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  • 1. Buli, Benti Geleta
    et al.
    Larm, Peter
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Nilsson, Kent
    Giannotta, Fabrizia
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. Mälardalen University, Sweden.
    Trends in adolescent mental health problems 2004–2020: do sex and socioeconomic status play any role?2023In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905Article in journal (Refereed)
    Abstract [en]

    Aims: This study aims to investigate trends in four types of adolescent mental health problems; that is, psychosomatic symptoms, depressive symptoms, suicidal ideations, and suicide attempts 2004–2020. A second aim is to investigate the moderating roles of socioeconomic status and sex in these trends.

    Methods: The analysis is based on repeated cross-sectional data 2004–2020 among grade 9 students in secondary schools in a Swedish county. In total, data from 19,873 students were included in the analysis. We fitted linear and logistic regression equations and used survey-years’ coefficients to estimate the trends. We also estimated the moderating effects of socioeconomic status and sex using interactions between survey year and socioeconomic status and sex, respectively.

    Results: The trends in all mental health problems declined over time. Through its interaction with survey year, socioeconomic status moderated the trends; psychosomatic symptoms (B = −0.115, P<0.001), depressive symptoms (B = −0.084, P<0.001) and suicidal ideations (odds ratio 0.953, confidence interval 0.924–0.983) significantly declined over time among those with high socioeconomic status. However, socioeconomic status did not have an association with the trend in suicide attempts. Interaction between sex and year of survey was associated with significant decreasing trends in depressive symptoms and suicidal ideations only among girls.

    Conclusions: Adolescent mental health problems have decreased over time, but only for adolescents with high socioeconomic status, or only in depressive symptoms and suicidal ideations for girls. The results shed light on the growing inequalities in health outcomes across levels of socioeconomic status.

  • 2. Buli, Benti Geleta
    et al.
    Larm, Peter
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Nilsson, Kent W.
    Hellström-Olsson, Charlotta
    Giannotta, Fabrizia
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. Mälardalen University, Sweden.
    Trends in mental health problems among Swedish adolescents: Do school-related factors play a role?2024In: PLOS ONE, E-ISSN 1932-6203, Vol. 19, no 3, article id e0300294Article in journal (Refereed)
    Abstract [en]

    Aim

    The aim of this study is to investigate the extent to which school-related factors, such as school liking, participation in decision-making, school-related parental support, teachers’ support, and school physical environment, explain trends in mental health problems. The problems considered are psychosomatic symptoms (PSS), depressive symptoms (DS), suicidal ideations (SI), and suicide attempts (SA) among Swedish adolescents of varying socioeconomic status (SES) from 2004 to 2020.

    Methods

    We analyzed data collected through repeated cross-sectional surveys from 19,873 15-year-old students at schools in a county in Sweden. Boys and girls each constituted 50% of the participants. We fitted linear and logistic regression models to investigate associations between the school-related factors and trends in mental health problems.

    Results

    Increased school-related parental support and school liking were cross-sectionally associated with decreased PSS, DS and SI, with school liking also associated with decreased SA. Conducive school physical environment was also found to be cross-sectionally associated with lower PSS and DS scores. Over time, mental health problems have shown a general increase among adolescents in the low SES group and a decrease among those in the high SES group. While school-related factors explained the improvement in mental health in the high SES group, we found such association only between parental support trends in PSS and DS, along with participation and trends in SA over time among adolescents in the low SES group.

    Conclusions

    The results show that school-related factors play significant roles in influencing adolescent mental health. The influence, however, varied across SES gradients over time. This suggests that working against inequities in school-related factors would help address inequities in mental health.

  • 3. Buli, Benti Geleta
    et al.
    Lehtinen-Jacks, Susanna
    Larm, Peter
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Nilsson, Kent W.
    Hellström-Olsson, Charlotta
    Giannotta, Fabrizia
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. Mälardalen University, Sweden; University of Turin, Italy.
    Trends in psychosomatic symptoms among adolescents and the role of lifestyle factors2024In: BMC Public Health, E-ISSN 1471-2458, Vol. 24, article id 878Article in journal (Refereed)
    Abstract [en]

    Background Adolescent mental health problems are on the rise globally, including in Sweden. One indicator of this trend is increased psychosomatic symptoms (PSS) over time. Lifestyle factors such as physical activity (PA), diet, smoking, and alcohol consumption may influence the time trends in PSS; however, the evidence base is scarce. The aim of this study was to investigate associations between time trends in PSS and lifestyle factors.

