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  • 1.
    Ahlborg, Mikael
    et al.
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI), Health and Nursing.
    Svedberg, Petra
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI), Health and Nursing.
    Nyholm, Maria
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
    Morgan, Antony
    Glasgow Caledonian University, Glasgow, United Kingdom.
    Nygren, Jens M.
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI), Health and Nursing.
    Socioeconomic inequalities in health among Swedish adolescents - adding the subjective perspective2017In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 17, article id 838Article in journal (Refereed)
    Abstract [en]

    Background

    Socioeconomic inequalities in adolescent health predict future inequalities in adult health. Subjective measures of socioeconomic status (SES) may contribute with an increased understanding of these inequalities. The aim of this study was to investigate socioeconomic health inequalities using both a subjective and an objective measure of SES among Swedish adolescents.

    Method

    Cross-sectional HBSC-data from 2002 to 2014 was used with a total sample of 23,088 adolescents aged 11–15 years. Three measures of self-rated health (dependent variables) were assessed: multiple health complaints, life satisfaction and health perception. SES was measured objectively by the Family Affluence Scale (FAS) and subjectively by “perceived family wealth” (independent variables). The trend for health inequalities was investigated descriptively with independent t-tests and the relationship between independent and dependent variables was investigated with multiple logistic regression analysis. Gender, age and survey year was considered as possible confounders.

    Results

    Subjective SES was more strongly related to health outcomes than the objective measure (FAS). Also, the relation between FAS and health was weakened and even reversed (for multiple health complaints) when subjective SES was tested simultaneously in regression models (FAS OR: 1.03, CI: 1.00;1.06 and subjective SES OR: 0.66, CI: 0.63;0.68).

    Conclusions

    The level of socioeconomic inequalities in adolescent health varied depending on which measure that was used to define SES. When focusing on adolescents, the subjective appraisals of SES is important to consider because they seem to provide a stronger tool for identifying inequalities in health for this group. This finding is important for policy makers to consider given the persistence of health inequalities in Sweden and other high-income countries. ©  The Author(s). 2017

  • 2.
    Almquist-Tangen, Gerd
    et al.
    Child Health Care Unit, Region Halland, Kungsbacka, Sweden & Department of Paediatrics, Institute for Clinical Sciences at the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Strömberg, Ulf
    Research and Development Department, Halland, Halmstad, Sweden.
    Holmén, Anders
    Research and Development Department, Halland, Halmstad, Sweden.
    Alm, Bernt
    Child Health Care Unit, Region Halland, Kungsbacka, Sweden & Department of Paediatrics, Institute for Clinical Sciences at the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Roswall, Josefine
    Department of Paediatrics, Halland Hospital, Halmstad, Sweden & Department of Paediatrics, Institute for Clinical Sciences at the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Bergman, Stefan
    Research and Development Centre, Spenshult Hospital, Oskarström, Sweden.
    Dahlgren, Jovanna
    Department of Paediatrics, Institute for Clinical Sciences at the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Influence of neighbourhood purchasing power on breastfeeding at four months of age: a Swedish population-based cohort study2013In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 13, no 1, article id 1077Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Parental socioeconomic status (SES) is an important determinant in child health, influencing beneficial factors such as breastfeeding. A better understanding of the influence of neighbourhood-level SES measures, relating to spatial determinants, might lead to targeted actions to promote breastfeeding during infancy.

    METHODS: A cross-sectional study analysis the association between breastfeeding at four months of age and neighbourhood purchasing power, taking account of individual-level variables including maternal age, smoking and parental level of education. Data were obtained from a prospective population- based cohort study recruited from birth in 2007-2008 in the Halland region, southwestern Sweden. Questionnaire data on the individual-level variables and the outcome variable of breastfeeding at four months (yes/no) were used (n=2,407). Each mother was geo-coded with respect to her residential parish (there are 61 parishes in the region) and then stratified by parish-level household purchasing power. It emerged that four neighbourhood characteristics were reasonable to use, viz. <10%, 10-19%, 20-29% and ≥ 30% of the resident families with low purchasing power.

    RESULTS: The proportion of mothers not breastfeeding at four months of age showed a highly significant trend across the neighbourhood strata (p=0.00004): from 16.3% (< 10% with low purchasing power) to 29.4% (≥ 30% with low purchasing power), yielding an OR of 2.24 (95% confidence interval: 1.45-3.16). After adjusting for the individual-level variables, the corresponding OR=1.63 (1.07-2.56) was significant and the trend across the strata was still evident (p=0.05). A multi-level analysis estimated that, in the neighbourhoods with ≥ 30% of the families with low purchasing power, 20% more mothers than expected, taking account of the individual-level factors, reported no breastfeeding at four months of age (≥ 95% posterior probability of an elevated observed-to-expected ratio).

