg, Lisa
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS). Stockholm University, Faculty of Social Sciences, The Swedish Institute for Social Research (SOFI).
    Posttraumatisk stress hos flyktingföräldrar och konsekvenser för barnen2019In: Barn, migration och integration i en utmanande tid / [ed] Karin Helander; Pernilla Leviner , Stockholm: Ragulka Press , 2019Chapter in book (Other (popular science, discussion, etc.))
  • 18.
    Berg, Lisa
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Brendler-Lindquist, Monica
    de Montgomery, Edith
    Mittendorfer-Rutz, Ellenor
    Hjern, Anders
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. Karolinska Institutet, Sweden.
    Parental Posttraumatic Stress and School Performance in Refugee Children2022In: Journal of Traumatic Stress, ISSN 0894-9867, E-ISSN 1573-6598, Vol. 35, no 1, p. 138-147Article in journal (Refereed)
    Abstract [en]

    Refugee children in the Nordic countries have been reported to perform poorly in school and carry a high burden of familial posttraumatic stress. The present study aimed to investigate the impact of maternal and paternal posttraumatic stress on the school performance of refugee children. We used national register data on school grades at age 15-16 along with demographic and migration indicators during 2011-2017 in a population of 18,831 children in refugee families in Stockholm County, Sweden. Parental posttraumatic stress was identified in regional data from three levels of care, including a tertiary treatment center for victims of torture and war. Multivariable linear and logistic regression models were fitted to analyze (a) mean grade point averages as Z scores and (b) eligibility for upper secondary school. In fully adjusted models, children exposed to paternal posttraumatic stress had a lower mean grade point average, SD = -0.14, 95% CI [-0.22, -0.07], and higher odds of not being eligible for upper secondary education, OR = 1.37, 95% CI [1.14, 1.65]. Maternal posttraumatic stress had a similar crude effect on school performance, SD = -0.15, 95% CI [-0.22, -0.07], OR = 1.25, 95% CI [1.00, 1.55], which was attenuated after adjusting for single-parent households and the use of child psychiatric services. The effects were similar for boys and girls as well as for different levels of care. Parental posttraumatic stress had a small negative effect on school performance in refugee children, adding to the intergenerational consequences of psychological trauma.

  • 19.
    Berg, Lisa
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Charboti, Susanna
    Montgomery, Edith
    Hjern, Anders
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS). Karolinska Institutet, Sweden.
    Parental PTSD and school performance in 16-year-olds – a Swedish national cohort study2019In: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 73, no 4-5, p. 264-272Article in journal (Refereed)
    Abstract [en]

    Aim: Posttraumatic stress disorder (PTSD) in parents can have severe consequences also for their children. Prevalence of PTSD is high among refugees. Refugee children have been reported to perform poorly in school. The aim of this study was to investigate the impact of PTSD in refugee and native Swedish parents on children’s school performance and to compare the impact of PTSD with that of other major psychiatric disorders.

    Methods: Register study where multiple regression models were used to analyse school performance in 15–16-year-olds in a national cohort (n = 703,813). PTSD and other major psychiatric disorders (bipolar, depression and/or psychotic disorders) were identified from out- and in-patient hospital care.

    Results: Maternal and paternal PTSD were associated with lower grades, with adjusted effects of 0.30–0.37 SD in refugee and 0.46–0.50 SD in native Swedish families. Impact of PTSD was greater than that of other psychiatric disorders and comorbidity to PTSD did not increase this impact. Although the impact of PTSD on grades was greater in children in native Swedish families, consequences with regard to eligibility to secondary education were greater for children in refugee families, where 35% of these children were ineligible.

    Conclusions: Parental PTSD has major consequences for children’s school performance and contributes to the lower school performance in children in refugee families in Sweden. Identification and treatment of PTSD in refugee parents is important for offspring educational achievement. Psychiatric clinics and treatment centres need to have a strategy for support, including educational support, to the offspring of their patients with PTSD.

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  • 20.
    Berg, Lisa
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    de Montgomery, Edith
    Brendler-Lindquist, Monica
    Mittendorfer-Rutz, Ellenor
    Hjern, Anders
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS). Karolinska Institutet, Sweden.
    Parental post-traumatic stress and psychiatric care utilisation among refugee adolescents2022In: European Child and Adolescent Psychiatry, ISSN 1018-8827, E-ISSN 1435-165X, Vol. 31, no 12, p. 1953-1962Article in journal (Refereed)
    Abstract [en]

    Parental psychiatric morbidity related to experiences of war and trauma has been associated with adverse psychological outcomes for children. The aim of this study was to investigate parental post-traumatic stress in relation to psychiatric care utilization among children of refugees with particular attention on the child's own refugee status, sex of both child and parents, and specific psychiatric diagnoses. This was a register study in a population of 16 143 adolescents from refugee families in Stockholm County born 1995-2000 and followed between 2011 and 2017 (11-18 years old). Parental post-traumatic stress, identified in three levels of care, was analysed in relation to child and adolescent psychiatric care use. Cox regression analysis was used to estimate hazard ratios (HR) and 95% confidence intervals (CI), adjusted for duration of residence and demographic and socioeconomic variables. Having a mother with post-traumatic stress was associated with higher psychiatric care utilization, with adjusted HR 2.44 (95% CI 1.90-3.14) among foreign-born refugee children and HR 1.77 (1.33-2.36) among Swedish-born children with refugee parents, with particularly high risks for children with less than five years of residence (HR 4.03; 2.29-7.10) and for diagnoses of anxiety and depression (HR 2.71; 2.11-3.48). Having a father with post-traumatic stress was not associated with increased HRs of psychiatric care utilization. Similar results were seen for boys and girls. Treatment for post-traumatic stress should be made available in refugee reception programmes. These programmes should use a family approach that targets both parents and children.

  • 21.
    Berg, Lisa
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Gustafsson, Nina-Katri
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Honkaniemi, Helena
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Juarez, Sol Pia
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Health risk behaviours among migrants by duration of residence: protocol for a systematic review and meta-analysis2020In: BMJ Open, E-ISSN 2044-6055, Vol. 10, no 10, article id e038388Article, review/survey (Refereed)
    Abstract [en]

    Introduction International migrants’ health has often been found to deteriorate in new countries, partly due to changes in health risk behaviours such as alcohol consumption, tobacco use, physical inactivity, and poor dietary habits. However, limited efforts have been made to comprehensively evaluate the extent to which migrants adopt unhealthy risk behaviours with longer duration of residence. This systematic review and meta-analysis will summarise evidence on international migrants’ behavioural patterns by duration of residence in multiple country contexts.

    Methods and analysis PubMed/MEDLINE, Web of Science and ProQuest databases will be searched for quantitative or mixed-method observational studies published in peer-reviewed scientific journals between 1 January 2000 and 31 December 2019. Studies comparing foreign-born individuals by duration of residence will be included. Information on study characteristics, descriptive statistics and measures of effect will be extracted. All included studies will be quality assessed using a modified Newcastle-Ottawa scale. The review will include narrative synthesis and, if sufficient and comparable data are available, random effects meta-analyses. The review will be conducted in compliance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

    Ethics and dissemination Ethical approval is not required since previously published information from peer-reviewed studies will be assessed. The results of this review will be published in peer-reviewed journals and presented at scientific conferences. Other forms of dissemination will include communication to broader audiences using well-established channels, including through university-based press releases. Progress will be regularly updated on the International Prospective Register of Systematic Reviews to ensure full transparency.

