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  • 1.
    Bramsved, Rebecka
    et al.
    Department of Pediatrics, Sahlgrenska Academy, University of Gothenburg, Sweden.
    Regber, Susann
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI), Health promotion and disease prevention.
    Mehlig, K.
    Section for Epidemiology and Social Medicine, Institute of Medicine, University of Gothenburg, Sweden.
    Novak, D.
    Department of Pediatrics, Shalgrenska Academy, University of Gotehburg, Sweden.
    Lissner, L.
    Section for Epidemiology and Social Medicine, Institute of Medicine, University of Gothenburg, Sweden.
    Mårild, S.
    Department of Pediatrics, Shalgrenska Academy, University of Gotehburg, Sweden.
    Parental education and income: independent and combined effects on children's growth and weight status2016Conference paper (Refereed)
  • 2.
    Bramsved, Rebecka
    et al.
    Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden.
    Regber, Susann
    School of Health and Education, University of Skövde, Skövde, Sweden.
    Mehlig, Kirsten
    Public Health Epidemiology Unit, Department of Public Health and Community Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Novak, Daniel
    Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden.
    Lissner, Lauren
    Public Health Epidemiology Unit, Department of Public Health and Community Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Mårild, Staffan
    Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden.
    Children's BMI is strongly effected by family income at birth – but parental education is of major importance for the growing social gap up to 8 years of age2015Conference paper (Refereed)
    Abstract [en]

    Background: The development of BMI in early childhood is dependent on socioeconomic factors. Our aim was to explore the impact of parental education level and family income for development of BMI from birth to 8 years age.

    Methods: 3018 children born in 1998–2006 from the IDEFICS study and register controls were included. Weight and height measurements from birth up to 8 years of age were obtained from the Child Health Services. Parental education and family disposable income, obtained from Statistics Sweden and the Medical Birth Register, were defined as high/low. Obesity was defined by WHO references. Confounders were sex and age of the child, parental origin, maternal smoking and maternal BMI.

    Results: At birth, the children’s mean BMI (SD) was lower in families of low vs. high income (13,74 (1,35) vs. 13,94 (1,36), p<0.0001). Results remained significant after adjusting for confounders. No differences in birth BMI were detected between children of low and high-educated parents (13,87 (1,37) vs. 13,83 (1,35), p=0.48). From 6 months onwards, children of low-educated parents showed higher mean BMI than children of high-educated. At 8 years, mean BMI in the low/high educated groups were 17.12 (2.44) and 16.38 (1.94), p<0.0001. Results remained significant after adjusting for confounders. Prevalence of obesity in the low and high-educated groups were 11% and 4,1%, p<0,0001. The difference in BMI at 8 years seen in the low/high income group disappeared after adjusting for confounders (17.5 vs. 17.6, p=0,63).

    Conclusion: Impact of family socioeconomic factors on children’s BMI differs by income and education. The effect of parental education becomes more evident by age up to 8 years of age. Interventions for healthy weight development must start very early in life.

  • 3.
    Bramsved, Rebecka
    et al.
    Department of Pediatrics, Institute of Clinical Sciences, The Queen Silvia Children’s Hospital, The Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden.
    Regber, Susann
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
    Novak, Daniel
    Department of Pediatrics, Institute of Clinical Sciences, The Queen Silvia Children’s Hospital, The Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden.
    Mehlig, Kirsten
    Section for Epidemiology and Social Medicine (EPSO), Institute of Medicine, The Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden.
    Lissner, Lauren
    Section for Epidemiology and Social Medicine (EPSO), Institute of Medicine, The Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden.
    Mårild, Staffan
    Department of Pediatrics, Institute of Clinical Sciences, The Queen Silvia Children’s Hospital, The Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden.
    Effects of family disposable income on development of height and BMI from birth up to eight years of age2016In: European Obesity Summit (EOS) – Joint Congress of EASO and IFSO-EC: ABSTRACTS, Freiburg: S. Karger, 2016, Vol. 9, p. 44-44Conference paper (Refereed)
    Abstract [en]

    Introduction: Low socioeconomic position (SEP) is a known risk factor for development of obesity in childhood. e level of parental education is commonly used as proxy for SEP, but family disposable income is likely to also be of importance for SEP. e aim of this study was to determine the e ects of family disposable income on BMI and height trajectories from birth up to eight years of age, and the development of obesity at eight years of age.

    Methods: Growth data from birth to eight years age were collected for 3030 Swedish children. Register data on family disposable income was re- trieved from Statistics Sweden, and dichotomized for the analysis by the median value for the group. Register-derived information on parental ed- ucation and national background, maternal BMI, age and smoking status were considered as covariates in longitudinal mixed models and regres- sion analyses.

    Results: Mean birth weight was lower in families of lower income, 3.51 kg (SD 0.54) vs. 3.60 kg (SD 0.53) for children of higher-income parents, p < 0.0001. By age 5.5 years and 8 years, however, a reversed relation between groups was seen, where the children of lower income families showed signi cantly higher mean BMI. is di erence was no longer sig- ni cant when adjusting for covariates. Considering height, lower income was strongly related to lower height at 5.5 and 8 years, di erences were strengthened a er adjusting for confounders, -0.44 cm (95% CI -0.75,- 0.13) for age 5.5 years and -0.56 cm (95% CI -0.88, -0.23) at 8 years. e OR of obesity at 8 years age was 1.69 (95% CI 1.05–2.7) for the group of low income compared to the group of high income.

    Conclusions: Low family disposable income is related to increased risk of childhood obesity at 8 years of age. is could be attributed to a di erent growth pattern compared to children of high income. Our ndings that children of lower family income had lower mean birth weight and dis- played lower height later in childhood suggest that these children might have an unfavourable metabolic pro le and increased risk of developing the metabolic syndrome. © 2016 S. Karger GmbH, Freiburg 

  • 4.
    Bramsved, Rebecka
    et al.
    The Queen Silvia Children’s Hospital, The Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden.
    Regber, Susann
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
    Novak, Daniel
    The Queen Silvia Children’s Hospital, The Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden.
    Mehlig, Kirsten
    Institute of Medicine, The Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden.
    Lissner, Lauren
    Institute of Medicine, The Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden.
    Mårild, Staffan
    The Queen Silvia Children’s Hospital, The Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden.
    Parental education and family income affect birthweight, early longitudinal growth and body mass index development differently2018In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 107, no 11, p. 1946-1952Article in journal (Refereed)
    Abstract [en]

    AIM: This study investigated the effects of two parental socio-economic characteristics, education and income, on growth and risk of obesity in children from birth to 8 years of age.

    METHODS: Longitudinal growth data and national register-based information on socio-economic characteristics were available for 3,030 Swedish children. The development of body mass index (BMI) and height was compared in groups dichotomised by parental education and income.

