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  • 1.
    Almquist, Ylva
    Stockholm University, Faculty of Social Sciences, Department of Sociology.
    A class of origin: The school class as a social context and health disparities in a life-course perspective2011Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    The aim of the present thesis is to examine various aspects of the school-class structure and their links to health in a life-course perspective. The empirical studies are based on two longitudinal data materials of cohorts born in the 1950s, followed up until middle age.

    In the first study, the overall status distribution in the school class was shown to be associated with both minor psychiatric disorder in childhood and self-rated health in adulthood. Thus, ill-health was more common among individuals who attended school classes less equal in terms of status.

    The second study demonstrated that it was more common among those who had fewer mutual friendships in the school class to report poorer health as adults. Socioeconomic career emerged as the primary explanation for men while, for women, these findings were largely unaccounted for by any of the included child and adult circumstances.

    Findings from the third study suggested the child’s status position in the school class, i.e. peer status, to be related to a wide range of health outcomes in adulthood. In particular, lower peer status was linked to an excess risk of mental and behavioural disorders, cardiovascular diseases and diabetes. Childhood social class did not confound these associations to any large extent.

    The fourth study examined two types of social isolation in the school class: marginalisation (low peer status) and friendlessness. Hospitalisation due to any disease was more common among marginalised children compared to among non-isolates, whereas no corresponding association was found for the friendless. For both types of isolates, the number of hospitalisations was greater than among non-isolated individuals. Of the studied childhood factors, scholastic ability emerged as an important mechanism.

    In sum, this thesis points to the relevance of the school class for health development across the life course and to the complexity of pathways through which influences of the school class may operate.

  • 2.
    Berman, Anne H
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Enhancing Health Among Drug Users in Prison2004Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Four interrelated studies on drug users in prison are presented within the framework of a proposed model for approaching the enhancement of health for persons that builds on an existential view of prisoners’ needs, as well as the risk management and “good lives” perspectives. Risk management is the major focus in current offender rehabilitation based on research on “what works,” which has shown that focusing treatment on risk factors termed “criminogenic needs,” such as impulsivity, poor family relations and drug abuse, reduces recidivism by 10-15 percentage points. The “good lives” perspective proposes that offender rehabilitation should go beyond risk management and also address non-criminogenic needs such as autonomy, relatedness and competence as foundations for building personally meaningful lives.

    Study I explores the assessment of drug use problems, and describes the psychometric evaluation of the Drug Use Disorders Identification Test (DUDIT), a newly developed 11-item test for quick screening of drug-related problems. Studies II-IV explore treatment for offenders in prison identified as drug users. Study II is a randomized controlled trial of two auricular acupuncture treatments for men and women in prison, inconclusive with regard to point specificity but showing that participants in both groups reported reduced symptoms of discomfort and improved night-time sleep. Study III evaluates the Reasoning & Rehabilitation program, an internationally widespread cognitive-behavioral program for groups of offenders. Results showed significant pro-social short-term changes in sense of coherence, impulsivity and attitudes towards the criminal justice system, as well as a 25% lower risk of reconviction among program completers compared to matched controls. However, the quasi-experimental nature of the study precludes any certainty regarding program effects; a selection bias whereby more motivated program participants are recruited could explain the findings. Study IV is a pilot project exploring the special needs of a subgroup of drug-using inmates with psychiatric and/or violent co-morbidity. Inmates housed in psychiatric prison units were offered long-term auricular acupuncture treatment. Half of the 22 inmates in the study received treatment twice a week for over eight weeks, and those treated over 25 times had lower psychopharmacological medication levels than untreated controls.

    Studies I-IV address individual facets of a proposed model for enhancing health among drug users in prison. The health enhancement model approaches offender rehabilitation from perspectives of existential psychology, good lives and risk management. Specific definitions of physical, social, psychological/personal and spiritual needs indicate a framework according to which prison treatment can help drug-using offenders find ways to secure healthy need satisfaction.

