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  • 1.
    Bergström, Malin
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). Karolinska Institutet, Sweden.
    Fransson, Emma
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Fabian, Helena
    Hjern, Anders
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). Karolinska Institutet, Sweden.
    Sarkadi, Anna
    Salari, Raziye
    Preschool children living in joint physical custody arrangements show less psychological symptoms than those living mostly or only with one parent2018In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 107, no 2, p. 294-300Article in journal (Refereed)
    Abstract [en]

    Aim

    Joint physical custody (JPC), where children spend about equal time in both parent's homes after parental separation, is increasing. The suitability of this practice for preschool children, with a need for predictability and continuity, has been questioned.

    Methods

    In this cross-sectional study, we used data on 3656 Swedish children aged three to five years living in intact families, JPC, mostly with one parent or single care. Linear regression analyses were conducted with the Strengths and Difficulties Questionnaire, completed by parents and preschool teachers, as the outcome measure.

    Results

    Children in JPC showed less psychological problems than those living mostly (adjusted B 1.81; 95% CI [0.66 to 2.95]) or only with one parent (adjusted B 1.94; 95% CI [0.75 to 3.13]), in parental reports. In preschool teacher reports, the adjusted Betas were 1.27, 95% CI [0.14 to 2.40] and 1.41, 95% CI [0.24 to 2.58], respectively. In parental reports, children in JPC and those in intact families had similar outcomes, while teachers reported lower unadjusted symptom scores for children in intact families.

    Conclusion

    Joint physical custody arrangements were not associated with more psychological symptoms in children aged 3–5, but longitudinal studies are needed to account for potential preseparation differences.

  • 2.
    Bergström, Malin
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Fransson, Emma
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Hjern, Anders
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). Karolinska Institutet, Sweden.
    Köhler, Lennart
    Wallby, Thomas
    Mental health in Swedish children living in joint physical custody and their parents' life satisfaction: A cross-sectional study2014In: Scandinavian Journal of Psychology, ISSN 0036-5564, E-ISSN 1467-9450, Vol. 55, no 5, p. 433-439Article in journal (Refereed)
    Abstract [en]

    This study compared the psychological symptoms of 129 children in joint physical custody with children in single care and nuclear families, using a nationally representative 2011 survey of 1,297 Swedish children aged between four and 18 years. The outcome measure was the Strengths and Difficulties Questionnaire (SDQ) and its association with three dimensions of parental life satisfaction was investigated. Linear regression analyses showed higher SDQ-scores for children in joint physical custody (B = 1.4, p < 0.001) and single care (B = 2.2, p < 0.001) than in nuclear families, after adjustment for socio-demographic variables. The estimates decreased to 1.1 and 1.3, respectively, after being adjusted for parental life satisfaction ( p < 0.01). Our findings confirm previous research that showed lower symptom scores for children in nuclear families than children in single care and joint physical custody. Parental life satisfaction should be investigated further as a possible explanation of differences in symptom load between children in different living arrangements.

  • 3.
    Bergström, Malin
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Fransson, Emma
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Modin, Bitte
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Berlin, Marie
    Stockholm University, Faculty of Social Sciences, Department of Sociology. National Board of Health and Welfare, Sweden.
    Gustafsson, Per A.
    Hjern, Anders
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). Karolinska Institutet, Sweden.
    Fifty moves a year: is there an association between joint physical custody and psychosomatic problems in children?2015In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 69, no 8, p. 769-774Article in journal (Refereed)
    Abstract [en]

    Background: In many Western countries, an increasing number of children with separated parents have joint physical custody, that is, live equally much in their parent's respective homes. In Sweden, joint physical custody is particularly common and concerns between 30% and 40% of the children with separated parents. It has been hypothesised that the frequent moves and lack of stability in parenting may be stressful for these children.

