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  • 1.
    Alexius, Susanna
    et al.
    Stockholm University, Faculty of Social Sciences, Stockholm Centre for Organizational Research (SCORE).
    Cisneros Örnberg, Jenny
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Grossi, Giuseppe
    Logics and mechanisms of board appointment in hybrid organizations2018Conference paper (Other academic)
    Abstract [en]

    The relevance of the paper to the panel topic 

    The management and governance of hybrid organizations involve a range of challenges and critical issues. One such issue concerns the people that embody the hybrid and their capabilities to represent and handle the complex missions and potential value conflicts at stake in a hybrid organization. Looking closer at processes of recruitment and nomination of key actors such as CFOs, managers and board members is relevant as it sheds light on high held ideals for hybrid management and governance and the human resources seen fit to handle complex hybrid missions.

    The significance of the research (why it is distinctive and its contribution to the field)

    Our case gives a micro illustration of the governance challenges involved in attempts to design the nomination process to reflect a wider range of goals and values. We also wish to briefly discuss how this shift in appointment logics – from “political discretion” (PA), over “professionalism as in efficiency and economization” (NPM) to “political correctness” (NPG) may affect the boards and management of the SOEs.

    The research question(s) and method

    The Swedish state has an outspoken aim to be an “active and professional” owner by generating economic value in its 49 state-owned enterprises. At the same time, there is a political ambition for these firms to be seen as national and international “role models”, in the forefront of gender equality and sustainability. In addition, for about 25 SOEs, there are specifically Government commissioned social “public policy assignments” to be taken into consideration. The aim of this paper is to analyse the logics (political vs. professional) in the Swedish Government offices concerning the mechanisms of appointment of board members of Swedish State-owned Enterprises (SOEs) with Government commissioned social public policy assignments.

    Findings are based on qualitative analyses of documents, observations and interviews with key actors. Focusing foremost on the daily work of civil servants responsible for board nomination in the Ministry of Commerce and Innovation the study also acknowledges the role of external head hunters and executive search firms, politically appointed civil servants, politicians and board chairs and members in the nomination process.

    The theoretical/conceptual foundations for the research

    The backdrop to our case story is the historical transition from traditional Public Administration (PA), over new public management (NPM) regimes to the emerging post-NPM era of “New Public Governance” (Osborne, 2010; Almqvist et al., 2003; Ivarsson Westernberg, 2017), their dominant institutional logics and the effects on the appointment of public representatives, such as board members of SOEs.

    The results to be reported

    Our claim is that in the emerging NPG era, the previously dominating professional (and typically economical) logic of NPM-inspired governance of State-owned enterprises is challenged. Public appointment officials now face increasing external pressure to demonstrate that the multiple social values at stake for the hybrid organizations are reflected in the nomination of their board members, without compromising business efficiency, public accountability and the public income derived from SOEs.

  • 2.
    Alm, Susanne
    et al.
    Stockholm University, Faculty of Social Sciences, The Swedish Institute for Social Research (SOFI).
    Brolin Låftman, Sara
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Bohman, Hannes
    Poor Family Relationships in Adolescence and the Risk of Premature Death: Findings from the Stockholm Birth Cohort Study2019In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 16, no 10, article id 1690Article in journal (Refereed)
    Abstract [en]

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

  • 3.
    Alm, Susanne
    et al.
    Stockholm University, Faculty of Social Sciences, The Swedish Institute for Social Research (SOFI).
    Brolin Låftman, Sara
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Sandahl, Julia
    Stockholm University, Faculty of Social Sciences, Department of Criminology.
    Modin, Bitte
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    School effectiveness and students' future orientation: A multilevel analysis of upper secondary schools in Stockholm, Sweden2019In: Journal of Adolescence, ISSN 0140-1971, E-ISSN 1095-9254, Vol. 70, p. 62-73Article in journal (Refereed)
    Abstract [en]

    Introduction

    Future orientation (FO) refers to individuals' beliefs and feelings about their future. Earlier research has primarily investigated correlates of FO at the individual and family level, but it seems likely that FO is also shaped by other central agents or institutions, such as the school. Earlier studies have found positive associations between “school effectiveness” and student performance, and negative associations in relation to e.g., bullying, delinquency, and health risk behaviors. The current study investigated three teacher-reported features of school effectiveness - school leadership, teacher cooperation and consensus, and school ethos - and their links with student-reported FO.

    Methods

    Survey data were collected in 2016 among 5131 students (aged 17–18 years) and 1061 teachers in 46 upper secondary schools in Stockholm, Sweden, and merged with school-level register data. Two-level binary logistic regression analyses were performed.

    Results

    The analyses showed that higher teacher ratings of school leadership and school ethos were associated with a greater likelihood of reporting an optimistic FO among students. Teacher cooperation and consensus was however not associated with students' FO.

    Conclusion

    The findings indicate that the school environment contributes to shaping students' beliefs about their future. Thus, enhancing features of school effectiveness may be a way of promoting a positive development and brighter objective future prospects for the young, via pathways such as good student-teacher relations and academic motivation and achievement.

  • 4.
    Almquist, Ylva B.
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Brännström, Lars
    Stockholm University, Faculty of Social Sciences, Department of Social Work.
    Do trajectories of economic, work- and health-related disadvantages explain child welfare clients’ increased mortality risk? A prospective cohort study2019In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 19, article id 418Article in journal (Refereed)
    Abstract [en]

    Background

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

    Methods

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

    Results

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

    Conclusions

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

  • 5.
    Almquist, Ylva B.
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Jackisch, Josephine
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Forsman, Hilma
    Stockholm University, Faculty of Social Sciences, Department of Social Work.
    Gauffin, Karl
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Vinnerljung, Bo
    Stockholm University, Faculty of Social Sciences, Department of Social Work.
    Hjern, Anders
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Brännström, Lars
    Stockholm University, Faculty of Social Sciences, Department of Social Work.
    A decade lost: does educational success mitigate the increased risks of premature death among children with experience of out-of-home care?2018In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 72, no 11, p. 997-1002Article in journal (Refereed)
    Abstract [en]

    Background: Past research has consistently identified children with experience of out-of-home care (OHC) as a high-risk group for premature mortality. While many have argued that educational success is a key factor in reducing these individuals’ excessive death risks, the empirical evidence has hitherto been limited. The aim of the current study was therefore to examine the potentially mitigating role of educational success for the association between OHC experience and premature mortality.

    Methods: Drawing on a Stockholm cohort born in 1953 (n=15,117), we analysed the associations between placement in OHC (ages 0-12), school performance (ages 13, 16, and 19), and premature all-cause mortality (ages 20-56) by means of Cox and Laplace regression analysis.

    Results: The Cox regression models confirmed the increased risk of premature mortality among individuals with OHC experience. Unadjusted Laplace regression models showed that these children died more than a decade, based on median survival time, before their majority population peers. However, among individuals who performed well at school, i.e. scored above-average marks at age 16 (grade 9) and age 19 (grade 12), respectively, the risks of premature mortality did not significantly differ between the two groups.

    Conclusion: Educational success seems to mitigate the increased risks of premature death among children with experience of OHC.