  • 3.
    Dunlavy, Andrea
    Stockholm University, Faculty of Social Sciences, Department of Sociology.
    Between Two Worlds: Studies of migration, work, and health2017Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    This thesis aims to investigate the extent to which work-related factors contribute to the health inequalities often observed between foreign-origin and native-origin persons in Sweden. Four empirical studies using survey data and population-based registers assessed the health impact of different labor market adversities among groups of foreign-origin persons who were both in and outside the labor market relative to native-origin Swedes.

    Studies I and II examined associations between different measures of working life quality, including adverse psychosocial and physical working conditions and educational mismatch, and self-reported health among the employed. Adverse psychosocial and physical working conditions minimally contributed to the excess risk of poor health found among workers from low- and middle-income countries. Over-education had a stronger association with increased risk of poor health, most notably among foreign-born workers from countries outside of Western Europe. Under-educated women from these countries also demonstrated an elevated risk of poor health.  There was no association between educational mismatch and poor health among native-born workers. 

    Studies III and IV focused on the health implications of labor market exclusion, and examined relationships between employment status and risk of all-cause mortality and suicide. The majority of foreign-origin groups that experienced unemployment showed an elevated risk of both mortality and suicide. The magnitude of excess risk varied by generational status and region of origin. Variations in patterns of suicide risk were also evident among migrants by age at arrival and duration of residence. Yet within many foreign-origin groups, health advantages were observed among the employed.

    The health of migrants is affected by the confluence of several different pre- and post-migration factors.  The extent to which health inequalities are found among persons of foreign-origin in Sweden is influenced by the degree to which they experience labor market adversities, as well as differential vulnerability to the negative effects of these adversities across foreign-origin groups.

  • 4.
    Eklund, Jenny M.
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Adolescents at risk of persistent antisocial behaviour and alcohol problems: The role of behaviour, personality and biological factors2005Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Antisocial behaviour and alcohol problems are areas of great concern to society, not only associated with personal and emotional costs for the affected individuals and their victims, but also with major societal financial costs. What makes some individuals more likely than others to develop these kinds of problems? The general aim of this thesis was to explore the role of individual characteristics in the development of antisocial behaviour and alcohol problems. More specifically, the research focused on aspects of hyperactive behaviour, personality traits and biological vulnerability indicators in relation to self-reported norm breaking and violent behaviour, registered general criminality and violent offending in particular, and further, on risky alcohol use and drinking offences. The studies were based on both a prospective longitudinal project in which a group of adolescent male lawbreakers and controls were followed from the 1960s into the 1990s, and on more recently collected data on a representative group of Swedish male and female adolescents.

    The results of the thesis supported that neuropsychological deficits, manifested in attention difficulties, and personality traits reflecting disinhibition and negative emotionality, influence the development of antisocial behaviour and risky alcohol use, which in turn increases the risk of subsequent alcohol problems. The findings indicated, furthermore, that these neuropsychological deficits may be associated with an underlying biological vulnerability to various forms of disinhibitory psychopathology. Although the thesis focuses on individual characteristics, the results also support the view that environmental risk factors such as the influence of family and peers and possible stress experiences, play an important role. It was emphasized that individual characteristics continuously interact with environmental conditions in shaping each individual’s developmental course. Results also revealed that adolescent females displaying violent behaviour and engaging in potentially harmful use of alcohol deviated more in personality traits than did the corresponding group of males. Further knowledge of the development of these problems in females is crucial, since most theories in this area have been developed primarily on male samples.

  • 5.
    Gisselmann, Marit
    Stockholm University, Faculty of Social Sciences, Department of Sociology.
    The first injustice: Socio-economic inequalities in birth outcome2007Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Adverse birth outcomes like preterm birth and infant mortality are unevenly distributed across socio-economic groups. Risks are usually lowest in groups with high socio-economic status and increase with decreasing status.