    Methods: We used data from a national classroom survey of all sixth and ninth grade students in Sweden (N=147839) to investigate the association between children's psychosomatic problems and living arrangements. Children in joint physical custody were compared with those living only or mostly with one parent and in nuclear families. We conducted sex-specific linear regression analyses for z-transformed sum scores of psychosomatic problems and adjusted for age, country of origin as well as children's satisfaction with material resources and relationships to parents. Clustering by school was accounted for by using a two-level random intercept model.

    Results: Children in joint physical custody suffered from less psychosomatic problems than those living mostly or only with one parent but reported more symptoms than those in nuclear families. Satisfaction with their material resources and parent–child relationships was associated with children's psychosomatic health but could not explain the differences between children in the different living arrangements.

    Conclusions: Children with non-cohabitant parents experience more psychosomatic problems than those in nuclear families. Those in joint physical custody do however report better psychosomatic health than children living mostly or only with one parent. Longitudinal studies with information on family factors before and after the separation are needed to inform policy of children's postseparation living arrangements.

  • 4.
    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.

  • 5.
    Bergström, Malin
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Modin, Bitte
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Fransson, Emma
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Rajmil, Luis
    Berlin, Marie
    Stockholm University, Faculty of Social Sciences, Department of Sociology.
    Gustafsson, Per A.
    Hjern, Anders
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Living in two homes-a Swedish national survey of wellbeing in 12 and 15 year olds with joint physical custody2013In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 13, article id 868Article in journal (Refereed)
    Abstract [en]

    Background The practice of joint physical custody, where children spend equal time in each parent's home after they separate, is increasing in many countries. It is particularly common in Sweden, where this custody arrangement applies to 30 per cent of children with separated parents. The aim of this study was to examine children's health-related quality of life after parental separation, by comparing children living with both parents in nuclear families to those living in joint physical custody and other forms of domestic arrangements.

    Methods Data from a national Swedish classroom study of 164,580 children aged 12 and 15-years-old were analysed by two-level linear regression modelling. Z-scores were used to equalise scales for ten dimensions of wellbeing from the KIDSCREEN-52 and the KIDSCREEN-10 Index and analysed for children in joint physical custody in comparison with children living in nuclear families and mostly or only with one parent.

    Results Living in a nuclear family was positively associated with almost all aspects of wellbeing in comparison to children with separated parents. Children in joint physical custody experienced more positive outcomes, in terms of subjective wellbeing, family life and peer relations, than children living mostly or only with one parent. For the 12-year-olds, beta coefficients for moods and emotions ranged from -0.20 to -0.33 and peer relations from -0.11 to -0.20 for children in joint physical custody and living mostly or only with one parent. The corresponding estimates for the 15-year-olds varied from -0.08 to -0.28 and from -0.03 to -0.13 on these subscales. The 15-year-olds in joint physical custody were more likely than the 12-year-olds to report similar wellbeing levels on most outcomes to the children in nuclear families.

    Conclusions Children who spent equal time living with both parents after a separation reported better wellbeing than children in predominantly single parent care. This was particularly true for the 15-year-olds, while the reported wellbeing of 12-years-olds was less satisfactory. There is a need for further studies that can account for the pre and post separation context of individual families and the wellbeing of younger age groups in joint physical custody.

  • 6.
    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, ISSN 1932-6203, 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.

  • 7.
    Brolin Låftman, Sara
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Fransson, Emma
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Modin, Bitte
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Östberg, Viveca
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    National data study showed that adolescents living in poorer households and with one parent were more likely to be bullied2017In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 106, no 12, p. 2048-2054Article in journal (Refereed)
    Abstract [en]

    Aim

    The aim of this study was to assess whether sociodemographic household characteristics were associated with which Swedish adolescents were more likely to be bullied.

    Methods

    The data were derived from the Swedish Living Conditions Survey and its child supplements from the survey years 2008-2011. The analyses included information on 3,951 adolescents aged 10-18 years. Exposure to bullying was reported by adolescents and information on sociodemographic household characteristics was reported by parents and obtained from official registers. Binary logistic regression was used to analyse the data.