  • 22.
    Berg, Lisa
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Rostila, Mikael
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Arat, Arzu
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. Karolinska Institute, Sweden.
    Hjern, Anders
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS). Karolinska Institutet, Sweden.
    Parental death during childhood and violent crime in late adolescence to early adulthood: a Swedish national cohort study2019In: Palgrave Communications, ISSN 2055-1045, Vol. 5, article id 74Article in journal (Refereed)
    Abstract [en]

    Childhood parental death has been associated with adverse health, social and educational outcomes. Studies on long-term outcomes are in general scarce and there is little evidence on the long-term impact on anti-social behaviour. This study takes advantage of high-quality register data to investigate risk of violent crime in relation to childhood parental death in a large national cohort covering the entire Swedish population born in 1983–1993 (n = 1,103,656). The impact of parental death from external (suicides, accidents, homicides) and natural causes on risk for violent crime from age 15 to 20–30 years, considering multiple aspects of the rearing environment (including parental psychiatric disorders and criminal offending), was estimated through Cox regression. Unadjusted hazard ratios associated with parental death from external causes ranged between 2.20 and 3.49. For maternal and paternal death from external causes, adjusted hazard ratios were 1.26 (95% confidence intervals: 1.04–1.51) and 1.44 (95% confidence intervals: 1.32–1.57) for men, and 1.47 (95% confidence intervals: 1.05–2.06) and 1.51 (95% confidence intervals: 1.27–1.78) for women. With the exception of maternal death among women (hazard ratio 1.26, 95% confidence intervals: 1.03–1.53), parental death from natural causes was not associated with increased risks in adjusted models. The results underscore the importance of preventive interventions to prevent negative life-course trajectories, particularly when death is sudden and clustered with other childhood adversities.

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  • 23.
    Bergström, Malin
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS). Karolinska Institutet, Sweden.
    Fransson, Emma
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Wells, Michael B.
    Köhler, Lennart
    Hjern, Anders
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS). Karolinska Institutet, Sweden.
    Children with two homes: Psychological problems in relation to living arrangements in Nordic 2- to 9-year-olds2019In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 47, no 2, p. 137-145Article in journal (Refereed)
    Abstract [en]

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

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  • 24.
    Bergström, Malin
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS). Karolinska Institutet, Sweden; Sachs’ Children and Youth Hospital, Sweden.
    Gebreslassie, Mihretab
    Hedqvist, Maria
    Lindberg, Lene
    Sarkadi, Anna
    Hjern, Anders
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS). Karolinska Institutet, Sweden; Sachs’ Children and Youth Hospital, Sweden.
    Narrative review of interventions suitable for well-baby clinics to promote infant attachment security and parents' sensitivity2020In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 109, no 9, p. 1745-1757Article in journal (Refereed)
    Abstract [en]

    Aim The aim of this narrative review was to evaluate the evidence for interventions for children's secure attachment relationships and parents' caregiving sensitivity that could potentially be implemented in the context of a well-baby clinic. Methods Literature search on programmes for parental caregiving sensitivity and secure attachment for infants aged 0-24 months. Randomised controlled trials (RCTs) published 1995-2018 with interventions starting from one week postpartum, and with a maximum of 12 sessions (plus potential booster session) were included. Results We identified 25 studies, of which 22 studied effects of home-based programmes using video feedback techniques. Positive effects of these interventions in families at risk were found on parental caregiving sensitivity and to a lesser extent also on children's secure or disorganised attachment. The effects of two of these programmes were supported by several RCTs. Three intervention studies based on group and individual psychotherapy showed no significant positive effects. Most of the interventions targeted mothers only. Conclusions The review found some evidence for positive effects of selective interventions with video feedback techniques for children's secure attachment and strong evidence for positive effects on parental caregiving sensitivity. Important knowledge gaps were identified for universal interventions and interventions for fathers and parents with a non-Western background.

  • 25.
    Bergström, Malin
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS). Karolinska Institutet, Sweden.
    Sarkadi, Anna
    Hjern, Anders
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS). Karolinska Institutet, Sweden.
    Fransson, Emma
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    "We also communicate through a book in the diaper bag" - Separated parents' ways to coparent and promote adaptation of their 1-4 year olds in equal joint physical custody2019In: PLOS ONE, E-ISSN 1932-6203, Vol. 14, no 4, article id e0214913Article in journal (Refereed)
    Abstract [en]

    Joint physical custody (JPC) refers to a practice where children with separated parents share their time between the parents' respective homes. Studies on parents' views of JPC for young children are scarce. The aim of this interview study was to explore parents' perceptions on how they experience and practice equally shared JPC for their 1-4 year-olds in Sweden. Forty-six parents (18 fathers and 28 mothers) of 50 children (31 boys and 19 girls) under 5 years of age were interviewed. Parents were recruited through information in the media and represented a broad range of socioeconomic backgrounds, as well as both voluntary and court-ordered custody arrangements. The interviews were semi-structured and analyzed using systematic text condensation. Two themes emerged regarding the research question. In the first theme, Always free, never free, parents described their striving to coparent without a love relationship. While they appreciated the freedom of being a half-time parent, doing things one's own way, they felt constrained by the long-term commitment to live close to and keep discussing child rearing issues with the ex-partner. Good communication was key and lessened parent's feelings of being cut-off from half of the child's life. When JPC was ordered by court or conflicts were intense, parents tried to have less contact and worried when the children were in the other home. The second theme, Is it right, is it good?, included descriptions of how the parents monitored the child's responses to the living arrangement and made changes to optimize their adjustment. Adaptations included visits for the child with the other parent mid-week, shared meals or adapting schedules. In conclusion, these parents worked hard to make JPC work and cause minimal damage to their children. Most parents were pleased with the arrangements with the notable exception of couples experiencing ongoing conflict.

  • 26.
    Berlin, Marie
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Sociology. The Swedish National Board of Health and Welfare, Sweden.
    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, Centre for Health Equity Studies (CHESS). Karolinska Institutet, Sweden.
    Brännström, Lars
    Stockholm University, Faculty of Social Sciences, Department of Social Work.
    Educational outcomes of children from long-term foster care: Does foster parents’ educational attainment matter?2019In: Developmental Child Welfare, ISSN 2516-1032, Vol. 1, no 4, p. 344-359Article in journal (Refereed)
    Abstract [en]

    Parental education is a robust predictor of children’s educational outcomes in general population studies, yet little is known about the intergenerational transmission of educational outcomes in alternative family settings such as children growing up in foster care. Using Swedish longitudinal register data on 2,167 children with experience of long-term foster care, this study explores the hypothesized mediating role of foster parents’ educational attainment on foster children’s educational outcomes, here conceptualized as having poor school performance at age 15 and only primary education at age 26. Results from gender-stratified regression analyses suggest that there was an association between foster parental educational attainment and foster children’s educational outcomes but that the educational transmission was weak and inconsistent and differed somewhat between males and females. For males, lower educational attainment in foster parents was associated with poor school performance but was not associated with educational attainment at age 26. The reverse pattern was found among females: the educational gradient was inconsistent for poor school performance but appeared in educational attainment. The results indicate that supported interventions for improving foster children’s educational achievements are needed, even when placements are relatively stable and foster parents have a long formal education.