    The general aim of this thesis was to contribute to the understanding of the relation between socio-economic status and birth outcomes, focussing on maternal education and class, studying a range of birth outcomes. More specific aims were to investigate the relation between maternal education and infant health, to study the combined influence of maternal childhood and adult social class on inequalities in infant health and to explore the contribution of maternal working conditions to class inequalities in birth outcomes. The studies are population based, focussing on singletons births 1973-1990. During the period under study, educational differences in birth outcomes increased, especially between those with the lowest and highest education. The low birth weight paradox emerged, suggesting that the distribution of determinants for low birthweight infants differs for these groups.

    Further, an independent association was found between maternal childhood social class and low birthweight and neonatal mortality, but not for postneonatal mortality. Since this was found for the two outcomes closest to birth, this indicates that the association is mediated through the maternal body.

    Finally, there is a contribution of maternal working conditions to class inequalities in birth outcome. Lower job control, higher job hazards and higher physical demands were all to some degree related to increased risk of the following adverse birth outcomes: infant mortality, low birthweight, very low birthweight, foetal growth, preterm birth, very and extremely preterm birth. Working conditions demonstrated disparate associations with the birth outcomes, indicating a high complexity in these relationships.

  • 6.
    Hossin, Muhammad Zakir
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Is the association between late-life morbidity and disability attenuated over time?: Exploring the dynamic equilibrium of morbidity hypothesis2016Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    Context: There is evidence suggesting that the prevalence of disability in late life has declined over time while the prevalence of disabling chronic diseases has increased. The dynamic equilibrium of morbidity hypothesis suggests that these seemingly contradictory trends are due to the attenuation of the morbidity-disability link over time. The aim of this study was to empirically test this assumption.Methods: Data were drawn from three repeated cross-sections of SWEOLD, a population-based survey among the Swedish men and women ages 77 and older. Logistic regression models were fitted to assess the trends in the prevalence of Activities of Daily Living (ADL) disability, Instrumental ADL (IADL) disability, and selected groups of chronic conditions. The changes in the associations between chronic conditions and disabilities were examined in both multiplicative and additive models.Results: Between 1992 and 2011, the odds of ADL disability significantly declined among women whereas the odds of IADL disability significantly declined among men. During the same period, the prevalence of most chronic morbidities including multimorbidity went up. Significant attenuations of the morbidity-disability associations were found for cardiovascular diseases, metabolic disorders, poor lung function, psychological distress, and multimorbidity.Conclusion: In agreement with the dynamic equilibrium hypothesis, this study concludes that the associations between chronic conditions and disability among the Swedish older adults have largely waned over time.

  • 7.
    Leinsalu, Mall
    Stockholm University, Faculty of Social Sciences, Department of Sociology.
    Troubled transitions: Social variation and long-term trends in health and mortality in Estonia2004Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    This thesis is about social variation and long-term trends in health and mortality in Estonia. After five decades of Soviet occupation Estonia’s independence was re-established in 1991 on the basis of the historical continuity of its statehood. Estonian independence changed political, economic and social realities; it was accompanied by a sharp decline in living standards. By 1994/1995 the socioeconomic and political situation had started to stabilize. Both transitions, the Sovietization and the return to independence, were particularly hard on the population. Life expectancy had improved little or not at all from the 1960s. At the beginning of the 1990s there was an unprecedented fall. From 1995, life expectancy started to rise again.

    Cause-specific mortality for 1965–2000 was examined in order to understand both the recent and the earlier long-term health crises in Estonia; educational and ethnic differences in cause-specific mortality were analysed for 1987–1990 and 1999–2000. Self-rated health was examined for 1996/1997. The cause-of-death data come from the national mortality database, and the self-rated health data come from the Estonian Health Interview Survey.