    Methods The study was based on data collected from a nationally representative sample of 9,196 fifteen-year-old boys and girls in Sweden using the Health Behavior in School-aged Children (HBSC) symptom checklist. The sample comprised nearly equal proportions of girls (50.5%) and boys. The lifestyle factors examined in this study included PA, regular breakfast intake, consumption of fruits, vegetables, sweets, or soft drinks, smoking, and alcohol drunkenness. We used data from 2002 to 2018 and stratified by family affluence scale (FAS) to demonstrate how the associations varied among the FAS groups. We fitted separate regression models for the high- and low-FAS groups, where interaction terms between the year of survey and each lifestyle factor were used to estimate the level and direction of associations between the factors and trends in PSS.

    Results There was a generally increasing trend in PSS mean scores from 2.26 in 2002 to 2.49 in 2018 (p <.001). The changes in each survey year compared to the average mean scores during the preceding years were significant in all years except 2010. Regular breakfast intake, daily fruit and vegetable consumption, and higher PA were associated with lower PSS mean scores, while smoking and drunkenness had opposite associations with PSS. The only significant interaction between survey year and the lifestyle factors was observed regarding drunkenness in the high FAS group, suggesting that the association between trends in PSS and the experience of getting drunk at least twice got stronger over time (B = 0.057; CI:0.016, 0.097; p <.01).

    Conclusions The results indicate increasing trends in PSS among young people in Sweden from 2002 to 2018, with a significant increase observed among adolescents in the high FAS group who reported getting drunk on at least two occasions.

  • 4.
    Giannotta, Fabrizia
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. Mälardalen University, Sweden.
    Nilsson, K. W.
    Åslund, C.
    Larm, Peter
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Among the swedish generation of adolescents who experience an increased trend of psychosomatic symptoms. Do they develop depression and/or anxiety disorders as they grow older?2022In: BMC Psychiatry, E-ISSN 1471-244X, Vol. 22, article id 779Article in journal (Refereed)
    Abstract [en]

    Background: Despite an increase in mental health problems, with psychosomatic symptoms having been observed in new generations of Swedish youth, the extent to which these problems correspond to an increase in adult mental problems is unknown. The present study investigates whether Swedish adolescents with high levels of psychosomatic symptoms are at risk of developing depression and anxiety problems in adulthood and whether sex moderates any association. Moreover, we aim to understand whether different clusters of youth psychosomatic symptoms – somatic, psychological and musculoskeletal – have different impacts on adult mental health.

    Methods: One thousand five hundred forty-five Swedish adolescents – aged 13 (49%) and 15 (51%) – completed surveys at baseline (T1) and 3 years later (T2); of them, 1174 (61% females) also participated after 6 years (T3). Multivariate logistic models were run.

    Results: Youth with high levels of psychosomatic symptoms had higher odds of high levels of depressive symptoms at T2 and T3. Moreover, psychosomatic symptoms at T1 predicted a high level of anxiety symptoms and diagnoses of anxiety disorders at T3. When analyzed separately, musculoskeletal symptoms predicted higher odds of having high levels of depressive symptoms at T2 and T3 while somatic symptoms predicted high levels of anxiety symptoms at T2. Moreover, somatic symptoms at T1 predicted diagnoses of depression and anxiety disorders at T3. Sex did not moderate any of the relationships.

    Conclusions: The study supports the idea that an increase in mental health problems, such as psychosomatic symptoms, can seriously impact the psychological health of new generations of young adults.

