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  • 201.
    Edman, Johan
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Berndt, Josefine
    Stockholm University, Faculty of Humanities, Department of History.
    Oniomaniacs: the popular framing of consumption as a disease2018In: Addiction Research and Theory, ISSN 1606-6359, E-ISSN 1476-7392, Vol. 26, no 6, p. 431-438Article in journal (Refereed)
    Abstract [en]

    The aim of this article is to examine the framing of excessive consumption as a disease-like condition in the Swedish press during the years 1992-2012. Against a theoretical background discussing medicalisation, we have analysed the characteristics of problematic consumption framed as a disease, as well as the presumed causes of and responses to this problem. Alongside and intertwined with a structural and a rationalisation perspective, we find discussions and explanations of problematic consumption as a disease all through the investigated period. Class and gender are noticeable components of the core problem description, but the reductionist assumption of addiction as a brain disease seems to point to a problem beyond historical and social context. The disease conceptualisation of problematic consumption can be seen as a compensatory perspective in an individualising and consumption affirming society. However, this perspective is ultimately decided by politics and not by research. Despite being a frequently occurring perspective on a conceptual level in Sweden, it is not a legitimate description in legislation or as a cause for public treatment interventions.

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

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

  • 203. Einiö, Elina
    et al.
    Moustgaard, Heta
    Martikainen, Pekka
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). University of Helsinki, Finland; Max Planck Institute for Demographic Research, Germany.
    Leinonen, Taina
    Does the risk of hospitalisation for ischaemic heart disease rise already before widowhood?2017In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 71, no 6, p. 599-605Article in journal (Refereed)
    Abstract [en]

    Background The death of a spouse has been shown to increase mortality from various causes, including ischaemic heart disease. It is unclear, however, whether cardiac problems are already on the rise before widowhood.

    Methods Using longitudinal register data of Finnish widows-to-be aged 65 and over at baseline (N=19 185), we assessed the risk of hospitalisation for ischaemic heart disease 18 months before and after widowhood. Hospital admissions were derived from national hospital discharge registers between 1996 and 2002. Analyses used population-averaged and fixed-effects logistic models, the latter of which controlled for unobserved time-invariant characteristics, such as genetic susceptibility, personality and behavioural and medical history.

    Results For men, fixed-effects model revealed that hospitalisation for ischaemic heart disease increased twofold already 0–3 months prior to the death of a spouse (OR=2.09, 95% CI 1.22 to 3.60), relative to the period of 15–18 months before widowhood. It stayed at a heightened level up to 6 months following bereavement (OR=2.15, 95% CI 1.07 to 4.30). Among women, the fixed-effects analysis detected no statistically significant increase in hospitalisation for ischaemic heart disease before or after widowhood.

    Conclusions These findings indicate that men are already vulnerable to cardiac problems before the death of a wife. Medical interventions and health counselling could be targeted to the husbands of terminally ill patients, in order to improve their cardiovascular health over the transition to widowhood.

  • 204. Einiö, Elina
    et al.
    Nisén, Jessica
    Martikainen, Pekka
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). University of Helsinki, Finland; Max Planck Institute for Demographic Research, Germany.
    Number of children and later-life mortality among Finns born 1938-502016In: Population Studies, ISSN 0032-4728, E-ISSN 1477-4747, Vol. 70, no 2, p. 217-238Article in journal (Refereed)
    Abstract [en]

    We investigated the association between number of offspring and later-life mortality of Finnish men and women born 1938–50, and whether the association was explained by living conditions in own childhood and adulthood, chronic conditions, fertility timing, and unobserved characteristics common to siblings. We used a longitudinal 1950 census sample to estimate mortality at ages 50–72. Relative to parents of two children, all-cause mortality is highest among childless men and women, and elevated among those with one child, independently of observed confounders. Fixed-effect models, which control for unobserved characteristics shared by siblings, clearly support these findings among men. Cardiovascular mortality is higher among men with no, one, or at least four children than among those with two. Living conditions in adulthood contribute to the association between the number of children and mortality to a greater extent than childhood background, and chronic conditions contribute to the excess mortality of the childless.

  • 205. Ek, Weronica E.
    et al.
    Reznichenko, Anna
    Ripke, Stephan
    Niesler, Beate
    Zucchelli, Marco
    Rivera, Natalia V.
    Schmidt, Peter T.
    Pedersen, Nancy L.
    Magnusson, Patrik
    Talley, Nicholas J.
    Holliday, Elizabeth G.
    Houghton, Lesley
    Gazouli, Maria
    Karamanolis, George
    Rappold, Gudrun
    Burwinkel, Barbara
    Surowy, Harald
    Rafter, Joseph
    Assadi, Ghazaleh
    Li, Ling
    Papadaki, Evangelia
    Gambaccini, Dario
    Marchi, Santino
    Colucci, Rocchina
    Blandizzi, Corrado
    Barbaro, Raffaella
    Karling, Pontus
    Walter, Susanna
    Ohlsson, Bodil
    Törnblom, Hans
    Bresso, Francesca
    Andreasson, Anna
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Karolinska Institutet, Sweden.
    Dlugosz, Aldona
    Simrén, Magnus
    Agréus, Lars
    Lindberg, Greger
    Boeckxstaens, Guy
    Bellini, Massimo
    Stanghellini, Vincenzo
    Barbara, Giovanni
    Daly, Mark J.
    Camilleri, Michael
    Wouters, Mira M.
    D'Amato, Mauro
    Exploring the genetics of irritable bowel syndrome: a GWA study in the general population and replication in multinational case-control cohorts2015In: Gut, ISSN 0017-5749, E-ISSN 1468-3288, Vol. 64, no 11, p. 1774-1782Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: IBS shows genetic predisposition, but adequately powered gene-hunting efforts have been scarce so far. We sought to identify true IBS genetic risk factors by means of genome-wide association (GWA) and independent replication studies.

    DESIGN: We conducted a GWA study (GWAS) of IBS in a general population sample of 11 326 Swedish twins. IBS cases (N=534) and asymptomatic controls (N=4932) were identified based on questionnaire data. Suggestive association signals were followed-up in 3511 individuals from six case-control cohorts. We sought genotype-gene expression correlations through single nucleotide polymorphism (SNP)-expression quantitative trait loci interactions testing, and performed in silico prediction of gene function. We compared candidate gene expression by real-time qPCR in rectal mucosal biopsies of patients with IBS and controls.

    RESULTS: One locus at 7p22.1, which includes the genes KDELR2 (KDEL endoplasmic reticulum protein retention receptor 2) and GRID2IP (glutamate receptor, ionotropic, delta 2 (Grid2) interacting protein), showed consistent IBS risk effects in the index GWAS and all replication cohorts and reached p=9.31×10(-6) in a meta-analysis of all datasets. Several SNPs in this region are associated with cis effects on KDELR2 expression, and a trend for increased mucosal KDLER2 mRNA expression was observed in IBS cases compared with controls.

    CONCLUSIONS: Our results demonstrate that general population-based studies combined with analyses of patient cohorts provide good opportunities for gene discovery in IBS. The 7p22.1 and other risk signals detected in this study constitute a good starting platform for hypothesis testing in future functional investigations.