    Circulatory diseases, neoplasms, and injuries and poisonings account for over 80% of all deaths in Estonia. Circulatory disease mortality started to decline considerably later than in Western countries, is very high by international standards and was sensitive to sudden social changes in the 1980s and 1990s. Cancer mortality rates among men increased, mostly because of lung cancer mortality. Mortality from injuries and poisonings is extremely high, has increasingly been contributing to Estonia’s long-term mortality stagnation and was the major contributor to the decline in life expectancy in the 1990s. Educational and ethnic differences in mortality increased sharply in 1989–2000. In 2000, male graduates aged 25 could expect to live 13.1 years longer than corresponding men with the lowest education; among women the difference was 8.6 years. Estonian men could expect to live 6.1 years longer than Russian men in 2000; among women this difference was 3.5 years. Injuries and poisonings were mainly responsible for the lagging behind of the lower educated and of Russians; in terms of total mortality the ethnic differences were small and not significant in 1989.

    Generally low living standards (particularly a poor diet), and the increasing gap with Western countries, may have contributed to the long-term mortality stagnation from the mid-1960s. In the 1990s, the increasing differentiation of wealth and opportunity, as well as perceived social exclusion and poor adaptation to the social and economic changes, in particular among the low educated and among ethnic Russians, are important determinants of the growing mortality divide in Estonia. Alcohol consumption, in particular binge drinking, has to be seen as a main cause of increasing mortality among middle aged men from the mid-1960s, most evident in those causes of death that can be directly linked to alcohol. It accounts for a considerable part of circulatory disease mortality as well. Alcohol also contributes to educational and ethnic differences in mortality and their widening over the 1990s. Tobacco smoking, similarly, has contributed to long-term mortality stagnation and the widening of educational, but not ethnic, differences in mortality. Adverse living conditions in childhood may also have contributed to the educational and ethnic differences in mortality and to the long-term mortality development in Estonia. Estonia needs to think hard about policies to remedy this situation.

  • 8.
    Manhica, Hélio
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Mental health, substance misuse and labour market participation in teenage refugees in Sweden – A longitudinal perspective2017Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Aim: To fill the knowledge gap about the importance of contextual factors after resettlement on mental health, substance misuse and labour market participation among young refugees who immigrate to Sweden as teenagers. Methods: Register studies in national registers of national cohorts of young refugees, unaccompanied and accompanied, who settled in Sweden as teenagers. Studies 1-4 used Cox regression models to study the risks of psychiatric care consumption and substance misuse, while Study 5 used multinomial regression to study position on the labour. These findings were compared with peers from the same birth cohorts in the general Swedish population and non-European intercountry adoptees (Studies 2 and 5). Results: The overall results suggest that young accompanied and unaccompanied refugees were more likely to be admitted to psychiatric inpatient and compulsory hospital care, but not outpatient care, with refugees born in the Horn of Africa and Iran having the highest risk (Study 1). Young accompanied and unaccompanied refugees also had higher risk of hospitalization and criminal conviction associated with substance misuse (Study 3). Longer duration of residence in Sweden was associated with increased risks of outpatient care (Study 1) and hospitalization related to substance misuse (studies 3 and 4). These increase risks of young refugees were associated with their socioeconomic living conditions (Studies 3 and 4), but risk factors associated with the country of origin of the refugee population and the intercountry adoptees were more important determinants of schizophrenia than socioeconomic conditions in Sweden (Study 2). Young accompanied and unaccompanied refugees and intercountry adoptees had a lower likelihood of being in full employment than native Swedes with comparable levels of education. Secondary education, however, increased employment chances and reduced the risk of being neither employed nor in education or training (Study 5). Conclusion: Evidence suggests that several groups of young refugees are at higher risk of mental health problems and substance misuse. They also face employment disadvantages and barriers to psychiatric care in the early stages of developing a psychiatric disorder.

  • 9.
    Miething, Alexander
    Stockholm University, Faculty of Social Sciences, Department of Sociology.
    Others’ income, one’s own fate: How income inequality, relative social position and social comparisons contribute to disparities in health2014Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    The overall aim of this thesis is to contribute to a greater understanding of how social inequalities in health evolve causally and to explore the missing links between social position and health in different social and economic contexts.