    Results

    Adolescents were more likely to be bullied if they lived in households with no cash margin, defined as the ability to pay an unexpected bill of 8,000 Swedish Kronor or about 800 Euros, and if they lived with just one custodial parent. In the unadjusted analyses, elevated risks were identified if adolescents lived in working class households and had unemployed and foreign-born parents. However, these associations were at least partly accounted for by other sociodemographic household characteristics, in particular the lack of a cash margin.

    Conclusion

    This study showed that Swedish adolescents living in households with more limited financial resources had an increased risk of being bullied, supporting results from previous international research.

  • 8.
    Brolin Låftman, Sara
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Fransson, Emma
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Östberg, Viveca
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Sociodemographic inequalities in adolescents’ health-related behaviours: The case of Sweden2016In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 26, no 1Article in journal (Refereed)
    Abstract [en]

    Background

    Earlier research suggests that socioeconomic inequalities in health-related behaviours exist among young people, but with less clearcut patterns than among adults. The aim of the study is to examine to what extent sociodemographic inequalities in health behaviours in terms of alcohol use, smoking, physical inactivity, and regularly skipping breakfast and lunch, exist among adolescents in Sweden.

    Methods

    The data were obtained from the Swedish Living Conditions Survey (ULF) and its child supplements (Child-ULF) from 2008-2011 (n = 4001). Health-related behaviours were reported by adolescents aged 10-18 years and information on sociodemographic characteristics was derived from parents and from official registers. Binary logistic regression analyses were conducted.

    Results

    Clear sociodemographic inequalities in health-related behaviours were shown. Compared with their peers with parents in upper non-manual occupations, adolescents in working-class households were more likely to smoke (OR 1.53, p = 0.033), to be physically inactive (OR 1.54, p = 0.004), and to regularly skip breakfast (OR 1.78, p = 0.000) and lunch (OR 1.42, p = 0.011). Adolescents in households lacking a cash margin were more inclined to smoke (OR 1.47, p = 0.033) and to skip breakfast (OR 1.62, p = 0.000) as well as to skip lunch (OR 1.31, p = 0.041) than those in better off households. Not living in a nuclear family was linked with a higher risk of drinking alcohol (OR 1.57, p = 0.002), smoking (OR 2.32, p = 0.000), and skipping breakfast (OR 1.54, p = 0.000) and lunch (OR 1.55, p = 0.000). Adolescents with foreign-born parents were more likely to be physically inactive (OR 1.67, p = 0.001) and to regularly skip breakfast (OR 1.55, p = 0.002) compared with those whose parents were born in Sweden.

    Conclusions

    Sociodemographic inequalities in health-related behaviours clearly exist among adolescents in Sweden, along lines of household social class, financial strain, family structure and parental country of birth.

  • 9. Danielson, M.
    et al.
    Månsdotter, A.
    Fransson, Emma
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS). Karolinska Institutet, Sweden.
    Dalsgaard, S.
    Larsson, J.-O.
    Clinicians' attitudes toward standardized assessment and diagnosis within child and adolescent psychiatry2019In: Child and Adolescent Psychiatry and Mental Health, ISSN 1753-2000, E-ISSN 1753-2000, Vol. 13, article id 9Article in journal (Refereed)
    Abstract [en]

    Background: There is a strong call for clinically useful standardized assessment tools in everyday child and adolescent psychiatric practice. The attitudes of clinicians have been raised as a key-facilitating factor when implementing new methods. An explorative study was conducted aimed to investigate the clinicians' attitudes regarding standardized assessments and usefulness of diagnoses in treatment planning.

    Methods: 411 mental health service personnel working with outpatient and inpatient assessment and treatment within the specialist child and adolescent mental health services, Stockholm County Council were asked to participate in the study, of which 345 (84%) agreed answer a questionnaire. The questionnaire included questions regarding Attitudes toward Standardized Assessment and Utility of Diagnosis. Descriptive analyses were performed and four subscales were compared with information from a similar study in US using the same instruments. The demographic and professional characteristics (age, working years, gender, education, profession, management position, involvement in assessment, level of service) in terms of prediction of attitudes were studied by univariate and multivariate linear regressions.