  • 6.
    Almquist, Ylva B.
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Landstedt, Evelina
    Jackisch, Josephine
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Rajaleid, Kristiina
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Westerlund, Hugo
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Hammarström, Anne
    Prevailing over Adversity: Factors Counteracting the Long-Term Negative Health Influences of Social and Material Disadvantages in Youth2018In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 15, no 9, article id 1842Article in journal (Refereed)
    Abstract [en]

    Disadvantaged circumstances in youth tend to translate into poor health development. However, the fact that this is not always the case has been seen as indicative of differential resilience. The current study highlights factors outside the context of the family with the potential to counteract the long-term negative influences of social and material adversity in adolescence on general health status. This study was based on two waves of questionnaire data from the Northern Swedish Cohort. From the wave in 1981 (age 16), indicators of social and material conditions as well as factors related to school, peers, and spare time were derived. From the wave in 2008 (age 43), information about self-rated health was used. Ordinal logistic regression models (n = 908) showed that adversity in youth was associated with poorer self-rated health in midlife among men and women alike, net of health status at baseline. However, having an advantaged situation with regard to school, peers, or spare time appeared to protect against the detrimental influences of disadvantaged circumstances in the family context on subsequent health. This suggests that health-promoting interventions may benefit from focusing on contexts outside the family in their effort to strengthen processes of resilience among disadvantaged youths.

  • 7.
    Arat, Arzu
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. Karolinska Institutet, Sweden.
    Burström, Bo
    Östberg, Viveca
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Hjern, Anders
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. Karolinska Institutet, Sweden.
    Social inequities in vaccination coverage among infants and pre-school children in Europe and Australia - a systematic review2019In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 19, article id 290Article, review/survey (Refereed)
    Abstract [en]

    Background

    Herd immunity levels of vaccine uptake are still not reached in some high-income countries, usually in countries with persisting social inequities in uptake. Previous studies have focused on factors within one health care system. This study takes a broader health care systems approach by reviewing the socioeconomic distribution of vaccination coverage on the national level in light of structural and organizational differences of primary care for children.

    Methods

    A systematic literature review of socio-economic patterns of uptake of Measles-Mumps-Rubella (MMR) and/or Diphteria-Tetanus-Pertusis (DTP) in population based studies of children 0–5 years of age living in the 30 European Economic Area (EEA) or European Free Trade Association (EFTA) countries and Australia, was carried out using the PRISMA guidelines. The health care system in the countries in the study were categorized by degree of freedom of the primary care provider (hierarchical or non-hierarchical) and whether preventive services were provided in a separate organization (well-baby clinics).

    Results

    The review identified 15 studies from 10 European countries and Australia that fulfilled the criteria. Although the heterogeneity of the socio-economic indicators did not allow for a conclusive meta-analysis, the study pointed towards lower levels of inequities in primary care models with well-baby clinics. In non-hierarchical primary care organizations that also lacked well-baby clinics, socioeconomic gaps in uptake were often found to be large.

    Conclusion

    This review indicates that structural and organizational aspects of health care systems for young children are important for equity in vaccine uptake.

  • 8.
    Aronsson, Vanda
    et al.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Toivanen, Susanna
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. Mälardalen University, Sweden.
    Leineweber, Constanze
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Nyberg, Anna
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Can a poor psychosocial work environment and insufficient organizational resources explain the higher risk of ill-health and sickness absence in human service occupations? Evidence from a Swedish national cohort2019In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 47, no 3, p. 310-317Article in journal (Refereed)
    Abstract [en]

    Aim: The aim of this study was to investigate differences in burnout, self-rated health (SRH) and sickness absence between human service occupations (HSOs) and other occupations, and whether they can be attributed to differences in psychosocial work environment and organizational resources. Methods: Data were derived from the Swedish Longitudinal Occupational Survey of Health, an approximately representative sample of the Swedish working population (n = 4408). Employment in HSOs, psychosocial work environment and organizational resources in 2012 predicted relative risks of sickness absence, burnout and suboptimal SRH in 2014 using modified Poisson regressions. The psychosocial work factors' and organizational resource variables' relative importance were estimated by adding them to the models one by one, and with population attributable fractions (PAFs). Results: Employment in HSOs was associated with a higher risk of sickness absence and the risk was explained by psychosocial and organizational factors, particularly high emotional demands, low work-time control and exposure to workplace violence. Employment in HSOs was not associated with burnout after sociodemographic factors were adjusted for, and furthermore not with SRH. A lower risk of suboptimal SRH was found in HSOs than in other occupations with equivalent psychosocial work environment and organizational resources. PAFs indicated that psychosocial work environment and organizational resource improvements could lead to morbidity reductions for all outcomes; emotional demands were more important in HSOs. Conclusions: HSOs had higher risks of sickness absence and burnout than other occupations. The most important work factors to address were high emotional demands, low work-time control, and exposure to workplace violence.

  • 9. Atzendorf, Josefine
    et al.
    Apfelbacher, Christian
    Gomes de Matos, Elena
    Kraus, Ludwig
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. IFT Institut für Therapieforschung, Germany; Eötvös-Loránd-Universität, Hungary.
    Piontek, Daniela
    Patterns of multiple lifestyle risk factors and their link to mental health in the German adult population: a cross-sectional study2018In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 8, no 12, article id e022184Article in journal (Refereed)
    Abstract [en]

    Objectives Lifestyle risk factors, such as drinking or unhealthy diet, can expotentiate detrimental health effects. Therefore, it is important to investigate multiple lifestyle risk factors instead of single ones. The study aims at: (1) identifying patterns of lifestyle risk factors within the adult general population in Germany and (2) examining associations between the extracted patterns and external factors.

    Design Cross-sectional study.

    Setting General German adult population (aged 18–64 years).

    Participants Participants of the 2015 Epidemiological Survey of Substance Abuse (n=9204).

    Primary outcome measures Lifestyle risk factors (daily smoking, at-risk alcohol consumption, unhealthy diet, low physical activity, weekly use of pharmaceuticals, as well as consumption of cannabis and other illicit drugs).

    Results A latent class analysis was applied to identify patterns of lifestyle risk factors, and a multinomial logistic regression was carried out to examine associations between the extracted classes and external factors. A total of four classes were extracted which can be described as healthy lifestyle (58.5%), drinking lifestyle (24.4%), smoking lifestyle (15.4%) and a cumulate risk factors lifestyle (1.7%). Individuals who were male, at younger age and single as well as individuals with various mental health problems were more likely to show multiple lifestyle risk factors.

    Conclusions Healthcare professionals should be aware of correlations between different lifestyle risk factors as well as between lifestyle risk groups and mental health. Health promotion strategies should further focus especially on younger and single men.

    This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

  • 10. Atzendorf, Josefine
    et al.
    Aschenbrenner, Annika Berit
    de Matos, Elena Gomes
    Kraus, Ludwig
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. FT Institut für Therapieforschung, Germany; Eötvös Loránd University, Hungary.
    Kroeger, Christoph
    Delle, Simone
    Piontek, Daniela
    E-Zigaretten: Einschätzung vonGesundheitsgefahren undNutzung zur Tabakentwöhnung2018In: Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz, ISSN 1436-9990, Vol. 61, no 11, p. 1415-1421Article in journal (Refereed)
    Abstract [de]

    BackgroundThe perception that e-cigarettes are less harmful than traditional tobacco products can influence the consumption of e-cigarettes.ObjectivesThree questions were examined: (1)How do different population groups perceive health risks of e-cigarettes? (2)Do sociodemographic variables explain differences in the risk assessment of e-cigarettes? (3)Does the perception of health risks predict the use of e-cigarettes for smoking cessation?MethodsData came from the 2015 Epidemiological Survey of Substance Abuse (ESA) with asample size of n=9204 participants, aged 18 to 64years (response rate 52.2%). Data were collected by telephone, online, or by written questionnaires. Assessments of risk perception of e-cigarettes and conventional cigarettes (more harmful, just as harmful, less harmful, do not know) were compared. Descriptive statistics and logistic regressions were performed.ResultsIndividuals with lower education rated e-cigarettes as more harmful. Older people and women perceived e-cigarettes as just as harmful. Smokers considered e-cigarettes to be more harmful than or just as harmful as conventional tobacco products. The likelihood of using e-cigarettes for smoking cessation was higher if people thought they were less harmful than conventional cigarettes.ConclusionsOnly one-third of the population knows that e-cigarettes are less harmful to health than conventional cigarettes. The perception of health risks is related to the usage of e-cigarettes for smoking cessation.