  • 5.
    Giannotta, Fabrizia
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. Mälardalen University, Sweden.
    Nilsson, K. W.
    Åslund, C.
    Larm, Peter
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Frequency of vigorous physical activity and depressive symptoms across adolescence: Disentangling the reciprocal associations between different groups and subtypes of symptoms2023In: Mental Health and Physical Activity, ISSN 1755-2966, E-ISSN 1878-0199, Vol. 25, article id 100536Article in journal (Refereed)
    Abstract [en]

    Physical activity has a demonstrated positive effect on youth depressive symptoms. However, very few studies have explored the bi-directionality of the links between physical activity and depression. The present study aims at filling this gap and tests whether any associations are moderated by sex. Moreover, the role of subtype of depressive symptoms, vegetative (i.e., lack of energy, poor sleep) or non-vegetative (i.e., mood-related), is explored. Participants were 910 12–13 year-old Swedish adolescents (56% girls) who answered a three-wave survey at ages 12–13 (T1), 15–16 (T2), and 18–19 (T3). Using a cross-lagged structural model, depression predicted decreased frequency of vigorous physical activity (VPA) from T1 to T2 (β = −0.09, p < .05) and from T2 to T3 (β = −0.10, p < .01), while frequency of VPA at T2 decreased depression at T3 (β = −0.12, p < .05). Associations did not differ between boys and girls. Non-vegetative symptoms predicted decreased frequency of VPA from T1 to T2 (β = −0.10, p < .05), while frequency of VPA at T2 predicted decreased non-vegetative symptoms at T3 (β = −0.15, p < .05). Vegetative symptoms predicted decreased frequency of VPA from T1 to T2 (β = −0.09, p < .05), while have a reciprocal influence with VPA from T2 to T3. Overall, our results highlight an association across adolescence between VPA and depression. The association becomes stronger and reciprocal in middle adolescence, which suggests this period as an effective developmental time to plan physical-activity-based interventions to decrease youth depressive symptoms.

  • 6.
    Giannotta, Fabrizia
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. Mälardalen University, Sweden; University of Turin, Italy.
    Nilsson, K. W.
    Åslund, C.
    Olofdotter, S.
    Vadlin, S.
    Larm, Peter
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Anxiety, Sleep Problems, and Vigorous Physical Activity: Bidirectional Associations from Early Adolescence to Early Adulthood in Swedish Adolescents2024In: Journal of Youth and Adolescence, ISSN 0047-2891, E-ISSN 1573-6601, Vol. 53, no 6, p. 1355-1369Article in journal (Refereed)
    Abstract [en]

    Anxiety symptoms and sleep problems typically emerge during adolescence and are frequently intertwined. However, there is a dearth of knowledge concerning their reciprocal influence and whether physical activity might play a protective role in this relationship. The present study aims at filling this gap exploring also the moderating role of sex. 915 13-year-old Swedish adolescents (56% girls) answered a survey conducted four times: at ages 13 (T1), 16 (T2), 19 (T3), and 22 (T4). A random intercept cross-lagged panel model was used. At within-levels, sleep problems and anxiety symptoms had a bidirectional positive association in middle adolescence. Vigorous physical activity and anxiety symptoms showed a reciprocal negative association from middle adolescence. Vigorous physical activity and sleep problems were reciprocally associated only in late adolescence. Associations were the same for girls and boys. This study demonstrated that the relations between anxiety symptoms, sleep problems, and vigorous physical activity cannot be understood without adopting a developmental perspective and that middle adolescence is a crucial period to plan interventions to reduce anxiety symptoms and sleep problems.

  • 7.
    Giannotta, Fabrizia
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. Mälardalen University, Sweden.
    Åslund, Cecilia
    Hellström, Charlotta
    Larm, Peter
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Problem gambling, risk behaviours, and mental health in adolescence: A person oriented study2022In: Journal of Gambling Issues, E-ISSN 1910-7595, Vol. 49, p. 90-107Article in journal (Refereed)
    Abstract [en]

    Adolescent gambling is becoming a public health problem. While comorbidities with other externalizing behaviours have been ascertained, few studies focus on adolescents with a multi-problem behaviour pattern, i.e., alcohol and tobacco use, in addition to antisocial behaviour, which includes problem gambling. The purpose of this study was to identify adolescents with multi-problem behaviours, i.e., alcohol abuse, daily smoking, antisocial behaviour, and problem gambling and to investigate the differences in relation to gender. Unlike most studies on this topic, we adopted a person-oriented approach to identify groups of adolescent boys and girls who reported multi-problem risk behaviours, i.e., alcohol abuse, daily smoking, antisocial behaviour, and problem gambling. Moreover, we explored to what extent these adolescents exhibited mental health problems, i.e., depressive, psychosomatic, and ADHD symptoms, as well as sleep problems. The sample consisted of 1,526 adolescents from two age cohorts, 15- to 16-year-olds (n = 711, 47%) and 17- to 18-year-olds (n = 815, 53%). Latent Variable Mixture Modeling (LVMM) revealed one group with low rates of all risk behaviours and three groups with multi-problem behaviours. Among the latter three groups, two reported problem gambling and had higher levels of mental health problems. These results suggest that gambling can be added to the constellation of risk behaviours in adolescence and might be more associated with mental health problems than other externalizing behaviours. 