    Results: Overall, the clinicians had quite positive attitudes and were more positive compared to a similar study conducted in the US earlier. There were differences in attitudes due to several characteristics but the only characteristic predicting all subscales was type of profession (counselor, nurse, psychiatrist, psychologist, other), with counselors being less positive than other groups.

    Conclusion: The overall positive attitudes toward standard assessment are of importance in the development of evidence-based practice and our study implies that clinicians in general value and are willing to use standardized assessment. Nevertheless, there are specific issues such as adequate training and available translated assessment instrument that need to be addressed. When implementing new methods in practice, there are general as well as specific resistances that need to be overcome. Studies in different cultural settings are of importance to further extend the knowledge of what is general and what is specific barriers.

  • 10.
    Fransson, Emma
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Bergström, Malin
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Hjern, Anders
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Barn i växelvis boende – en forskningsöversikt2015Report (Other academic)
    Abstract [sv]

    Varje år separerar föräldrar till ungefär 50 000 barn i Sverige. Sedan 1980-talet bor en ökande andel av dessa barn växelvis efter separationen. Växelvis boende innebär att barnen flyttar regelbundet mellan sina föräldrars respektive hem och bor ungefär lika mycket hos båda. En högre andel barn bor i växelvis boende i Sverige än i något annat land, ca 35-40 procent av de barn som har särlevande föräldrar, totalt cirka 200 000 barn.

    Denna rapport har skrivits av forskare i Elvis-projektet på CHESS vid Stockholms Universitet/Karolinska institutet på uppdrag av Socialstyrelsen. Den ger en sammanfattning av den forskningsbaserade kunskapen om hälsa och välbefinnande hos barn i växelvis boende. När det gäller barn under sex år, där kunskapsläget är mest osäkert, ger rapporten en heltäckande bild av den internationella forskningen, inklusive en översikt av den psykologiska teoribildningen på området. För skolbarnen finns det ett ganska stort antal svenska studier och därför har vi här valt att lägga fokus på dessa och endast komplettera med särskilt relevant forskning från andra länder. Att det finns mer forskning kring skolbarn beror delvis på att växelvis boende är vanligare för de åldersgrupperna, men främst på att man lättare kan ta in deras egna åsikter och erfarenheter, medan forskning kring de yngre barnen är mer komplicerad metodologiskt sett, och därför mer resurskrävande.

    Anknytningsteorins betoning av kvaliteten i interaktionen mellan små barn och deras vårdgivare ger anledning att särskilt skärskåda konsekvenserna av växelvist boende för de yngsta barnen. Resultaten från studierna av barn 0-3 år ger inte en entydig bild av barns välbefinnande och anknytningsrelationer. Flera av de få studierna håller låg vetenskaplig kvalitet och studerar små grupper. En tillräcklig empirisk bas för de yngsta barnen i växelvis boende saknas därmed. Sammantaget visar studierna att föräldrars samarbetsförmåga, sätt att hantera konflikter och lyhördhet för barnets behov spelar större roll än boendeform.

    I rapporten presenteras tio svenska tvärsnittsstudier av skolbarn från 10 års ålder i stora nationellt eller regionalt representativa surveyundersökningar samt en studie med biologiska data. I en majoritet av studierna rapporteras barn i växelvis boende ha mindre psykisk ohälsa och bättre välbefinnande än jämnåriga som bor med bara en förälder. Detta mönster är likartat hos pojkar och flickor. Tvärsnittsdesignen i samtliga studier gör dock att man bör vara försiktig med alltför definitiva slutsatser, eftersom denna design inte gör det möjligt att fullt ut ta hänsyn till skillnader i bakomliggande faktorer som t ex föräldrars hälsa, sociala situation och kommunikation sinsemellan.