  • 206.
    Elling, Devy
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. Karolinska Institutet, Sweden.
    Surkan, Pamela J.
    Enayati, Sahba
    El-Khatib, Ziad
    Sex differences and risk factors for diabetes mellitus - an international study from 193 countries2018In: Globalization and Health, ISSN 1744-8603, E-ISSN 1744-8603, Vol. 14, article id 118Article in journal (Refereed)
    Abstract [en]

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

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

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

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

  • 207.
    Elstad, Jon Ivar
    et al.
    Oslo Metropolitan University, University of Oslo.
    Hermansen, Åsmund
    Oslo Metropolitan University, University of Oslo.
    Brønnum-Hansen, Henrik
    Københavns Universitet, University of Copenhagen.
    Martikainen, Pekka
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS). University of Helsinki, Finland; The Max Planck Institute for Demographic Research, Germany.
    Östergren, Olof
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Tarkiainen, Lasse
    Department of Social Research, University of Helsinki.
    Income security in Nordic welfare states for men and women who died when aged 55–69 years old2019In: Journal of International and Comparative Social Policy, ISSN 2169-9763, E-ISSN 2169-978XArticle in journal (Refereed)
    Abstract [en]

    Income security when health impairment or other social risks occur is a major objective of welfare states. This comparative study uses register data from four Nordic welfare states for examining equivalized disposable income during the last 12 years alive among men and women who died when aged 55–69 years old. The analysed outcome indicates the aggregate result of a varied set of income maintenance mechanisms. Median income increased in the Finnish, Norwegian and Swedish samples, but decreased somewhat in Denmark, probably due to relatively frequent transitions to retirement and larger income drops after retirement than in the other Nordic countries. Analyses of comparison samples weighted by propensity scores indicated a better income development among those who lived beyond the observation period than among those who died. The higher educated had a more favourable income development during the years prior to death than those with low education.

  • 208.
    Elveborg Lindskog, Elina
    Stockholm University, Faculty of Social Sciences, Department of Sociology.
    The effect of war on infant mortality in the Democratic Republic of Congo2016In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 16, article id 1059Article in journal (Refereed)
    Abstract [en]

    Background: The Democratic Republic of Congo (DRC) has suffered from war and lingering conflicts in East DRC and has one of the highest infant mortality rates in the world. Prior research has documented increases in infant and child mortality associated with war, but the empirical evidence is limited in several respects. Measures of conflict are quite crude or conflict is not tightly linked to periods of exposure to infant death. Few studies have distinguished between the effects of war on neonatal versus post-neonatal infants. No study has considered possible differences between women who give birth during wartime and those who do not that may be related to greater infant mortality. Methods: The analysis used the nationally representative sample of 15,103 mothers and 53,768 children from the 2007 and 2013/2014 Demographic Health Survey in the DRC and indicators of conflict events and conflict deaths from the 2013 Uppsala Conflict Data. To account for unobserved heterogeneity across women, a multi-level modeling approach was followed by grouping all births for each woman and estimating random intercepts in discrete time event history models. Results: Post-neonatal mortality increased during the Congolese wars, and was highest where conflict events and deaths were extreme. Neonatal mortality was not associated with conflict levels. Infant mortality was not higher in East DRC, where conflicts continued during the post Congolese war period. Models specifying unobserved differences between mothers who give birth during war and those who have children in peacetime did not reduce the estimated effect of war, i.e., no support was found for selectivity in the sample of births during war. Conclusion: Differences in effects of the Congolese war on neonatal versus post-neonatal mortality suggest that conflict influences the conditions of infants' lives more than the aspects of mothers' pregnancy conditions and delivery that are relevant for infant mortality. These differences may, however, be specific to the nature of conflict and prior conditions in the DRC. Because of continued political instability, violent conflict may be expected to continue in contexts such as the DRC; we must therefore continue to document, analyze and monitor the mechanisms through which war influences infant mortality.

  • 209. Engström, K
    et al.
    Johnson, C
    Rostila, Mikael
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Can social capital explain mental health inequalities between immigrant groups?2014Conference paper (Other academic)
  • 210.
    Ericsson, Malin
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Contraceptive behaviour and births among Swedish child welfare clients: A register based study on 14–19 year old females2012Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    Background: Teen pregnancy is associated with an array of negative social and health related outcomes for the mother as well as the baby. The risk of becoming a parent before the age of 20 is clearly elevated for former child welfare clients. Aim: The aim of this study is therefore to investigate the elevated birth rates among female adolescent child welfare clients by examining the relationship between contraceptive behaviour and pregnancies. Method: The study was based on a set of compiled register data. The study population were all females between the ages 14 and 19 during the years 2006-2008 (n. 487 115). The study group of main interest were child welfare clients who were compared to peers in the majority population as well as international and national adoptees. Analysis was conducted with multivariate logistic regression and the observed association was controlled for maternal, socio-demographic and behavioural factors. Results: The two sub-populations of child welfare clients both had much higher rates of retrieved hormonal contraceptives compared to the majority population, the international and the national adoptees up to age 17. In the ages 18 and 19 the rates were instead lower than the majority population. The child welfare clients had a stronger association to births than all groups of comparison, which was consistent with earlier research. All findings persisted after controlling for socio-demographic, maternal and behavioural factors. Conclusion: The child welfare clients showed a specific pattern of contraceptive behaviour over the age groups which was not consistent with the groups of comparison or with the expected relationship to birth rates. This suggests that teenage births cannot unanimously be predicted by the rates of retrieved hormonal contraceptives. The results imply that other factors than those investigated in this study are more influential regarding the contraceptive behaviour of this adolescent population.

  • 211.
    Eriksson, Charli
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Kimber, Birgitta
    Skoog, Therése
    Design and implementation of RESCUR in Sweden for promoting resilience in children: a study protocol2018In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 18, article id 1250Article in journal (Refereed)
    Abstract [en]

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

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

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

  • 212.
    Eriksson, Lena
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Edman, Johan
    Stockholm University, Faculty of Social Sciences, Department of Criminology.
    Great expectations: The bureaucratic handling of Swedish residential rehabilitation in the 21st century2018In: Nordic Studies on Alcohol and Drugs, ISSN 1455-0725, E-ISSN 1458-6126, Vol. 35, no 4, p. 257-274Article in journal (Refereed)
    Abstract [en]

    Background and aims: Increasingly, efforts to counteract perceived problems in drug treatment at residential rehabilitation centres have come to rely on measures drawing on evidence-based practice (EBP). However, the Swedish media, government inquiries, and international research have identified a number of problems regarding both residential rehabilitation and EBP. This suggests that caution should be exercised when placing expectations on EBP. The aim of this study is to investigate how the responsible authorities have handled increasing demands for EBP with administrative control while facing critical evaluations of their steering and implementation efforts. The study examines the maturation of a widespread treatment ideology, which aims to be based on evidence, in a country known for its restrictive drug policy and its goal of becoming a drug-free society. Methods: Through a qualitative textual analysis of 17 years (2000-2016) of inquiries, directives, and authority archives we have traced the interplay between problem descriptions, intended goals, and implemented solutions. Findings: The analysis shows that the ambition to provide care and welfare based on EBP is still an ambition. Also, the authorities' control over the care actually provided still leaves room for improvement. Recurring criticism and the empirical material indicate that the expectations have not been met. Conclusions: We would like to suggest that continued frustration can be traced to the misconception that EBP is the opposite of values and ideology, and hence preferable. As drug treatment strives for scientific credibility to give it legitimacy, some types of evidence are preferred above others. We would like to suggest that we need to bring ideology to the fore, and openly discuss our restrictive policy goals and choices of evidence.

  • 213.
    Eriksson, Lena
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Edman, Johan
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Knowledge, Values, and Needle Exchange Programs in Sweden2017In: Contemporary Drug Problems, ISSN 0091-4509, E-ISSN 2163-1808, Vol. 44, no 2, p. 105-124Article in journal (Refereed)
    Abstract [en]

    Since the turn of the millennium, calls for evidence-based drug policy have become increasingly louder. In response, researchers have generated a large body of evidence in support of measures such as needle exchange programs (NEPs), while another strand of research testifies that policy makers often neglect to take the research evidence into account and hence fail to introduce these programs. This article studies the interplay between research-based knowledge, values, and policy making during 16 years of intense parliamentary debate in Sweden on the needle exchange issue. In 2000, the future of the two existing experimental NEPs was uncertain; in 2006, the regulations were reformed; and in 2015, they underwent a government inquiry. Both the reform and the inquiry aimed at regulating and expanding the programs. The analysis is guided by work done within the tradition of science-policy nexus, where the increased emphasis on evidence-based political measures is problematized. As drug policy arouses normative and ethical concerns, the analysis also explores values. The study illustrates the central role that values play in a policy field which is repeatedly declared to be science based. Within the overall framework of the Swedish drug policy ideology of a drug-free society, the advocates of NEPs framed drug misuse as a consequence of either an unjust society or a disease, arguing that because misuse is a condition beyond the control of the individual, the Swedish welfare state has an obligation to take care of those affected. For their part, the opponents framed drug misuse as a result of misguided attitudes, which would only be corrected by restrictions and prohibition. In their view, NEPs are a tool for drug policy liberalization. In the debate between the two positions, research evidence played only a minor role.