  • 8.
    Karlsson, Patrik
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Social Work.
    Larm, Peter
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Svensson, Johan
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Raninen, Jonas
    The factor structure of the Strength and Difficulties Questionnaire in a national sample of Swedish adolescents: Comparing 3 and 5-factor models2022In: PLOS ONE, E-ISSN 1932-6203, Vol. 17, no 3, article id e0265481Article in journal (Refereed)
    Abstract [en]

    The Strength and Difficulties Questionnaire (SDQ) is one of the most common screening instruments for emotional and behavioral problems in children and adolescents. Although exploratory factor analyses support the originally proposed 5-factor structure of SDQ as well as a 3-factor model, the evidence from confirmatory factor analyses is more mixed. Some of the difficulties items in SDQ are positively worded and it has been proposed that this leads to method effects, i.e. these items share variance that is due to the method used rather than to a substantive construct. Also, there seems to be minor factors in some subscales. This study tests a series of 3- and 5- factor models pertaining to the factor structure of SDQ, also considering method effects and minor factors. The sample consists of a nationally representative cohort of Swedish adolescents born in 2001 (n = 5549). Results show a relatively better fit of the 5-factor model compared with the 3-factor model although neither of these had a satisfactory fit. Model fit was improved when specifying cross-loadings of the positively worded difficulties items on the prosocial scale as well as minor factors on the hyperactivity scale. Although no model provided a completely satisfactory fit to the data, the results show that the 5-factor model performs better than the 3-factor model and has an acceptable fit. We conclude that for the purposes of epidemiological research, SDQ has acceptable factorial validity, provided that researchers consider method effects and minor factors.

  • 9.
    Larm, Peter
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Hellström, Charlotta
    Raninen, Jonas
    Åslund, Cecilia
    Nilsson, Kent W.
    Giannotta, Fabrizia
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Do non-drinking youth drink less alcohol in young adulthood or do they catch up? Findings from a Swedish birth cohort2023In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 33, no 4, p. 640-644Article in journal (Refereed)
    Abstract [en]

    Background: Alcohol consumption among adolescents has declined considerably during the last two decades. However, it is unknown if these adolescents’ alcohol consumption will remain low as they grow older. To our knowledge, this is one of the first studies that uses longitudinal data to examine if non-drinking adolescents have a lower alcohol consumption in young adulthood or if they catch up. Methods: A self-report survey was distributed to a birth cohort (n = 794) born in 1997 in a Swedish region when cohort members attended ninth grade (age 14–15 years) in 2012. Responders were divided into non-drinkers and alcohol users and assessed again in their late teens (17–18 years) and young adulthood (20–21 years). Results: In their late teens (17–18 years), non-drinkers at baseline consumed less alcohol and had a lower probability of harmful use compared with their alcohol-using peers. In young adulthood (20–21 years), these effects disappeared when adjustment was made for covariates. However, a stratified analysis showed that non-drinking adolescents low in conduct problems consumed less alcohol and had a lower probability of harmful use in young adulthood than alcohol-using peers. Conclusions: This study suggests that the decline in alcohol use among adolescents in the past decades may be associated with a lower alcohol consumption in the late teens and young adulthood among those low in conduct problems. This may have promising implications for alcohol-related morbidity and mortality.