    CONCLUSION: The neighbourhood purchasing power provided a spatial determinant of low numbers of mothers breastfeeding at four months of age, which could be relevant to consider for targeted actions. The elevated observed-to-expected ratio in the neighbourhoods with the lowest purchasing power points toward a possible contextual influence. © 2013 Almquist-Tangen et al.; licensee BioMed Central Ltd.

  • 3.
    Hubertsson, Jenny
    et al.
    Clinical Sciences Lund, Lund University, Lund, Sweden.
    Petersson, Ingmar
    Clinical Sciences Lund, Lund University, Lund, Sweden.
    Arvidsson, Barbro
    Halmstad University, School of Social and Health Sciences (HOS), Centre of Research on Welfare, Health and Sport (CVHI).
    Thorstensson, Carina
    Clinical Sciences Lund, Lund University, Lund, Sweden.
    Sickness absence in musculoskeletal disorders: patients' experiences of interactions with the Social Insurance Agency and health care. A qualitative study2011In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 11, no 107Article in journal (Refereed)
    Abstract [en]

    Background:

    Sickness absence has represented a growing public health problem in many Western countries over the last decade. In Sweden disorders of the musculoskeletal system cause approximately one third of all sick leave. The Social Insurance Agency (SIA) and the health care system are important actors in handling the sickness absence process. The objective was to study how patients with personal experience of sickness absence due to musculoskeletal disorders perceived their contact with these actors and what they considered as obstructing or facilitating factors for recovery and return to work in this situation.

    Methods:

    In-depth interviews using open-ended questions were conducted with fifteen informants (aged 33-63, 11 women), all with experience of sickness absence due to musculoskeletal disorders and purposefully recruited to represent various backgrounds as regards diagnosis, length of sick leave and return to work. The interviews were audio-recorded, transcribed verbatim and analysed using content analysis.

    Results:

    The informants' perceived the interaction with the SIA and health care as ranging from coherent to fragmented. Being on sick leave was described as going through a process of adjustment in both private and working life. This process of adjustment was interactive and included not only the possibilities to adjust work demands and living conditions but also personal and emotional adjustment. The informants' experiences of fragmented interaction reflected a sense that their entire situation was not being taken into account. Coherent interaction was described as facilitating recovery and return to work, while fragmented interaction was described as obstructing this. The complex division of responsibilities within the Swedish rehabilitation system may hamper sickness absentees' possibilities of taking responsibility for their own rehabilitation.

    Conclusions:

    This study shows that people on sick leave considered the interaction with the SIA and health care as an important part of the rehabilitation process. The contact with these actors was perceived as affecting recovery and return to work. Working for a more coherent process of rehabilitation and offering professional guidance to patients on sick leave might have an empowering effect.

  • 4.
    Hutton, Katrin
    et al.
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI), Health promotion and disease prevention. Affecta psychiatric out-patients clinic, Halmstad, Sweden.
    Nyholm, Maria
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI), Sport Health and Physical activity.
    Nygren, Jens
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI), Health promotion and disease prevention.
    Svedberg, Petra
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI), Health promotion and disease prevention.
    Kadrija, Ibadete (Contributor)
    Halmstad University, School of Health and Welfare.
    Self-rated mental health and socio-economic background: a study of adolescents in Sweden2014In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 14, no 1, article id 394Article in journal (Refereed)
    Abstract [en]

    Background: Adolescents' mental health is a major public health issue. Previous research has shown that socio-economic factors contribute to the health status of adolescents. The present study explores the association between socio-economic status and self-rated mental health among adolescents.

    Methods: Cross sectional data from the Halmstad Youth Quality of Life cohort was collected in a town in Sweden. In all, 948 adolescents (11-13 younger age group and 14-16 older age group) participated. Information on self-rated mental health was collected from the subscale Psychological functioning in the Minneapolis Manchester Quality of Life instrument. The items were summarized into a total score and dichotomized by the mean. Indicators measuring socio-economic status (SES) were collected in a questionnaire using the Family Affluence Scale (FAS) and additional factors regarding parents' marital status and migration were added. Logistic models were used to analyze the data.

    Results: Girls were more likely to rate their mental health below the mean compared to boys. With regard to FAS (high, medium, low), there was a significantly increased risk of self-rated mental health below the mean among younger boys in the medium FAS score OR; 2.68 (95% CI 1.35;5.33) and among older boys in the low FAS score OR; 2.37 (1.02;5.52) compared to boys in the high FAS score. No such trend was seen among girls. For younger girls there was a significant protective association between having parents born abroad and self-rated mental health below mean OR: 0.47 (0.24;0.91).

    Conclusions: A complex pattern of associations between SES and self-rated mental health, divergent between age and gender groups, was shown. The total FAS score was only associated with boys' self-rated mental health in both age groups, whereas parents' migratory status influenced only the girls' self-rated mental health. Because of the different association for girls' and boys' self-rated mental health and SES, other factors than SES should also be considered when investigating and exploring the mental health of adolescents in affluent communities. © 2014 Hutton et al.; licensee BioMed Central Ltd.

