Background: Young refugees are at increased risk of labor market marginalization (LMM). We sought to examine whether the association of multimorbidity patterns and LMM differs in refugee youth compared to Swedish-born youth and identify the diagnostic groups driving this association. Methodology: We analyzed 249,245 individuals between 20–25 years, on 31 December 2011, from a combined Swedish registry. Refugees were matched 1:5 to Swedish-born youth. A multimorbidity score was computed from a network of disease co-occurrences in 2009–2011. LMM was defined as disability pension (DP) or >180 days of unemployment during 2012–2016. Relative risks (RR) of LMM were calculated for 114 diagnostic groups (2009–2011). The odds of LMM as a function of multimorbidity score were estimated using logistic regression. Results: 2841 (1.1%) individuals received DP and 16,323 (6.5%) experienced >180 annual days of unemployment during follow-up. Refugee youth had a marginally higher risk of DP (OR (95% CI): 1.59 (1.52, 1.67)) depending on their multimorbidity score compared to Swedish-born youth (OR (95% CI): 1.51 (1.48, 1.54)); no differences were found for unemployment (OR (95% CI): 1.15 (1.12, 1.17), 1.12 (1.10, 1.14), respectively). Diabetes mellitus and influenza/pneumonia elevated RR of DP in refugees (RRs (95% CI) 2.4 (1.02, 5.6) and 1.75 (0.88, 3.45), respectively); most diagnostic groups were associated with a higher risk for unemployment in refugees. Conclusion: Multimorbidity related similarly to LMM in refugees and Swedish-born youth, but different diagnoses drove these associations. Targeted prevention, screening, and early intervention strategies towards specific diagnoses may effectively reduce LMM in young adult refugees.

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

Background: Undocumented migrants face many hardships in their everyday life such as poor living conditions, discrimination, and lack of access to healthcare. Previous studies have demonstrated considerable health care needs for psychiatric disorders as well as physical diseases. The aim of this paper was to find out the main barriers that undocumented migrants experience in accessing the Swedish healthcare system and to explore their relation with socioeconomic factors.

Methods: A cross-sectional study with adult undocumented migrants was performed in the three largest cities of Sweden in 2014–2016. Sampling was done via informal networks. A socioeconomic questionnaire was constructed including 22 barriers to health care. Trained field workers conducted the interviews. A principal component analysis was conducted of all barriers to reveal central components. Then, Pearson’s chi-squared test was used to explore the characteristics of undocumented migrants experiencing barriers to care.

Results: Two main components/barriers were extracted: “Fear of being taken by police/authorities”, which was related to fear of disclosure by or in relation to seeking health care, and “Structural and psychosocial factors” which was related to practical obstacles or shame of being ill. Lower age (74.1 % vs 56.0 %), lower level of education (75.0 % vs. 45.1 %), and having no children (70.3 % vs. 48.1 %) were significantly related to a higher likelihood of experiencing a barrier.

Conclusion: Fear of deportation and practical and psychosocial factors constitute hinderance of access to healthcare for undocumented migrants in Sweden. This highlights the importance of clear instructions, both to undocumented migrants and health professionals about the right to health care according to the international law on human rights as well as the law of confidentiality.

Background: Self-rated health (SRH) - one of the most common health indicators used to verify health conditions - can be influenced by several types of socioeconomic conditions, thereby reflecting health inequalities. This study aimed to evaluate the participant profiles regarding the association between self-rated health and social and occupational characteristics of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil).

Methods: Cross-sectional design, including 11,305 individuals. Self-rated health was categorized as good, fair, and poor. The relationship between socio-demographic, psychosocial work environment, health-related variables, and self-rated health was analyzed by multiple correspondence analysis (stratified by age: up to 49 years old and 50 years old or more).

Results: For both age strata, group composition was influenced by socioeconomic conditions. Poor SRH was related to lower socioeconomic conditions, being women, black self-declared race/ethnicity, being non-married/non-united, low decision authority, low skill discretion, and obesity.

Conclusion: To promote health, interventions should focus on reducing existing socioeconomic, race, and gender inequalities in Brazil.

Objectives: Group-level characteristics in shared contexts such as schools may affect adolescent psychological health. This study examined if the immigrant density in the classroom was associated with the level of self-reported psychological complaints among students with an immigration background.

Methods: Cross-sectional data were derived from 2,619 lower secondary school students (aged 13-15) in the 2017/18 wave of the Swedish Health Behaviour in School-aged Children (HBSC) survey. Using multilevel analysis estimating two-level random intercept linear regression models, classroom immigrant density was considered as a potential predictor of immigrant students' psychological complaints.