  • 214.
    Eyjolfsdottir, Harpa Sif
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Social capital, self-rated health and the importance of sleep: The case of Iceland in 2007 and 20092012Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    The frequently studied concept of social capital has often been related to health, but theconceptualisationand measurement of the conceptisanon-goingdebate. The main aim of this thesis is to study the relationship of four different indicators of social capital; informal social capital, formal social capital, trust towards institutions and trust towards others, with self-rated physical health and self-rated mental health in Iceland in 2009, shortly after a harsh economic crash. Insomnia symptoms will be studied as a possible mediator or moderator in the relationship. Furthermore, longitudinal data on informal social capital will be used to see the causal effect of social capital on health and to see if informal social capital decreased after the economic collapse. Population-based panel data from Iceland in 2007 and 2009 will be used to perform both cross-sectional analysis (n = 3,243) and longitudinal analysis (n = 3,131). The main results are that the four indicators of social capital all relate differently to physical and mental self-rated health, and insomnia symptoms seem to mediate the relationship between social capital and health, especially physical health. Surprisingly, informal social capital did increase during the economic collapse. The panel analysis further suggests that having poor informal social capital has causal effects on poor self-rated mental health when adjusted for symptoms of insomnia, age, gender, family status, education and smoking. 

  • 215. Falkstedt, Daniel
    et al.
    Sorjonen, Kimmo
    Hemmingsson, Tomas
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). Karolinska institutet, Sverige.
    Deary, Ian J.
    Melin, Bo
    Psychosocial Functioning and Intelligence Both Partly Explain Socioeconomic Inequalities in Premature Death. A Population-Based Male Cohort Study2013In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 8, no 12, article id e82031Article in journal (Refereed)
    Abstract [en]

    Objective: The possible contributions of psychosocial functioning and intelligence differences to socioeconomic status (SES)-related inequalities in premature death were investigated. None of the previous studies focusing on inequalities in mortality has included measures of both psychosocial functioning and intelligence. Methods: The study was based on a cohort of 49 321 men born 1949-1951 from the general community in Sweden. Data on psychosocial functioning and intelligence from military conscription at similar to 18 years of age were linked with register data on education, occupational class, and income at 35-39 years of age. Psychosocial functioning was rated by psychologists as a summary measure of differences in level of activity, power of initiative, independence, and emotional stability. Intelligence was measured through a multidimensional test. Causes of death between 40 and 57 years of age were followed in registers. Results: The estimated inequalities in all-cause mortality by education and occupational class were attenuated with 32% (95% confidence interval: 20-45%) and 41% (29-52%) after adjustments for individual psychological differences; both psychosocial functioning and intelligence contributed to account for the inequalities. The inequalities in cardiovascular and injury mortality were attenuated by as much as 51% (24-76%) and 52% (35-68%) after the same adjustments, and the inequalities in alcohol-related mortality were attenuated by up to 33% (8-59%). Less of the inequalities were accounted for when those were measured by level of income, with which intelligence had a weaker correlation. The small SES-related inequalities in cancer mortality were not attenuated by adjustment for intelligence. Conclusions: Differences in psychosocial functioning and intelligence might both contribute to the explanation of observed SES-related inequalities in premature death, but the magnitude of their contributions likely varies with measure of socioeconomic status and cause of death. Both psychosocial functioning and intelligence should be considered in future studies.

  • 216.
    Falkstedt, Daniel
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). Karolinska Institutet, Sweden; University of Strasbourg, France; Stockholm County Council, Sweden.
    Wolff, Valerie
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). Karolinska Institutet, Sweden; University of Strasbourg, France; Stockholm County Council, Sweden.
    Allebeck, Peter
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). Karolinska Institutet, Sweden; University of Strasbourg, France; Stockholm County Council, Sweden.
    Hemmingsson, Tomas
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). Karolinska Institutet, Sweden; University of Strasbourg, France; Stockholm County Council, Sweden.
    Danielsson, Anna-Karin
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). Karolinska Institutet, Sweden; University of Strasbourg, France; Stockholm County Council, Sweden.
    Cannabis, Tobacco, Alcohol Use, and the Risk of Early Stroke: A Population-Based Cohort Study of 45000 Swedish Men2017In: Stroke, ISSN 0039-2499, E-ISSN 1524-4628, Vol. 48, no 2, p. 265-270Article in journal (Refereed)
    Abstract [en]

    Background and Purpose - Current knowledge on cannabis use in relation to stroke is based almost exclusively on clinical reports. By using a population-based cohort, we aimed to find out whether there was an association between cannabis use and early-onset stroke, when accounting for the use of tobacco and alcohol.

    Methods - The cohort comprises 49321 Swedish men, born between 1949 and 1951, who were conscripted into compulsory military service between the ages of 18 and 20. All men answered 2 detailed questionnaires at conscription and were subject to examinations of physical aptitude, psychological functioning, and medical status. Information on stroke events up to approximate to 60 years of age was obtained from national databases; this includes strokes experienced before 45 years of age.

    Results - No associations between cannabis use in young adulthood and strokes experienced 45 years of age or beyond were found in multivariable models: cannabis use >50 times, hazard ratios=0.93 (95% confidence interval [CI], 0.34-2.57) and 0.95 (95% CI, 0.59-1.53). Although an almost doubled risk of ischemic stroke was observed in those with cannabis use >50 times, this risk was attenuated when adjusted for tobacco usage: hazards ratio=1.47 (95% CI, 0.83-2.56). Smoking 20 cigarettes per day was clearly associated both with strokes before 45 years of age, hazards ratio=5.04 (95% CI, 2.80-9.06), and with strokes throughout the follow-up, hazards ratio=2.15 (95% CI, 1.61-2.88).

    Conclusions - We found no evident association between cannabis use in young adulthood and stroke, including strokes before 45 years of age. Tobacco smoking, however, showed a clear, dose-response shaped association with stroke.

  • 217. Feng, Lei
    et al.
    Ng, Xue-Ting
    Yap, Philip
    Li, Jialiang
    Lee, Tih-Shih
    Håkansson, Krister
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Kua, Ee-Heok
    Ng, Tze-Pin
    Marital Status and Cognitive Impairment among Community-Dwelling Chinese Older Adults: the Role of Gender and Social Engagement.2014In: Dementia and geriatric cognitive disorders extra, E-ISSN 1664-5464, Vol. 4, no 3, p. 375-384Article in journal (Refereed)
    Abstract [en]

    AIMS: To examine the association between marital status and cognitive impairment among community-dwelling Chinese older adults.

    METHODS: We analyzed data from 2,498 Chinese aged 55 and older from the Singapore Longitudinal Aging Study cohort. Cognitive impairment was defined as a Mini-Mental State Examination total score of 23 or below. Odds ratios of associations were reported and adjusted for potential confounders in logistic regression models.

    RESULTS: The prevalence of cognitive impairment was 12.2% (n = 306). Being single was associated with about 2.5 times increased odds of cognitive impairment compared to being married (adjusted OR = 2.53, 95% CI: 1.41-4.55). The association between marital status and cognitive impairment was much stronger in men compared to that in women, and was indeed statistically significant only for men. Among the single and widowed persons social engagement was associated with a lower risk of cognitive impairment. Compared with subjects in the lowest tertile of social engagement scores, the odds of having cognitive impairment was lowered by 50% for subjects in the second and the third tertile.