    RESULTS: Low parental education was associated with a higher BMI from 4 years of age, independent of income, immigrant background, maternal BMI and smoking during pregnancy. Low family income was associated with a lower birthweight, but did not independently predict BMI development. At 8 years of age, children from less educated families had a three times higher risk of obesity, independent of parental income. Children whose parents had fewer years of education but high income had significantly higher height than all other children.

    CONCLUSION: Parental education protected against childhood obesity, even after adjusting for income and other important parental characteristics. Income-related differences in height, despite similar BMIs, raise questions about body composition and metabolic risk profiles. The dominant role of education underscores the value of health literacy initiatives for the parents of young children. ©2018 Foundation Acta Pædiatrica.

  • 5.
    Börnhorst, Claudia
    et al.
    Leibniz Institute for Prevention Research and Epidemiology – BIPS, Bremen, Germany.
    Siani, Alfonso
    Unit of Epidemiology and Population Genetics, Institute of Food Sciences, National Research Council, Avellino, Italy.
    Russo, Paola
    Unit of Epidemiology and Population Genetics, Institute of Food Sciences, National Research Council, Avellino, Italy.
    Kourides, Yannis
    Research and Education Institute of Child Health, Strovolos, Cyprus.
    Sion, Isabelle
    Department of Public Health, Ghent University, Ghent, Belgium.
    Molnár, Denés
    Department of Pediatrics, University of Pécs, Pécs, Hungary.
    Moreno, Luis A.
    Rodríguez, Gerardo
    GENUD (Growth, Exercise, Nutrition and Development) Research Group, Faculty of Health Sciences, University of Zaragoza, Zaragoza, Spain.
    Ben-Shlomo, Yoav
    School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom.
    Howe, Laura
    School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom, MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, United Kingdom.
    Lissner, Lauren
    Section for Epidemiology and Social Medicine, Department of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Mehlig, Kirsten
    Section for Epidemiology and Social Medicine, Department of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Regber, Susann
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
    Bammann, Karin
    Institute for Public Health and Nursing Research (IPP), Faculty for Human and Health Sciences, University Bremen, Bremen, Germany.
    Foraita, Ronja
    Leibniz Institute for Prevention Research and Epidemiology – BIPS, Bremen, Germany.
    Ahrens, Wolfgang
    Leibniz Institute for Prevention Research and Epidemiology – BIPS, Bremen, Germany, Faculty of Mathematics and Computer Science, University of Bremen, Bremen, Germany.
    Tilling, Kate
    School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom.
    Early Life Factors and Inter-Country Heterogeneity in BMI Growth Trajectories of European Children: The IDEFICS Study2016In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 11, no 2, article id e0149268Article in journal (Refereed)
    Abstract [en]

    Background

    Starting from birth, this explorative study aimed to investigate between-country differences in body mass index (BMI) trajectories and whether early life factors explain these differences.

    Methods

    The sample included 7,644 children from seven European countries (Belgium, Cyprus, Germany, Hungary, Italy, Spain, Sweden) participating in the multi-centre IDEFICS study. Information on early life factors and in total 53,409 repeated measurements of height and weight from 0 to <12 years of age were collected during the baseline (2007/2008) and follow-up examination (2009/2010) supplemented by records of routine child health visits. Country-specific BMI growth curves were estimated using fractional polynomial mixed effects models. Several covariates focussing on early life factors were added to the models to investigate their role in the between-countries differences.

    Results

    Large between-country differences were observed with Italian children showing significantly higher mean BMI values at all ages ≥ 3 years compared to the other countries. For instance, at age 11 years mean BMI values in Italian boys and girls were 22.3 [21.9;22.8; 99% confidence interval] and 22.0 [21.5;22.4], respectively, compared to a range of 18.4 [18.1;18.8] to 20.3 [19.8;20.7] in boys and 18.2 [17.8;18.6] to 20.3 [19.8;20.7] in girls in the other countries. After adjustment for early life factors, differences between country-specific BMI curves became smaller. Maternal BMI was the factor being most strongly associated with BMI growth (p<0.01 in all countries) with associations increasing during childhood. Gestational weight gain (GWG) was weakly associated with BMI at birth in all countries. In some countries, positive associations between BMI growth and children not being breastfed, mothers’ smoking during pregnancy and low educational level of parents were found.

    Conclusion

    Early life factors seem to explain only some of the inter-country variation in growth. Maternal BMI showed the strongest association with children’s BMI growth.

  • 6.
    Börnhorst, Claudia
    et al.
    a Biometry and Data Management, Leibniz Institute for Epidemiology and Prevention Research, BIPS, Bremen, Germany.
    Siani, Alfonso
    Institute of Food Sciences, National Research Council, Avellino, Italy.
    Tornaritis, M.
    c Research and Education Institute of Child Health, Research and Education Institute of Child Health, Strovolos, Cyprus.
    Molnár, D.
    Department of Pediatrics, University of Pécs, Pécs, Hungary.
    Lissner, Lauren
    Section for Epidemiology and Social Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Regber, Susann
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
    Potential selection effects when estimating associations between the infancy peak or adiposity rebound and later body mass index in children2018In: Revue d'épidémiologie et de santé publique, ISSN 0398-7620, E-ISSN 1773-0627, Vol. 66, no Suppl. 5, p. S422-S423Article in journal (Refereed)
    Abstract [en]

    Aim: Lots of research has been conducted to identify early life factors or growth characteristics in infancy and childhood related to an unfavorable weight development. For instance, a late age at infancy peak (IP), an early age at adiposity rebound (AR) as well as body mass index (BMI) at IP and AR were shown to be positively associated with later adiposity status. The present study aims to investigate the usefulness of the IP and AR in comparison to other measures of BMI growth as indicators of later weight status. For the first time, the selection effect possibly occurring when excluding children with non-identifiable IP or AR will be explored.

    Methods: Identification and Prevention of Dietary- and Lifestyle-Induced Health Effects in Children and Infants (IDEFICS)/I. Family is an ongoing cohort study conducted in eight European countries with 16,229 children participating in the baseline survey in 2006/2007 [1]. In a subset of 4744 children with at least four repeated measurements of height and weight in the age interval from 0 to 8 years (37,998 measurements in total; survey data supplemented with records of routine child visits), fractional polynomial mixed-effects models were used to derive individual BMI trajectories. Based on these trajectories, age and BMI at IP and AR, BMI values and growth velocities at selected ages as well as the area under the BMI curve were estimated. The BMI growth measures were standardized and related to later BMI z-scores (mean age at outcome assessment: 9.2 years).