Results: Students with an immigration background reported significantly fewer psychological complaints, on average, than students without such a background, even when adjusting for other sociodemographic characteristics. A cross-level interaction indicated that both first- and second-generation immigrant students experienced fewer psychological complaints in immigrant-dense classes compared to when the proportion of immigrant students was lower.

Conclusion: Students with an immigration background fare better psychologically in classes with a higher proportion of immigrant students. Such compositional effects could be alleviated by strengthening all schools' capacities to provide a more inclusive classroom climate.

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

Aim: To study the association of parental country of origin—expressed as low-, medium- and high-Human Development Index (HDI) countries—with caries experience in children of immigrant families in Stockholm.

Methods: This registry-based cohort study included all children born in 2000–2003 who resided in Stockholm County, Sweden, at age 3 years (n = 83,147) with follow-up at 7 years of age. A logistic regression was performed for the multivariate analysis with adjustments for socio-demographic factors.

Results: After adjustments, logistic regression analyses revealed that, compared with Swedish children of the same age, the risk of caries was highest when the immigrant parents originated in a medium (OR 4.22 (95% CI 3.99:4.47)) or low (OR 2.80 (95% CI 2.56:3.06)) income country background at age 7 years, but was increased also for high-income country background, OR 1.77 (95% CI 1.52–2.05). Furthermore, the risk of presenting with caries experience at age 7 years increased for all children in the 1^st (lowest) household income quintile in the host country Sweden.

Conclusion: This study shows that the developmental level of the parental country of birth as well as the family socioeconomic position in Sweden influence the risk for caries development in their children.

Child welfare involvement reflects childhood adversity and is associated with increased adult mortality, but it remains unclear how this association changes over the life course. Drawing on the Stockholm Birth Cohort Multigenerational Study (Sweden) and the National Childhood Development Study (Great Britain) this study examines whether inequalities within these cohorts diverge or converge. Involvement with child welfare services (ICWS) is divided into two levels ('child welfare contact' and 'out-of-home care'). For each cohort, we quantify absolute health inequalities as differences in cumulative probabilities of death (18-58 years) and temporary life expectancy; and relative inequalities as hazard ratios in ten-year intervals and ratios of lifetime lost. Persistently, ICWS was associated with premature mortality. The strength of the association varied by age, sex and level of ICWS. Consistently across both countries, the most robust relationship was between out-of-home care and mortality, with statistically significant age-specific hazard ratios ranging between 1.8 and 3.4 for males and 1.8-2.1 for females. Child welfare contact that did not result in out-of-home placement showed less consistent results. Among females the mortality gap developed later compared to males. Estimates attenuate after controlling for family socioeconomic and other background variables but patterns remain intact. Our results show that absolute inequalities widen with increasing age, while relative inequalities might peak in early adulthood and then stabilize in midlife. The relative disadvantage among looked-after children in early adulthood is heightened by overall low rates of mortality at this age. Absolute inequality increases with age, highlighting the weight of the accumulation of disadvantage in mortality over time. The bulk of excess deaths that could be attributed to ICWS occurs from midlife onwards. Mechanisms that uphold the disadvantage after childhood experiences require further exploration. This study highlights that the association between out-of-home care and premature mortality seems to transcend welfare systems.

The objective was two-fold: to examine possible associations between dopamine-related genetic polymorphisms and (1) substance dependence; and (2) self-reported psychiatric disturbances, behavioral problems, and personality. Genotyping of single nucleotide polymorphisms (SNP: s) in COMT, DAT and DRD4 was conducted in 174 Russian male juvenile inmates (14–18 years of age) subdivided into having a diagnosis of substance dependence or not, as assessed by using K-SADS-PL. The inmates completed several self-reports assessing psychiatric symptoms (CPTS-RI, BDI), behavioral problems (YSR), and personality traits (TCI). Results revealed that juveniles meeting the criteria for substance dependence differed significantly from their counterparts in four polymorphisms, namely COMT rs737865, DAT rs6347, DRD4 C_1611535 and DRD4 exon III; and exact binary regression analysis indicated a highly significant association between the DRD4 C_1611535 GG genotype and substance dependence. One-way ANOVA tests further showed this gene polymorphism variant to be significantly associated with higher levels of posttraumatic stress, thought problems, aggressive behavior, and personality traits indicating antisocial personality disturbances, as compared with the other gene polymorphism variants. In conclusion, the results underscore the role of the DRD4 polymorphism C_1611535 GG genotype for substance dependence, and suggest its associations with different self-reported phenotype characteristics.