    Studier pekar på olika faktorer som kan tänkas förklara att barn i växelvis boende överlag verkar ha en större chans till god psykisk hälsa än barn som bor med enbart en förälder. Barn i växelvis boende har genomsnittligt bättre materiella resurser än barn som bor med bara en förälder. Även med god kontroll för socioekonomiska skillnader mellan olika slags familjer visar dock merparten av studierna att skolbarn och tonåringar i växelvis boende mår bättre än de som bor enbart med en förälder, varför det är rimligt att spekulera i andra fördelar med växelvis boende. En möjlig förklaring skulle kunna vara att barn i växelvis boende har tillgång till, och stöd från, båda sina föräldrar. Barn i växelvis boende har också oftare en god relation till båda sina föräldrar än de som bor med enbart eller mest med en förälder.

    En rad kunskapsluckor identifieras i rapporten. Studier av god metodologisk kvalitet som fokuserar på de yngsta barnen, framför allt 0-3 år, saknas i särskilt hög grad. Longitudinella studier som har förutsättningar att mäta förändringar i psykisk hälsa och välbefinnande före och efter att föräldrar separerar är också mycket angelägna, liksom studier med ett individperspektiv som kan ge vägledning för beslut om boendeform för särskilt sårbara barn när föräldrar separerar. Ökningen av andelen barn som bor växelvis är en av de största förändringarna i barns livsvillkor i Sverige under de senaste åren. Det är också en förändring som är en uppenbart påverkbar faktor i barns liv. Det är således angeläget att resurser görs tillgängliga för att fylla de kunskapsluckor som identifieras.

    Avslutningsvis kan konstateras att det saknas forskning som kan ge ett definitivt svar på vilka konsekvenser växelvis boende har för barns hälsa och välbefinnande efter att föräldrar separerat. Med denna begränsning är det ändå värt att notera är att inte finns någon studie som tyder på att barns hälsa skulle vara sämre i växelvis boende än i boende med enbart en förälder från 4 års ålder, men att avsaknaden av kunskap om barn 0-3 år gör att några slutsatser inte alls bör dras om denna åldersgrupp.

  • 11.
    Fransson, Emma
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Brolin Låftman, Sara
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Östberg, Viveca
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Hjern, Anders
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Bergström, Malin
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    The Living Conditions of Children with Shared Residence – the Swedish Example2018In: Child Indicators Research, ISSN 1874-897X, E-ISSN 1874-8988, Vol. 11, no 3, p. 861-883Article in journal (Refereed)
    Abstract [en]

    Among children with separated parents, shared residence–i.e., joint phys-ical custody where the child is sharing his or her time equally between two custodialparents’homes–is increasing in many Western countries and is particularly commonin Sweden. The overall level of living among children in Sweden is high; however, thepotential structural differences between children in various post-separation familyarrangements have not been sufficiently studied. Potential risks for children with sharedresidence relate to the daily hassles and stress when having two homes. This study aimsat investigating the living conditions of children with shared residence compared withchildren living with two custodial parents in the same household and those living withone custodial parent, respectively. Swedish national survey data collected from childrenaged 10–18 years (n≈5000) and their parents were used. The outcomes were groupedinto: Economic and material conditions, Social relations with parents and peers, Healthand health behaviors, Working conditions and safety in school and in the neighbor-hood, and Culture and leisure time activities. Results from a series of linear probabilitymodels showed that most outcomes were similar for children with shared residence andthose living with two custodial parents in the same household, while several outcomeswere worse for children living with one parent. However, few differences due to livingarrangements were found regarding school conditions. This study highlights the in-equalities in the living conditions of Swedish children, with those living with oneparent having fewer resources compared with other children.