  • 27.
    Bishop, Lauren
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. Max Planck Institute for Demographic Research.
    Brännström Almquist, Ylva
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS). Stockholm University, Faculty of Social Sciences, Department of Sociology.
    Offspring hospitalization for substance misuse and changes in parental mental health: A Swedish register-based studyManuscript (preprint) (Other academic)
  • 28. Björkenstam, Emma
    et al.
    Burström, Bo
    Hjern, Anders
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS). Karolinska Institutet, Sweden.
    Vinnerljung, Bo
    Stockholm University, Faculty of Social Sciences, Department of Social Work. Karolinska Institutet, Sweden.
    Kosidou, Kyriaki
    Berg, Lisa
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Cumulative childhood adversity, adolescent psychiatric disorder and violent offending in young adulthood2019In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 29, no 5, p. 855-861Article in journal (Refereed)
    Abstract [en]

    Background

    Childhood adversity (CA) is a risk indicator for psychiatric morbidity. Although CA has been linked to violent offending, limited research has considered adolescent psychiatric disorder as a mediating factor. The current study examined whether adolescent psychiatric disorder mediates the association between CA and violent offending.

    Methods

    We used a cohort of 476 103 individuals born in 1984–1988 in Sweden. Register-based CAs included parental death, substance abuse and psychiatric disorder, parental criminal offending, parental separation, public assistance, child welfare intervention and residential instability. Adolescent psychiatric disorder was defined as being treated with a psychiatric diagnosis prior to age 20. Estimates of risk of violent offending after age 20 were calculated as incidence rate ratios (IRRs) with 95% confidence intervals (CIs). Mediation was tested with the bootstrap method.

    Results

    Exposure to CA was positively associated with violent offending, especially when accumulated. Individuals exposed to 4+ CAs who were also treated for psychiatric disorder had a 12-fold elevated risk for violent offending (adjusted IRR 12.2, 95% CI 10.6–14.0). Corresponding IRR among 4+ CA youth with no psychiatric disorder was 5.1 (95% CI 4.5–5.6). Psychiatric disorder mediated the association between CA and violent offending.

    Conclusion

    CA is associated with elevated risk for violent offending in early adulthood, and the association is partly mediated by adolescent psychiatric disorder. Individuals exposed to cumulative CA who also develop adolescent psychopathology should be regarded as a high-risk group for violent offending, by professionals in social and health services that come into contact with this group.

  • 29.
    Blomqvist, Sandra
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Stress Research Institute. Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Högnäs, Robin S.
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Stress Research Institute. Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Virtanen, Marianna
    LaMontagne, Anthony D.
    Magnusson Hanson, Linda
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Stress Research Institute.
    Job loss and job instability during the COVID-19 pandemic and the risk of depression and anxiety among Swedish employees2023In: SSM - Population Health, ISSN 2352-8273, Vol. 22, article id 101424Article in journal (Refereed)
    Abstract [en]

    The COVID-19 pandemic led to permanent and temporary job losses but the mental health consequences of different types of employment transitions are not well-understood. In particular, knowledge is scarce concerning furloughs, which was a common job protection strategy in many high-and upper middle-income countries during this crisis. This study focuses on how different types of job instability and job loss during the pandemic influences depression and anxiety in the context of Sweden.A subset of participants from the Swedish Longitudinal Occupational Survey of Health were contacted in February 2021 and again in February 2022. A total of 1558 individuals participated in either or both waves and worked before the pandemic. We examined whether i) workplace downsizing, ii) furlough, or iii) unemploy-ment/job loss were associated with depression and anxiety over this one-year period during the pandemic. Logistic regression models with cluster-robust standard errors were estimated, adjusting for sociodemographic factors and prior mental health problems. Effect modification by sex and prior mental health problems was also examined.In comparison to stable employment, being furloughed was unrelated to mental health, while experiencing workplace downsizing during the pandemic was associated with an increased risk of anxiety (adjusted Odds Ratio (OR) = 2.09, 95% Confidence interval (CI) = 1.08-4.05). Job loss/unemployment increased the risk of depression (OR = 1.91, 95% CI = 1.02-3.57) compared to being stably employed, but the risk estimate crossed unity when considering prior mental health status. No effect modification by sex or by prior mental health problems was found.This study found that while job loss and downsizing during the COVID-19 pandemic were associated with depression and anxiety, respectively, being furloughed was not. These findings thus suggest that job retention schemes in the form of short-time work allowances, as implemented in Sweden during the COVID-19 pandemic, may prevent mental health problems among employees during economic crises.

  • 30. Borsch, Anne Sofie
    et al.
    De Montgomery, Christopher Jamil
    Gauffin, Karl
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Eide, Ketil
    Heikkilä, Elli
    Smith Jervelund, Signe
    Health, Education and Employment Outcomes in Young Refugees in the Nordic Countries: A Systematic Review2019In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 47, no 7, p. 735-747Article, review/survey (Refereed)
    Abstract [en]

    Objectives: Since 2000, approximately 500,000 refugees have settled in the Nordic countries, about a third of them being children and young people. To identify general trends, and to detect gaps in the existing knowledge about the socioeconomic and health status of these young refugees, this review discusses the literature regarding three key areas related to welfare policy: health, education and employment. Methods: A systematic search in PubMed, Scopus, SocINDEX, Sociological Abstracts, Embase and Cochrane, and a search for publications from relevant institutions were undertaken. All publications had to be original quantitative studies published since 1980. The total number of studies identified was 1353, 25 publications were included. Results: Young refugees had poorer mental health than ethnic minority and native-born peers. Mental health problems were related to pre-migration experiences but also to post-migration factors, such as discrimination and poor social support. Refugees performed worse in school than native-born and few progressed to higher education. Experiencing less discrimination and having better Nordic language proficiency was associated with higher educational attainment. A higher proportion of refugees were unemployed or outside the labour force compared with other immigrants and native-born. Assessment instruments varied between studies, making comparisons difficult. Conclusions: The study suggests pre-migration factors but also post-migration conditions such as perceived discrimination, social support and Nordic language proficiency as important factors for the mental health, education and employment outcomes of young refugees in the Nordic countries. Further Nordic comparative research and studies focusing on the relationship between health, education and employment outcomes are needed.

  • 31.
    Brandén, Maria
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Sociology. Linköping University, Sweden .
    Aradhya, Siddartha
    Stockholm University, Faculty of Social Sciences, Department of Sociology.
    Kolk, Martin
    Stockholm University, Faculty of Social Sciences, Department of Sociology. Institute for Futures Studies, Sweden .
    Härkönen, Juho
    Stockholm University, Faculty of Social Sciences, Department of Sociology. European University Institute, Italy .
    Drefahl, Sven
    Stockholm University, Faculty of Social Sciences, Department of Sociology.
    Malmberg, Bo
    Stockholm University, Faculty of Social Sciences, Department of Human Geography.
    Rostila, Mikael
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Cederström, Agneta
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Andersson, Gunnar
    Stockholm University, Faculty of Social Sciences, Department of Sociology.
    Mussino, Eleonora
    Stockholm University, Faculty of Social Sciences, Department of Sociology.
    Residential context and COVID-19 mortality among adults aged 70 years and older in Stockholm: a population-based, observational study using individual-level data2020In: The Lancet Healthy Longevity, E-ISSN 2666-7568, Vol. 1, no 2, p. e80-e88Article in journal (Refereed)
    Abstract [en]

    Background Housing characteristics and neighbourhood context are considered risk factors for COVID-19 mortality among older adults. The aim of this study was to investigate how individual-level housing and neighbourhood characteristics are associated with COVID-19 mortality in older adults.