  • 11. Atzendorf, Josefine
    et al.
    Gomes de Matos, Elena
    Kröger, Christoph
    Kraus, Ludwig
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. IFT Institut für Therapieforschung, Germany; Eötvös-Loránd-Universität, Hungary.
    Piontek, Daniela
    Die Nutzung von E-Zigaretten in der deutschen Bevölkerung – Ergebnisse des Epidemiologischen Suchtsurvey 20152019In: Das Gesundheitswesen, ISSN 0941-3790, E-ISSN 1439-4421, Vol. 81, no 02, p. 137-143Article in journal (Refereed)
    Abstract [en]

    Aim Estimates of e-cigarette consumption in Germany vary considerably. The use of e-cigarettes for tobacco cessation is critically discussed. Based on current data, the distribution of the consumption of e-cigarettes and their use in the adult general population of Germany will be presented.

    Methods The 2015 Epidemiological Survey of Substance Abuse, a nationwide survey of 18 to 64 year-old people in Germany (n=9,204, response rate: 52,2%), was used as data basis.

    Results E-cigarettes were known to most of the respondents (85,3%, 43,5 Mio.), whereas only 2,9% (1,5 Mio.) used e-cigarettes in the last 30 days. Higher risk of consuming e-cigarettes was seen in younger people (OR=0,95, 95%-KI=(0,93; 0,97)), men (OR=1,45, 95%-KI=(1,02; 2,07)) and smokers (OR=12,53, 95%-KI=(8,71; 18,03)). About a third of smokers and ex-smokers of conventional cigarettes (36,6%) who consumed e-cigarettes used these for tobacco cessation of which one fifth (21,3%) was able to quit smoking.

    Conclusion E-cigarette users seem to be more likely to be male, younger and smokers of conventional cigarettes. In addition to curiosity, the change in smoking behavior is an important motive for consumption. The results indicate that the use of e-cigarettes can contribute to tobacco cessation, the majority of users, however, continue to consume conventional and/or e-cigarettes.

  • 12. Autto, Janne
    et al.
    Törrönen, Jukka
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    ‘Yes, but all responsible Finns want to stop living on credit’: Feeling rules in the Finnish politics of austerity2019In: Citizenship Studies, ISSN 1362-1025, E-ISSN 1469-3593, Vol. 23, no 1, p. 78-95Article in journal (Refereed)
    Abstract [en]

    In 2015, the newly elected government of Finland introduced austerity measures designed to improve the public economy, which had not recovered from the financial crisis of 2007–2008. The article examines how the government sought to secure acceptance for austerity by appealing to citizens’ emotions. We analyse how the measures were emotionally motivated and how, according to the parties in power, citizens should and should not have felt about them. The article shows how the politics of austerity produces various and contradictory feeling rules. These seek to temper citizens’ negative emotions towards austerity, such as dissatisfaction over unfair sharing of pain and distrust towards political authority. Interestingly, the rules evoke hope that a better future lies ahead if citizens follow the proposed measures, yet prompt fears of what will happen if they do not. The government also emphasised its transparency and honesty to prompt empathy and trust from the population.

  • 13.
    B. Låftman, Sara
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Alm, Susanne
    Stockholm University, Faculty of Social Sciences, The Swedish Institute for Social Research (SOFI).
    Sandahl, Julia
    Stockholm University, Faculty of Social Sciences, Department of Criminology.
    Modin, Bitte
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Future Orientation among Students Exposed to School Bullying and Cyberbullying Victimization2018In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 15, no 4, article id 605Article in journal (Refereed)
    Abstract [en]

    Future orientation can be defined as an individual’s thoughts, beliefs, plans, and hopes for the future. Earlier research has shown adolescents’ future orientation to predict outcomes later in life, which makes it relevant to analyze differences in future orientation among youth. The aim of the present study was to analyze if bullying victimization was associated with an increased likelihood of reporting a pessimistic future orientation among school youth. To be able to distinguish between victims and bully-victims (i.e., students who are both bullies and victims), we also took perpetration into account. The data were derived from the Stockholm School Survey performed in 2016 among ninth grade students (ages 15–16 years) (n = 5144). Future orientation and involvement in school bullying and in cyberbullying were based on self-reports. The statistical method used was binary logistic regression. The results demonstrated that victims and bully-victims of school bullying and of cyberbullying were more likely to report a pessimistic future orientation compared with students not involved in bullying. These associations were shown also when involvement in school bullying and cyberbullying were mutually adjusted. The findings underline the importance of anti-bullying measures that target both school bullying and cyberbullying.

  • 14. Beller, Johannes
    et al.
    Miething, Alexander
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Regidor, Enrique
    Lostao, Lourdes
    Epping, Jelena
    Geyer, Siegfried
    Trends in grip strength: Age, period, and cohort effects on grip strength in older adults from Germany, Sweden, and Spain2019In: SSM - Population Health, ISSN 2352-8273, Vol. 9, article id 100456Article in journal (Refereed)
    Abstract [en]

    Grip strength is seen as an objective indicator of morbidity and disability. However, empirical knowledge about trends in grip strength remains incomplete. As trends can occur due to effects of aging, time periods and birth cohorts, we used hierarchical age-period-cohort models to estimate and disentangle putative changes in grip strength. To do this, we used population-based data of older adults, aged 50 years and older, from Germany, Sweden, and Spain from the SHARE study (N = 22500) that encompassed multiple waves of first-time respondents. We found that there were contrasting changes for different age groups: Grip strength improved over time periods for the oldest old, whereas it stagnated or even decreased in younger older adults. Importantly, we found strong birth cohort effects on grip strength: In German older adults, birth cohorts in the wake of the Second World War exhibited increasingly reduced grip strength, and in Spanish older adults, the last birth cohort born after 1960 experienced a sharp drop in grip strength. Therefore, while grip strength increased in the oldest old aged 80 years and older, grip strength stagnated or decreased in comparatively younger cohorts, who might thus be at risk to experience more morbidity and disability in the future than previous generations. Future studies should investigate factors that contribute to this trend, the robustness of the observed birth cohort effects, and the generalizability of our results to other indicators of functional health.

  • 15.
    Berg, Lisa
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. Stockholm University, Faculty of Social Sciences, The Swedish Institute for Social Research (SOFI).
    Brännström, Lars
    Stockholm University, Faculty of Social Sciences, Department of Social Work.
    Evicted children and subsequent placement in out-of-home care: A cohort study2018In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 13, no 4, article id e0195295Article in journal (Refereed)
    Abstract [en]

    Background

    Evictions may have serious consequences for individuals’ health and wellbeing. Even though an eviction may be experienced as a significant crisis for the family, there is little previous knowledge on consequences for evicted children. This study represents the first attempt to examine to what extent children from evicted households were separated from their parents and placed in out-of-home care (foster family or residential care) using population-based data, net of observed confounding factors related to the socioeconomic and psychosocial circumstances of their parents.

    Methods

    This study takes advantage of information from a Swedish national database, consisting of about 8 000 evicted individuals and a random sample of 770 000 individuals from the national population, linked to individual-level, longitudinal data from Swedish national registers. Our analytical sample consists of information for more than 250 000 children born in 1995–2008, including 2 224 children from evicted households. We used binary logistic regression based on the Karlson/Holm/Breen method to account for observed imbalances at baseline between evicted and non-evicted children.