Aim: Parental separation has been associated with poor mental health in children with better outcomes in children living in joint physical custody compared with those living with one parent after the separation. In this study, we investigated socioeconomic and relational predictors in early childhood of later parental separation and family arrangements thereafter. Methods: This study included 34 768 children from the Danish National Birth Cohort, who were living with both parents at the 6 months' data collection and followed up in 2010-2014 at age 11 years. Questionnaire data from the two data collections were linked with population registers in Statistics Denmark about parental income, education and psychiatric care and analysed in logistic regression models. Results: Socioeconomic indicators of the family and parental psychiatric disorders before birth of the child and family relationships in infancy predicted parental separation at age 11 year. For children with separated parents, a high family income and a high parental educational level were the main predictors of living in joint physical custody at the 11-year follow-up. Conclusion: Socioeconomic living conditions predict parental separation as well as living arrangements thereafter. Studies of consequences of living arrangements after parental separation should account for family factors preceding the separation.

Objective: To examine whether the association between women's origin and early pregnancy overweight and obesity (OW/OB) varies by length of residence in Sweden.

Design: This cross-sectional observational study used pooled Swedish population register data from 1992 to 2012. Logistic regression models were run to estimate odds ratios (OR) of early pregnancy OW/OB and 95 % confidence intervals (95 % CI), comparing Swedish-born and immigrants by length-of-residence categories while adjusting for covariates.

Setting: Sweden.

Participants: In total, 1 771 821 pregnant women, 315 992 of whom were immigrants.

Results: With longer residence in Sweden, more immigrant women from various origins exhibited higher odds of experiencing early OW/OB compared with Swedish-born women. Findings specifically showed increased odds of early pregnancy OW/OB with increasing length of residence for women born in Latin America, Europe-27 and Southeast Asia. For example, immigrant women from Latin America residing in Sweden for < 6 years showed similar odds as Swedish-born (OR <= 5 years 0 center dot 92, 95 % CI 0 center dot 87, 0 center dot 98), while their longer residing counterparts showed higher odds than Swedish-born women (OR(6-15 years)1 center dot 21, 95 % CI 1 center dot 14, 1 center dot 28 and OR >= 16 years 1 center dot 68, 95 % CI 1 center dot 59, 1 center dot 78). Mixed results were found for other origins.

Conclusions: The current study suggests that host country conditions might play an important role in explaining OW/OB among some groups of immigrant women. Although further studies are needed to disentangle the mechanisms that generate these health inequalities, policy efforts should focus on immigrant reception and early integration to prevent pregnancy-related OW/OB.

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

It is a well-known fact that family background characteristics affect school achievement, and according to Swedish law, school should play a compensatory role to outweigh such differences. Previous research has demonstrated that a strong school ethos is associated with higher student achievement, but whether school ethos can play a compensatory role for family background has not been investigated to the same extent. This study examines whether the predictive capacity of students’ family background on school achievement is moderated by school ethos. Data were derived from 9,349 ninth grade students (15–16 years) and 2,176 teachers in 159 school units in Stockholm. Multilevel linear regression analyses showed that family background characteristics, as well as school ethos, were associated with student achievement. School ethos did not, however, moderate the association between family background and school achievement. The results suggest that school ethos does not play a compensatory role, but rather, promotes school achievement for all students alike.

With labor being a central social determinant of health, there is an increasing need to investigate health inequalities within the heterogenous and growing population in self-employment. This study aimed to longitudinally investigate the relationship between income level, self-employment status and multiple work-related health indicators in a Swedish national cohort (n = 3,530,309). The study investigated the relationship between self-employment status and health outcomes later in life. All poor health outcomes, with the exception of alcohol-related disorders, were more common in the self-employed population, compared to the group in regular employment. The income gradient, however, was more pronounced in the group with regular employment than the groups in self-employment. The study found clear connections between low income and poor health in all employment groups, but the gradient was more pronounced in the group in regular employment. This suggests that income has a weaker connection to other types of health promoting resources in the self-employed population. Potentially, lacking social and public support could make it difficult for unhealthy individuals to maintain low-income self-employment over a longer time period.

Background In the context of containment measures against the COVID-19 pandemic, the aims were to examine the impact of lockdown and school closures on childs’ and adolescents’ health and well-being and social inequalities in health.

Methods Literature review by searching five databases until November 2020. We included quantitative peer-reviewed studies reporting health and well-being outcomes in children (0–18 years) related to closure measures' impact due to COVID-19. A pair of authors assessed the risk of bias of included studies. A descriptive and narrative synthesis was carried out.