    Results: Age and BMI at IP and AR were not identifiable in 5.4% and 7.8% of the children, respectively. These groups of children showed a significantly higher BMI growth during infancy and childhood. In the remaining sample, BMI at IP correlated almost perfectly (r ≥ 0.99) with BMI at ages 0.5, 1 and 1.5 years, whereas BMI at AR correlated perfectly with BMI at ages 4–6 years (r ≥ 0.98). In the total study group, BMI values in infancy and childhood were positively associated with later BMI z-scores where associations increased with age. Associations between BMI velocities and later BMI z-scores were largest at ages 5 and 6 years. Results markedly differed for children with non-identifiable IP and AR, demonstrating a selection effect.

    Conclusions: IP and AR may not be estimable in children with higher-than-average BMI growth. Excluding these children from analyses may result in a selection bias that distorts effect estimates. BMI values at ages 1 and 5 years might be more appropriate to use as predictors for later weight status instead.

    © 2018 Published by Elsevier Masson SAS

  • 7.
    Börnhorst, Claudia
    et al.
    Biometry and Data Management, Leibniz Institute for Prevention Research and Epidemiology-BIPS, Bremen, Germany.
    Siani, Alfonso
    Unit of Epidemiology and Population Genetics, Institute of Food Sciences, National Research Council, Avellino, Italy.
    Tornaritis, Michalis
    Research and Education Institute of Child Health, Strovolos, Cyprus.
    Molnár, Dénes
    Department of Pediatrics, University of Pécs, Pécs, Hungary.
    Lissner, Lauren
    Section for Epidemiology and Social Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Regber, Susann
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
    Reisch, Lucia
    Department of Intercultural Communication and Management, Copenhagen Business School, Frederiksberg, Denmark.
    De Decker, Annelies
    Department of Public Health, Ghent University, Ghent, Belgium.
    Moreno, Luis A
    GENUD (Growth, Exercise, Nutrition and Development) Research Group, Faculty of Health Sciences, Universidad de Zaragoza, Instituto Agroalimentario de Aragón (IA2), Instituto de Investigación Sanitaria Aragón (IIS Aragón), Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBERObn), Zaragoza, Spain.
    Ahrens, Wolfgang
    Biometry and Data Management, Leibniz Institute for Prevention Research and Epidemiology-BIPS & Faculty of Mathematics and Computer Science, University of Bremen, Bremen, Germany.
    Pigeot, Iris
    Biometry and Data Management, Leibniz Institute for Prevention Research and Epidemiology-BIPS, Bremen, Germany & Faculty of Mathematics and Computer Science, University of Bremen, Bremen, Germany.
    Potential selection effects when estimating associations between the infancy peak or adiposity rebound and later body mass index in children2017In: International Journal of Obesity, ISSN 0307-0565, E-ISSN 1476-5497, Vol. 41, no 4, p. 518-526Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION:This study aims to evaluate a potential selection effect caused by exclusion of children with non-identifiable infancy peak (IP) and adiposity rebound (AR) when estimating associations between age and body mass index (BMI) at IP and AR and later weight status

    SUBJECTS AND METHODS: In 4744 children with at least 4 repeated measurements of height and weight in the age interval from 0 to 8 years (37 998 measurements) participating in the IDEFICS (Identification and Prevention of Dietary- and Lifestyle-Induced Health Effects in Children and Infants)/I.Family cohort study, fractional polynomial multilevel models were used to derive individual BMI trajectories. Based on these trajectories, age and BMI at IP and AR, BMI values and growth velocities at selected ages as well as the area under the BMI curve were estimated. The BMI growth measures were standardized and related to later BMI z-scores (mean age at outcome assessment: 9.2 years).

    RESULTS: Age and BMI at IP and AR were not identifiable in 5.4% and 7.8% of the children, respectively. These groups of children showed a significantly higher BMI growth during infancy and childhood. In the remaining sample, BMI at IP correlated almost perfectly (r⩾0.99) with BMI at ages 0.5, 1 and 1.5 years, whereas BMI at AR correlated perfectly with BMI at ages 4-6 years (r⩾0.98). In the total study group, BMI values in infancy and childhood were positively associated with later BMI z-scores where associations increased with age. Associations between BMI velocities and later BMI z-scores were largest at ages 5 and 6 years. Results differed for children with non-identifiable IP and AR, demonstrating a selection effect.

    CONCLUSIONS: IP and AR may not be estimable in children with higher-than-average BMI growth. Excluding these children from analyses may result in a selection bias that distorts effect estimates. BMI values at ages 1 and 5 years might be more appropriate to use as predictors for later weight status instead. © 2017 Macmillan Publishers Limited, part of Springer Nature. All rights reserved.

  • 8.
    Haerens, L.
    et al.
    Research Foundation-Flanders, Department of Movement and Sports Sciences, Ghent University, Ghent, Belgium.
    De Bourdeaudhuij, I.
    Research Foundation-Flanders, Department of Movement and Sports Sciences, Ghent University, Ghent, Belgium.
    Barba, G.
    Unit of Epidemiology and Population Genetics, Institute of Food Sciences, National Research Council, Avellino, Italy.
    Eiben, G.
    Department of Public health and Community Medicine, Göteborg University, Göteborg, Sweden.
    Fernandez, J.
    University School of Health Sciences, University of Zaragoza, Zaragoza, Spain.
    Hebestreit, A.
    Bremen Institute for Prevention Research and Social Medicine, University of Bremen, Bremen, Germany.
    Kovács, É.
    Medical Faculty, Department of Paediatrics, University of Pécs, Pécs, Hungary.
    Lasn, H.
    National Institute for Health Development, Tallinn, Estonia.
    Regber, Susann
    Department of Pediatrics, Sahlgrenska University Hospital, Göteborg, Sweden.
    Shiakou, M.
    Research and Education Institute for Child Health, Strovolos, Cyprus.
    De Henauw, S.
    Department of Public Health, Ghent University, Ghent, Belgium.
    Developing the IDEFICS community-based intervention program to enhance eating behaviors in 2- to 8-year-old children: findings from focus groups with children and parents2009In: Health Education Research, ISSN 0268-1153, E-ISSN 1465-3648, Vol. 24, no 3, p. 381-393Article in journal (Refereed)
    Abstract [en]

    One purpose of 'identification and prevention of dietary- and lifestyle-induced health effects in children and infants' (IDEFICS) is to implement a standardized community-based multi-component healthy eating intervention for younger children in eight different countries. The present study describes important influencing factors for dietary behaviors among children aged 2-8 years old in order to determine the best approaches for developing the dietary components of the standardized intervention. Twenty focus groups with children (74 boys, 81 girls) and 36 focus groups with 189 parents (28 men, 161 women) were conducted. Only in two countries, children mentioned receiving nutrition education at school. Rules at home and at school ranged from not allowing the consumption of unhealthy products to allowing everything. The same diversity was found for availability of (un)healthy products at home and school. Parents mentioned personal (lack of time, financial constraints, preferences), socio-environmental (family, peer influences), institutional (school policies) and physical-environmental (availability of unhealthy products, price, season) barriers for healthy eating. This focus group research provided valuable information to guide the first phase in the IDEFICS intervention development. There was a large variability in findings within countries. Interventions should be tailored at the personal and environmental level to increase the likelihood of behavioral change.