  • 10.
    Ramstedt, Mats
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. Swedish Council for Information on Alcohol and Other Drugs (CAN), Sweden; Karolinska Institutet, Sweden.
    Raninen, Jonas
    Larm, Peter
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Are changes in parenting related to the decline in youth drinking? Evidence from a comparison of Sweden and Denmark2022In: Nordic Studies on Alcohol and Drugs, ISSN 1455-0725, E-ISSN 1458-6126, Vol. 39, no 2, p. 124-133Article in journal (Refereed)
    Abstract [en]

    Introduction: The aim of this study was to replicate earlier studies suggesting that changes in parenting have contributed to the recent decline in youth drinking by comparing parenting in a country experiencing a sharp decline in youth drinking (Sweden) with a country with only a small decline (Denmark). Data and analysis: Data stem from self-reported information from 15–16-year-old children in the Swedish and Danish subsamples of ESPAD. Youth drinking was measured by prevalence and frequency of drinking over the past year. Parenting was measured in terms of the extent the child reported that: (1) parents’ attitudes towards offspring drinking are restrictive, (2) parents set up general rules for what their children are allowed to do, and (3) parents have high level of knowledge about where and with whom their children spend time. The association between these indicators of parenting and youth drinking was first estimated with logistic regressions. Second, changes in parenting between 1999 and 2015 were compared between Denmark and Sweden across the study period. Results: Restrictive parental attitudes were associated with a lower likelihood of past-year drinking and frequent drinking in both Sweden and Denmark. This attitude was more common in Sweden, where it also became more prevalent between 2003 and 2015 in contrast to in Denmark. The association between strict parental rule-setting and youth drinking was weak in both countries. A high parental knowledge of the child's whereabouts was linked to a lower likelihood of past-year drinking in Sweden and a lower frequency of drinking in both countries. Parental knowledge of offspring's whereabouts did not develop differently in Sweden and Denmark, with a high and stable proportion in both countries. Conclusion: More restrictive parental attitudes towards youth drinking may have contributed to the decline in youth drinking, whereas the importance of general parental rule-setting and parental knowledge of offspring's whereabouts was not supported.

  • 11.
    Ramstedt, Mats
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. Karolinska Institutet, Sweden; The Swedish Council for Information on Alcohol and Other Drugs, Sweden.
    Raninen, Jonas
    Larm, Peter
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Livingston, Michael
    Children with problem drinking parents in Sweden: Prevalence and risk of adverse consequences in a national cohort born in 20012022In: Drug and Alcohol Review, ISSN 0959-5236, E-ISSN 1465-3362, Vol. 41, no 3, p. 625-632Article in journal (Refereed)
    Abstract [en]

    Introduction. To estimate the prevalence of children with problem drinking parents in Sweden and the extent to which they have an elevated risk of poor health, social relationships and school situation in comparison with other children. Methods. Survey with a nationally representative sample of Swedish youth aged 15-16 years (n = 5576) was conducted in 2017. A short version of The Children of Alcoholics Screening Test (CAST-6) was used to identify children with problem drinking parents. Health status, social relations and school situation were measured by well-established measures. Overall prevalences for girls and boys were presented as well as relative risks (RR) of harm for children with problem drinking parents compared with other children. Results. A total of 13.1% of the sample had at least one problem drinking parent during adolescence according to CAST-6-a higher proportion of girls (15.4%) than boys (10.8%). This group had an elevated risk of poor general health as well psychosomatic problems compared with other children (RR 1.2-1.9). They were also more likely to use medication for depression, sleeping difficulties and anxiety (RR 2.2-2.6). Their social relations were also worse especially with their father (RR 3.1) and they had more problems at school (RR 2.6). Discussion and Conclusions. The risk of problems related to parental drinking goes beyond the most severe cases where parents have been in treatment for their alcohol problem. This is important knowledge since the majority of problem drinkers never seek treatment and the major part of parental problem drinking is found in population samples.

  • 12.
    Ramstedt, Mats
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. Karolinska Institutet, Stockholm, Sweden; The Swedish Council for Information on Alcohol and Other Drugs (CAN), Stockholm, Sweden.
    Raninen, Jonas
    Larm, Peter
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Livingston, Michael
    Children with problem-drinking parents in a Swedish national sample: is the risk of harm related to the severity of parental problem drinking? 2023In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 33, no 2, p. 312-316Article in journal (Refereed)
    Abstract [en]

    Background: The aim of this paper is to examine the link between severity in exposure to parental problem drinking in a Swedish national population sample of children aged 15–16 years. Specifically, we assessed whether the risk of poor health, poor relationships and a problematic school situation increase with severity in exposure to parental problem drinking.

    Methods: National population survey from 2017 with a representative sample of 5 576 adolescents born in 2001. Logistic regression models were used to estimate odds ratios (ORs) with 95% confidence intervals (95% CIs). A short version of The Children of Alcoholics Screening Test, CAST-6, was used to identify children with problem-drinking parents. Health status, social relations and school situation were assessed by well-established measures.