    A premise in the thesis is that in affluent societies, not only material aspects and purchasing power linked to income and social positions are important explanations for the health of individuals, but also the relative socio-economic standards in society. The concept of relative income position was used to explore this notion across time and country contexts: A comparison of income-related health inequalities between the different welfare contexts of Sweden and Germany showed similar magnitudes in poor health. When exploring the role of absolute and relative income changes over time in Sweden, income volatility was found to influence individuals’ health.

    Another aim was to explore the specific social mechanisms reflecting intra- and interpersonal social comparisons and their role for health. Subjective measures of social position were found to capture non-material aspects of social positions. Self-rated class affinity revealed strong associations with health, particularly for women. Income satisfaction, predicting mortality, was shown to be a measure that accounts for internalized reference standards regarded as meaningful by individuals.

    Conceptually, the used subjective measures capture aspects of social comparisons and relative deprivation and further suggest that not the material dimension of social position alone matters for health. It is also shown that income satisfaction operates as a mediator between income position and mortality. Subjective measures such as income satisfaction and class affinity provide a plausible link in the understanding of how social inequality entails persistent effects on health and mortality.

  • 10.
    Modin, Bitte
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Setting the scene for life. Longitudinal studies of early social disadvantage and later life chances: Department of Sociology2002Doctoral thesis, monograph (Other academic)
    Abstract [en]

    This thesis concerns the long-term life chances of children brought up under various conditions in Sweden during the first half of the twentieth century. The main purpose is to examine the consequences of children’s early family environment for later educational career, and ultimately, for their mortality risk at different stages of the life-course. Two aspects of family structure are focused upon: the birth order of the subject and the mother’s marital status at the time of childbirth. The four studies are all based on the 14,192 babies that were born alive at the Uppsala Academic Hospital during the period 1915–29. Nearly all these children (97.3 percent) have been successfully followed up in parish archives and later through computerised linking to census and death registries. While social class is probably one of the most commonly used indicators of childhood social conditions, the two measures of family structure used here may be assumed to capture additional aspects of childhood social circumstances in ways that differ from that of the social structure position of the parent(s). However, social class and certain biological conditions at the time of birth are also taken into consideration in the analyses as well as several indicators of adult social circumstances.

    The results showed that third grade school marks worsened steadily with increasing birth order, whereas children who were born outside marriage did not manage significantly worse than those who were born inside marriage. As for achieved education, the chance of having completed upper secondary school declined dramatically with increasing birth order, and was significantly lower for subjects born outside marriage than for those who were born inside marriage. Also with regard to birth order patterns of all cause mortality in four stages of the life-course (infancy, childhood, adulthood and middle to old age) the overall picture pointed towards laterborns being at a disadvantage throughout the studied age intervals. The analyses suggested that adult socio-economic status served as a mediating variable in the association between childhood birth order position and adult mortality.

    Another potential mediator between conditions in early life and later mortality is ‘marital career’. A recent study found that men who were small at birth were less likely to marry. Based on these findings the authors proposed that the link between marital status and cardiovascular disease could have its origins in intrauterine life. A replication of this study verified the link between fetal growth and subsequent marital status for men, but not for women. However, the results did not support the suggestion that growth rate in utero could explain why unmarried people have higher death rates. The final study examines whether the mother’s marital status at the time of childbirth is associated with her son’s long-term risk of ischaemic heart disease mortality, and whether any such association works via these men’s own marital status  in adulthood. The results demonstrated a significant excess IHD mortality among men born outside marriage, which was largely explained by the mortality risk among those men born outside wedlock and who never married being over twice as high as that of the corresponding group of men born to married parents.