    Methods For this population-based, observational study, we used data from the cause-of-death register held by the Swedish National Board of Health and Welfare to identify recorded COVID-19 mortality and mortality from other causes among individuals (aged ≥70 years) in Stockholm county, Sweden, between March 12 and May 8, 2020. This information was linked to population-register data from December, 2019, including socioeconomic, demographic, and residential characteristics. We ran Cox proportional hazards regressions for the risk of dying from COVID-19 and from all other causes. The independent variables were area (m2) per individual in the household, the age structure of the household, type of housing, confirmed cases of COVID-19 in the borough, and neighbourhood population density. All models were adjusted for individual age, sex, country of birth, income, and education.

    Findings Of 279 961 individuals identified to be aged 70 years or older on March 12, 2020, and residing in Stockholm in December, 2019, 274 712 met the eligibility criteria and were included in the study population. Between March 12 and May 8, 2020, 3386 deaths occurred, of which 1301 were reported as COVID-19 deaths. In fully adjusted models, household and neighbourhood characteristics were independently associated with COVID-19 mortality among older adults. Compared with living in a household with individuals aged 66 years or older, living with someone of working age (<66 years) was associated with increased COVID-19 mortality (hazard ratio 1·6; 95% CI 1·3–2·0). Living in a care home was associated with an increased risk of COVID-19 mortality (4·1; 3·5–4·9) compared with living in independent housing. Living in neighbourhoods with the highest population density (≥5000 individuals per km2) was associated with higher COVID-19 mortality (1·7; 1·1–2·4) compared with living in the least densely populated neighbourhoods (0 to <150 individuals per km2).

    Interpretation Close exposure to working-age household members and neighbours is associated with increased COVID-19 mortality among older adults. Similarly, living in a care home is associated with increased mortality, potentially through exposure to visitors and care workers, but also due to poor underlying health among care-home residents. These factors should be considered when developing strategies to protect this group.

  • 32. Brismar Wendel, Sophia
    et al.
    Liu, Can
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS). Karolinska Institutet, Stockholm, Sweden.
    Stephansson, Olof
    The association between episiotomy or OASIS at vacuum extraction in nulliparous women and subsequent prelabor cesarean delivery: A nationwide observational study2023In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 102, no 3, p. 378-388Article in journal (Refereed)
    Abstract [en]

    Introduction: Severe perineal injuries at childbirth affect women's postnatal health, including future childbirths. First births with vacuum extraction carry an increased risk of obstetric anal sphincter injuries (OASIS). Lateral or mediolateral episiotomy at vacuum extraction may decrease the risk of OASIS. Our aim was to assess whether lateral or mediolateral episiotomy, or OASIS, at vacuum extraction in nulliparous women is associated with prelabor cesarean delivery in the subsequent childbirth.

    Material and methods: This is a nationwide observational study using data from the Swedish Medical Birth Register, including women having a first birth with vacuum extraction and a second birth in 2000–2014. Both births were live, single, cephalic, ≥34 gestational weeks without malformations. The association between episiotomy or OASIS in the first birth and prelabor cesarean delivery in the second birth was examined using univariate and multivariate logistic regression with inverse probability of treatment weighting, and interaction analysis. Main outcome measure was prelabor cesarean delivery in the second birth.

    Results: In total, 44 656 women with vacuum extraction at their first birth were included. The rate of prelabor cesarean delivery in the second birth was 5.9% (824 of 13 950) in women with episiotomy, compared with 6.0% (1830 of 30 706) in women without episiotomy. Thus, women with episiotomy did not have an increased risk of prelabor cesarean delivery (adjusted odds ratio [aOR] 1.00, 95% confidence interval [95% CI] 0.83–1.20) compared with women without episiotomy. For comparison, the rate of prelabor cesarean delivery in the second birth was 20.6% (1275 of 6176) in women with OASIS, compared with 3.6% (1379 of 38 480) in women without OASIS (aOR 6.57, 95% CI 5.97–7.23). There was no interaction between episiotomy and OASIS.

    Conclusions: Lateral or mediolateral episiotomy at vacuum extraction in nulliparous women did not increase the risk of prelabor cesarean delivery in the subsequent childbirth. OASIS increased the odds of prelabor cesarean delivery more than sixfold.

  • 33.
    Brolin Låftman, Sara
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Bjereld, Ylva
    Modin, Bitte
    Löfstedt, Petra
    Sexual jokes at school and psychological complaints: Student- and class-level associations.2021In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 49, no 3, p. 285-291Article in journal (Refereed)
    Abstract [en]

    Background: Students who are subjected to sexual harassment at school report lower psychological well-being than those who are not exposed. Yet, it is possible that the occurrence of sexual harassment in the school class is also stressful for those who are not directly targeted, with potential negative effects on well-being for all students. Aim: The aim was to examine whether exposure to sexual jokes at the student level and at the class level was associated with students' psychological complaints, and if these associations differed by gender. Method: Data from the Swedish Health Behaviour in School-aged Children (HBSC) of 2017/18 was used, with information from students aged 11, 13 and 15 years (N=3720 distributed across 209 classes). Psychological health complaints were constructed as an index based on four items. Exposure to sexual jokes at the student level was measured by one item, and at the class level as the class proportion of students exposed to sexual jokes, in per cent. Two-level linear regression analyses were performed.Results: Students who had been exposed to sexual jokes at school reported higher levels of psychological complaints, especially boys. Furthermore, the class proportion of students who had been exposed to sexual jokes was also associated with psychological complaints, even when adjusting for student-level exposure to sexual jokes, gender, grade and class size. Conclusions: Sexual jokes seem to be harmful for those who are directly exposed, but may also affect indirectly exposed students negatively. Thus, a school climate free from sexual jokes may profit all students.

  • 34.
    Brolin Låftman, Sara
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Bjereld, Ylva
    Modin, Bitte
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Löfstedt, Petra
    Sexual jokes at school and students' life satisfaction: findings from the 2017/18 Swedish Health Behaviour in School-aged Children study2021In: BMC Research Notes, E-ISSN 1756-0500, Vol. 14, no 1, article id 288Article in journal (Refereed)
    Abstract [en]

    Objective: In a previous study we demonstrated that the occurrence of sexual jokes in the class was associated with higher levels of psychological health complaints. Building on and extending these findings, the aim of the current study was to examine if exposure to sexual jokes at the student and at the class level was inversely associated with students' life satisfaction. Data were derived from the 2017/18 Swedish Health Behaviour in School-aged Children (HBSC) study, with students aged 11, 13 and 15 years (n = 3710 distributed across 209 classes). Exposure to sexual jokes at the student level was captured by one item. Exposure to sexual jokes at the class level was calculated by aggregating this measure. The Cantril ladder was used to operationalise life satisfaction. Two-level logistic regression analyses were performed.