  • 12.
    Fransson, Emma
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Folkesson, Lisa
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Bergström, Malin
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Östberg, Viveca
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Lindfors, Petra
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Exploring salivary cortisol and recurrent pain in mid-adolescents living in two homes2014In: International Journal of Behavioral Medicine, ISSN 1070-5503, E-ISSN 1532-7558, Vol. 21, p. S23-S23Article in journal (Refereed)
    Abstract [en]

    Introduction: Every year, around 50.000 children in Sweden experience a separation between their parents. Joint physical custody (JPC), where the child alternates homes between the parents for about equal amount of time, has become a common living arrangement after parental separation. Children living in two homes can benefit from everyday contact with both parents and access to both parents’ financial resources. However, children can also experience stress from constantly moving and from exposure to any parental conflict. Yet, research on JPC and stress-related biological functioning is limited. The aimof this study was to investigate how living arrangements (intact family/JPC) relate toHPA-axis activity and recurrent pain in mid-adolescents. Methods: Mid-adolescents (106 girls and 51 boys) provided demographic details, self-reports of recurrent pain (headache, stomachache, neck/shoulder and back pain) and salivary samples. Salivary cortisol samples were collected: 1) immediately at awakening, 2) +30 minutes, 3) +60 minutes, and 4) at 8 p.m. Results: Hierarchical regressions showed that living arrangements did not predict morning cortisol levels, the diurnal cortisol rhythm nor recurrent pain. However, sex was significantly associated with both morning cortisol and recurrent pain. Conclusion: Living arrangements were not linked to HPA-axis activity or recurrent pain in this group of well-functioning mid-adolescents. Although this is the first study investigating how living arrangements relate to HPA-axis functioning, which means that additional research is needed, the findings suggest that these mid-adolescents have adapted to their living arrangements and that other factors seem more pertinent for HPA-functioning and subjective health complaints.

  • 13.
    Fransson, Emma
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Folkesson, Lisa
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Bergström, Malin
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Östberg, Viveca
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Lindfors, Petra
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Exploring salivary cortisol and recurrent pain in mid-adolescents living in two homes2014In: BMC Psychology, E-ISSN 2050-7283, Vol. 2, no 1, p. 1-7, article id 46Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Each year, around 50.000 children in Sweden experience a separation between their parents. Joint physical custody (JPC), where the child alternates homes between the parents for about equal amount of time, has become a common living arrangement after parental separation. Children in two homes could benefit from everyday contact with both parents and access to both parents' financial resources. However, children could experience stress from being constantly moving and potentially exposed to parental conflicts. Still, studies on JPC and biological functioning related to stress, are lacking. The aim of this study was to investigate how living arrangements (intact family/JPC) relate to HPA-axis activity and recurrent pain in mid-adolescents.

    METHODS: Mid-adolescents (106 girls and 51 boys) provided demographic details, self-reports of recurrent pain (headache, stomachache, neck/shoulder and back pain) and salivary samples. Salivary cortisol samples were collected: 1) immediately at awakening, 2) +30 minutes, 3) +60 minutes, and 4) at 8 p.m. The cortisol awakening response (CAR) was computed using an established formula. Additionally, the diurnal decline between the waking and 8 p.m. samples was computed.

    RESULTS: Hierarchical multiple regressions showed that living arrangements (intact family/JPC) was not associated with morning cortisol (CAR), the diurnal cortisol decline or with recurrent pain. However, sex was a significant predictor of both cortisol measures and recurrent pain with girls exhibiting a higher cortisol awakening response and a greater diurnal decline value as well as reporting more recurrent pain than did boys.

    CONCLUSIONS: Living arrangements were not associated with HPA-axis activity or recurrent pain in this group of well-functioning mid-adolescents. Although this study is the first to investigate how living arrangements relate to HPA-axis functioning and additional studies are needed, the tentative findings suggest that these mid-adolescents have adapted to their living arrangements and that other factors play a more pertinent role for HPA-functioning and subjective health.