    Results

    Compared to non-evicted children, the crude odds ratio for placement in out-of-home care in evicted children was 12.10 (95% CI 8.54–17.14). Net of observed confounding factors related to the socioeconomic and psychosocial circumstances of the parents, evicted children had a twofold elevated risk of being placed in out-of-home care (odds ratio 2.26, 95% CI 1.55–3.27). Crude OR for evicted children in comparison with children under threat of eviction (eviction not formally executed) was 1.71 (95% CI 1.17–2.49) and adjusted OR 1.58 (95% CI 1.06–2.35).

    Conclusion

    Children who experience eviction constitute a disadvantaged group and are at significant risk of being separated from their parents and placed in out-of-home care. These results demonstrate the importance of providing support for these children and their parents. Strategies to prevent households with children from being evicted seem to be an important and viable intervention path.

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

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

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

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

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

  • 17.
    Berg, Lisa
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Mikael, Rostila
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Jan, Saarela
    Kawachi, Ichiro
    Hjern, Anders
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. Harvard T.H. Chan School of Public Health, USA; Karolinska Institutet, Sweden.
    Experience of sibling death in childhood and risk of psychiatric care in adulthood: a national cohort study from Sweden2019In: European Child and Adolescent Psychiatry, ISSN 1018-8827, E-ISSN 1435-165XArticle in journal (Refereed)
    Abstract [en]

    Studies have found that sibling loss is associated with an increased risk of death from external causes (i.e. suicides, accidents and homicides). Increased psychiatric health problems following bereavement could underlie such an association. We studied the influence of sibling loss during childhood on psychiatric care in young adulthood, adjusting for psychosocial covariates shared by siblings in childhood. A national cohort born in Sweden in 1973–1982 (N = 701,270) was followed prospectively until 2013. Cox proportional hazards models were used to analyse the association between sibling loss during childhood and psychiatric inpatient and outpatient care identified by the Hospital Discharge Register. After adjustment for confounders, the HRs of psychiatric care in men who experienced sibling loss were 1.17 (95% CI 1.07–1.27) while the associations turned non-significant in women after adjustment for family-related psychosocial covariates, HR 1.07 (95% CI 0.99–1.16). An increased risk was found in men bereaved in early childhood (1.22 95% CI 1.07–1.38) and adolescence (1.27 95% CI 1.08–1.48). Among women, loss of a sibling during adolescence was significantly associated with psychiatric care (1.19 95% CI 1.03–1.36). Increased psychiatric health problems following bereavement could underlie the previously found association between sibling loss and mortality from external causes. Family-related psychosocial conditions shared by siblings in childhood may account for the association between sibling death and psychiatric care in adulthood.

  • 18.
    Berg, Lisa
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Rostila, Mikael
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Arat, Arzu
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. Karolinska Institute, Sweden.
    Hjern, Anders
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS). Karolinska Institutet, Sweden.
    Parental death during childhood and violent crime in late adolescence to early adulthood: a Swedish national cohort study2019In: Palgrave Communications, ISSN 2055-1045, Vol. 5, article id 74Article in journal (Refereed)
    Abstract [en]

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

  • 19.
    Bergström, Malin
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS). Karolinska Institutet, Sweden.
    Fransson, Emma
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Wells, Michael B.
    Köhler, Lennart
    Hjern, Anders
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS). Karolinska Institutet, Sweden.
    Children with two homes: Psychological problems in relation to living arrangements in Nordic 2- to 9-year-olds2019In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 47, no 2, p. 137-145Article in journal (Refereed)
    Abstract [en]

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

  • 20.
    Bergström, Malin
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS). Karolinska Institutet, Sweden.
    Sarkadi, Anna
    Hjern, Anders
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS). Karolinska Institutet, Sweden.
    Fransson, Emma
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    "We also communicate through a book in the diaper bag" - Separated parents' ways to coparent and promote adaptation of their 1-4 year olds in equal joint physical custody2019In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 14, no 4, article id e0214913Article in journal (Refereed)
    Abstract [en]

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

  • 21. Berthelsen, Hanne
    et al.
    Muhonen, Tuija
    Toivanen, Susanna
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. Mälardalen University, Sweden.
    What happens to the physical and psychosocial work environment when activity-based offices are introduced into academia?2018In: Journal of Corporate Real Estate, ISSN 1463-001X, E-ISSN 1479-1048, Vol. 20, no 4, p. 230-243Article in journal (Refereed)
    Abstract [en]

    Purpose There is an increased interest for introducing activity-based offices at universities. The purpose of this study is to contribute to the knowledge about the importance of the built environment for the psychosocial work environment within academia by analyzing how staff at a large Swedish university experienced the physical and psychosocial work environment before and after moving to activity-based offices. Design/methodology/approach A Web-based survey was distributed to all employees at two faculties at a university three months before (2015, n = 217, response rate 51 per cent) and nine months after (2016, n = 200, response rate 47 per cent) relocation to a new activity-based university building. Findings In the new premises, a vast majority (86 per cent) always occupied the same place when possible, and worked also more often from home. The social community at work had declined and social support from colleagues and supervisors was perceived to have decreased. The participants reported a lower job satisfaction after the relocation and were more likely to seek new jobs. No aspects in the physical or psychosocial work environment were found to have improved after the relocation. Research/limitations implications The study had a two-wave cross-sectional design, which does not allow establishing causal relations. Practical implications There is reason to be cautious about relocation to activity-based offices at universities. The potential savings in costs for premises may lead to may be followed by an increase in other costs. The risk that staff cannot concentrate on their work in activity-based university workplaces and lose their sense of community with colleagues are factors, which in the long run may lead to decreased efficiency, more conflicts and poorer well-being. Originality/value This paper contributes with new knowledge concerning changes in the physical and psychosocial work environment when relocating from cell offices to activity-based offices in a university setting.

  • 22. Bohman, Hannes
    et al.
    Brolin Låftman, Sara
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Cleland, Neil
    Lundberg, Mathias
    Päären, Aivar
    Jonsson, Ulf
    Somatic symptoms in adolescence as a predictor of severe mental illness in adulthood: a long-term community-based follow-up study2018In: Child and Adolescent Psychiatry and Mental Health, ISSN 1753-2000, E-ISSN 1753-2000, Vol. 12, article id 42Article in journal (Refereed)
    Abstract [en]

    Background: Somatic symptoms are common and costly for society and correlate with suffering and low functioning. Nevertheless, little is known about the long-term implications of somatic symptoms. The objective of this study was to assess if somatic symptoms in adolescents with depression and in their matched controls predict severe mental illness in adulthood by investigating the use of hospital-based care consequent to different mental disorders. Methods: The entire school population of 16-17-year-olds in the city of Uppsala, Sweden, was screened for depression in 1991-1993 (n = 2300). Adolescents with positive screenings (n = 307) and matched non-depressed controls (n = 302) participated in a semi-structured diagnostic interview for mental disorders. In addition, 21 different self-rated somatic symptoms were assessed. The adolescents with depression and the matched non-depressed controls were engaged in follow-up through the National Patient Register 17-19 years after the baseline study (n = 375). The outcome measures covered hospital-based mental health care for different mental disorders according to ICD-10 criteria between the participants' ages of 18 and 35 years. Results: Somatic symptoms were associated with an increased risk of later hospital-based mental health care in general in a dose-response relationship when adjusting for sex, adolescent depression, and adolescent anxiety (1 symptom: OR = 1.63, CI 0.55-4.85; 2-4 symptoms: OR = 2.77, 95% CI 1.04-7.39; >= 5 symptoms: OR = 5.75, 95% CI 1.98-16.72). With regards to specific diagnoses, somatic symptoms predicted hospital-based care for mood disorders when adjusting for sex, adolescent depression, and adolescent anxiety (p<0.05). In adolescents with depression, somatic symptoms predicted later hospital-based mental health care in a dose-response relationship (p<0.01). In adolescents without depression, reporting at least one somatic symptom predicted later hospital-based mental health care (p<0.05). Conclusions: Somatic symptoms in adolescence predicted severe adult mental illness as measured by hospital-based care also when controlled for important confounders. The results suggest that adolescents with somatic symptoms need early treatment and extended follow-up to treat these specific symptoms, regardless of co-occurring depression and anxiety.