  • 11.
    Olsson, Gabriella
    Stockholm University, Faculty of Social Sciences, Department of Sociology.
    Expressions of context: Studies of schools, families, and health risk behaviours2016Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    This thesis explores the health behaviours of young people. The main focus is on risk behaviours, i.e. those which may have adverse consequences for health. Two fields of interest are looked at. On the one hand, the thesis explores social determinants of such behaviours, with particular focus on the influence of schools’ structural and social environment on health risk behaviours among youth. On the other hand, the thesis addresses the role of such behaviours in the relationship between childhood social inequalities and adult health. In terms of theory, the study sets out from Coleman's view of the association between structure and agency and the assumption that macro level structures and patterns can be understood on the basis of individual actors’ actions. The thesis consists of four studies addressing different, but related, aspects of the above areas of interest. The overall conclusion of studies I-III is that the school context has direct and indirect effects on young people's risk behaviours. The results of multilevel analyses indicate, more specifically, that students who attend more advantaged schools report more risk behaviours such as smoking, alcohol- and drug use than students at more disadvantaged schools. Self-reported crime is however higher in the more disadvantaged school settings. Further analyses show that a school's social and normative climate also is important for the extent to which youth consume alcohol, smoke, or have used drugs. These risk behaviours are most prevalent in schools where a large proportion of the parents have a more permissive attitude towards alcohol and smoking, and where teacher-rated levels of trust and informal social control (collective efficacy) are high. The results show, further, that school contexts also act indirectly on youth risk behaviours. Young people who reports weak bonds with their parents tend generally to be more involved in risk behaviours than those who report strong bonds. This tendency is reinforced in more advantaged school settings. Finally, Study IV demonstrates that youth risk behaviours act accumulatively and indirectly on later health, rather than directly. Moreover, the importance of risk behaviours for later health varies between the birth cohorts. Health behaviours explain a larger part of the relationship between socioeconomic conditions in childhood and health as an adult in the younger cohort.

  • 12.
    Rajaleid, Kristiina
    Institutionen för folkhälsovetenskap, Karolinska institutet.
    Early and later life mechanisms in the aetiology of cardiovascular disease2010Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Evidence over the recent decades indicates that susceptibility to cardiovascular disease (CVD) may be established already prenatally and in early childhood, and that the aetiological processes of the disease involve biological and social influences occurring throughout a person’s life span. Numerous studies have shown that small size at birth is associated with increased risk of CVD later in life. This finding is suggested to reflect the influence of poor foetal nutrition on the body’s organ structure, physiology and metabolism. Surprisingly, there is little empirical evidence available to support the proposed causal mechanisms. The aim of this thesis is to study the mechanisms under­lying the inverse association of size at birth with CVD.

    Three studies in the thesis are based on Uppsala Birth Cohort Study (UBCoS), a prospective cohort study which includes men and women, who were born at the Uppsala Academic Hospital between 1915 and 1929. Information from birth records, school catalogues, Hospital Discharge Register, Cause of Death Register and Censuses is used. One study is based on Stockholm Heart Epidemiology Program (SHEEP), a population based case-control study of risk factors for acute myocardial infarction (AMI) with study base including all Swedish citizens aged 45-70 years with no prior clinically diagnosed AMI, who lived in Stockholm County during 1992-1994. Data from birth records, questionnaire, health examination and blood sampling is used.

    In both data materials small size at birth was associated with increased risk of disease. Further analyses showed that birth weight for gestational age in men was associated with ischemic heart disease (IHD) mortality within the non-manual class but not among the manual workers, even if the overall mortality rate was higher in the latter. There was no difference in the association by the men’s family’s social class at birth. For women, social class neither at birth nor in adulthood modified the association between birth weight for gestational age and IHD mortality.

    We found that there was a synergistic interaction between low weight for gestational age and overweight in adulthood on risk of AMI.

    The simultaneous analysis of foetal growth, cognitive ability and IHD mortality suggested that there is an indirect association between foetal growth and cognitive ability through childhood cognitive ability.

    Finally, men with very low and very high birth weight for gestational age had a higher risk of dying after an AMI than men with intermediate birth size. Case fatality in women was not associated with their size at birth.