  • 14.
    Fransson, Emma
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Hjern, Anders
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). Karolinska Institutet, Sweden.
    Bergström, Malin
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). Karolinska Institutet, Sweden.
    What Can We Say Regarding Shared Parenting Arrangements for Swedish Children?2018In: Journal of Divorce and Remarriage, ISSN 1050-2556, E-ISSN 1540-4811, Vol. 59, no 5, p. 349-358Article in journal (Refereed)
    Abstract [en]

    Joint physical custody (JPC) refers to children living alternatively and about equally with both parents after a parental separation or divorce. The practice has been debated in relation to child well-being because of the frequent moves imposed on children and the potential stress from living in 2 homes. This study describes the background to the high frequency of Swedish children in JPC and the results from research on Swedish children’s well-being in this living arrangement. Children in JPC report better well-being and mental health than children who live mostly or only with 1 parent. No Swedish studies have found children’s health to be worse in JPC than in sole parental care from child age of 3 years and beyond. The existing literature cannot, however, inform us about the mechanisms behind the findings. The risks of selection effects into living arrangements are plausible. For this purpose, longitudinal studies are warranted.

  • 15.
    Fransson, Emma
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Sarkadi, Anna
    Hjern, Anders
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). Karolinska University Hospital, Sweden.
    Bergström, Malin
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Why should they live more with one of us when they are children to us both?: Parents' motives for practicing equal joint physical custody for children aged 0–42016In: Children and youth services review, ISSN 0190-7409, E-ISSN 1873-7765, Vol. 66, p. 154-160Article in journal (Refereed)
    Abstract [en]

    Joint physical custody, i.e., children spending an equal amount of time in both parents' home after a separation or divorce, is increasing in many countries. In line with the national policy to promote paternal involvement in parenting, two-thirds of Swedish preschoolers with non-cohabiting parents live in two homes. Internationally, there has been a debate regarding the benefits or risks with joint physical custody for infants and toddlers. The aim of this qualitative study was to explore the reasons given by divorced parents for sharing joint physical custody of children 0-4 years of age. Interviews were conducted with 46 parents (18 fathers and 28 mothers) and analyzed using systematic text condensation. Two themes emerged in response to the research question. In the theme Same rights and responsibilities, parents described that joint physical custody was 'a given' as both parents were seen to have equal rights to and responsibility for the children. Both men and women described involved fatherhood as an ideal goal. In the theme For the sake of the child, parents emphasized that joint physical custody was in the best interest of the child. Some parents had conflicts with their ex-spouses, but were still convinced of the benefits of joint physical custody and strove to make it work.

  • 16.
    Fransson, Emma
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Turunen, Jani
    Stockholm University, Faculty of Social Sciences, Department of Sociology.
    Hjern, Anders
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). Karolinska Institutet, Sweden.
    Östberg, Viveca
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Bergström, Malin
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Psychological complaints among children in joint physical custody and other family types: Considering parental factors2016In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 44, no 2, p. 177-183Article in journal (Refereed)
    Abstract [en]

    Aims: Increasing proportions of Scandinavian children and children in other Western countries live in joint physical custody, moving between parents’ homes when parents live apart. Children and parents in non-intact families are at risk of worse mental health. The potential influence of parental ill-health on child well-being in the context of differing living arrangements has not been studied thoroughly. This study investigates the psychological complaints of children in joint physical custody in comparison to children in sole parental care and nuclear families, while controlling for socioeconomic differences and parental ill-health. Methods: Data were obtained from Statistics Sweden’s yearly Survey of Living Conditions 2007–2011 and child supplements with children 10–18 years, living in households of adult participants. Children in joint physical custody (n=391) were compared with children in sole parental care (n=654) and children in nuclear families (n=3,639), using a scale of psychological complaints as the outcome measure. Results: Multiple regression modelling showed that children in joint physical custody did not report higher levels of psychological complaints than those in nuclear families, while children in sole parental care reported elevated levels of complaints compared with those in joint physical custody. Adding socioeconomic variables and parental ill-health only marginally attenuated the coefficients for the living arrangement groups. Low parental education and parental worry/anxiety were however associated with higher levels of psychological complaints. Conclusions: Psychological complaints were lower among adolescents in joint physical custody than in adolescents in sole parental care. The difference was not explained by parental ill-health or socioeconomic variables.