  • 23. Borsch, Anne Sofie
    et al.
    De Montgomery, Christopher Jamil
    Gauffin, Karl
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Eide, Ketil
    Heikkilä, Elli
    Smith Jervelund, Signe
    Health, Education and Employment Outcomes in Young Refugees in the Nordic Countries: A Systematic Review2018In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905Article, review/survey (Refereed)
    Abstract [en]

    OBJECTIVES: Since 2000, approximately 500,000 refugees have settled in the Nordic countries, about a third of them being children and young people. To identify general trends, and to detect gaps in the existing knowledge about the socioeconomic and health status of these young refugees, this review discusses the literature regarding three key areas related to welfare policy: health, education and employment.

    METHODS: A systematic search in PubMed, Scopus, SocINDEX, Sociological Abstracts, Embase and Cochrane, and a search for publications from relevant institutions were undertaken. All publications had to be original quantitative studies published since 1980. The total number of studies identified was 1353, 25 publications were included.

    RESULTS: Young refugees had poorer mental health than ethnic minority and native-born peers. Mental health problems were related to pre-migration experiences but also to post-migration factors, such as discrimination and poor social support. Refugees performed worse in school than native-born and few progressed to higher education. Experiencing less discrimination and having better Nordic language proficiency was associated with higher educational attainment. A higher proportion of refugees were unemployed or outside the labour force compared with other immigrants and native-born. Assessment instruments varied between studies, making comparisons difficult.

    CONCLUSIONS: The study suggests pre-migration factors but also post-migration conditions such as perceived discrimination, social support and Nordic language proficiency as important factors for the mental health, education and employment outcomes of young refugees in the Nordic countries. Further Nordic comparative research and studies focusing on the relationship between health, education and employment outcomes are needed.

  • 24. Bowden, Jacqueline A.
    et al.
    Delfabbro, Paul
    Room, Robin
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). La Trobe University, Australia.
    Miller, Caroline
    Wilson, Carlene
    Parental drinking in Australia: Does the age of children in the home matter?2019In: Drug and Alcohol Review, ISSN 0959-5236, E-ISSN 1465-3362, Vol. 38, no 3, p. 306-315Article in journal (Refereed)
    Abstract [en]

    Introduction and Aims Parental role modelling of alcohol use is known to influence alcohol consumption in adolescence and in later life. This study aimed to assess relationships between parental status, child age and alcohol consumption, which have not been well documented. Design and Methods Data were sourced from the 2013 Australian National Drug Strategy Household Survey. Analyses were conducted for 25-55 year olds (n = 11 591) by parental status, gender and age of youngest child in the household, controlling for socio-demographic factors. Results Parents were less likely than non-parents to exceed the alcohol guideline for increased lifetime risk (18.2% vs. 24.2%) and short-term risk: at least weekly (14.2% vs. 21.2%); and at least monthly (27.5% vs. 35.9%). Fathers were just as likely to exceed the guidelines for lifetime risk as other men, but those with children aged 0-2, were less likely to exceed the guideline for short-term risk. Women were least likely to exceed the guideline for lifetime risk if they had children aged 0-2, 6-11 or 15 years and over, or the guideline for short-term risk, if they had children aged 0-2, or 15 years and over in the household. Parents were more likely to report drinking in the home. Discussion and Conclusions Parents were less likely to exceed alcohol guidelines than non-parents, especially mothers whose youngest child was an infant or in high school or older. Consistent with population rates in men, fathers were more likely to exceed alcohol guidelines than mothers, and this excess consumption warrants public health attention.

  • 25. Braun, Barbara
    et al.
    Behrendt, Silke
    Piontek, Daniela
    Kraus, Ludwig
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. IFT Institut für Therapieforschung, Germany; Eötvös-Loránd-Universität, Germany.
    Bühringer, Gerhard
    Therapie alkoholbezogener Störungen im Alter: Ergebnisse der deutschen Stichprobe der randomisiert-kontrollierten ELDERLY-Studie bis zum 12-Monats-Follow-up2019In: SUCHT, ISSN 0939-5911, E-ISSN 1664-2856, Vol. 65, no 2, p. 101-114Article in journal (Refereed)
    Abstract [en]

    Treatment of alcohol use disorder in higher ages: Results of the German sample of the randomized-controlled ELDERLY study up to 12 months follow-up

    Aim: The demographic change implicates a higher number of older persons with alcohol related problems, for which therapeutic care is insufficient up to now. Within the international randomized-controlled ELDERLY study two versions of an outpatient psychotherapeutic treatment for persons aged 60 years or older having an alcohol use disorder according to DSM-5 (AUD) were tested in three countries. Methods: After baseline, the randomized treatment groups were reassessed after 1, 3, 6 and 12 months. Changes (time and group) regarding drinking quantity, number of abstinent days, number of days with binge drinking, and number of days with low-risk consumption as well as number of fulfilled criteria for AUD were evaluated. Complete case- and intention-to-treat analyses for the German subsample are presented (n=203). Results: Both treatment groups showed stably up to 12 months after baseline higher abstinence rates (18 %; t0: 4 %), rates of persons without any days of risky use (45 %, t0: 4 %) and without binge drinking days (68 %; t0: 15 %). Also, a reduction in drinking quantity (median of 27 g pure alcohol per drinking day; t0: 58 g) and number of fulfilled AUD criteria (median of 2; t0: 5) was observed. Conclusion: The improvements with regard to drinking behavior and symptoms of AUD remained steady despite the relatively short treatment duration. Motivational interventions, especially personalized feedback of drinking behavior, evoke changes in drinking behavior in older persons with alcohol related disorders. Therapeutic nihilism is misplaced; rather is it necessary to consider special needs of this target group to implement tailored help offers.

  • 26.
    Brolin Låftman, Sara
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Alm, Susanne
    Stockholm University, Faculty of Social Sciences, The Swedish Institute for Social Research (SOFI).
    Olsson, Gabriella
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Sundqvist, Kristina
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Wennberg, Peter
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. Karolinska Institutet, Sweden .
    Future orientation, gambling and risk gambling among youth: A study of adolescents in Stockholm2019In: International Journal of Adolescence and Youth, ISSN 0267-3843, E-ISSN 2164-4527Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to analyze the association between adolescents’ future orientation and their engagement in gambling and in risk gambling, respectively. The data used come from the Stockholm School Survey, collected in 2016 among students in the ninth grade in elementary school (15–16 years) and in the second grade of upper secondary school (17–18 years) in Stockholm municipality (n = 11,661). The results showed that adolescents who expected their future to be ‘much worse’ than that of others were more inclined to engage in gambling and in risk gambling compared with adolescents who expected their future to be similar to that of others. Furthermore, adolescents who expected their future to be ‘much better’ than that of others had an increased likelihood of engaging in gambling but not in risk gambling. The results are discussed in the light of elements from rational choice theory.

  • 27.
    Brydsten, Anna
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Hammarström, Anne
    San Sebastian, Miguel
    Health inequalities between employed and unemployed in northern Sweden: a decomposition analysis of social determinants for mental health2018In: International Journal for Equity in Health, ISSN 1475-9276, E-ISSN 1475-9276, Vol. 17, article id 59Article in journal (Refereed)
    Abstract [en]

    Background: Even though population health is strongly influenced by employment and working conditions, public health research has to a lesser extent explored the social determinants of health inequalities between people in different positions on the labour market, and whether these social determinants vary across the life course. This study analyses mental health inequalities between unemployed and employed in three age groups (youth, adulthood and mid-life), and identifies the extent to which social determinants explain the mental health gap between employed and unemployed in northern Sweden.