    CONCLUSION: Being single or widowed was associated with higher odds of cognitive impairment compared to being married in a cohort of older Chinese men but not women.

  • 218. Fernandes Portela, Luciana
    et al.
    Kröning Luna, Caroline
    Rotenberg, Lúcia
    Silva-Costa, Aline
    Toivanen, Susanna
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Araújo, Tania
    Härter Griep, Rosane
    Oswaldo Cruz Institute (IOC/Fiocruz), Brazil.
    Job strain and self-reported insomnia symptoms among nurses: What about the influence of emotional demands and social support?2015In: BioMed Research International, ISSN 2314-6133, E-ISSN 2314-6141, article id 820610Article in journal (Refereed)
    Abstract [en]

    Job strain, derived from high psychological demands and low job control, is associated with insomnia, but information on the role of emotional demands and social support in this relationship is scarce. The aims of this study were (i) to test the association between job strain and self-reported insomnia symptoms, (ii) to evaluate the combination of emotional demands and job control regarding insomnia symptoms, and (iii) to analyze the influence of social support in these relationships. This cross-sectional study refers to a sample of nurses (N = 3,013 and N = 3,035 for Job Strain and Emotional demand-control model, resp.) working at public hospitals in Rio de Janeiro, Brazil. Data were collected through a self-report questionnaire. The prevalence of insomnia symptoms was 34.3%. Job strain was associated with increased odds for insomnia symptoms (OR: 2.20); the same result was observed with the combination of emotional demands and low job control (OR: 1.99). In both models, the inclusion of low social support combined with high demands and low job control led to increased odds for insomnia symptoms, compared to groups with high social support from coworkers and supervisors. Besides job strain, the study of emotional demands and social support are promising with regards to insomnia symptoms, particularly among nurses.

  • 219.
    Ferrarini, Tommy
    et al.
    Stockholm University, Faculty of Social Sciences, The Swedish Institute for Social Research (SOFI).
    Nelson, Kenneth
    Stockholm University, Faculty of Social Sciences, The Swedish Institute for Social Research (SOFI).
    Sjöberg, Ola
    Stockholm University, Faculty of Social Sciences, The Swedish Institute for Social Research (SOFI). Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Decomposing the effect of social policies on population health and inequalities: An empirical example of unemployment benefits2014In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 42, no 7, p. 635-642Article in journal (Refereed)
    Abstract [en]

    Aim: The purpose of this study is to discuss and empirically contrast different conceptualizations and operationalizations of social policies in analysing health and educational differences in health cross-nationally. Methods: Country-level institutional and expenditure data on unemployment benefit schemes and individual-level data from the EU-SILC for 23 countries were used to analyse the association between unemployment benefits and self-assessed health for individuals with different educational attainment. Results: The analyses indicate that higher coverage rate (i.e. the proportion of the relevant population eligible for benefits) is associated with better self-related health among both low- and high-educated individuals, but is not linked to smaller educational differences in health. In contrast, replacement rate (i.e. the amount of benefits received) in isolation is not related to self-assessed health. However, in countries where coverage rates are high, higher replacement rates are associated with better health among both low- and high-educated individuals and smaller educational differences in health. Conclusions: Decomposing unemployment benefit programmes into two main dimensions – the proportion in the labour force covered by such programmes and the replacement rate received in case of unemployment – may present further insights into institutional mechanisms linking macro-level social policies to individual-level health outcomes.

  • 220. Ferrie, Jane E.
    et al.
    Virtanen, Marianna
    Jokela, Markus
    Madsen, Ida E. H.
    Heikkilä, Katriina
    Alfredsson, Lars
    Batty, G. David
    Bjorner, Jakob B.
    Borritz, Marianne
    Burr, Hermann
    Dragano, Nico
    Elovainio, Marko
    Fransson, Eleonor I.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Karolinska Institutet, Sweden; Jönköping University, Sweden.
    Knutsson, Anders
    Koskenvuo, Markku
    Koskinen, Aki
    Kouvonen, Anne
    Kumari, Meena
    Nielsen, Martin L.
    Nordin, Maria
    Oksanen, Tuula
    Pahkin, Krista
    Pejtersen, Jan H.
    Pentti, Jaana
    Salo, Paula
    Shipley, Martin J.
    Suominen, Sakari B.
    Tabak, Adam
    Theorell, Töres
    Väänänen, Ari
    Vahtera, Jussi
    Westerholm, Peter J. M.
    Westerlund, Hugo
    Rugulies, Reiner
    Nyberg, Solja T.
    Kivimäki, Mika
    Job insecurity and risk of diabetes: a meta-analysis of individual participant data2016In: CMJA. Canadian Medical Association Journal. Onlineutg. Med tittel: ECMAJ. ISSN 1488-2329, ISSN 0820-3946, E-ISSN 1488-2329, Vol. 188, no 17-18, p. E447-E455Article in journal (Refereed)
    Abstract [en]

    Background: Job insecurity has been associated with certain health outcomes. We examined the role of job insecurity as a risk factor for incident diabetes. Methods: We used individual participant data from 8 cohort studies identified in 2 open-access data archives and 11 cohort studies participating in the Individual-Participant-Data Meta-analysis in Working Populations Consortium. We calculated study-specific estimates of the association between job insecurity reported at baseline and incident diabetes over the follow-up period. We pooled the estimates in a meta-analysis to produce a summary risk estimate. Results: The 19 studies involved 140 825 participants from Australia, Europe and the United States, with a mean follow-up of 9.4 years and 3954 incident cases of diabetes. In the preliminary analysis adjusted for age and sex, high job insecurity was associated with an increased risk of incident diabetes compared with low job insecurity (adjusted odds ratio [OR] 1.19, 95% confidence interval [CI] 1.09-1.30). In the multivariable-adjusted analysis restricted to 15 studies with baseline data for all covariates (age, sex, socioeconomic status, obesity, physical activity, alcohol and smoking), the association was slightly attenuated (adjusted OR 1.12, 95% CI 1.01-1.24). Heterogeneity between the studies was low to moderate (age- and sex-adjusted model: I-2 = 24%, p = 0.2; multivariable-adjusted model: I-2 = 27%, p = 0.2). In the multivariable-adjusted analysis restricted to high-quality studies, in which the diabetes diagnosis was ascertained from electronic medical records or clinical examination, the association was similar to that in the main analysis (adjusted OR 1.19, 95% CI 1.04-1.35). Interpretation: Our findings suggest that self-reported job insecurity is associated with a modest increased risk of incident diabetes. Health care personnel should be aware of this association among workers reporting job insecurity.

  • 221. Fischer, Benedikt
    et al.
    Kuganesan, Sharan
    Room, Robin
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Medical marijuana programs: implications for control policy – observations from Canada2015In: International Journal of Drug Policy, ISSN 0955-3959, Vol. 26, no 1, p. 15-19Article in journal (Refereed)
    Abstract [en]

    While prohibition has been the dominant regime of cannabis control in most countries for decades, anincreasing number of countries have been implementing cannabis control reforms recently, includingdecriminalization or even legalization frameworks. Canada has held out from this trend, although ithas among the highest cannabis use rates in the world. Cannabis use is universally criminalized, and thecurrent (conservative) federal government has vowed not to implement any softening reforms to cannabiscontrol. As a result of several higher court decisions, the then federal government was forced to implementa ‘medical marijuana access regulations’ program in 2001 to allow severely ill patients therapeutic useand access to therapeutic cannabis while shielding them from prosecution. The program’s regulationsand approval processes were complex and subject to extensive criticism; initial uptake was low andmost medical marijuana users continued their use and supply outside the program’s auspices. This year,the government introduced new ‘marijuana for medical purposes regulations’, which allow physicians to‘authorize’ medical marijuana use for virtually any health condition for which this is considered beneficial;supply is facilitated by licensed commercial producers. It is expected that some 500,000 users, and dozensof commercial producers will soon be approved under the program, arguably constituting – as withmedical marijuana schemes elsewhere, e.g. in California – de facto ‘legalization’. We discuss the questionwhether the evolving scope and realities of ‘medical cannabis’ provisions in Canada offer a ‘sneaky sidedoor’ or a ‘better third way’ to cannabis control reform, and what the potential wider implications are ofthese developments.