  • 9.
    Haerens, Leen
    et al.
    Dept. of Movement and Sports Sciences, Research Foundation Flanders, Ghent University, Ghent, Belgium.
    De Bourdeaudhuij, Ilse
    Dept. of Movement and Sports Sciences, Research Foundation Flanders, Ghent University, Ghent, Belgium.
    Eiben, Gabriele
    Dept. of Public Health and Community Medicine, University of Gothenburg, Gothenburg, Sweden.
    Lauria, Fabio
    Dept. of Epidemiology and Population Genetics, Institute of Food Science, CNR, Avellino, Italy.
    Bel, Silvia
    University School of Health Sciences, University of Zaragoza, Zaragoza, Spain.
    Keimer, Katharina
    Institute for Prevention Research and Social Medicine, University of Bremen, Bremen, Germany.
    Kovács, Eva
    Dept. of Pediatrics, University of Pécs, Pécs, Hungary.
    Lasn, Helen
    National Institute for Health Development, TAI (Tervise Arengu Instituut), Tallinn, Estonia.
    Regber, Susann
    Nordic School of Public Health, Gothenburg, Sweden.
    Shiakou, Monica
    Research and Education Institute of Child Health, Nicosia, Cyprus.
    Maes, Lea
    Dept. of Public Health, Ghent University, Gent, Belgium.
    Formative Research to Develop the IDEFICS Physical Activity Intervention Component: Findings From Focus Groups With Children and Parents2010In: Journal of Physical Activity and Health, ISSN 1543-3080, E-ISSN 1543-5474, Vol. 7, no 2, p. 246-256Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The current study aimed at describing influencing factors for physical activity among young children to determine the best approaches for developing the IDEFICS community based intervention.

    METHODS: In 8 European sites a trained moderator conducted a minimum of 4 focus groups using standardized questioning guides. A total of 56 focus groups were conducted including 36 focus groups with parents and 20 focus groups with children, of which 74 were boys and 81 girls. Key findings were identified through independent reviews of focus group summary reports using content analysis methods.

    FINDINGS: Findings were generally consistent across countries. The greatest emphasis was on environmental physical (eg, seasonal influences, availability of facilities and safety), institutional (eg, length of breaks at school), and social factors (eg, role modeling of parents). Most cited personal factors by parents were age, social economical status, and perceived barriers. Both children and parents mentioned the importance of children's preferences.

    CONCLUSIONS: To increase physical activity levels of young children the intervention should aim at creating an environment (physical, institutional, social) supportive of physical activity. On the other hand strategies should take into account personal factors like age and social economical status and should consider personal barriers too. © 2010 Human Kinetics, Inc.

  • 10.
    Mårild, Staffan
    et al.
    Dept. Paediatrics, Inst. of the Health of Women and Children, Göteborg, Sweden.
    Arfwidsson, Charlotte
    Dept. Paediatrics, Inst. of the Health of Women and Children, Göteborg, Sweden.
    Elmberg, Karin
    Dept. Paediatrics, Inst. of the Health of Women and Children, Göteborg, Sweden.
    Hellström, Sara
    Viktväktarna AB, Sweden, Weight Watchers International, Malmö, Sverige.
    Nilsson, Marie
    Dept. Paediatrics, Inst. of the Health of Women and Children, Göteborg, Sweden.
    Regber, Susann
    Dept. Paediatrics, Inst. of the Health of Women and Children, Göteborg, Sweden.
    One Year Follow-up of Two Group Treatments for Children with Obesity2004Conference paper (Refereed)
    Abstract [en]

    Aims: To assess the one-year efficacy, in children with obesity, of group treatments by either a paediatric weight watcher’s model (WW) or by a physical training program (PT).

    Methods: A total of 162 children were invited to the treatments. Fifty-five accepted and allocation was made of 34 (20 girls), mean age 13.6, SD 1.86 years, to the WW and of 21 (11 girls), mean age 12.7 SD 1.45, to the PT programs, age and gender NS different. All group meetings were in parallel, from September 2002 to January 2003, with weekly one-hour sessions.

    Parents participated in the WW groups. Body mass index was monitored before, after and one year from the start and expressed in standard deviation score (BMISDS).

    Results: The BMISDS was 3.14 and 3.13 in the WW and PT groups at the start (NS). Immediately after the treatment, it was 2.94 (n=34) and 3.17 (n=19), respectively, p<0.05 for difference between groups. Five children in the WW and 0 in the PT were now no longer obese. One year from the start, the BMISDS was 3.01 (n=26) and 2.97 (n=10) in the WW and PT children who had had no further interventions, those with 2 and 1 were now not obese, NS. Non-compliant children were those with 1 and 7, p<0.01.

    Conclusions: The WW treatment resulted in a significant reduction of BMISDS directly after the treatment. After 1 year from start, a non-significant effect was present in both groups. Compliance was significantly better in the WW group. A randomised controlled trial is of interest for further evaluation.

  • 11.
    Mårild, Staffan
    et al.
    Department of Pediatrics, Institute of Clinical Sciences, The Queen Silvia Children’s Hospital, The Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden.
    Regber, Susann
    Nordic School of Public Health, Göteborg, Sweden.
    Novak, M.
    Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Eiben, G.
    Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Bammann, K.
    BIPS-Institute, Bremen, Germany.
    De Henauw, S.
    Ghent University, Ghent, Belgium.
    Fernández-Alvira, J.M.
    University of Zaragoza, Zaragoza, Spain.
    Gwozdz, W.
    Copenhagen Business School, Frederiksberg, Denmark.
    Kourides, Y.
    Research & Education Institute of Child Health, Strovolos, Cyprus.
    Moreno, L.
    University of Zaragoza, Zaragoza, Spain.
    Molnár, D.
    University of Pécs, Pécs, Hungary.
    Reisch, L.
    Copenhagen Business School, Frederiksberg, Denmark.
    Russo, P.
    CNR, Avellino, Italy.
    Veidebaum, T.
    National Institute for Health Development, Tallinn, Estonia.
    Borup, I.
    Nordic School of Public Health, Gothenburg, Sweden.
    Pigeot, I.
    BIPS-Institute, Bremen, Germany.
    Parental perceptions of and concerns about child´s body weight in eight European countries - the IDEFICS study2014In: Obesity Reviews, ISSN 1467-7881, E-ISSN 1467-789X, Vol. 15, no S2, p. 105-105Article in journal (Refereed)
    Abstract [en]

    Background: Few studies have studied parental perceptions in different settings of their children's weight in relation to objective measurements.