    Methods: The Health on Equal Terms survey of 2014 was used, with self-reported employment (unemployed or employed) as exposure and the General Health Questionnaire (GHQ-12) as mental health outcome. The social determinants of health inequalities were grouped into four dimensions: socioeconomic status, economic resources, social network and trust in institutional systems. The non-linear Oaxaca decomposition analysis was applied, stratified by gender and age groups.

    Results: Mental health inequality was found in all age groups among women and men (difference in GHQ varying between 0.12 and 0.20). The decomposition analysis showed that the social determinants included in the model accounted for 43-51% of the inequalities among youths, 42-98% of the inequalities among adults and 60-65% among middle-aged. The main contributing factors were shown to vary between age groups: cash margin (among youths and middle-aged men), financial strain (among adults and middle-aged women), income (among men in adulthood), along with trust in others (all age groups), practical support (young women) and social support (middle-aged men); stressing how the social determinants of health inequalities vary across the life course.

    Conclusions: The health gap between employed and unemployed was explained by the difference in access to economic and social resources, and to a smaller extent in the trust in the institutional systems. Findings from this study corroborate that much of the mental health inequality in the Swedish labour market is socially and politically produced and potentially avoidable. Greater attention from researchers, policy makers on unemployment and public health should be devoted to the social and economic deprivation of unemployment from a life course perspective to prevent mental health inequality.

  • 28.
    Brydsten, Anna
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Rostila, Mikael
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Dunlavy, Andrea
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Social integration and mental health - a decomposition approach to mental health inequalities between the foreign-born and native-born in Sweden2019In: International Journal for Equity in Health, ISSN 1475-9276, E-ISSN 1475-9276, Vol. 18, article id 48Article in journal (Refereed)
    Abstract [en]

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

  • 29.
    Carlbring, Per
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Rozental, Alexander
    Kottorp, Anders
    Forsström, David
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Månsson, Kristoffer
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Boettcher, Johanna
    Furmark, Tomas
    Andersson, Gerhard
    The Negative Effects Questionnaire: Psychometric Properties of an Instrument for Assessing Negative Effects in Psychological Treatments2019Conference paper (Other academic)
    Abstract [en]

    Background: Psychological treatments provide many benefits for patients with psychiatric disorders, but research also suggest that negative effects might occur from the interventions involved. The Negative Effects Questionnaire (NEQ) has previously been developed as a way of determining the occurrence and characteristics of such incidents, consisting of 32 items and six factors. However, the NEQ has yet to be examined using modern test theory, which could help to improve the understanding of how well the instrument works psychometrically. 

    Methods: The current study investigated the reliability and validity of the NEQ from both a person and item perspective, establishing goodness-of-fit, item bias, and scale precision.

    Method: The NEQ was distributed to 564 patients in five clinical trials at post-treatment. Data was analyzed using Rasch analysis, i.e., a modern test theory application. Results: 1) the NEQ exhibits fairness in testing across sociodemographics, 2) shows comparable validity for a final and condensed scale of 20 instead of 32 items, 3) uses a rating scale that advances monotonically in steps of 0-4, and 4) is suitable for monitoring negative effects on an item-level. 

    Conclusion: The NEQ is proposed as a useful instrument for investigating negative effects in psychological treatments, and its newer shorter format could facilitate its use in clinical and research settings. However, further research is needed to explore the relationship between negative effects and treatment outcome, as well as to test it in more diverse patient populations.

  • 30.
    Cisneros Örnberg, Jenny
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Hettne, Jörgen
    The Future Swedish Gambling Market: Challenges in Law and Public Policies2018In: Gambling Policies in European Welfare States: Current Challenges and Future Prospects / [ed] Michael Egerer, Virve Marionneau, Janne Nikkinen, Palgrave Macmillan, 2018, p. 197-216Chapter in book (Refereed)
    Abstract [en]

    Swedish gambling regulation has been questioned from an EU law perspective. While no changes have yet taken place, a reform proposal has during 2017 been submitted and the Government has in April 2018 passed a bill to Parliament based on that proposal. The new Swedish Gambling Act shall be based on a licensing system: anyone who wants to act in the Swedish gambling market must have a designated licence. The proposal underlines that the negative consequences of gambling should be limited and that extensive consumer protection calls for curbs on marketing. This chapter will discuss different aspects of gambling regulation in Sweden, especially in the light of EU law. Particular attention will be paid to the legal scope for reform, differences in taxation including the position held by public interest non-profit organisations, marketing and consumer protection.

  • 31. Dams, Judith
    et al.
    Buchholz, Angela
    Kraus, Ludwig
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. IFT Institute for Therapeutic Research Munich, Germany; ELTE Eötvös Loránd University, Hungary.
    Reimer, Jens
    Scherbaum, Norbert
    Konnopka, Alexander
    König, Hans-Helmut
    Excess costs of alcohol-dependent patients in German psychiatric care compared with matched non-alcohol-dependent individuals from the general population: a secondary analysis of two datasets2018In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 8, no 8, article id e020563Article in journal (Refereed)
    Abstract [en]

    Objectives Heavy alcohol use can cause somatic and mental diseases, affects patients' social life and is associated with social isolation, unemployment and reduced quality of life. Therefore, societal costs of alcohol dependence are expected to be high. The aim of this study was to estimate excess costs of patients with alcohol dependence diagnosed using the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition criteria compared with individuals without alcohol dependence in Germany. Design In a secondary analysis, baseline data of patients with alcohol dependence enrolled in a randomised controlled trial (German Clinical Trials Register DRS00005035) were compared with data collected via a telephone survey from individuals without alcohol dependence and that had been matched by entropy balancing. Health service use was evaluated retrospectively for a 6-month period. Settings Four German psychiatric university clinics (patients with alcohol dependence) and the German general adult population (individuals without alcohol dependence). Participants n=236adult patients with alcohol dependence and n=4687adult individuals without alcohol dependence. Primary and secondary outcome measures The excess costs of health service use, absenteeism and unemployment of patients with alcohol dependence were calculated and compared with individuals without alcohol dependence. In subgroup analyses, the associations between excess cost and gender, comorbidities and the duration of disease were investigated. Results Total 6-month excess costs of Euro11839 (95% CI Euro11 529 to Euro12 147) were caused by direct excess costs of Euro4349 (95% CI Euro4129 to Euro4566) and indirect costs of Euro7490 (95% CI Euro5124 to Euro9856). In particular, costs of inpatient treatment, formal long-term care, absenteeism and unemployment were high. Conclusions Alcohol dependence causes substantial direct and indirect excess costs. Cost-effective interventions to prevent and treat alcohol dependence are urgently needed. Trial registration number DRKS00005035.

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

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

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

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

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

  • 33. Dauber, Hanna
    et al.
    Pogarell, Oliver
    Kraus, Ludwig
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. IFT Institut für Therapieforschung, Germany; ELTE Eötvös-Loránd-University, Hungary.
    Braun, Barbara
    Older adults in treatment for alcohol use disorders: service utilisation, patient characteristics and treatment outcomes2018In: Substance Abuse Treatment, Prevention, and Policy, ISSN 1747-597X, E-ISSN 1747-597X, Vol. 13, article id 40Article in journal (Refereed)
    Abstract [en]

    Background In western countries demographic changes are leading to an ageing society. Consequently, the number of older adults with alcohol use disorders (AUDs) will rise and the demand of treatment is likely to increase. However, thus far not many older adults with an AUD are seeking treatment and little is known about the efficacy of treatment for older adults. The present study aimed at determining the proportion of older adults with an AUD in addiction treatment, particular characteristics and treatment outcomes of this clientele.