  • 222. Floderus, Birgitta
    et al.
    Hagman, Maud
    Aronsson, Gunnar
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Marklund, Staffan
    Wikman, Anders
    Medically certified sickness absence with insurance benefits in women with and without children2012In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 22, no 1, p. 85-92Article in journal (Refereed)
    Abstract [en]

    Background: Sickness absence in Sweden is high, particularly in young women and the reasons are unclear. Many Swedish women combine parenthood and work and are facing demands that may contribute to impaired health and well-being. We compared mothers and women without children under different conditions, assuming increased sickness absence in mothers, due to time-based stress and psychological strain. Methods: All women born in 1960-79 (1.2 million) were followed from 1993 to 2003. Information on children in the home for each year was related to medically certified sickness absence with insurance benefits the year after. We used age and time-stratified proportional hazard regression models accounting for the individual's changes on study variables over time. Data were retrieved from national administrative registers. Results: Sickness absence was higher in mothers than in women without children, the relative risks decreased by age, with no effect after the age of 35 years. An effect appeared in lonely women irrespective of age, while in cohabiting women only for the ages 20-25 years. Mothers showed increased sickness absence in all subgroups of country of birth, education, income, sector of employment and place of residence. The relation between number of children and sickness absence was nonlinear, with the highest relative risks for mothers of one child. The upward trend of sickness absence at the end of 1990s was steeper for mothers compared to women without children. Conclusion: Despite the well-developed social security system and child care services in Sweden, parenthood predicts increased sickness absence, particularly in young and in lone women.

  • 223.
    Fors, Stefan
    et al.
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). Stockholm University, Faculty of Social Sciences, Department of Social Work.
    Agahi, Neda
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Shaw, Benjamin A.
    Paying the price? The impact of smoking and obesity on health inequalities in later life2012In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 41, no 2, p. 134-141Article in journal (Refereed)
    Abstract [en]

    Aims: The aims of the study are twofold: (i) to explore the impact of socioeconomic position, as measured 13 years earlier, on cognitive functioning and mobility impairment in later life, and (ii) to explore the extent to which obesity and smoking status can explain socioeconomic inequalities in cognitive and mobility impairments in later life. Methods: Data from a nationally representative sample of Swedish adults aged 56-76 in 1991 who were re-interviewed 13 years later in 2004, was analysed to explore the impact of socioeconomic position, smoking, and obesity on cognitive and physical functioning in late life. Results: The results showed that both smoking and obesity in late mid-life were stratified by socioeconomic position. Moreover, the results showed significant associations between socioeconomic position and both cognitive and physical functioning in later life. However, these inequalities in late life function could only partially be explained by the socioeconomic differences in smoking and obesity. Conclusions: The findings of this study suggest that socioeconomic differences in the rates of smoking and obesity may explain some, but not all, of the socioeconomic inequalities in physical and cognitive functioning during old age.

  • 224.
    Fors, Stefan
    et al.
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Torssander, Jenny
    Stockholm University, Faculty of Social Sciences, The Swedish Institute for Social Research (SOFI).
    B. Almquist, Ylva
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Is childhood intelligence associated with coexisting disadvantages in adulthood? Evidence from a Swedish cohort study2018In: Advances in Life Course Research, ISSN 1569-4909, E-ISSN 1879-6974, Vol. 38, p. 12-21Article in journal (Refereed)
    Abstract [en]

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

  • 225.
    Fransson, Eleonor I.
    et al.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Karolinska Institutet, Sweden; Jönköping University, Sweden.
    Heikkilä, Katriina
    Nyberg, Solja T.
    Zins, Marie
    Westerlund, Hugo
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. University College London, United Kingdom.
    Westerholm, Peter
    Väänänen, Ari
    Virtanen, Marianna
    Vahtera, Jussi
    Theorell, Töres
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Suominen, Sakari
    Singh-Manoux, Archana
    Siegrist, Johannes
    Sabia, Séverine
    Rugulies, Reiner
    Pentti, Jaana
    Oksanen, Tuula
    Nordin, Maria
    Nielsen, Martin L
    Marmot, Michael G
    Magnusson Hanson, Linda L.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Madsen, Ida E. H.
    Lunau, Thorsten
    Leineweber, Constanze
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Kumari, Meena
    Kouvonen, Anne
    Koskinen, Aki
    Koskenvuo, Markku
    Knutsson, Anders
    Kittel, France
    Jöckel, Karl-Heinz
    Joensuu, Matti
    Houtman, Irene L.
    Hooftman, Wendela E.
    Goldberg, Marcel
    Geuskens, Goedele A.
    Ferrie, Jane E.
    Erbel, Raimund
    Dragano, Nico
    De Bacquer, Dirk
    Clays, Els
    Casini, Annalisa
    Burr, Hermann
    Borritz, Marianne
    Bonenfant, Sébastien
    Bjorner, Jakob B.
    Alfredsson, Lars
    Hamer, Mark
    Batty, G. David
    Kivimäki, Mika
    Job Strain as a Risk Factor for Leisure-Time Physical Inactivity: An Individual-Participant Meta-Analysis of Up to 170,000 Men and Women The IPD-Work Consortium2012In: American Journal of Epidemiology, ISSN 0002-9262, E-ISSN 1476-6256, Vol. 176, no 12, p. 1078-1089Article in journal (Refereed)
    Abstract [en]

    Unfavorable work characteristics, such as low job control and too high or too low job demands, have been suggested to increase the likelihood of physical inactivity during leisure time, but this has not been verified in large-scale studies. The authors combined individual-level data from 14 European cohort studies (baseline years from 1985-1988 to 2006-2008) to examine the association between unfavorable work characteristics and leisure-time physical inactivity in a total of 170,162 employees (50% women; mean age, 43.5 years). Of these employees, 56,735 were reexamined after 2-9 years. In cross-sectional analyses, the odds for physical inactivity were 26% higher (odds ratio = 1.26, 95% confidence interval: 1.15, 1.38) for employees with high-strain jobs (low control/high demands) and 21% higher (odds ratio = 1.21, 95% confidence interval: 1.11, 1.31) for those with passive jobs (low control/low demands) compared with employees in low-strain jobs (high control/low demands). In prospective analyses restricted to physically active participants, the odds of becoming physically inactive during follow-up were 21% and 20% higher for those with high-strain (odds ratio = 1.21, 95% confidence interval: 1.11, 1.32) and passive (odds ratio = 1.20, 95% confidence interval: 1.11, 1.30) jobs at baseline. These data suggest that unfavorable work characteristics may have a spillover effect on leisure-time physical activity.