    Results: Students who were exposed to sexual jokes at school were less likely to report high life satisfaction (OR 0.38, 95% CI 0.27-0.53). An inverse association was found between the class proportion of students who were exposed to sexual jokes and students' likelihood of reporting high life satisfaction, whilst adjusting for exposure to sexual jokes at the student level (OR 0.98, 95% CI 0.97-0.9994). The findings highlight the importance of promoting a school climate without sexual harassment.

  • 35.
    Brolin Låftman, Sara
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Granvik Saminathen, Maria
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Modin, Bitte
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Löfstedt, Petra
    Excellent Self-Rated Health among Swedish Boys and Girls and Its Relationship with Working Conditions in School: A Cross-Sectional Study2021In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 18, no 3, article id 1310Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to investigate the extent to which school demands, teacher support, and classmate support were associated with excellent self-rated health among students, and to examine if any such statistical predictions differed by gender. Data were drawn from the Swedish Health Behaviour in School-aged Children (HBSC) study of 2017/18, performed among adolescents in grades five, seven, and nine (n = 3701). Linear probability models showed that school demands were negatively associated with excellent self-rated health, whereas teacher and classmate support showed positive associations. The link with school demands was stronger for girls than boys, driven by the finding that in grades five and nine, school demands were associated with excellent self-rated health only among girls. In conclusion, the study suggests that working conditions in school in terms of manageable school demands and strong teacher and classmate support may benefit adolescents' positive health. The finding that the link between school demands and excellent self-rated health was more evident among girls than among boys may be interpreted in light of girls' on average stronger focus on schoolwork and academic success. The study contributes with to knowledge about how working conditions in school may impede or promote students' positive health.

  • 36.
    Brolin Låftman, Sara
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Grigorian, Karina
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Lundin, Andreas
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. Karolinska Institutet, Sweden.
    Östberg, Viveca
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Raninen, Jonas
    Bullying experiences before and after the transition from lower to upper secondary school: associations with subsequent mental health in a Swedish cohort2024In: BMC Public Health, E-ISSN 1471-2458, Vol. 24, no 1, article id 27Article in journal (Refereed)
    Abstract [en]

    Background: Previous research has shown that exposure to bullying is linked to long-term adverse mental health consequences. However, prospective studies examining the persistence of bullying, using information from repeated time points, are limited. The aim of this study was to examine, firstly, the extent to which exposure to bullying among adolescents in Sweden changes between grades 9 (age 15-16) and 11 (age 17-18) (i.e., before and after the transition from lower to upper secondary school); secondly, whether being bullied in grade 9 or 11 is associated with depression and anxiety symptoms at age 20-21; and thirdly, if being bullied in both grade 9 and 11 is linked to an even higher likelihood of subsequent depression and anxiety symptoms. Potential differences by gender were investigated throughout.

    Methods: Data was derived from the Swedish cohort study Futura01 involving individuals attending grade 9 in the school year 2016/17 (n = 2323). We utilised self-reported information from three survey waves conducted in 2017, 2019, and 2022, and linked registry information on sociodemographic characteristics. Bullying was assessed using a single item in waves 1 and 2. Depression and anxiety symptoms were measured using the Patient Health Questionnaire-4 (PHQ-4) in wave 3. Gender stratified binary logistic regressions were performed.

    Results: Among those who were bullied in grade 9, 22.6% of males and 35.8% of females continued to experience bullying in grade 11. For females, exposure to bullying in grade 9 or 11 was associated with an increased likelihood of reporting depression and anxiety symptoms at age 20-21, with the highest odds for those bullied at both time points. For males, only one statistically significant association was identified - specifically, between being bullied in grade 9 and subsequent depression symptoms.ConclusionsFor a majority of adolescents who experience bullying in lower secondary school, but not all, the transition to upper secondary school proves to be beneficial as the bullying typically does not persist. However, bullying can have long-term health effects, in particular for females. These findings emphasise the importance of effective measures to address bullying within schools.

  • 37.
    Brolin Låftman, Sara
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Magnusson, Charlotta
    Stockholm University, Faculty of Social Sciences, The Swedish Institute for Social Research (SOFI).
    Olsson, Gabriella
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Svensson, Johan
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Wahlström, Joakim
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Modin, Bitte
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Problematic alcohol use in the family and adolescents’ stress-related complaints2021In: European Journal of Public Health: Supplement 3, October 2021. Supplement 14th European Public Health Conference Public health futures in a changing world, 2021, Vol. 31, article id ckab165.519Conference paper (Other academic)
    Abstract [en]

    Background. A non-negligible proportion of children grow up in families where problematic alcohol use is present. From a resilience perspective and for the implementation of effective interventions, it is relevant to examine to what extent favourable conditions in other contexts may buffer against such family adversities. The aim of the current study was to examine the relationship between problematic familial alcohol use and offspring stress-related complaints. Another aim was to explore whether teacher ratings of the school's degree of student focus can buffer against negative health consequences of problem drinking at home.

    Methods. Data were drawn from four cross-sectional surveys conducted in 2014 and in 2016 among 8,728 students (∼15-16 years) and 2,024 teachers in 147 Stockholm senior-level school units, with linked school-level register information. Stress-related complaints were measured from students' reports on the weekly co-occurrence of stomach-ache and headache. Teachers' ratings of the school's student focus were measured by an index based on four items which was aggregated to the school level. Student-level sociodemographic characteristics were included as control variables along with the schools' composition and student-teacher ratio. Two-level binary logistic regression analyses were performed.

    Results. Problematic familial alcohol use was associated with an increased likelihood of stress-related complaints among students (OR 1.74, 95% CI 1.44-2.10). The cross-level interaction revealed that this association was weaker among students in schools with higher levels of student focus.

    Conclusions. The study showed that the association between problematic familial alcohol use and students' stress-related complaints was less pronounced in schools with higher teacher ratings of student focus. This finding indicates that favourable conditions in schools can buffer against problematic conditions in the family, thus serving a compensatory role.

    Key messages. Students reporting problematic familial alcohol use were more likely to suffer from stress-related complaints.High teacher ratings of the school’s student focus buffered against the association between problematic familial alcohol use and stress-related complaints.

  • 38.
    Brolin Låftman, Sara
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Magnusson, Charlotta
    Stockholm University, Faculty of Social Sciences, The Swedish Institute for Social Research (SOFI).
    Olsson, Gabriella
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Wahlström, Joakim
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Modin, Bitte
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Perceived problematic alcohol use in the family and adolescents’ stress-related complaints: examining the buffering role of the school’s degree of student focus as rated by its teachers2023In: BMC Public Health, E-ISSN 1471-2458, Vol. 23, article id 1754Article in journal (Refereed)
    Abstract [en]

    Background A non-negligible proportion of children grow up with problematic alcohol use in the family. Problematic familial drinking can be regarded as a stressor, and prior studies have consistently reported poorer mental health among adolescents who are exposed. However, it is also of relevance to identify modifiable protective factors which may buffer against stress-related ill-health in this group of adolescents. One context where such factors may be present is the school. The aim of this study is to examine the relationship between perceived problematic familial alcohol use and students’ stress-related complaints, and specifically to explore if the school’s degree of student focus can buffer against any such negative health consequences of problem drinking at home.