    Methods Using data of 10,860 patients with an AUD aged 60 and over that are documented within the national German addiction care system we conducted exploratory analyses with regard to prevalence, sociodemographic, disorder- and treatment-related variables.

    Results Overall, we found a low proportion of older patients in treatment due to AUDs, but highly positive treatment outcomes. With regard to sociodemographic and disorder-related characteristics, older females and late-onset patients in particular constitute a unique clientele.

    Conclusions The low service utilisation on the one hand but good treatment prognosis on the other emphasise the need to promote treatment seeking among older adults with AUDs. In this context, the special characteristics we found among older patients may contribute to better reach this population and to improve provisions of targeted treatment approaches.

  • 34. de-Graft Aikins, Ama
    et al.
    Wikler, Dan
    Allotey, Pascale
    Arrhenius, Gustaf
    Stockholm University, Faculty of Humanities, Department of Philosophy. Institute for Futures Studies, Sweden.
    Beisel, Uli
    Cooper, Melinda
    Eyal, Nir
    Hausman, Dan
    Lutz, Wolfgang
    Norheim, Ole F.
    Roberts, Elizabeth
    Vågerö, Denny
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Jebari, Karim
    Global Health and the Changing Contours of Human Life2018In: Rethinking Society for the 21st Century: Report of the International Panel on Social Progress: Volume 3: Transformations in Values, Norms, Cultures / [ed] International Panel on Social Progress (IPSP), Cambridge University Press, 2018, p. 713-752Chapter in book (Other academic)
    Abstract [en]

    The “contours of human life” include childhood and adolescence, reproduction, the experiences of health, illness, disability, and death. These stages and aspects of life are universal and will remain so. However, social, environmental, and scientific changes are transforming their timing, texture, and patterns – and these transformations are not universally shared. Serious inequalities persist, among and within countries and regions, in longevity, morbidity, and disability, control over reproduction and sexuality, and care at the end of life. This chapter addresses these changing contours of human life in six sections: coming into being; longevity; diminished health; reproduction; enhancement; and death and dying.

  • 35. de-Graft Aikins, Ama
    et al.
    Wikler, Dan
    Allotey, Pascale
    Beisel, Uli
    Cooper, Melinda
    Eyal, Nir
    Hausman, Dan
    Lutz, Wolfgang
    Norheim, Ole F.
    Roberts, Elisabeth
    Vågerö, Denny
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Jebari, Karim
    Global Health and the Changing Contours of Human Life2018In: Rethinking Society for the 21st Century: Report of the International Panel on Social Progress: Volume 3: Transformations in Values, Norms, Cultures, Cambridge: Cambridge University Press, 2018, p. 713-752Chapter in book (Refereed)
    Abstract [en]

    The contours of human life – birth, childhood, maturity, reproduction, the experiences of health, illness, and disability, and death – have been and will remain nearly universal; but their duration and texture are undergoing great changes. In this chapter, we chart the transformations and make projections into the near future. Many of the trends are favorable: fewer children are dying, and many enjoy greater longevity. But these advances are not distributed uniformly among and within countries and regions. Furthermore, the value of longevity is compromised by an increasing number of people living with diminished health under inequitable systems of health and social care. A more just future can be achieved by a continuing emphasis on equity in global health systems even as human lives continue to be extended and enhanced.

  • 36.
    Dunlavy, Andrea C.
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Juárez, Sol
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Rostila, Mikael
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Employment status and risk of all-cause mortality among native- and foreign-origin persons in Sweden2018In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 28, no 5, p. 891-897Article in journal (Refereed)
    Abstract [en]

    Background: The association between exposure to unemployment and increased risk of mortality is well established. Yet migrants and their children often experience a number of stressors in the country of residence which could exacerbate the negative effects of job loss or unemployment. This study examined the extent to which region of origin and generational status modified associations between employment status and risk of all-cause mortality.

    Methods: Using population-based registers, an open cohort of 2 178 321 individuals aged 25-64 years was followed from 1993 to 2008. Hazard ratios for mortality were calculated using Cox regression. Employment status and socio-demographic covariates were included as time-varying variables in all models.

    Results: Relative to employed native-origin Swedes, excess risk of mortality was found among most groups of unemployed persons. The excess risk of mortality found among African women exposed to long-term unemployment (HR = 3.26, 95% CI: 2.30-4.63), Finnish men exposed to short-and long-term unemployment (HR = 2.74, 95% CI: 2.32-3.24 and HR = 2.39, 95% CI: 2.12-2.69), and second generation Swedish men exposed to short-term unemployment (HR = 2.34, 95% CI: 2.06-2.64) was significantly greater (P < 0.05) than that found among their unemployed native-origin counterparts. Excess risk of mortality among the unemployed in other foreign-origin groups was of a similar or lower magnitude to that found in unemployed native-origin Swedes. A decreased risk of mortality was observed among the employed in nearly all foreign-origin groups.

    Conclusions: With some exceptions, mortality risk in foreign-origin individuals across all categories of employment status was generally similar to or lower than the risk observed in native-origin Swedes.

  • 37.
    Dunlavy, Andrea C.
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Juárez, Sol
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Toivanen, Susanna
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. Mälardalen University, Sweden.
    Rostila, Mikael
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Suicide risk among native- and foreign-origin persons in Sweden: a longitudinal examination of the role of unemployment status2019In: Social Psychiatry and Psychiatric Epidemiology, ISSN 0933-7954, E-ISSN 1433-9285, Vol. 54, no 5, p. 579-590Article in journal (Refereed)
    Abstract [en]

    PURPOSE: Prior research has documented an association between unemployment and elevated suicide risk. Yet, few Swedish studies have explicitly considered how such risk may vary by different migration background characteristics among persons of foreign-origin, who often experience diverse forms of labor market marginalization. This study examines the extent to which unemployment status may differentially influence suicide risk among the foreign-origin by generational status, region of origin, age at arrival, and duration of residence.

    METHODS: Population-based registers were used to conduct a longitudinal, open cohort study of native-origin and foreign-origin Swedish residents of working age (25-64 years) from 1993 to 2008. Hazard ratios and 95% confidence intervals for suicide mortality were estimated using gender-stratified Cox proportional hazards models.

    RESULTS: Elevated suicide risk observed among foreign-origin unemployed groups was generally of a similar or lower magnitude than that found in unemployed native-origin, although unemployed second-generation Swedish men demonstrated significantly greater (p < 0.05) excess risk of suicide than that observed among their native-origin counterparts. Unemployed foreign-born men with a younger age at arrival and longer duration of residence demonstrated an increased risk of suicide, while those who arrived as adults, and a shorter duration of residence did not show any increased risk. Among foreign-born women, excess suicide risk persisted regardless of age at arrival and duration of residence in the long-term unemployed.

    CONCLUSIONS: Multiple migration background characteristics should be considered when examining relationships between employment status and suicide among the foreign-origin.

  • 38.
    Dunlavy, Andrea
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Juárez, Sol
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Rostila, Mikael
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Unemployment status and risk of all-cause mortality among native- and foreign-origin persons in Sweden: An open cohort study from 1993-2008Manuscript (preprint) (Other academic)
    Abstract [en]

    Background: The association between exposure to unemployment and increased risk of mortality is well established. Yet migrants and their children often experience a number of stressors in the country of residence which could exacerbate the negative effects of job loss or unemployment. This study examined the extent to which region of origin and generational status modified associations between employment status and risk of all-cause mortality.

    Methods: Using population-based registers, an open cohort study of 2,178,321 individuals aged 25-64 was followed from 1993-2008. Hazard ratios for mortality were calculated using Cox regression. Employment status and socio-demographic covariates were included as time-varying variables in all models.