  • 17.
    Ramberg, Joacim
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Brolin Låftman, Sara
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Fransson, Emma
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Modin, Bitte
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    School effectiveness and truancy: a multilevel study of upper secondary schools in Stockholm2019In: International Journal of Adolescence and Youth, ISSN 0267-3843, E-ISSN 2164-4527, Vol. 24, no 2, p. 185-198Article in journal (Refereed)
    Abstract [en]

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

  • 18.
    Turunen, Jani
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Sociology. Karlstad University, Sweden.
    Fransson, Emma
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Bergström, Malin
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Self-esteem in children in joint physical custody and other living arrangements2017In: Public Health, ISSN 0033-3506, E-ISSN 1476-5616, Vol. 149, p. 106-112Article in journal (Refereed)
    Abstract [en]

    Objectives: Parental support has been shown to be important for children's self-esteem, which in turn is related to later important life outcomes. Today, an increasing number of children in the Western world spend time in both the parents' respective households after a separation. Children who live with both parents report more parental support than children who live only with one parent after a divorce. We took the opportunity of the commonness of children sharing their time between their parents' homes in Sweden to investigate children's self-esteem in relation to family type. Study design and methods: With nationally representative survey data (ULF) collected from both parents and children, we analyze differences in children's self-esteem among 4823 10-18 year olds in nuclear families, joint physical custody and those living mostly or only with one parent after a separation using ordinary least squares regression, adjusting for demographic and socioeconomic characteristics. Results: We found no significant difference in self-esteem between children who lived equally much with both parents, mostly with one parent and those in nuclear families, whereas children in single care showed lower self-esteem compared with children in the other living arrangements. The difference was not explained by socioeconomic factors. Conclusion: The self-esteem of children who share their time between their parent's respective homes after a separation does not deviate from that in their peers in nuclear families. Instead, those in single care reported lower self-esteem than those in the other living arrangements. These differences were not explained by socioeconomic factors. Longitudinal studies are needed to establish pre- and post-separation family characteristics that influence self-esteem and well-being in young people.

  • 19.
    Östberg, Viveca
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Fransson, Emma
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Låftman Brolin, Sara
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Inequalities in subjective health complaints in Swedish adolescents: An intersectional approach2016In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 26, no 1Article in journal (Other academic)
    Abstract [en]

    Background

    Health inequality has been defined as the association between individuals’ health and their position in societal hierarchies. Such associations can be used as a starting-point in the search for social determinants of health. With regard to subjective health complaints among adolescents the evidence of socio-economic inequalities has been inconclusive. Inequalities by gender are, in contrast, clear and a female excess emerge or increase during adolescence. The aim of this study is to apply an intersectional approach and analyse differences in health complaints by parental education among girls and boys, taking age into account. Furthermore, data with information from both adolescents and their parents will be used which is ideal since adolescents seldom have correct information on parental education.

    Methods

    The data was obtained from a Swedish nationally representative survey (ULF) and its child supplement (Child-ULF) from the years 2007-2011 (n = 5280). Subjective health complaints were reported by adolescents (aged 10-18) and measures indicating psychological (e.g. feeling sad) and somatic complaints (i.e. head- and stomach ache) calculated. Information on education was obtained for one parent and five educational groups distinguished. Binary logistic regression was used and odds ratios with 95% confidence limits computed.

    Results

    Among girls, a clear gradient was found. From higher to lower level of parental education the odds ratios for psychological complaints were; 1.00 (ref); 1.07 (0.7-1.6); 1.38 (1.0-2.0); 1.73 (1.3-2.4); 2.05 (1.3-3.3); and for somatic complaints; 1.00 (ref); 1.27 (0.8-1.9); 1.55 (1.1-2.3); 1.69 (1.2-2.4); 2.82 (1.8-4.5). No association was found among boys. Gender differences per se were pervasive and, in ages where female excess is present, substantial within all educational groups.

    Conclusions

    The higher burden of subjective health complain

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