  • 226. Fransson, Eleonor I.
    et al.
    Nyberg, Solja T.
    Heikkilä, Katriina
    Alfredsson, Lars
    De Bacquer, Dirk
    Batty, G. David
    Bonenfant, Sebastien
    Casini, Annalisa
    Clays, Els
    Goldberg, Marcel
    Kittel, France
    Koskenvuo, Markku
    Knutsson, Anders
    Leineweber, Constanze
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Magnusson Hanson, Linda L.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Nordin, Maria
    Singh-Manoux, Archana
    Suominen, Sakari
    Vahtera, Jussi
    Westerholm, Peter
    Westerlund, Hugo
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. University College London, UK.
    Zins, Marie
    Theorell, Töres
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Kivimäki, Mika
    Comparison of alternative versions of the job demand-control scales in 17 European cohort studies: the IPD-Work consortium2012In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 12, article id 62Article in journal (Refereed)
    Abstract [en]

    Background: Job strain (i.e., high job demands combined with low job control) is a frequently used indicator of harmful work stress, but studies have often used partial versions of the complete multi-item job demands and control scales. Understanding whether the different instruments assess the same underlying concepts has crucial implications for the interpretation of findings across studies, harmonisation of multi-cohort data for pooled analyses, and design of future studies. As part of the 'IPD-Work' (Individual-participant-data meta-analysis in working populations) consortium, we compared different versions of the demands and control scales available in 17 European cohort studies. Methods: Six of the 17 studies had information on the complete scales and 11 on partial scales. Here, we analyse individual level data from 70 751 participants of the studies which had complete scales (5 demand items, 6 job control items). Results: We found high Pearson correlation coefficients between complete scales of job demands and control relative to scales with at least three items (r > 0.90) and for partial scales with two items only (r = 0.76-0.88). In comparison with scores from the complete scales, the agreement between job strain definitions was very good when only one item was missing in either the demands or the control scale (kappa > 0.80); good for job strain assessed with three demand items and all six control items (kappa > 0.68) and moderate to good when items were missing from both scales (kappa = 0.54-0.76). The sensitivity was > 0.80 when only one item was missing from either scale, decreasing when several items were missing in one or both job strain subscales. Conclusions: Partial job demand and job control scales with at least half of the items of the complete scales, and job strain indices based on one complete and one partial scale, seemed to assess the same underlying concepts as the complete survey instruments.

  • 227.
    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.

  • 228.
    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.

  • 229.
    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.

  • 230.
    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.

  • 231.
    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.

  • 232. Franzén, Eva
    et al.
    Vinnerljung, Bo
    Stockholm University, Faculty of Social Sciences, Department of Social Work.
    Hjern, Anders
    The epidemiology of out-of-home care for children and youth: A national cohort study2008In: British Journal of Social Work, ISSN 0045-3102, E-ISSN 1468-263X, Vol. 38, no 6, p. 1043-1059Article in journal (Refereed)
    Abstract [en]

    We used data from several national registers for fifteen entire cohorts (n > 1.5 million) of Swedish children and youth to examine the influence of parental socio-economic background on the risk of entry into out-of-home care. Logistic regression models were used to analyse the statistical impact of twelve background variables, including parental psycho-social risk markers. The results confirm and expand findings from a classic study by Bebbington and Miles, published in 1989. After controlling for other background variables, including parent hospitalizations for attempted suicide, psychiatric disorders or addiction problems, children of single mothers had three to four-fold higher odds of entering care than children from two-parent households. Low maternal education and receipt of social assistance were strongly associated with higher odds for care entries. Aggregations of socio-economic risk factors increased dramatically the risk of entering care. Among pre-school children with mothers who had received basic education only, were unemployed and received social assistance during three consecutive years, one in seven was placed in care before their seventh birthday. Among same-age children from two-parent families whose mothers were educated to post-secondary level, were employed and had not received social assistance for three consecutive years in the middle of the observation period, fewer than one in 2,000 entered care.

  • 233.
    Fresk, Henrik
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Sociology.
    Övelius, Martin
    Stockholm University, Faculty of Social Sciences, Department of Sociology.
    Folkhälsa i förändring: En komparativ studie av hälsoutvecklingen i de postkommunistiska staterna Tjeckien, Polen, Estland och Ryssland2005Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Denna uppsats avser att utreda om och i så fall varför folkhälsan i de postkommunistiska staterna Ryssland, Polen, Tjeckien och Estland har utvecklats olika sedan Sovjetunionens sammanbrott. Huvudsyftet med uppsatsen är att undersöka och förklara skillnaden i hälsoläget efter den så kallade rubelkrisen 1998. Skillnader i hälsoutveckling ställs mot å ena sidan ekonomiska - och å andra sidan sociala faktorer. Tänkbara samband mellan bland annat förväntad livslängd och bruttonationalprodukten (BNP) per capita samt inkomstfördelning prövas. Dödlighet och förväntad livslängd undersöks i respektive land för perioden 1989-2002. Mortalitetens eventuella samband med sjukdomen levercirros samt alkoholkonsumtion över samma tidsperiod analyseras. Datamaterialet är sekundärdata och en kvantitativ komparativ metod används för analysen. Data är konstruerad främst som medelvärden för ett specifikt årtal för respektive land. Materialet består således av ett populationsurval.

    Två olika teoretiska utgångspunkter gör anspråk på att försöka förklara problematiken med transformationen från kommunism till demokrati. Det är den nyliberala - samt den mer socialorienterade ekonomiska teorin. Dessa ställs mot varandra i början av denna uppsats. Tidigare forskningsresultat tyder på en kraftig försämring av folkhälsan efter 1989 i främst Ryssland och Estland medan Tjeckien och Polen uppvisat en positiv hälsoutveckling. Våra resultat visar att det troligtvis är sociala och psykosociala faktorer, såsom hur en familje- och arbetssituation exempelvis kan påverka en persons hälsotillstånd, som verkar vara avgörande för förståelsen av ökad ohälsa. Analysen visar vidare att en ojämn ekonomisk fördelningspolitik tillsammans med en svag institutionell infrastruktur har en stark inverkan på ovannämnda faktorer. Ryssland presenterar ett avvikande resultat i jämförelse med de tre övriga länderna för flertalet av undersökta variabler. Vi har funnit att Tjeckien och Polen står för den mest hoppingivande förändringen beträffande dödlighet och förväntad livslängd. Estland har dragits med svårigheter att komma tillrätta med landets hälsoproblematik, men har under senare år uppvisat mer positiva siffror. Ryssland representerar däremot fortsatt negativ hälsoutveckling trots en liknande ekonomisk tillväxt. Att landet så sent som år 2002 redovisar en mycket hög dödlighetsfrekvens och låg förväntad livslängd ser vi som anmärkningsvärt. Skillnader i dödlighet och förväntad livslängd mellan könen och mellan de olika länderna visade sig vara mycket stora. Det bör noteras att denna uppsats endast är inriktad på att belysa den skillnad i förväntad livslängd och dödlighet som uppkommit sedan sammanbrottet 1989 fram till 2002.

  • 234.
    Fritzell, Johan
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Kangas, O.
    Bacchus Hertzman, Jennie
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Blomgren, J.
    Hiilamo, H.
    Dynamics of cross-national poverty and mortality rates.2011In: EUROPEAN JOURNAL OF PUBLIC HEALTH:: 4TH EUROPEAN PUBLIC HEALTH CONFERENCE: ABSTRACT SUPPLEMENT / [ed] Torben Jørgensen, Finn Kamper-Jørgensen, Dineke Zeegers Paget, 2011, Vol. 21, no suppl 1, p. 202-202Conference paper (Refereed)
  • 235.
    Fritzell, Johan
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Kangas, Olli
    Bacchus Hertzman, Jennie
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Blomgren, Jenni
    Hiilamo, Heikki
    Cross-Temporal and Cross-National Poverty and Mortality Rates among Developed Countries2013In: Journal of Environmental and Public health, ISSN 1687-9805, E-ISSN 1687-9813, Vol. 2013, article id 915490Article in journal (Refereed)
    Abstract [en]

    A prime objective of welfare state activities is to take action to enhance population health and to decrease mortality risks. For several centuries, poverty has been seen as a key social risk factor in these respects. Consequently, the fight against poverty has historically been at the forefront of public health and social policy. The relationship between relative poverty rates and population health indicators is less self-evident, notwithstanding the obvious similarity to the debated topic of the relationship between population health and income inequality. In this study we undertake a comparative analysis of the relationship between relative poverty and mortality across 26 countries over time, with pooled cross-sectional time series analysis. We utilize data from the Luxembourg Income Study to construct age-specific poverty rates across countries and time covering the period from around 1980 to 2005, merged with data on age- and gender-specific mortality data from the Human Mortality Database. Our results suggest not only an impact of relative poverty but also clear differences by welfare regime that partly goes beyond the well-known differences in poverty rates between welfare regimes.