  • 5.
    Regber, Susann
    et al.
    Nordic School of Public Health NHV, Gothenburg, Sweden.
    Novak, Masuma
    Department of Molecular and Clinical Medicine, the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Eiben, Gabriele
    Department of Public Health and Community Medicine, Public Health Epidemiology Unit Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Lissner, Lauren
    Department of Public Health and Community Medicine, Public Health Epidemiology Unit Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Hense, Sabrina
    Department of Epidemiological Methods and Etiologic Research, Institute for Epidemiology and Prevention Research (BIPS), Bremen, Germany.
    Zverkova Sandström, Tatiana
    Nordic School of Public Health NHV, Gothenburg, Sweden.
    Ahrens, Wolfgang
    Department of Epidemiological Methods and Etiologic Research, Institute for Epidemiology and Prevention Research (BIPS), Bremen, Germany.
    Mårild, Staffan
    Department of Paediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Assessment of selection bias in a health survey of children and families – the IDEFICS Sweden-study2013In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 13, article id 418Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: A health survey was performed in 2007-2008 in the IDEFICS/Sweden study (Identification and prevention of dietary- and lifestyle-induced health effects in children and infants) in children aged 2-9 years. We hypothesized that families with disadvantageous socioeconomic and -demographic backgrounds and children with overweight and obesity were underrepresented.

    METHODS: In a cross-sectional study, we compared Swedish IDEFICS participants (N=1,825) with referent children (N=1,825) using data from Statistics Sweden population registers. IDEFICS participants were matched for age and gender with a referent child living in the same municipality. Longitudinal weight and height data from birth to 8 years was collected for both populations (n=3,650) from the children's local health services. Outcome measures included the family's socioeconomic and demographic characteristics, maternal body mass index (BMI) and smoking habits before pregnancy, the children's BMI standard deviation score (SDS) at the age of inclusion in the IDEFICS study (BMISDS-index), and the children's BMI-categories during the age-span. Comparisons between groups were done and a multiple logistic regression analysis for the study of determinants of participation in the IDEFICS study was performed.

    RESULTS: Compared with IDEFICS participants, referent families were more likely to have lower education and income, foreign backgrounds, be single parents, and have mothers who smoked before pregnancy. Maternal BMI before pregnancy and child's BMISDS-index did not differ between groups. Comparing the longitudinal data-set, the prevalence of obesity was significantly different at age 8 years n= 45 (4.5%) versus n= 31 (2.9%) in the referent and IDEFICS populations, respectively. In the multivariable adjusted model, the strongest significant association with IDEFICS study participation was parental Swedish background (odds ratio (OR) = 1.91, 95% confidence interval (CI) (1.48-2.47) followed by parents having high education OR 1.80, 95% CI (1.02-3.16) and being married or co-habiting OR 1.75 95% CI (1.38-2.23).

    CONCLUSION: Families with single parenthood, foreign background, low education and income were underrepresented in the IDEFICS Sweden study. BMI at inclusion had no selection effect, but developing obesity was significantly greater among referents. © 2013 Regber et al.; licensee BioMed Central Ltd.

  • 6.
    Roswall, Josefine
    et al.
    Department of Paediatrics, Halland Hospital, Halmstad, Sweden & Department of Paediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Almqvist-Tangen, Gerd
    Department of Paediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden & Child Health Care Unit, Region Halland, Kungsbacka, Sweden.
    Holmén, Anders
    Department of Research and Development, Region Halland, Halmstad, Sweden.
    Alm, Bernt
    Department of Paediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden & Child Health Care Unit, Region Halland, Kungsbacka, Sweden.
    Bergman, Stefan
    Primary Health Care Unit, Department of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden & Research and Development Centre Spenshult, Halmstad, Sweden.
    Dahlgren, Jovanna
    Department of Paediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Strömberg, Ulf
    Department of Research and Development, Region Halland, Halmstad, Sweden & Health Metrics Unit, Department of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Overweight at four years of age in a Swedish birth cohort: Influence of neighbourhood-level purchasing power2016In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 16, no 1, article id 546Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: A number of child/parental factors have been shown to be significant predictors of childhood overweight, although a better understanding of possible contextual influences of neighbourhood-level characteristics might provide new insights leading to tailored, targeted interventions. The aim of this study was to explore the impact of neighbourhood purchasing power and its relationship with other known risk factors related to childhood overweight in a prospective birth cohort.