    Methods Data were drawn from four separate surveys, the Stockholm School Survey (SSS) and the Stockholm Teacher Survey (STS) conducted in 2014 and 2016 among 7,944 students (~ 15–16 years) and 2,024 teachers in 147 Stockholm senior-level school units. Perceived problematic familial alcohol use was measured by one item in the SSS. Stress-related complaints were captured by co-occurring somatic complaints and psychological distress, and reported by students in the SSS. The school’s student focus was measured by an index based on teachers’ ratings of four items in the STS. A set of covariates at the student and the school level were also included. Two-level binary logistic and linear regression models were performed.

    Results Perceived problematic familial alcohol use was linked with an increased likelihood of reporting co-occurring somatic complaints as well as psychological distress. Cross-level interactions revealed that the association between perceived problematic familial alcohol use and co-occurring somatic complaints was weaker among students attending schools with stronger teacher-rated student focus. Regarding psychological distress, the association was weaker for students attending schools with intermediate or strong teacher-rated student focus, compared with those attending schools with weaker teacher-rated student focus.

    Conclusions The findings provide support for the assumption that favourable conditions in schools can buffer against negative health consequences of problematic conditions in the family, thus serving a compensatory role.

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  • 39.
    Brolin Låftman, Sara
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Modin, Bitte
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Granvik Saminathen, Maria
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Östberg, Viveca
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Löfstedt, Petra
    Rajaleid, Kristiina
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Stress Research Institute.
    Psychosocial school conditions and students’ positive mental well-being2021In: European Journal of Public Health: Supplement 3, October 2021 Supplement 14th European Public Health Conference Public health futures in a changing world, 2021, Vol. 31, article id ckab165.518Conference paper (Other academic)
    Abstract [en]

    Background. School is a key social determinant of adolescent health. However, earlier research on psychosocial school conditions has largely focused on their relationship with aspects of adverse health, and fewer studies have examined the links with positive health. The aim of this study was to investigate boys' and girls' experiences of school demands, teacher support, and classmate support and their associations with positive mental well-being.

    Methods. Data were derived from the Swedish Health Behaviour in School-aged Children (HBSC) study of 2017/18, with information collected among 1,418 students in grade 9 (∼15-16 years). School demands, teacher support, and classmate support were captured by indices based on multiple items. Positive mental well-being was measured by the Short Warwick-Edinburgh Mental Wellbeing Scale (SWEMBWS). Gender-stratified linear regression analyses were performed, clustering for school class.

    Results. Higher demands were associated with lower mental well-being (boys: b=-0.36, p < 0.05; girls: b=-0.65, p < 0.05). Conversely, mental well-being increased with greater teacher support (boys: b = 0.53, p < 0.05; girls: b = 0.56, p < 0.05) and classmate support (boys: b = 0.70, p < 0.05; girls: b = 0.50, p < 0.05). Interactions between demands and the support variables showed that at the lowest levels of teacher and of classmate support, mental well-being was low and not associated with school demands. With increasing levels of teacher and classmate support, the overall level of mental-well-being increased and revealed an inverse association between school demands and mental well-being.

    Conclusions. The findings indicate that psychosocial school conditions are important not only for adverse health among adolescents, but also for their positive health. The study contributes with knowledge about how psychosocial conditions in school may hinder or enhance positive health among students.

    Key messages. School demands, teacher and classmate support were associated with mental well-being among both boys and girls, although the association with demands was seen only at higher levels of support.

  • 40.
    Brolin Låftman, Sara
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Modin, Bitte
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Olsson, Gabriella
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Sundqvist, Kristina
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Svensson, Johan
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Wennberg, Peter
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. Karolinska Institutet, Sweden.
    School ethos and adolescent gambling: a multilevel study of upper secondary schools in Stockholm, Sweden2020In: BMC Public Health, E-ISSN 1471-2458, Vol. 20, no 1, article id 130Article in journal (Refereed)
    Abstract [en]

    Background: Gambling is not uncommon among adolescents, and a non-trivial minority has serious problems with gambling. Therefore, enhanced knowledge about factors that may prevent against problematic gambling among youth is needed. Prior research has shown that a strong school ethos, which can be defined as a set of attitudes and values pervading at a school, is associated with a lower inclination among students to engage in various risk behaviours. Knowledge about the link between school ethos and adolescent gambling is however scarce. The aim of the study was to investigate the association between teacher-rated school ethos and student-reported gambling and risk gambling, when controlling also for sociodemographic characteristics at the student- and the school-level.

    Methods: Data from two separate cross-sectional surveys were combined. The Stockholm School Survey (SSS) was performed among 5123 students (aged 17–18years) in 46 upper secondary schools, and the Stockholm Teacher Survey (STS) was carried out among 1061 teachers in the same schools. School ethos was measured by an index based on teachers’ ratings of 12 items in the STS. Adolescent gambling and risk gambling were based on a set of single items in the SSS. Sociodemographic characteristics at the student-level were measured by student-reported information from the SSS. Information on sociodemographic characteristics at the school-level was retrieved from administrative registers. The statistical method was multilevel regression analysis. Two-level binary logistic regression models were performed.

    Results: The analyses showed that higher teacher ratings of the school’s ethos were associated with a lower likelihood of gambling and risk gambling among students, when adjusting also for student- and school-level sociodemographic characteristics.

    Conclusions: This study showed that school ethos was inversely associated with students’ inclination to engage in gambling and in risk gambling. In more general terms, the study provides evidence that schools’ values and norms as reflected by the teachers’ ratings of their school’s ethos have the potential to counteract unwanted behaviours among the students.

  • 41.
    Brolin Låftman, Sara
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Ramberg, Joacim
    Stockholm University, Faculty of Social Sciences, Department of Special Education.
    Modin, Bitte
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    School Ethos and Recurring Sickness Absence: A Multilevel Study of Ninth-Grade Students in Stockholm2020In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 17, no 3, article id 745Article in journal (Refereed)
    Abstract [en]

    School absence has been identified as a severe problem in Sweden, both at the individual level and for society as a whole. Despite the multitude and complexity of reasons behind school absence, health-related problems are likely to be one important determinant. This indicates that knowledge about factors that may contribute to preventing health-related absence among students is relevant. The aim was to investigate whether a higher level of teacher-reported school ethos was associated with less recurring sickness absence among students. Data from four cross-sectional surveys performed in 2014 and 2016 were combined. The Stockholm School Survey was carried out among 9482 ninth-grade students (ages 15–16 years) in 150 school units, and the Stockholm Teacher Survey was performed among 2090 teachers in the same units. School ethos was operationalised by an index of 12 teacher-reported items that was aggregated to the school-level. Recurring student sickness absence was captured by self-reports and defined as absence on >10 occasions during the current school year. Two-level logistic regressions were performed. The results show that about 9.5% of the students reported recurring sickness absence. Students attending schools with higher levels of teacher-rated school ethos were less likely to reporting recurring sickness absence than those attending schools with lower levels of ethos, even when adjusting for potential confounders (OR 0.79, 95% CI 0.65–0.97). In conclusion, recurring sickness absence was less common among students attending schools with higher levels of teacher-rated ethos. The findings suggest that schools may contribute to promoting student health.