    The results suggest that the effect of poor foetal nutrition on CVD may be modified by social exposures later in life. The synergistic interaction between small size at birth and high adult body mass index with respect to AMI risk supports the thrifty phenotype hypothesis according to which a mismatch between foetal and adult nutrition is causing the disease. The existence of an indirect association between foetal growth and IHD mortality through childhood cognitive ability implies that mechanisms related to brain development are contributing to the association between poor foetal nutrition and IHD, in addition to the effects on physiology and metabolism. As the association of size at birth with case fatality was different from the associations with incidence and mortality, the mechanisms that operate after the AMI event and determine the prognosis might partly be different from the mechanisms that drive the development of the disease.

  • 13.
    Rostila, Mikael
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Healthy bridges: Studies of social capital, welfare, and health2008Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    The aim of this thesis is to study whether social capital is related to health and health inequality, and to investigate the significance of welfare state features for levels of social capital. Another aim is to examine whether social capital may be important for the relation between the welfare state and health. A final aim is to examine the downsides of social capital in relation to health.

    The theoretical definition of social capital guiding this thesis suggests that it comprises social resources that evolve in social networks and social structures characterized by mutual trust. These social resources, in turn, facilitate access to various instrumental and expressive returns, which might benefit the individual as well as the collective.

    The findings suggest that universal welfare states generally seem to have a positive influence on levels of social capital, as social capital increased rather than decreased during the time period when the Swedish welfare state was maturing. Accordingly, cross-national comparisons show that the highest levels of social capital are to be found in the universal welfare states, amongst them Sweden.

    The findings further show that both individual and collective social capital are related to various health outcomes, although the most robust findings are found at the individual level. Some of the findings also support that associations may be causal. Hence, social capital may be considered an important social determinant of health. Moreover, social capital at the individual level is important in explaining health inequalities especially between groups based on country of birth in Sweden, whereas collective social capital is important in explaining health inequalities between clusters of European countries, grouped into welfare regimes. Thus, social capital seems important in explaining and understanding health inequalities both between and within countries.

    Finally, the principle of migrant homophily – when migrants chiefly interact with other migrants – has negative consequences for migrants’ health in Sweden. However, only those migrants included in homogenous and closed networks have poorer health. This supports the hypothesis that social capital chiefly has negative health externalities when social networks are characterized by a high degree of network closure, lacking bridges to other networks.

  • 14.
    Toivanen, Susanna
    Stockholm University, Faculty of Social Sciences, Department of Sociology.
    Work-Related Inequalities in Health: Studies of income, work environment, and sense of coherence2007Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Ill health is unevenly distributed across different groups in society, with the disadvantaged groups displaying higher rates of ill health than the more advantaged groups. The aim of the thesis is to study work-related inequalities in health, and to focus on how income, aspects of the physical and psychosocial work environment, and sense of coherence, individually or jointly, generate inequalities in a number of health outcomes in the Swedish working population. The studies are based on survey data and national registers during the period 1990-2003.

    For cardiovascular disease (CVD) prevalence and mortality, the impact of income was stronger than that of work environment factors. The psychosocial work environment (women and men) and income (men only) were associated with psychological distress. Income (women) and the psychosocial work environment (men) were associated with musculoskeletal pain. Thus, both income and work environment are important in generating health inequalities in the working population.

    A strong sense of coherence (SOC) moderated the effect of physical demands on musculoskeletal pain in both genders. SOC moderates, yet not consistently, the impact of adverse working conditions on psychological distress and musculoskeletal pain. Hence, the results do not fully support the hypothesis that sense of coherence is a global health-protective factor. However, differential vulnerability in terms of the strength of SOC contributed to work-related inequalities in health.

    The risk of stroke was higher for women and men in occupations with low job control than for those with high job control. The risk of intracerebral hemorrhage was highest in women in low job-control occupations, while low job control did not significantly increase the risk of brain infarction in women. Job control was related to mortality from stroke in women, but not in men. The effect of job control on stroke mortality in women was consistent in all classes except for upper non-manuals.