    Aim: To evaluate parental perceptions of their child's weight category in relation to anthropometric measurements.

    Key Methods: This was cross-sectional study of 16 220 children, 2–9 year of age, from eight European countries. Parents completed a questionnaire on their perception of the children's weight and concern for future weight deviations. Objective children's weight categories from the International Obesity Task Force were used.

    Results: Parental weight perception corresponded overall to children's mean body mass index (BMI) z-scores, but there were exceptions, e.g. 63% of parents to children with overweight marked ‘proper weight’. One-third of the total indicated concern for future underweight, most often in parents of children in the overweight category. The strongest predictor for accurate parental weight perception for children with overweight and obesity was BMI z-score (odds ratio [OR] 7.2, 95% confidence interval [CI] 6.1–8.7). Compared to Southern Europe, ORs for accurate parental weight perception were 4.4 (95% CI 3.3–6.0) in Northern Europe and 3.4 (95% CI 2.7–4.2) in Central Europe.

    Conclusion: Parents of children categorized as being overweight or obese systematically underestimated weight category. Parents differed regionally in accurate perception of weight.

  • 12.
    Povlsen, Lene
    et al.
    Nordic School of Public Health NHV, Gothenburg, Sweden.
    Eklund Karlsson, Leena
    Unit for Health Promotion Research, University of Southern Denmark, Denmark.
    Regber, Susann
    Nordic School of Public Health NHV, Gothenburg, Sweden.
    Sandstig, Gabriella
    Department of Journalism, Media and Communication, University of Gothenburg, Gothenburg, Sweden.
    Fosse, Elisabeth
    Department of Health Promotion and Development, Faculty of Psychology, Bergen University, Bergen, Norway.
    Are equity aspects communicated in Nordic public health documents?2014In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 42, no 3, p. 235-241Article in journal (Refereed)
    Abstract [en]

    AIMS: To explore if the term equity was applied and how measures for addressing social inequalities in health and reducing inequity were communicated in selected Nordic documents concerning public health.

    METHODS: Documents from Denmark, Finland, Norway, and Sweden were collected and analysed by Nordic authors. Data included material from websites of ministries and authorities responsible for public health issues, with primary focus on steering documents, action programmes, and reports from 2001 until spring 2013.

    RESULTS: Most strategies applied in Danish, Finnish, and Swedish documents focused on the population in general but paid special attention to vulnerable groups. The latest Danish and Finnish documents communicate a clearer commitment to address social inequalities in health. They emphasise the social gradient and the need to address the social determinants in order to improve the position of disadvantaged groups. Norwegian authorities have paid increasing attention to inequity/social inequalities in health and initiated a new law in 2012 which aims to address the social gradient in a more clear way than seen elsewhere in the Nordic countries.

    CONCLUSIONS: In the Nordic countries, redistribution by means of universal welfare policies is historically viewed as a vital mechanism to improve the situation of vulnerable groups and level the social gradient. To establish the concept of equity as a strong concern and a core value within health promotion, it is important to be aware how policies can contribute to enable reduction of social health differences. © 2014 the Nordic Societies of Public Health.

  • 13.
    Povlsen, Lene
    et al.
    Unit for Health Promotion Research, University of Southern Denmark, Esbjerg, Denmark.
    Regber, Susann
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
    Fosse, Elisabeth
    Department of Health Promotion and Development, Faculty of Psychology, Bergen University, Bergen, Norway.
    Eklund Karlsson, Leena
    Unit for Health Promotion Research, University of Southern Denmark, Esbjerg, Denmark.
    Gunnarsdottir, Hrafnhildur
    Department of Health Sciences, University West, Trollhättan, Sweden.
    Economic poverty among children and adolescents in the Nordic countries2018In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 46, no Suppl. 20, p. 30-37Article in journal (Refereed)
    Abstract [en]

    Aims: This study aimed to identify applied definitions and measurements of economic poverty and to explore the proportions and characteristics of children and adolescents living in economic poverty in Denmark, Finland, Iceland, Norway and Sweden during the last decade and to compare various statistics between the Nordic countries.

    Methods: Official data from central national authorities on statistics, national reports and European Union Statistics of income and living conditions data were collected and analysed during 2015–2016.

    Results: The proportion of Nordic children living in economic poverty in 2014 ranged from 9.4% in Norway to 18.5% in Sweden. Compared with the European Union average, from 2004 to 2014 Nordic families with dependent children experienced fewer difficulties in making their money last, even though Icelandic families reported considerable difficulties. The characteristics of children living in economic poverty proved to be similar in the five countries and were related to their parents’ level of education and employment, single-parent households and – in Denmark, Norway and Sweden – to immigrant background. In Finland, poverty among children was linked in particular to low income in employed households.

    Conclusions: This study showed that economic poverty among Nordic families with dependent children has increased during the latest decade, but it also showed that poverty rates are not necessarily connected to families’ ability to make their money last. Therefore additional studies are needed to explore existing policies and political commitments in the Nordic countries to compensate families with dependent children living in poverty. © 2018, © Author(s) 2018.

  • 14.
    Regber, Susann
    Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Barriers and Facilitators of Health Promotion and Obesity Prevention in Early Childhood: A Focus on Parents, Results from the IDEFICS Study2014Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Background: Childhood obesity has increased dramatically during the past thirty years. Parents are key persons in their children’s lives and their efforts to create healthy lifestyles are very important. However, social and economic determinants of health also affect parents’ opportunities to promote a healthy lifestyle.

    Aims: To explore barriers and facilitators in promoting healthy lifestyles and preventing childhood obesity, focusing on parental roles.

    Methods and main findings: Three studies originated from the Identification and Prevention of Dietary- and Lifestyle-induced health Effects in Children and InfantS (IDEFICS) study of determinants for two to nine-year-old children’s health in eight European countries. The fourth study was a qualitative interview study conducted in southwest Sweden.

    Paper I: In focus group discussions (20 focus groups with children and 36 with parents), parents described lack of time, financial constraints, availability and food marketing techniques as barriers for promoting healthy eating. School policies about food varied; only Sweden and Estonia provided free school lunches. Children described great variation in the availability of unhealthy foods and beverages in their homes.

    Paper II: Objectively measured Body Mass Index (BMI) of children (n=16 220) were compared to parents’ perception of and concern for their children’s health and weight status. In all weight categories and all countries, a substantial proportion of parents failed to accurately judge their child’s weight status. In general, parents considered their children to be healthy, irrespective of their weight status. Parents of children with overweight or obesity systematically underestimated their children’s weight status across eight European countries. Accurate parental weight perception in Europe differed according to geographic region.