  • 42.
    Brolin Låftman, Sara
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Raninen, Jonas
    Östberg, Viveca
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Trust in adolescence and depression and anxiety symptoms in young adulthood: findings from a Swedish cohort2024In: BMC Research Notes, E-ISSN 1756-0500, Vol. 17, article id 7Article in journal (Refereed)
    Abstract [en]

    Objective Trust and health are both fundamental elements of a socially sustainable society. While much research has shown that trust is associated with better mental health outcomes in adults, studies of young people are relatively scarce, despite the fact that mental health problems are common in young ages. In particular, there are few longitudinal studies that cover different dimensions of trust. Building on a previous study on trust and psychosomatic complaints in adolescents, the aim was to examine the links between generalised and institutional trust in adolescence and depression and anxiety symptoms in young adulthood. Data was obtained from a Swedish cohort study with self-reported information on generalised and institutional trust at ages 15–16 and 17–18 and depression and anxiety symptoms at age 20–21 (n = 2,668). Covariates included sociodemographic characteristics and indicators of prior mental health status.

    Results Binary logistic and linear regressions showed that higher levels of generalised trust at ages 15–16 and 17–18 were inversely associated with depression and anxiety symptoms at age 20–21. Institutional trust was however not linked with subsequent depression and anxiety symptoms when adjusting for generalised trust and covariates. The findings indicate that generalised trust is a social determinant for mental health in young people.

  • 43.
    Brolin Låftman, Sara
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Östberg, Viveca
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Raninen, Jonas
    Trust and Psychosomatic Complaints in Adolescence: Findings From a Swedish Cohort Study2023In: International Journal of Public Health, ISSN 1661-8556, E-ISSN 1661-8564, Vol. 68, article id 1606032Article in journal (Refereed)
    Abstract [en]

    Objectives: To examine the cross-sectional and longitudinal associations between generalised and institutional trust and psychosomatic complaints in mid and late adolescence.

    Methods: Data were derived from the Swedish cohort study Futura01, using survey information collected amongst 3,691 grade 9 students (∼15–16 years, t1) who were followed-up 2 years later (∼17–18 years, t2). Registry information on sociodemographic characteristics was linked to the data. Linear regression analyses were performed. The longitudinal analyses applied the first difference (FD) approach as well as the lagged dependent variable (LDV) approach. Covariates included gender, family type, parental education, parental country of birth, and upper secondary programme.

    Results: Higher levels of generalised and institutional trust were cross-sectionally associated with lower levels of psychosomatic complaints at both time points. The FD analyses showed that increases in generalised and in institutional trust between ages 15–16 and 17–18 years were associated with corresponding decreases in psychosomatic complaints. The LDV analyses demonstrated reciprocal temporal associations between trust and psychosomatic complaints.

    Conclusion: The findings indicate that trust is a social determinant of psychosomatic complaints in adolescents, but also that health may affect trust.

  • 44.
    Brydsten, Anna
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS). Umeå University, Sweden.
    Cederström, Agneta
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Rostila, Mikael
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS). Stockholm University.
    Young people's labour market patterns and later mental health: A sequence analysis exploring the role of region of origin for young people's labour market trajectories and mental health2020In: SSM - Population Health, ISSN 2352-8273, no 11, article id 100600Article in journal (Refereed)
    Abstract [en]

    Background: This study used Swedish longitudinal register data to identify clusters of trajectories in labour market positions from young adulthood to mid-life, analyse the trajectory cluster composition regarding region of origin, and to examine if the trajectories was associated with mid-life mental ill health.

    Method: A cohort of 98 634 individuals (at age 20, 1998) were followed yearly across 18 years, of whom 23.4% were foreign-born or second-generation migrants. Sequence Analysis with Hierarchical Cluster Analysis was used to map individual labour market trajectories (age 20–37) and identify clusters of trajectories, and logistic regression to assess the association between trajectories and mental ill health in mid-life (age 36 to 38). Labour market states were constructed by main source of income, while mental health was operationalised as hospital admission for psychiatric care or receiving a psychiatric diagnosis at a health centre. Early-life course factors and previous health status was included as covariates.

    Results: Four clusters of trajectories were identified, separately for women and men, reflecting a rapid labour market entry with stable employment (T1), higher education into stable employment (T2), turbulence with several transitions between states (T3), and turbulence into labour market exclusion (T4). Migrants and secondgeneration migrants were more often found in trajectory 3 and 4 than native-born, and these trajectories were also associated with poor mental health in mid-life.

    Conclusion: Migrants showed more turbulent transitions between labour market states than natives, and more often found in trajectories with long-term instability and labour market exclusion. Furthermore, the risk of mental ill health in mid-life were higher among trajectories more frequent among migrants.

  • 45.
    Brydsten, Anna
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Rostila, Mikael
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Dunlavy, Andrea
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Social integration and mental health - a decomposition approach to mental health inequalities between the foreign-born and native-born in Sweden2019In: International Journal for Equity in Health, E-ISSN 1475-9276, Vol. 18, article id 48Article in journal (Refereed)
    Abstract [en]

    Background: The increasing mental health inequalities between native- and foreign-born persons in Sweden is an important public health issue. Improving social integration has been stressed as a key strategy to combat this development. While a vast amount of studies have confirmed the importance of social integration for good mental health, less is known about the role of different types of social integration, and how they relate to mental health inequalities. This study aimed to examine the extent to which indicators of social integration explained mental health inequalities between the native- and foreign-born. Methods: Based on the Health on Equal Terms survey from 2011/2015 in Vastra Gotaland, Sweden (n=71,643), a non-linear Oaxaca-Blinder decomposition analysis was performed comparing native- and foreign-born individuals from Nordic-, European- and non-European countries. The General Health Questionnaire was used to assess psychological distress, while 11 items assessed employment conditions and economic disparities, social relations, and experiences of discrimination to measure different aspects of social integration. Results: Differences in social integration explained large proportions of observed mental health differences between the native- and foreign-born. Important indicators included low levels of social activity (20%), trust in others (17%) and social support (16%), but also labour market disadvantages, such as being outside the labour market (15%), unemployment (10%) and experiencing financial strain (16%). In analyses stratified by region of origin, low trust in others and discrimination contributed to the mental health gap between the native-born and European-born (17 and 9%, respectively), and the native-born and non-European-born (19 and 10%, respectively). Precarious labour market position was a particularly important factor in the mental health gap between the native-born and Nordic-origin (22%), and non-European origin (36%) populations. Conclusion: Social integration factors play a central role in explaining the mental health inequality between natives and migrants in Sweden. Our findings suggest that public health actions targeting mental health gaps could benefit from focusing on inequalities in social and economic recourses between natives and migrants in Sweden. Areas of priority include improving migrants' financial strain, as well as increasing trust in othersand social support and opportunities for civic engagement.

  • 46.
    Brännström Almquist, Ylva
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Miething, Alexander
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    The impact of an unemployment insurance reform on incidence rates of hospitalisation due to alcohol-related disorders: a quasi-experimental study of heterogeneous effects across ethnic background, educational level, employment status, and sex in Sweden2022In: BMC Public Health, E-ISSN 1471-2458, Vol. 22, article id 1847Article in journal (Refereed)
    Abstract [en]

    Background: Many Western countries have scaled back social and health expenditure, including decreases in the generosity and coverage of unemployment insurance, resulting in negative effects on general health and well-being at the aggregate level. Yet, research has not sufficiently looked into heterogeneity of such effects across different subgroups of the population. In Sweden, the 2006 unemployment insurance reform, implemented on the 1st of January 2007, encompassed a drastic increase of insurance fund membership fees, reduced benefit levels, and stricter eligibility requirements. As this particularly affected already socioeconomically disadvantaged groups in society, such as foreign-born and low-educated individuals, the current study hypothesise that the reform would also have a greater impact on health outcomes in these groups.