  • 15.
    Väfors Fritz, Marie
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Psychosocial adjustment problems: Individual and acculturation differences2008Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    This thesis addresses individual and environmental risk factors in the development of adjustment problems and antisocial behaviour. Namely, temperament and character, anxiety, psychopathic-like traits, antisocial attitudes, alcohol use, and parental rearing strategies are explored as risk factors for behaviour problems in childhood, adolescence and adulthood. When interpreting results of specific studies, an ecological framework is applied to take into account socio-cultural and acculturation circumstances.

    In Studies I and II, the subjects under investigation are incarcerated Russian detainees aged 14-19 years (n=250). The main purpose of Study I was to investigate the validity of the Antisocial Process Screening Device (APSD) in a sample of Russian juvenile delinquents. Study II examined the relationship between psychopathy and violent behaviour. An association between psychopathy and quality of life is explored in Study III, using a sample of Swedish early criminals and controls aged 38-41 years (n=199). In Study IV, international and national college students aged 17-51 years (n=246), are studied regarding perceived adjustment stressors and acculturational differences.

    The results suggested good validity of the APSD in the Russian male detainees. Additionally, the results support a dimensional aspect of the psychopathy construct as measured by the PCL and APSD, and suggest that individual and environmental antecedents of psychopathy may differ between the distinct psychopathy factors. The more violent group showed higher levels of psychopathic traits and physical aggression, had more alcohol related problems, and perceived antisocial behavior as more ‘normative’. Moreover, impulsiveness, anger, verbal aggression and antisocial attitudes discriminated between the psychopathic and non-psychopathic subgroups. The results further indicated that self reported quality of life was poorer among individuals with psychopathic-like traits. Finally, grouping the detainees, criminals and controls, as well as the students according to their unique needs seemed to be beneficial, not only regarding psychopathic-like traits, violent behaviour and antisocial attitudes, but also in the context of acculturation and adjustment processes.

  • 16.
    Östergren, Olof
    Stockholm University, Faculty of Social Sciences, Department of Sociology.
    Understanding the Educational Gradient in Mortality2017Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    There is a positive association between education and longevity. Individuals with a university degree tend to live longer than high school graduates who, in turn, live longer than those with compulsory education. These differences are neither larger nor smaller in Sweden than in other European countries, despite its ambitious welfare-state policies. Furthermore, educational differences in longevity are growing, especially among women.

    In this thesis I look at the structural, individual and behavioral processes which generate and maintain the educational gradient in mortality. This is done by compiling theoretical insights and empirical research from a range of scientific disciplines. In doing so, this thesis aims to contribute to a more comprehensive understanding of the educational gradient in mortality.

    Several factors contribute to the association between education and health. Social and biological processes initiated in early life influence both educational achievement and adult health. Education helps individuals become more effective as agents by fostering generic skills such as information-gathering and decision-making. This aspect of education, learned effectiveness, promotes control and health regardless of available resources and prevailing conditions. Education thus has a direct influence on health. Education also indirectly influences health by giving access to better occupational positions and higher incomes, as well as by promoting social capital and healthy habits.

    The empirical section of the thesis consists of four separate quantitative studies using register data. Three of the studies use Swedish national register data while one uses register data from 18 European populations. The results indicate that widening income inequalities in mortality have contributed to a widening of educational inequalities in mortality, since education is a determinant of income. Both alcohol and smoking contribute to educational inequalities in longevity, but smoking has played an especially pronounced role in the widening of inequalities among women. Smoking represents a significant part of the explanation as to why women with low education have experienced smaller gains in life expectancy than the rest of the population. The results also indicate that the general trend towards more well-educated populations has contributed to the widening educational inequalities in mortality in Europe and that education is a stronger predictor of mortality among low income-earners than among the rest of the population.

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