    Paper III: Swedish IDEFICS participants (n=1825) were compared with an age- and sex-matched referent population (n=1825), using registers from Statistics Sweden and the Swedish Medical Birth Register. Longitudinal child growth data (n=3650) were collected from child health centers and school health services. Families with low income, less education, foreign background or single parenthood were underrepresented in the IDEFICS study. BMI at inclusion had no selection effect but, at eight years of age, the obesity prevalence was significantly greater among referents.

    Paper IV: A qualitative content analysis was used to interpret the findings from interviews with nurses (n=15) working at child health centers in the southwest of Sweden. The BMI Chart to identify overweight and obesity in children facilitated greater recognition but nurses used it inconsistently, a barrier to prevention. Other barriers were obesity considered a sensitive issue and that some parents wanted overweight children.

    Conclusion: Parents may not perceive their child’s growth trajectory from overweight to obesity, and the preschool years may pass without effort to change lifestyle. Therefore, objective measurement and information of children’s BMI weight status by healthcare professionals is of great importance. To reach all parents and avoid selection bias, health surveys or health promoting activities must be tailored. Health promoting activities at the family level as well as the societal level should start early in children’s lives to prevent childhood obesity.

  • 15.
    Regber, Susann
    Drottning Silvias barn- och ungdomssjukhus, Göteborg, Sverige.
    Föräldramodeller vid behandling av ungdomar med fetma2005Conference paper (Other academic)
    Abstract [sv]

    Runda barn-teamet har sedan år 2000 behandlat ca 300 barn och ungdomar i åldrarna 10-18 år med fetma. Behandlingsmodeller med syfte att skapa livsstilsförändringar avseende kost, fysisk aktivitet och beteendemodifikation har prövats i grupp och individuellt. Föräldramedverkan i olika grader har varit ett krav i alla former av behandling. Kunskapen om hur integration och engagemang av föräldrar påverkar behandlingsresultat är vetenskapligt otillräckligt belyst. Klinisk erfarenhet har dock ökat förståelsen för dessa samband. Ett syfte är att beskriva föräldraroller och dess inverkan i förändringsarbetet med barn och ungdomar med svår fetma och att identifiera typsituationer i dessa familjer som har betydelse för behandlingen. Med utgångspunkt från ungdomsmedicinsk modell för föräldraroller kan effekter på förändringsarbete beskrivas. Ett femtonatal åldersspecifika typsituationer har från klinisk behandling kunnat identifieras och illustreras. Föräldrastilen vid ledningen av ungdomarna har i dessa situationer en central roll att spela vid förändringsarbetets fortskridan.

  • 16.
    Regber, Susann
    Nordic School of Public Health, Göteborg, Sverige.
    Föräldrar underskattar ofta sina barns övervikt2012In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 109, no 51-52, p. 2343-2343Article in journal (Other academic)
  • 17.
    Regber, Susann
    Drottning Silvias barn- och ungdomssjukhus, Göteborg, Sverige.
    Rökbeslut hos ungdomar med diabetes: en intervjustudie2003Conference paper (Refereed)
    Abstract [sv]

    Rökning hos ungdomar med diabetes är otillräckligt belyst inom forskningsområdet för diabetesvård. Det är dock klarlagt att kombinationen diabetes och rökning ytterligare ökar diabetessjukdomens risker för senkomplikationer som leder till ökad morbiditet och mortalitet. En intervjustudie med syfte att få en ökad förståelse för hur rökande ungdomar med diabetes tänker kring rökning, sjukdom och hälsa genomfördes from hösten 1999 tom hösten 2000. Bandinspelade intervjuer gjordes med 12 rökande ungdomar med diabetes i åldern 15-20 år. Ett ungdomsmedicinskt-, ett utvecklingsekologiskt och ett psykologiskt perspektiv på mänskligt beslutsfattande utgjorde grund för intervjufrågorna. Materialet analyserades kvalitativt utifrån Miles och Hubermann (1994) och resulterade i 3 huvudteman: Rökprocessen, Ungdomarnas syn på hälsa i relation till rökning och diabetes och Påverkansfaktorer ur ett ekologiskt perspektiv på individ-, mikro-, meso-, exo-, och makronivå. Resultatet visar att utvecklingen av regelbundet rökande föregås av en process, där ett led är ett aktivt val att bli rökare. Rökbeslutet förklaras av att rökning ingår som en integrerad del i en önskad identitet eller att man vill tillhöra kretsen av rökare i sin närmiljö. Resultatet visar också att det dock finns en möjlighet till påverkan och omprövning av beslutet att bli rökare på alla ekologiska nivåer. En majoritet av ungdomarna i studien beskrev nikotinberoende som en orsak till att man befäst sitt rökande. Slutsatsen är att ungdomar med diabetes- och sannolikt ungdomar generellt, väljer att bli rökare under rökbefrämjande omständigheter men att mottaglighet för omvärdering av rökbeslut finns och rökpreventiva insatser kan sättas in, under skilda faser av utvecklingen till rökare och i skilda miljöer.

  • 18.
    Regber, Susann
    et al.
    Sahlgrenska University Hospital, Göteborg, Sweden.
    Arfwidsson, Charlotte
    Sahlgrenska University Hospital, Göteborg, Sweden.
    Mårild, Staffan
    Sahlgrenska University Hospital, Göteborg, Sweden.
    Rönnbäck, Cathrine
    Sahlgrenska University Hospital, Göteborg, Sweden.
    Do Obese Adolescents Have Anorectic Body Ideals?2004Conference paper (Refereed)
    Abstract [en]

    Aims: To assess if obese adolescents have a realistic perception of current body size and a reasonable expectation of body size outcome when starting a paediatric weight watcher´s (WW) treatment programme.

    Methods: The tool used was a 7-point scale with gender relevant figures, ranging from thin to fat in a fixed, sequentially ordered way and with height held constant (Collins, M. E. 1991). Before starting up a 16-week paediatric WW programme, 34 subjects (age 10-17, mean 13.6 years, 20girls) filled in their rated actual body size and their expected body size after treatment. Obesity was defined according to International Obesity Task Force measured with Body mass index standard deviation score(BMI SD).

    Results: The Mean score for chosen current body size picture was 6.0,min.- max.values 5-7 and mean score 4.4, min-max.values 3-5 for the expected body size picture. Children’s choice of body figure correlated to their BMI SD as follows: Picture 5, BMI SD = 2.96 (n=4), Picture 6, BMISD = 3.07 (n=25), Picture 7, BMI SD 3.61 (n=5), R=0.40*. The mean picture difference was 1.65 min.-max value 1-3. The slimmest figures 1 and 2 were never chosen.

    Conclusions: Obese adolescents appear to have a realistic perception of their current body size and reasonable expectations of body size outcome after treatment intervention. The risk of inducing anorectic behaviour when starting the treatment appears to be small in adolescents with obesity.