    Results: The risk of having poor health, poor school performance and poor social relations increased with severity of parental problem drinking. The risk was lowest among children least severely affected (Crude models ranged from OR: 1.2, 95% CI 1.0–1.4 to OR: 2.2, 95% CI 1.8–2.6) and highest among children most severely affected (Crude models ranges from OR: 1.7, 95% CI 1.3–2.1 to OR: 6.6, 95% CI 5.1–8.6). The risk became lower when adjusting for gender and socioeconomic position but were still higher compared to children without problem-drinking parents.

    Conclusions: Appropriate screening and intervention programs are necessary for children with problem-drinking parents especially when exposure is severe but also at mild forms of exposure.

  • 13. Raninen, Jonas
    et al.
    Karlsson, Patrik
    Stockholm University, Faculty of Social Sciences, Department of Social Work.
    Svensson, Johan
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. Swedish Council for Information on Alcohol and Other Drugs (CAN), Sweden; Department of Clinical Neuroscience, Karolinska Institutet, Sweden.
    Livingston, Michael
    Sjödin, Lars
    Larm, Peter
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Reasons Not to Drink Alcohol among 9th Graders in Sweden2022In: Substance Use & Misuse, ISSN 1082-6084, E-ISSN 1532-2491, Vol. 57, no 11, p. 1747-1750Article in journal (Refereed)
    Abstract [en]

    AIM Alcohol is one of the leading contributors to the disease burden among young people. Drinking motives are one of the strongest factors influencing drinking behaviors among youth, yet we know little about reasons for why young people do not drink. The aim of the present study is to examine reasons for not drinking in a nationally representative sample of Swedish youth.

    DATA AND METHODS Data from a survey of a nationally representative sample of students in year 9 (15-16 years old) was used. Data was collected in 2017 and the total sample comprise 5549 respondents. Ten items measured reasons not to drink alcohol. Comparisons were made between drinkers and nondrinkers in endorsement of the reasons for not drinking. A multivariable logistic regression model was fitted to examine the relative importance of the different reasons.

    RESULTS That alcohol is bad for health and parents disapproval of drinking was the most commonly endorsed reasons both among drinkers and nondrinkers. The multivariable analysis showed that the strongest association with being a nondrinker was found for “Alcohol tastes horrible” (OR 2.995), “I have religious reasons for not drinking” (OR 2.775), “People who drink lose control in an unpleasant way” (OR 2.460) and “Drinking is too likely to lead to serious accidents” (OR 2.458).

    DISCUSSION AND CONCLUSIONS Harm avoidance and religious reasons are the most important reasons not to drink among Swedish youth. Future research should examine how different reasons predict abstinence.

  • 14. Raninen, Jonas
    et al.
    Larm, Peter
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Svensson, Johan
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. Swedish Council for Information on Alcohol and Other Drugs (CAN), Sweden; Karolinska Institutet, Sweden.
    Livingston, Michael
    Sjödin, Lars
    Karlsson, Patrik
    Stockholm University, Faculty of Social Sciences, Department of Social Work.
    Normalization of Non-Drinking? Health, School Situation and Social Relations among Swedish Ninth Graders That Drink and Do Not Drink Alcohol2021In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 18, no 21, article id 11201Article in journal (Refereed)
    Abstract [en]

    Alcohol consumption is a major contributor to the disease burden among adolescents. The adolescent alcohol abstainer is still often depicted as problematic in the research literature and in prominent theoretical frameworks. However, over the past two decades, there has been a marked trend of declining youth drinking in Sweden. The declining trend has led to a shift in the majority behaviour of youth, from drinking to non-drinking. It is plausible that this trend has also shifted the position of non-drinkers. This paper examines the position of non-drinkers in a nationally representative sample of Swedish adolescents. A survey was carried out in 2017 in 500 randomly selected schools. A total of 5549 respondents (15–16-year-olds) agreed to participate and answered the questionnaire. A minority (42.8%) had consumed alcohol during their lifetime. The results show that non-drinkers had better health and school performance when compared to drinkers. The results also showed that there were no differences in the social position between non-drinkers and drinkers. These findings are new and indicate a changed position of non-drinkers among Swedish adolescents. With non-drinking being the majority behaviour among Swedish adolescents this seems to have shifted the position of non-drinkers. There is a need for research on the long-term importance of not drinking during adolescence.