    Results: Relative to employed native-origin Swedes, excess risk of mortality was found among most groups of foreign-origin persons exposed to unemployment. The excess risk of mortality found among African women exposed to long-term unemployment (HR=3.26, 95% CI: 2.30-4.63),  Finnish men exposed to short-and long-term unemployment (HR=2.74, 95% CI: 2.32-3.24 and HR=2.39, 95% CI: 2.12-2.69), and  second generation Swedish men exposed to short-term unemployment (HR=2.34, 95% CI: 2.06-2.64) was significantly greater (p<0.05) than that found among their unemployed native-origin counterparts. Decreased risk of mortality was observed among the employed in nearly all foreign-origin groups.

    Conclusions: Our findings suggest that the mortality health advantage often observed among foreign-origin groups is most evident among the employed, while the magnitude of excess risk for mortality in the foreign-origin exposed to unemployment varies by generational status and region of origin.

  • 39. 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.
    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.

  • 40.
    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.

  • 41. Elo, Irma T.
    et al.
    Martikainen, Pekka
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. University of Helsinki, Finland; The Max Planck Institute for Demographic Research, Germany.
    Aaltonen, Mikko
    Children's educational attainment, occupation, and income and their parents' mortality2018In: Population Studies, ISSN 0032-4728, E-ISSN 1477-4747, Vol. 72, no 1, p. 53-73Article in journal (Refereed)
    Abstract [en]

    Using data from Finland, this paper contributes to a small but growing body of research regarding adult children's education, occupation, and income and their parents' mortality at ages 50+ in 1970-2007. Higher levels of children's education are associated with 30-36 per cent lower parental mortality at ages 50-75, controlling for parents' education, occupation, and income. This association is fully mediated by children's occupation and income, except for cancer mortality. Having at least one child educated in healthcare is associated with 11-16 per cent lower all-cause mortality at ages 50-75, an association that is largely driven by mortality from cardiovascular diseases. Children's higher white-collar occupation and higher income is associated with 39-46 per cent lower mortality in the fully adjusted models. At ages 75+, these associations are much smaller overall and children's schooling remains more strongly associated with mortality than children's occupation or income.

  • 42. Elstad, Jon Ivar
    et al.
    Hermansen, Åsmund
    Brønnum-Hansen, Henrik
    Martikainen, Pekka
    Östergren, Olof
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Tarkiainen, Lasse
    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 2169-978X, Vol. 35, no 2, p. 157-176Article 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.

  • 43.
    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.

  • 44.
    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.

  • 45.
    Fors, Stefan
    et al.
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Almquist, Ylva B.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Brännström, Lars
    Stockholm University, Faculty of Social Sciences, Department of Social Work.
    Coexisting Social, Economic, and Health-Related Disadvantages in More than 2.4 Million Swedes: Combining Variable-Centred and Person-Centred Approaches2019In: Social Indicators Research, ISSN 0303-8300, E-ISSN 1573-0921, Vol. 143, no 1, p. 115-132Article in journal (Refereed)
    Abstract [en]

    The notion of coexisting disadvantages has been recognised in social welfare policy and welfare research, not least in the Nordic countries. The prevalence and patterning of coexisting disadvantages in society have far reaching implications for well-being, social policy, and social inequality. Using longitudinal register-based data for the years 1998‒2008 for all Swedish individuals born 1946‒1965 (n > 2.4 million), this exploratory study maps out the occurrence of coexisting disadvantages in the Swedish working-age population, and examines to what extent observed prevalence rates are associated with sex, age, immigrant status, and marital status. Coexisting disadvantages are analysed in terms of four broad register-based indicators intended to capture individuals’ resources in key areas of the society: education, income, labour market, and mental health. The results show that while most individuals are not disadvantaged in these areas, coexisting disadvantages do occur and its prevalence varies according to sex, age, immigrant status, and marital status. This study shows that combinations of person-centred and variable-centred analyses of register-based indicators can play a part when developing effective systems for policy surveillance.

  • 46.
    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.

  • 47.
    Forsström, David
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Jenny, Cisneros Örnberg
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Responsible gambling in practice: A case study of views and practices of Swedish oriented gambling companies2019In: Nordic Studies on Alcohol and Drugs, ISSN 1455-0725, E-ISSN 1458-6126, Vol. 36, no 2, p. 91-107Article in journal (Refereed)
    Abstract [en]

    The Swedish gambling market faces a major change in legislation that will allow foreign-based companies to apply for a gambling licence in Sweden. A key element in the new legislation are consumer protection measures. The Swedish gambling market is currently divided between licensed companies and non-Swedish-based companies providing online gambling services without a licence in Sweden. How these companies view their responsibility for preventing gambling-related harm and how prepared they are for the new regulations are important questions regarding the new Swedish gambling market. Aims: To compare and analyse the views and practices on problem gambling and responsible gambling (RG) measures among licensed and unlicensed gambling companies on the Swedish market. Design/Methods/Data: Eleven semi-structured interviews were carried out with responsible gambling managers who are members of either of the two Swedish industry associations. Content analysis was used to analyse the interviews. Results: Non-licensed companies have implemented behaviour tracking and monitoring of gamblers in a more extensive way than licensed companies. Both the licensed and the unlicensed companies conceptualise problem gambling in a similar manner and rely on informed choice in preventing gamblers from developing problems, seemingly arguing that offering responsible gambling measures on their website is enough. Conclusions: There are several similarities in how the two types of companies define problem gambling and responsible gambling. Both groups lack a critical perspective when discussing RG. There is a need for companies not only to provide RG measures, but to take an active role in preventing harm among gamblers. Future research should focus on exploring how companies work with RG after the legislative change.

  • 48.
    Forsström, David
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Samuelsson, Eva
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Utbud av stöd och behandling för spelproblem: En studie om utmaningar inför förtydligat ansvar i lagstiftningen2018Report (Other academic)
    Abstract [en]

    On the 1st of January 2018, the Swedish legislation was subject to change due to a need to clarify the responsibility of care givers to prevent and provide support and treatment for gambling problems. The aim of this study has been to review the current situation of available support and treatment for gambling problems in Sweden, before the change in legislation took place. The Public Health Agency of Sweden and the Support Line (a telephone hotline service) has provided relevant information. Interviews have been conducted with sixteen key actors in the gambling treatment field representing municipalities, regional health care, authorities and non-governmental organisations. The interview material was analysed using thematic analysis. Preliminary results were presented for a group of treatment providers to validate the results and to collect further comments. The study showed that support and treatment for people with gambling problems are fragmentary and arbitrary on the national level. Support and treatment is available in some parts of the country but often relying on individual treatment providers’ own engagement, which creates a vulnerable situation in terms of availability and continuity of competence. The treatment offered is mainly cognitive behavioural therapy and there is a need to diversify and integrate various treatment options for different target groups. Non-governmental organisations play an important role by offering complimentary support as such, but also when treatment is not available. The main conclusion was that the municipal social services and the regional healthcare system in general are badly equipped to meet the needs of problem gamblers due to lack of resources and competence. Further efforts to provide education for personnel and implementation of screening routines to facilitate early detection in social services and health care settings are suggested. Despite ongoing development work, the legislative changes are challenging for municipalities and regional health care to accomplish satisfactory cooperation based on the needs of gamblers and their concerned significant others. A follow-up study will take place during 2019/2020 to review the development of support and treatment for gambling problems after the implementation of the new legislation.

  • 49. 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 study2019In: Journal of Developmental Origins of Health and Disease, ISSN 2040-1744, E-ISSN 2040-1752, Vol. 10, no 2, p. 246-252Article 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.

  • 50. 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.

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