Findings Twenty-two studies, including high-income, middle-income and low-income countries, fulfilled our search criteria and were judged not to have an increased risk of bias. Studies from Australia, Spain and China showed an increase in depressive symptoms and decrease in life satisfaction. A decrease in physical activity and increase in unhealthy food consumption were shown in studies from two countries. There was a decrease in the number of visits to the emergency department in four countries, an increase in child mortality in Cameroon and a decrease by over 50% of immunisations administered in Pakistan. A significant drop of 39% in child protection medical examination referrals during 2020 compared with the previous years was found in the UK, a decrease in allegations of child abuse and neglect by almost one-third due to school closures in Florida, and an increase in the number of children with physical child abuse trauma was found in one centre in the USA.

Interpretation From available reports, pandemic school closure and lockdown have adverse effects on child health and well-being in the short and probably long term. We urge governments to take the negative public health consequences into account before adopting restrictive measures in childhood.

Background: Teachers constitute an occupational group experiencing high levels of stress and with high sick-leave rates. Therefore, examining potentially protective factors is important. While prior research has mainly focused on the link between teachers’ own experiences of their work environment and stress-related outcomes, it is also possible that colleagues’ perception of the work environment and their possibilities for dealing with work-related stress contribute to influencing individual teachers’ stress. Aim: The aim of this study was to investigate how teachers’ reports of high job strain (i.e. high demands and low control) and sense of coherence (SOc), as well as the concentration of colleagues reporting high strain and high SOc, were associated with perceived stress and depressed mood. Methods: The data were derived from the Stockholm Teacher Survey, with information from two cross-sectional web surveys performed in 2014 and in 2016 (N=2732 teachers in 205 school units). Two-level random intercept linear regression models were performed. Results: High job strain at the individual level was associated with higher levels of perceived stress and depressed mood, but less so for individuals with high SOc. furthermore, a greater proportion of colleagues reporting high SOc was associated with lower levels of perceived stress and depressed mood at the individual level. Conclusions: High SOC may be protective against work-related stress among teachers. Additionally, the proportion of colleagues reporting high SOC was related to less individual stress, suggesting a protective effect of school-level collective SOC.

Aim: This study compared mental health after parental separation in 7-year-old children living in joint physical custody with sole physical custody family arrangements.

Methods: The study population included 39 661 children from the Danish National Birth Cohort, living in a nuclear family at age 6 months. Child mental health was measured at age 7 years with maternal reports of the Strength and Difficulties Questionnaire (SDQ) operationalised as a high total score. Associations between living arrangements and mental health were analysed using logistic regression models, taking into account early childhood indicators of family relations, parental mental health and socioeconomic conditions.

Results: There were no statistically significant differences between the living arrangements after parental separation with joint physical custody having an odds ratio (OR) of 1.37 (95% CI 1.10–1.70), sole physical custody without a new partner OR 1.33 (95% CI 1.19–1.47) and OR 1.55 (95% CI 1.30–1.84) for sole physical custody with new partner, with children in a nuclear family as reference.

Conclusion: This study indicates that living arrangements after parental separation have a minimal influence on child mental health at age 7 years.

Background: Childhood family income has been shown to be associated with later psychiatric disorders, substance misuse and violent crime, but the consistency, strength and causal nature of these associations remain unclear.

Methods: We conducted a nationwide cohort and co-sibling study of 650 680 individuals (426 886 siblings) born in Finland between 1986 and 1996 to re-examine these associations by accounting for unmeasured confounders shared between siblings. The participants were followed up from their 15^th birthday until they either migrated, died, met criteria for the outcome of interest or reached the end of the study period (31 December 2017 or 31 December 2018 for substance misuse). The associations were adjusted for sex, birth year and birth order, and expressed as adjusted hazard ratios (aHRs). The outcomes included a diagnosis of a severe mental illness (schizophrenia-spectrum disorders or bipolar disorder), depression and anxiety. Substance misuse (e.g. medication prescription, hospitalization or death due to a substance use disorder or arrest for drug-related crime) and violent crime arrests were also examined. Stratified Cox regression models accounted for unmeasured confounders shared between differentially exposed siblings.

Results: For each $15 000 increase in family income at age 15 years, the risks of the outcomes were reduced by between 9% in severe mental illness (aHR = 0.91; 95% confidence interval: 0.90–0.92) and 23% in violent crime arrests (aHR = 0.77; 0.76–0.78). These associations were fully attenuated in the sibling-comparison models (aHR range: 0.99–1.00). Sensitivity analyses confirmed the latter findings.

Conclusions: Associations between childhood family income and subsequent risks for psychiatric disorders, substance misuse and violent crime arrest were not consistent with a causal interpretation.