    Methods: Based on register data for the total population, we utilise a quasi-experimental approach to investigate heterogeneous health effects of the reform across ethnic background, educational level, employment status, and sex. Due to behaviourally caused diseases having a relatively shorter lag time from exposure, hospitalisation due to alcohol-related disorders serves as the health outcome. A series of regression discontinuity models are used to analyse monthly incidence rates of hospitalisation due to alcohol-related disorders among individuals aged 30–60 during the study period (2001–2012), with the threshold set to the 1st of January 2007.

    Results: The results suggest that, in general, there was no adverse effect of the reform on incidence rates of hospitalisation due to alcohol-related disorders. A significant increase is nonetheless detected among the unemployed, largely driven by Swedish-born individuals with Swedish-born or foreign-born parents, low-educated individuals, and men.

    Conclusions: We conclude that the Swedish 2006 unemployment insurance reform generally resulted in increasing incidence rates of hospitalisation due to alcohol-related disorders among unemployed population subgroups known to have higher levels of alcohol consumption.

  • 47.
    Brännström Almquist, Ylva
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    S. Straatmann, Viviane
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Drivers of Inequalities among Families Involved with Child Welfare Services: A General Overview2022In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 19, no 13, article id 7881Article in journal (Refereed)
    Abstract [en]

    When parents are unable to raise their children or to meet the minimum acceptable standards for their care, this can lead to involvement with child welfare services. In some cases, children are separated from their families and taken into out-of-home care (OHC). For good reason, prior research has primarily focused on the lifelong development of these children, and there is now extensive evidence showing that the experience of placement in OHC is predictive of worse outcomes in almost every dimension of adult life [1,2,3,4,5,6]. It is nonetheless likely that the treatment of OHC as a risk factor at the level of the individual child greatly underestimates the scope of the issue from a public health perspective. Here, we argue that gaining more knowledge about the familial circumstances under which the child welfare services enter—and, in many cases, later on exit—the scene would not only facilitate the understanding of why experiences of OHC tend to leave such long-lasting marks on children, but also how they reflect and contribute to inequalities at the population level.

  • 48.
    Chaparro, M. Pia
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS). University of California Los Angeles, USA.
    Langellier, B. A.
    Wang, M. C.
    Koleilat, M.
    Whaley, S. E.
    Effects of Parental Nativity and Length of Stay in the US on Fruit and Vegetable Intake Among WIC-Enrolled Preschool-Aged Children2015In: Journal of Immigrant and Minority Health, ISSN 1557-1912, E-ISSN 1557-1920, Vol. 17, no 2, p. 333-338Article in journal (Refereed)
    Abstract [en]

    Exposure to US culture is negatively associated with fruits and vegetables (F&V) intake. Our goal was to investigate how parent's nativity and length of stay in the US influences preschoolers' F&V intake. We analyzed survey data from 2,352 children, aged 36-60 months, who participate in the Supplemental Nutrition Program for Women, Infants and Children (WIC) in Los Angeles County. Using multiple linear regression, we examined children's F&V intake by parent's nativity and years in the US, adjusting for possible confounders. Children of foreign born parents who had lived in the US for < 10 years consumed fewer servings of vegetables than children of US born parents and of foreign born parents who had lived in the US for a parts per thousand yen10 years. Children of newer immigrant families may be at greater risk for consuming poor-quality diets. Research to identify determinants of poor diet quality among children of immigrant families may increase the effectiveness of WIC in addressing this population's nutritional needs.

  • 49. Chen, Hua
    et al.
    Hemmingsson, Tomas
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. Karolinska Institutet, Sweden.
    Forsell, Yvonne
    Rostila, Mikael
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Janszky, Imre
    László, Krisztina D.
    Death of a Parent During Childhood and the Risk of Ischemic Heart Disease and Stroke in Adult Men2020In: Psychosomatic Medicine, ISSN 0033-3174, E-ISSN 1534-7796, Vol. 82, no 9, p. 810-816Article in journal (Refereed)
    Abstract [en]

    Objective

    The death of a parent during childhood is a severe life event with potentially long-term consequences. Earlier studies have shown an increased risk of cardiovascular diseases (CVD) after the death of a spouse, child, or sibling. Whether parental death during childhood is associated with an increased risk of incident CVD is unknown and was investigated in this study.

    Methods

    We studied 48,992 men born 1949 to 1951 and enlisted for military conscription in 1969 to 1970. We obtained information on death of a parent during childhood, CVD up to 2008, and covariates by linking the questionnaire and the clinical examination data from conscription with nationwide socioeconomic and health registers.

    Results

    Men who lost a parent during childhood had an increased risk of ischemic heart disease (IHD; adjusted hazard ratio (HR) and 95% confidence interval [CI] = 1.30 [1.13-1.49]) but not of stroke during the 39-year follow-up (adjusted HR [95% CI] = 0.87 [0.66-1.15]). Maternal death was associated with IHD both when the loss was due to cardiovascular (adjusted HR [95% CI] = 2.04 [1.02-4.08]) and unnatural causes (adjusted HR [95% CI] = 2.50 [1.42-4.42]); in case of paternal death, an increased IHD risk was observed only when the loss was due to cardiovascular causes (adjusted HR [95% CI] = 1.82 [1.37-2.42]). There were no substantial differences in CVD according to the child's age at the loss.

    Conclusions

    Parental death during childhood was associated with an increased risk of IHD in men. If these associations are confirmed in future studies, the long-term effects of childhood bereavement may warrant attention.

  • 50. Chen, Hua
    et al.
    Janszky, Imre
    Rostila, Mikael
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Wei, Dang
    Yang, Fen
    Li, Jiong
    László, Krisztina D.
    Bereavement in childhood and young adulthood and the risk of atrial fibrillation: a population-based cohort study from Denmark and Sweden2023In: BMC Medicine, E-ISSN 1741-7015, Vol. 21, article id 8Article in journal (Refereed)
    Abstract [en]

    Background Adverse childhood life events are associated with increased risks of hypertension, ischemic heart disease, and stroke later in life. Limited evidence also suggests that stress in adulthood may increase the risk of atrial fibrillation (AF). Whether childhood adversity may lead to the development of AF is unknown. We investigated whether the loss of a parent or sibling in childhood is associated with an increased risk of AF and compared this effect to that of similar losses in young adulthood.

    Methods We studied 6,394,975 live-born individuals included in the Danish (1973–2018) and Swedish Medical Birth Registers (1973–2014). We linked data from several national registers to obtain information on the death of parents and siblings and on personal and familial sociodemographic and health-related factors. We analyzed the association between bereavement and AF using Poisson regression.

    Results Loss of a parent or sibling was associated with an increased AF risk both when the loss occurred in childhood and in adulthood; the adjusted incident rate ratios and 95% confidence intervals were 1.24 (1.14–1.35) and 1.24 (1.16–1.33), respectively. Bereavement in childhood was associated with AF only if losses were due to cardiovascular diseases or other natural causes, while loss in adulthood was associated with AF not only in case of natural deaths, but also unnatural deaths. The associations did not differ substantially according to age at loss and whether the deceased was a parent or a sibling.

    Conclusions Bereavement both in childhood and in adulthood was associated with an increased AF risk.

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