  • 15. Raninen, Jonas
    et al.
    Livingston, Michael
    Holmes, John
    Svensson, Johan
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. Swedish Council for Information on Alcohol and Other Drugs, Sweden; Karolinska Institutet, Sweden.
    Larm, Peter
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Declining youth drinking: A matter of faith?2022In: Drug and Alcohol Review, ISSN 0959-5236, E-ISSN 1465-3362, Vol. 41, no 4, p. 721-723Article in journal (Other academic)
    Abstract [en]

    Youth drinking has declined in many high-income countries for two decades. This development is still largely unexplained. Developing evidence and extending our understanding as to the mechanisms behind these changes is imperative for advising governments and policy makers on how to support and maintain the trends. Given the international scope of the trends, comparative studies have been suggested for improving our understanding of the development. In this commentary, we explore the patterns observed across several waves of the European School Survey Project on Alcohol and Other Drugs between 1999 and 2019, and how these match-up with the World Values Survey. We found that the declines in youth drinking are limited to a smaller number of countries and that in Europe these are all found in two groups from the World Values Survey, protestant Europe and English-speaking countries. If the declines in youth drinking are systematic and limited to a smaller number of countries, this challenges some of the hypothesised drivers of this development, but can also help guide future research.

  • 16. Raninen, Jonas
    et al.
    Livingston, Michael
    Ramstedt, Mats
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. Swedish Council for Information on Alcohol and Other Drugs (CAN), Sweden; Karolinska Institutet, Sweden.
    Zetterqvist, Martina
    Larm, Peter
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Svensson, Johan
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. Swedish Council for Information on Alcohol and Other Drugs (CAN), Sweden; Karolinska Institutet, Sweden.
    17 Is the New 15: Changing Alcohol Consumption among Swedish Youth2022In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 19, no 3, article id 1645Article in journal (Refereed)
    Abstract [en]

    To examine and compare trends in drinking prevalence in nationally representative samples of Swedish 9th and 11th grade students between 2000 and 2018. A further aim is to compare drinking behaviours in the two age groups during years with similar drinking prevalence. Data were drawn from annual surveys of a nationally representative sample of students in year 9 (15–16 years old) and year 11 (17–18 years old). The data covered 19 years for year 9 and 16 years for year 11. Two reference years where the prevalence of drinking was similar were extracted for further comparison, 2018 for year 11 (n = 4878) and 2005 for year 9 (n = 5423). The reference years were compared with regard to the volume of drinking, heavy episodic drinking, having had an accident and quarrelling while drunk. The prevalence of drinking declined in both age groups during the study period. The rate of decline was somewhat higher among year 9 students. In 2018, the prevalence of drinking was the same for year 11 students as it was for year 9 students in 2005. The volume of drinking was lower among year 11 students in 2018 than year 9 students in 2005. No differences were observed for heavy episodic drinking. The decline in drinking has caused a displacement of consumption so that today’s 17–18-year-olds have a similar drinking behaviour to what 15–16-year-olds had in 2005.

  • 17. Sjödin, Lars
    et al.
    Larm, Peter
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Karlsson, Patrik
    Stockholm University, Faculty of Social Sciences, Department of Social Work.
    Livingston, Michael
    Raninen, Jonas
    Drinking motives and their associations with alcohol use among adolescents in Sweden2021In: Nordic Studies on Alcohol and Drugs, ISSN 1455-0725, E-ISSN 1458-6126, Vol. 38, no 3, p. 256-269Article in journal (Refereed)
    Abstract [en]

    Aims: Previous studies have shown a close association between drinking motives and drinking behaviour among adolescents. However, there is a lack of evidence from the Nordic countries since few studies covering this topic have been carried out in this context. The present study among Swedish adolescents aims to examine (1) the prevalence of different drinking motives, (2) how drinking motives are associated with drinking frequency and heavy drinking frequency, and (3) whether the associations are moderated by sex.