  • 236.
    Fritzell, Johan
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Kangas, Olli
    Bacchus Hertzman, Jennie
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Blomgren, Jenni
    Hiilamo, Heikki
    Cross-Temporal and Cross-National Poverty and Mortality Rates among Developed Countries2012Report (Other academic)
  • 237.
    Fritzell, Johan
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Rehnberg, Johan
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Bacchus Hertzman, Jennie
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Blomgren, Jenni
    Absolute or relative? A comparative analysis of the relationship between poverty and mortality2015In: International Journal of Public Health, ISSN 1661-8556, E-ISSN 1661-8564, Vol. 60, no 1, p. 101-110Article in journal (Refereed)
    Abstract [en]

    We aimed to examine the cross-national and cross-temporal association between poverty and mortality, in particular differentiating the impact of absolute and relative poverty. We employed pooled cross-sectional time series analysis. Our measure of relative poverty was based upon the standard 60 % of median income. The measure of absolute, or fixed, poverty was based upon the US poverty threshold. Our analyses were conducted on data for 30 countries between 1978 and 2010, a total of 149 data points. We separately studied infant, child, and adult mortality. Our findings highlight the importance of relative poverty for mortality. Especially for infant and child mortality, we found that our estimates of fixed poverty is close to zero either in the crude models, or when adjusting for gross domestic product. Conversely, the relative poverty estimates increased when adjusting for confounders. Our results seemed robust to a number of sensitivity tests. If we agree that risk of death is important, the public policy implication of our findings is that relative poverty, which has close associations to overall inequality, should be a major concern also among rich countries.

  • 238. Fritzell, Sara
    et al.
    Bakshi, A.-S.
    Fritzell, Johan
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Burström, B.
    Lone mothers talking money and health: A discourse analysis of focus groups with Swedish lone mothers with financial difficulties.2011In: EUROPEAN JOURNAL OF PUBLIC HEALTH: 4TH EUROPEAN PUBLIC HEALTH CONFERENCE: ABSTRACT SUPPLEMENT / [ed] Torben Jørgensen, Finn Kamper-Jørgensen, Dineke Zeegers Paget, 2011, Vol. 21, no suppl 1, p. 62-62Conference paper (Refereed)
  • 239. Fritzell, Sara
    et al.
    Vannoni, Francesca
    Whitehead, Margaret
    Burström, Bo
    Costa, Giuseppe
    Clayton, Stephen
    Fritzell, Johan
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). Institute for Futures Studies, Sweden.
    Does non-employment contribute to the health disadvantage among lone mothers in Britain, Italy and Sweden? Family policy and synergy effects2012In: Health and Place, ISSN 1353-8292, E-ISSN 1873-2054, Vol. 18, no 2, p. 199-208Article in journal (Refereed)
    Abstract [en]

    This study analyses self-rated health and non-employment and potential synergy effects among lone and couple mothers aged 25–59 in Britain, Sweden and Italy, representing different family policy categories using data from national surveys (2000–2005). Synergy effects on health were calculated by synergy index. Non-employment only marginally contributed to the excess risk of poor health among lone mothers but there were synergy effects between lone motherhood and non-employment in all three countries, producing a higher risk of poor health than would be expected from a simple addition of these exposures. Results are discussed in relation to the different family policy and living contexts.

  • 240. Fröberg, Frida
    et al.
    Modin, Bitte
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Rosendahl, Ingvar K
    Tengström, Anders
    Hallqvist, Johan
    The association between compulsory school achievement and problem gambling among Swedish young people2015In: Journal of Adolescent Health, ISSN 1054-139X, E-ISSN 1879-1972, Vol. 56, no 4, p. 420-428Article in journal (Refereed)
    Abstract [en]

    Purpose: We aimed to examine the association between school grades at the age of 16 years and problem gambling at the age of 17-25 years among Swedish females and males. Methods: In a cohort design, we followed the 16-to 24-year-old participants in the representative Swedish Longitudinal Gambling Study for 2 years, 2008/2009 and 2009/2010, generating 3,816 person-years of follow-up time. The outcome, incidence of mild and moderate/severe gambling problems, was measured by the Problem Gambling Severity Index in telephone interviews. The exposure was register-linked information about final grades in compulsory school. The association between school grades and problem gambling was estimated in multinomial logistic regressions. Results: Low and average school grades were associated with increased incidence of mild and moderate/severe problem gambling compared to high grades, adjusted for sociodemographic characteristics, psychological distress, and alcohol use. Low grades, compared to high grades, were associated with a higher risk of mild gambling problems for adolescent males, whereas the incidence proportion of moderate/severe problem gambling was high for males aged 20-25 years with low grades, among whom unemployment was also very high. Furthermore, we found a strong and graded association between school grades and moderate/severe problem gambling for women in both age groups, despite a low prevalence of gambling participation among females compared to males. Conclusions: Our findings show that Swedish youth with low school achievement have an increased risk of gambling problems up to 8 years after school graduation, after control for confounding from sociodemographic characteristics, psychological distress, and alcohol use, and that this association is stronger for females than males.

  • 241. Gao, M.
    et al.
    Goodman, Anna
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Mishra, Gita
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Koupil, Ilona
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Developmental origins of perimenopausal disorders: evidence from a Swedish cohort2017In: Journal of Developmental Origins of Health and Disease, ISSN 2040-1744, E-ISSN 2040-1752, Vol. 8, no Suppl. 1Article in journal (Refereed)
  • 242.
    Gao, Menghan
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Exposure to out-of-home care in childhood and adult all-cause mortality: A life-course perspective2016Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    Background: The experience of childhood out-of-home care (OHC) has been linked to

    adverse health outcomes in young adulthood. However, less is known about the long-term

    influence of OHC on alumni’s mortality risk, or about the mechanisms from a life-course

    perspective.

    Objectives: This study aimed to examine the gender-specific association between exposure to

    OHC in childhood and all-cause mortality in adulthood, while taking into account different

    placement characteristics. Additionally, mechanisms based on different life-course models

    were analysed.

    Methods: A longitudinal study of the 1953 Stockholm birth cohort (n=14,294). Sex-stratified

    Cox regression analyses were used to examine all-cause mortality during 1981 to 2009.

    Results: Male and female OHC alumni had around three times higher risk of all-cause

    mortality in adulthood, compared to the majority population. Mortality risks were particularly

    pronounced among those who were placed during adolescence because of behavioural

    problems, who experienced both family foster care and residential care, and who spend more

    than one year in care. The associations were reduced but remained significant after

    adjustments for life-course socioeconomic factors.

    Conclusions: Adults with OHC experience constitute a high-risk group for earlier death. In

    terms of being a social intervention, OHC does not seem to improve this vulnerable group’s

    life chances.

  • 243.
    Gao, Menghan
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Brännström, Lars
    Stockholm University, Faculty of Social Sciences, Department of Social Work.
    Almquist B., Ylva
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Exposure to out-of-home care in childhood and adult all-cause mortality: a cohort study2017In: International Journal of Epidemiology, ISSN 0300-5771, E-ISSN 1464-3685, Vol. 46, no 3, p. 1010-1017Article in journal (Refereed)
    Abstract [en]

    Background: Children placed in out-of-home care (OHC) have exceedingly high rates of health problems. Their poor health tends to persist across adolescence and into young adulthood, resulting in increased risks of mortality. Yet, very little is known about this group’s mortality risks later in life. The aim of this study was to investigate whether OHC was associated with the risk of all-cause mortality across adulthood, and whether these risks varied across different placement characteristics. Moreover, the study addressed potential confounding by including two comparison groups with children who grew up under similarly adverse living conditions but did not experience placement.

    Methods: Data were derived from a 60-year follow-up of a Stockholm cohort born in 1953 (n = 15 048), of whom around 9% have had experiences of OHC. The associations between OHC and subsequent all-cause mortality were analysed by means of Cox’s proportional hazards regression models.

    Results: Individuals who were placed in OHC at any point during their formative years had increased mortality risks across ages 20 to 56 years. Elevated risk of mortality was particularly pronounced among those who were placed in adolescence and/or because of their own behaviours. Children who were exposed to OHC had increased risks of mortality also when compared with those who grew up under similar living conditions but did not experience placement.