  • 19.
    Regber, Susann
    et al.
    Department of Pediatrics, Institute for the Health of Women and Children, Göteborg University, The Queen Silvia Children’s Hospital, Göteborg, Sweden.
    Berg Kelly, Kristina
    Department of Pediatrics, Institute for the Health of Women and Children, Göteborg University, The Queen Silvia Children’s Hospital, Göteborg, Sweden.
    Missed opportunities–adolescents with a chronic condition (insulin-dependent diabetes mellitus) describe their cigarette-smoking trajectories and consider health risks2007In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 96, no 12, p. 1770-1776Article in journal (Refereed)
    Abstract [en]

    AIM: To enhance our knowledge on why adolescents with a chronic condition (insulin-dependent diabetes mellitus, IDDM) choose to smoke despite possible awareness of health risks.

    METHODS: Twelve patients aged 15-20 with IDDM who smoked cigarettes volunteered to participate in qualitative interviews. The results were analyzed with content analysis according to Miles and Huberman 1994.

    RESULTS: One set confirmed what is earlier known on cigarette smoking among adolescents, such as plain exploring, needs to conform with group norms, identity needs and denial of risks. Other themes gave new insights. One was the emotional attitudes-or lack of emotions-expressed by important others, which exerted strong influences on the smoking trajectories. These emotions affected both initiation and motivation for quitting cigarette smoking and seemed crucial as means of meaningful communications concerning smoking. One theme was a flow path of cigarette smoking, which demonstrated opportunities for secondary prevention. Finally, developmental reasons for smoking and motivation for quitting could be described.

    CONCLUSIONS: There are several windows of opportunities to lower the risk of adolescents with IDDM and other chronic conditions from becoming and remaining smokers, as reported by young people themselves. © 2007 The Author(s).

  • 20.
    Regber, Susann
    et al.
    Queen Silvia Children's Hospital, Göteborg, Sweden.
    Berg-Kelly, Kristina
    Department Of Pediatrics Medical Faculty, Göteborg, Sweden.
    Mårild, Staffan
    Queen Silvia Children's Hospital, Göteborg, Sweden.
    Parenting Styles and Treatment of Adolescents with Obesity2007In: Pediatric Nursing, ISSN 0097-9805, Vol. 33, no 1, p. 21-28Article in journal (Refereed)
    Abstract [en]

    Professional caregivers have an important task in building a trusting relationship with parents and adolescents and in supporting parents in their parental roles. Our clinical experience of some 300 adolescents with obesity between 9 and 18 years of age and their parents has convinced us that consideration of parenting styles is fundamental in the treatment of children and adolescents with obesity. Typical case situations supporting the significance of parenting styles and illustrating the relationships between parents and adolescents with obesity can be identified. Group sessions with parents are the preferred mode for discussing typical parenting issues in the management of obese adolescents. The purpose of this paper is to describe different parenting styles, and to present a set of typical case situations and treatment strategies for nurses working with adolescents with obesity.

  • 21.
    Regber, Susann
    et al.
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
    Dahlgren, Jovanna
    Department of Pediatrics, Institute of Clinical Sciences, The Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden.
    Janson, Staffan
    Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden.
    Neglected children with severe obesity have a right to health: Is foster home an alternative?—A qualitative study2018In: International Journal of Child Abuse & Neglect, ISSN 0145-2134, E-ISSN 1873-7757, no 83, p. 106-119Article in journal (Refereed)
    Abstract [en]

    Objective: To explore key person’s perspectives of foster home placement or notification of risk of harm to Social Services of children with severe obesity.

    Methods: This case study research was performed in the southwest of Sweden and based on interviews with nine informants: a foster home youth, two foster parents, a social worker, two hospital social workers, a pediatric physician, a pediatric nurse, and a psychologist. Content analysis was used for narrative evaluations, within- and cross case analyses and displays.

    Results: Positive health outcomes of the foster home placement were described as a healthy and normalized weight status, a physically and socially active life, and an optimistic outlook on the future. The foster parents made no major changes in their family routines, but applied an authoritative parenting style regarding limit setting about sweets and food portions and supporting physical activity. The professionals described children with severe obesity as having suffered parental as well as societal neglect. Their biological parents lacked the ability to undertake necessary lifestyle changes. Neglected investigations into learning disabilities and neuropsychiatric disorders were seen in the school and healthcare sector, and better collaboration with the Social Services after a report of harm might be a potential for future improvements. Rival discourses were underlying the (in) decision regarding foster home placement.

    Conclusion: A child’s right to health was a strong discourse for acting when a child was at risk for harm, but parental rights are strong when relocation to a foster home is judged to be necessary. © 2018 Elsevier Ltd

  • 22.
    Regber, Susann
    et al.
    Dep. of Pediatrics, The Queen Silvia Children's Hospital, Göteborg University, Göteborg, Sweden.
    Grufman, Marianne
    Dep. of Pediatrics, The Queen Silvia Children's Hospital, Göteborg University, Göteborg, Sweden.
    Jochens, Petra
    Dep. of Pediatrics, The Queen Silvia Children's Hospital, Göteborg University, Göteborg, Sweden.
    Mårild, Staffan
    Dep. of Pediatrics, The Queen Silvia Children's Hospital, Göteborg University, Göteborg, Sweden.
    Gender related coping-strategies in obese children and adolescents2002Conference paper (Refereed)
  • 23.
    Regber, Susann
    et al.
    Drottning Silvias barn- och ungdomssjukhus, Göteborg, Sverige.
    Grufman, Marianne
    Primärvården, Göteborg, Sverige.
    Jochens, Petra
    Drottning Silvias barn- och ungdomssjukhus, Göteborg, Sverige.
    Mårild, Staffan
    Drottning Silvias barn- och ungdomssjukhus, Göteborg, Sverige & Göteborgs universitet, Göteborg, Sverige.
    Genusrelaterade coping-strategier hos ungdomar med fetma2003Conference paper (Refereed)
    Abstract [sv]

    Bakgrund: Övervikt och fetma ökar i förekomst bland barn i Sverige. Många upplever sig bli retade i skolan och den sociala och psykologiska påverkan av detta har inte blivit kartlagt tidigare. ´Bullying´+´obesity´i Medline gav t ex inga träffar! Att kartlägga överviktiga ungdomars hälsa, livssituation och livsstil samt jämföra detta med en kontrollgrupp och en referensgrupp kändes därför angeläget.

    Metod: Vi gjorde en enkätundersökning på fyrtio ungdomar med fetma, 10-17 år gamla, som deltog i Runda Barn-teamets verksamhet i Göteborg. Undersökningen utfördes 2000-2001. Fetma definierades med åldersanpassade Body Mass Index värden motsvarande BMI 30 vid 18 års ålder. Tjugo kontroller med normalvikt deltog. Vid första besöket användes en enkät, Q 90, för att beskriva egen upplevd hälsa. Socioekonomiska, psykologiska och fysiska hälso- och livsstils-faktorer studerades. Referensdata för enkäten baserades på svar från 4502 13-14 år gamla pojkar och flickor insamlade 1998.