    Methods: A nationally representative sample (n = 5,549) of Swedish adolescents (aged 15–16 years) answered a questionnaire in school. Of these, 2,076 were drinkers and were included in our study. Eighteen items from the Modified Drinking Motives Questionnaire-Revised (Modified DMQ-R) were used. Bivariate relationships between motives and drinking were examined with correlations. Linear regression models were used to assess the links between motives and drinking. Moderating effects of sex were examined with interactions.

    Results: Most common were social motives, followed by enhancement, coping-anxiety, coping-depression, and conformity motives. Coping-depression motives were slightly more common among girls. Conformity motives were associated with a lower frequency of drinking and heavy drinking while enhancement, social and coping-depression motives were associated with a higher frequency of both outcomes. No associations were found for coping-anxiety motives. No moderation effect of sex was found.

    Conclusions: Approach motives (social/enhancement) are the most prevalent drinking motives among Swedish adolescents. These also have the strongest association for both frequency of drinking and frequency of heavy drinking. This shows that Swedish adolescents drink to achieve something positive, rather than to avoid something negative, raising implications for prevention and intervention.

  • 18. Sjödin, Lars
    et al.
    Livingston, Michael
    Karlsson, Patrik
    Stockholm University, Faculty of Social Sciences, Department of Social Work.
    Larm, Peter
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Raninen, Jonas
    Associations between trust and drinking among adolescents2022In: Drug and Alcohol Review, ISSN 0959-5236, E-ISSN 1465-3362, Vol. 41, no 1, p. 221-229Article in journal (Refereed)
    Abstract [en]

    Introduction: Trust is closely linked with health, but previous research on its association with alcohol use has yielded mixed findings. The aim of this study is to examine: (i) how two different dimensions of trust (general/institutional) are associated with alcohol use among adolescents; (ii) how these dimensions interact with alcohol use; and (iii) whether the associations are moderated by sex, parenting, health, school satisfaction or economic disadvantage. Methods: A nationwide sample of 5549 adolescents (aged 15–16 years) in Sweden answered a questionnaire in school. General and institutional trust were measured with five items each. Logistic regressions were used to examine associations between drinking and the trust dimensions, and the cross-combinations of these. Moderation by sex, parenting, health, school satisfaction and economic disadvantage was tested. Results: General and institutional trust were both significantly associated with drinking. High scores on both dimensions simultaneously were associated with the lowest probability of drinking, and low scores on both with the highest. Low institutional trust had a stronger association than low general trust. The combination of high institutional/low general trust was more protective than low institutional/high general trust. The association between general trust and drinking was moderated by school satisfaction, and the relationship between institutional trust and drinking was moderated by parental support and control. Discussion and Conclusions: High trust is associated with a lower probability of past-year drinking among 15–16-year-olds. Parents and schools can be useful in endeavours to prevent low-trusting individuals in this age group from drinking.

  • 19. Söderqvist, Fredrik
    et al.
    Larm, Peter
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Psychometric evaluation of the mental health continuum - short form in Swedish adolescents2023In: Current Psychology, ISSN 1046-1310, E-ISSN 1936-4733, Vol. 42, no 3, p. 2136-2144Article in journal (Refereed)
    Abstract [en]

    The Mental Health Continuum - Short form (MHC-SF) is a self-report measure that has been increasingly used to monitor mental well-being at the population level. The aim of this study was to evaluate, for the first time, the psychometric properties of the MHC-SF in a population of Swedish adolescents. First, the evaluation was performed by examining face validity and test-retest reliability obtained in a pre-study. Then using data from the Survey of Adolescent Life in Vestmanland 2020 (n = 3880) we performed confirmatory factor analysis on different factor structures based on theory and previous research. Model-based estimates were calculated for assessing the internal reliability of the factor structure with the best fit. Convergent validity was assessed by bivariate as well as model-based correlations, and test-retest reliability was evaluated by intra-class correlation coefficients. The results show that the MHC-SF is best described with a bifactor model consisting of a dominant general well-being factor and three specific group factors of emotional, social and psychological well-being. Its overall reliability was high to very high, while the reliability of its subscales was low. A practical implication of the latter is that the subcales should not be used on their own because they are more likely to reliably measure the general well-being factor than the specific group factors. Test-retest reliability of the total scale was acceptable, and convergent validity was supported. In conclusion, we consider the Swedish MHC-SF to be a psychometrically sound instrument for monitoring overall mental well-being in Swedish adolescents.

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