    METHODS: A prospective, population-based, birth-cohort study was conducted in south-western Sweden, comprising 2,666 infants born in 2007-2008. Childhood overweight was assessed by body mass index (BMI) data from follow-up examinations at four years of age (n = 2,026) and overweight defined according to the International Obesity Task Force. Using logistic regression analysis, the influential child/parental predictors were identified from the candidate predictors, viz. child's gender, as well as birth weight adjusted for gestational age and parental factors at recruitment, including maternal smoking status, maternal BMI (before pregnancy), paternal BMI and parental educational level. The children's residential parishes at follow-up were stratified by parish-level household purchasing power (<10 %, 10-19.9 %, 20-29.9 % and ≥30 % of all resident families with low purchasing power) and the "contextual" influence was analysed. In each such neighbourhood stratum, the adjusted overweight ratio (AOR), i.e. the ratio between the observed number of overweight children and the expected number, taking account of the influential child/parental predictors, was estimated.

    RESULTS: The prevalence of overweight at four years of age was 11.9 %. In the economically strongest neighbourhoods (i.e. <10 % of resident families with low purchasing power), the AOR was 0.60 (95 % confidence interval (CI): 0.34-0.98). The corresponding empirically Bayes-adjusted AOR was 0.73 (95 % CI: 0.46-1.02; 97 % posterior probability of AOR <1). In the other neighbourhood strata, the statistical evidence of a deviant AOR was weaker.

    CONCLUSION: The economically strongest neighbourhoods had a lower prevalence than expected of overweight at four years of age. This finding should prompt studies to acquire more knowledge of potentially modifiable factors that differ between neighbourhoods and are related to childhood overweight, providing a basis for tailored, targeted interventions.

  • 7.
    Önnerfält, Jenny
    et al.
    Department of Paediatrics, Clinical Sciences Lund, Lund University, Lund, Sweden & Vårdalinstitutet, Swedish Institute for Health Sciences, Lund University, Lund, Sweden & Department of Paediatrics, Lund University, Lund, Sweden & Skåne University Hospital, Lund, Sweden.
    Erlandsson, Lena-Karin
    Vårdalinstitutet, Swedish Institute for Health Sciences, Lund University, Lund, Sweden & Department of Health Sciences, Faculty of medicine, Lund University, Lund, Sweden.
    Orban, Kristina
    Vårdalinstitutet, Swedish Institute for Health Sciences, Lund University, Lund, Sweden & Department of Health Sciences, Faculty of medicine, Lund University, Lund, Sweden.
    Broberg Olsson, Malin
    Vårdalinstitutet, Swedish Institute for Health Sciences, Lund University, Lund, Sweden & Department of Psychology, University of Gothenburg, Gothenburg, Sweden.
    Thorngren-Jerneck, Kristina
    Department of Paediatrics, Clinical Sciences, Lund University, Lund, Sweden & Vårdalinstitutet, Swedish Institute for Health Sciences, Lund University, Lund, Sweden & Skåne University Hospital, Lund, Sweden.
    A family-based intervention targeting parents of preschool children with overweight and obesity: Conceptual framework and study design of LOOPS- Lund Overweight and Obesity Preschool Study2012In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 12, no 1, article id 879Article in journal (Refereed)
    Abstract [en]

    Background: As the rate of overweight among children is rising there is a need for evidence-based research that will clarify what the best interventional strategies to normalize weight development are. The overall aim of the Lund Overweight and Obesity Preschool Study (LOOPS) is to evaluate if a family-based intervention, targeting parents of preschool children with overweight and obesity, has a long-term positive effect on weight development of the children. The hypothesis is that preschool children with overweight and obesity, whose parents participate in a one-year intervention, both at completion of the one-year intervention and at long term follow up (2-, 3- and 5-years) will have reduced their BMI-for-age z-score.

    Methods/Design: The study is a randomized controlled trial, including overweight (n=160) and obese (n=80) children 4-6-years-old. The intervention is targeting the parents, who get general information about nutrition and exercise recommendations through a website and are invited to participate in a group intervention with the purpose of supporting them to accomplish preferred lifestyle changes, both in the short and long term. To evaluate the effect of various supports, the parents are randomized to different interventions with the main focus of: 1) supporting the parents in limit setting by emphasizing the importance of positive interactions between parents and children and 2) influencing the patterns of daily activities to induce alterations of everyday life that will lead to healthier lifestyle. The primary outcome variable, child BMI-for-age z-score will be measured at referral, inclusion, after 6 months, at the end of intervention and at 2-, 3- and 5-years post intervention. Secondary outcome variables, measured at inclusion and at the end of intervention, are child activity pattern, eating habits and biochemical markers as well as parent BMI, exercise habits, perception of health, experience of parenthood and level of parental stress.

    Discussion: The LOOPS project will provide valuable information on how to build effective interventions to influence an unhealthy weight development to prevent the negative long-term effects of childhood obesity.

    Trial registration: ClinicalTrials.gov NCT00916318

    © 2012 Önnerfält et al.; licensee BioMed Central Ltd.

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