    Conclusions: Children in OHC constitute a high-risk group for subsequent mortality. In order to narrow the mortality gap, interventions may need to monitor not only health aspects but also to target the cognitive and social development of these children.

  • 244. Gao, Menghan
    et al.
    Allebeck, Peter
    Mishra, Gita D.
    Koupil, Ilona
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS). Karolinska Institutet, Sweden.
    Developmental origins of endometriosis: a Swedish cohort study2019In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 73, no 4, p. 353-359Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Endometriosis is a chronic condition affecting women of reproductive age and is associated with multiple health burdens. Yet, findings regarding its 'developmental origins' are inconsistent. We aimed to investigate the associations of birth characteristics with endometriosis. We also explored potential mediation by adult social and reproductive factors.

    METHODS: This cohort study consisted of 3406 women born in Uppsala, Sweden, between 1933 and 1972. We used data from archived birth records and endometriosis diagnoses at ages 15-50 recorded in the national patient registers. Socioeconomic and reproductive characteristics were obtained from routine registers. HRs were estimated from Cox regression.

    RESULTS: During the follow-up, 111 women have been diagnosed with endometriosis, and most cases are external endometriosis (ie, outside the uterus, n=91). Lower standardised birth weight for gestational age was associated with increased rate of endometriosis (HR 1.35 per standard deviation decrease; 95% CI 1.08 to 1.67). This increased rate was also detected among women with fewer number of live births (HR 2.38; 95% CI 1.40 to 4.07 for one child vs ≥2 children; HR 6.09; 95% CI 3.88 to 9.57 for no child vs ≥2 children) and diagnosed infertility problem (HR 2.00; 95% CI 1.10 to 3.61) prior to endometriosis diagnosis. All the observed associations were stronger for external endometriosis. However, no evidence was found that number of births was the mediator of the inverse association between standardised birth weight and endometriosis.

    CONCLUSION: This study supports the developmental origins theory and suggests that exposure to growth restriction during the fetal period is associated with increased risk of endometriosis during reproductive years.

  • 245. Gao, M.
    et al.
    Goodman, Anna
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS). London School of Hygiene and Tropical Medicine, UK.
    Mishra, G.
    Koupil, Ilona
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS). Karolinska Institutet, Sweden.
    Associations of birth characteristics with perimenopausal disorders: a prospective cohort study2018In: Journal of Developmental Origins of Health and Disease, ISSN 2040-1744, E-ISSN 2040-1752, p. 1-7Article in journal (Refereed)
    Abstract [en]

    Perimenopausal disorders (PDs) are prevalent and importantly affect quality of life among middle-aged women. Yet, very little is known about the developmental origins of these disorders. The objective of this study was to investigate the associations of birth characteristics with PDs. This cohort study is based on archived birth records for birth weight and gestational age, and followed prospectively in Swedish inpatient and outpatient registers for 8 years (n=3212). The main outcomes were menopausal and climacteric states (e.g. flushing, sleeplessness), perimenopausal bleeding and other PDs (e.g. atrophic vaginitis). Cox proportional hazards regression models were used to estimate the hazard ratios (HRs) for three subtypes of PDs separately. During the follow-up, 218 women had PDs, among whom 125 had menopausal and climacteric states, 61 had perimenopausal bleeding and 58 had other PDs as first recorded disorder. Birth weight was linearly associated with incidence rate of menopausal and climacteric states [HR=1.66 per 1 kg increase, 95% confidence interval (95% CI)=1.14-2.41]. Gestational age (rather than birth weight) was associated with incidence rate of other PDs (HR=0.87 per 1 week increase, 95% CI=0.79-0.95). Neither birth weight nor gestational age was associated with perimenopausal bleeding. Similar results were found after adjustment for other early-life and adult socio-demographic characteristics. This observational study provides, for the first time, evidence regarding the developmental origins of PDs. Future research is required to investigate the underlying causal mechanisms, which may shed further light on the etiology of this class of disorders.

  • 246.
    Garcy, Anthony
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Whitehead, M
    The relationship between school quality, educational quality, and health inequalities: A critical review. In: Developing Methodologies to Reduce Inequalities in the Determinants of Health (DEMETRIQ),2014Report (Other academic)
  • 247.
    Garcy, Anthony M.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Extending the Uppsala Birth Cohort Multigenerational Study Database With a New Collection From Archival Sources: Collection and Error Correction Strategies When Problems Arise2018Other (Refereed)
    Abstract [en]

    This case study is an account of the 2014-2016 effort to expand a Swedish research database called the Uppsala Birth Cohort Multigenerational Study. The research project collected and photographed available data on school quality from local, regional, and national Swedish archives. The discovery of a widespread data quality issue in the existing database ultimately prevented the completion of the data collection and the execution of the planned research. A narrative is given about the challenges of conducting a complex, multistage archival data collection. Some of the problems that were encountered are mentioned. Practical methods and strategies that were used to collect the relevant data from the archival material are discussed. The methods used in the conversion and entry of some of this material into an electronic, numerical database format are also reviewed.

  • 248.
    Garcy, Anthony M.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    The Effects of Health Insurance Coverage on the Math Achievement Trajectories of School Children in Yuma County, Arizona: Implications for Education Accountability Policy2013In: Education Policy Analysis Archives, ISSN 1068-2341, E-ISSN 1068-2341, Vol. 21, no 80, p. 1-28Article in journal (Refereed)
    Abstract [en]

    U.S. Federal and state education policies place considerable emphasis on assessing the effects that schools and teachers have on student test score performance. It is important for education policy makers to also consider other factors that can affect student achievement. This study finds that an exogenous school factor, discontinuous health insurance coverage, leads to a deficit in math achievement over time. A sample of Yuma County, Arizona public school students who experienced an illness or injury and whose health insurance coverage status was known were selected for inclusion into the study over five consecutive school years (1999 – 2003). The longitudinal math achievement trajectory of students who had private health insurance coverage was compared to students who had discontinuous coverage. Net of a student’s poverty status and other background characteristics the findings suggest that students who experienced a health event when they had no healthcare insurance had the same growth rate but lower overall math achievement. The average achievement gap was a constant -8.84 scale score points. However, separate analyses for specific types of illness/injury suggest the achievement deficit varied considerably and is typically larger.

  • 249.
    Garcy, Anthony M.
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Berliner, David C.
    A critical review of the literature on the relationship between school quality and health inequalities2018In: Review of Education/Pedagogy/Cultural Studies, ISSN 1071-4413, E-ISSN 1556-3022, Vol. 6, no 1, p. 40-66Article, review/survey (Refereed)
    Abstract [en]

    Robust evidence suggesting a strong association between greater educational attainment, betterhealth and lower mortality, has led to speculation that the quality of schooling can also have effectson health. This review critically summarises findings from 15 studies in a growing area of researchconcerning the effects of school quality on health. Findings suggested positive, long-term benefits ofhigh-quality pre-school. Other findings suggested that higher teacher wages, lower pupil–teacherratios, a longer school year, and higher college selectivity had mostly positive long-term effects onhealth and mortality. Several studies found that school quality modified the effect of years of completededucation on various health outcomes. Some measures of school quality including smallerclass size in relation to mortality, and higher college selectivity in the case of smoking were not consistentlyrelated to better health. While studies varied in their consistency and significance, theweight of the evidence together, suggests that some health inequalities over the life course wereexplained partly by differences in school quality. This may be related to improved cognition, occupationalcharacteristics, and the incomes of those exposed to better quality schooling. Direct healthknowledge and behaviour may also play a role.

  • 250.
    Garcy, Anthony M.
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Berliner, David C.
    Context and Implications Document for: A critical review of the literature on the relationship between school quality and health inequalities2018In: Review of Education, ISSN 2049-6613, Vol. 6, no 1, p. 67-68Article in journal (Other academic)
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