    Resultat: Följande skillnader mellan grupperna framkom: mobbning rapporterades hos 58%, 15% och 25% för de med fetma, för kontroller och i referensgrupp. Läs- och skrivsvårigheter rapporterades för 22%, 0% och 13 % i respektive grupp. Genusrelaterade skillnader var undvikande av skolgymnastik hos flickor (45% mot 25 % i referensgruppen) och ökad förekomst av slagsmål hos pojkar (82% mot 65%). Livssynen scorades på en visuell analogskala till 7.1 för ungdomar med fetma, 7.6 för referensgruppen och 8.6 för kontrollgruppen.

    Sammanfattning: Fetma hos ungdomar innebär en försvårad livssituation på många vis. Sjukdomen i sig har många medicinska konsekvenser och samband men därutöver för den med sig ytterligare sociala och psykologiska svårigheter. Detta är viktigt att beakta i behandlingsarbetet.

  • 24.
    Regber, Susann
    et al.
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
    Jormfeldt, Henrika
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
    Foster homes for neglected children with severe obesity— Debated but rarely studied2019In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 108, no 11, p. 1955-1964Article in journal (Refereed)
    Abstract [en]

    Aim: To explore current research and theoretical articles on foster home placement of children with severe obesity.

    Methods: An integrative literature review. Literature searches in six electronic databases included theoretical, quantitative and qualitative articles and case reports published in English (2008‐2018) on the topic of severe childhood obesity and foster home placement.

    Results: Seventeen selected papers included six theoretical articles, nine quantitative studies, one qualitative study and one case report. Eight of the nine quantitative studies did not specify the grading of obesity in children in foster care. The case report and the qualitative study showed distinct and sustainable body mass index (BMI) reductions after a child had been placed in foster care. Five theoretical articles justified foster care placement when chronic parental neglect led to severe obesity in the child, while one article emphasised the opposite.

    Conclusion: Parental and societal neglect of children with severe obesity placed in a foster home is rarely studied or the exclusive aim of research. The views of the chil‐dren themselves are lacking in research articles, as well as the child’s right to health obligations concerning children with severe obesity. © 2019 Foundation Acta Pædiatrica. Published by John Wiley & Sons Ltd.

  • 25.
    Regber, Susann
    et al.
    Sahlgrenska Academy, Göteborg University, Göteborg, Sweden.
    Mårild, Staffan
    Sahlgrenska Academy, Göteborg University, Göteborg, Sweden.
    Parenting styles and treatment of adolescents with obesity2005Conference paper (Refereed)
    Abstract [en]

    Aim: To describe parenting models and support of parents in treatment of adolescents with obesity, identify age specific and typical situations of relevance for the treatment of adolescents with obesity, and suggest treatment strategies from these perspectives.

    Method: Four cornerstones are used: (1) employ a model of parent roles used in adolescent medicine to describe changes and treatment effects, (2) adapt treatment to characteristics typical for different ages and developmental stages of adolescents as defined in adolescent medicine, (3) create motivating dialogues with parents and adolescents and build a trusting relationship that gives incitement to change, (4) use the feedback experience from group and individual treatment from a total of 180 patients, 10–18 y, with parents.

    Results: Fifteen age-specific, typical situations where parenting roles and styles in the rearing of adolescents have a central role in the treatment of adolescents with obesity were identified and illustrated.

    Conclusion: There are typical situations in the relations between parents and adolescents with obesity where the parenting style plays a key role and where caregivers can have an important task in supporting the parents in their parent role. These situations need to be given a more central place and opportunity for dialogue in treatment in order to be able to form changes in lifestyle and behaviour in the young.

  • 26.
    Regber, Susann
    et al.
    Drottning Silvias barn- och ungdomssjukhus, Göteborg, Sverige.
    Mårild, Staffan
    Drottning Silvias barn- och ungdomssjukhus, Göteborg, Sverige.
    Eiben, Gabriele
    Sahlgrenska Akademien, Göteborgs Universitet, Göteborg, Sverige.
    Fokusgrupper och individuella intervjuer som instrument för hälsofrämjande insatser i Västra Götaland och som del i EU-projektet IDEFICS: Intervjuer i fokusgrupper, Resultatet i korthet/rapport2007Report (Other academic)
  • 27.
    Regber, Susann
    et al.
    Nordic School of Public Health NHV, Gothenburg, Sweden & Department of Public Health and Community Medicine, Public Health Epidemiology Unit, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Mårild, Staffan
    Department of Paediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Johansson Hanse, Jan
    Nordic School of Public Health NHV, Gothenburg, Sweden & Department of Psychology, University of Gothenburg, Gothenburg, Sweden.
    Barriers to and facilitators of nurse-parent interaction intended to promote healthy weight gain and prevent childhood obesity at Swedish child health centers2013In: BMC Nursing, ISSN 1472-6955, E-ISSN 1472-6955, Vol. 12, article id 27Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Overweight and obesity in preschool children have increased worldwide in the past two to three decades. Child Health Centers provide a key setting for monitoring growth in preschool children and preventing childhood obesity.

    METHODS: We conducted semi-structured interviews with 15 nurses working at Child Health Centers in southwest Sweden in 2011 and 2012. All interviews were tape recorded and transcribed verbatim and imported to QSR N'Vivo 9 software. Data were analyzed deductively according to predefined themes using content analysis.

    RESULTS: Findings resulted in 332 codes, 16 subthemes and six main themes. The subthemes identified and described barriers and facilitators for the prevention of childhood obesity at Child Health Centers. Main themes included assessment of child's weight status, the initiative, a sensitive topic, parental responses, actions and lifestyle patterns. Although a body mass index (BMI) chart facilitated greater recognition of a child's deviant weight status than the traditional weight-for-height chart, nurses used it inconsistently. Obesity was a sensitive topic. For the most part, nurses initiated discussions of a child's overweight or obesity.

    CONCLUSION: CHCs in Sweden provide a favorable opportunity to prevent childhood obesity because of a systematic organization, which by default conducts growth measurements at all health visits. The BMI chart yields greater recognition of overweight and obesity in children and facilitates prevention of obesity. In addition, visualization and explanation of the BMI chart helps nurses as they communicate with parents about a child's weight status. On the other hand, inconsistent use and lack of quality assurance regarding the recommended BMI chart was a barrier to prevention, possibly delaying identification of overweight or obesity. Other barriers included emotional difficulties in raising the issue of obesity because it was perceived as a sensitive topic. Some parents deliberately wanted overweight children, which was another specific barrier. Concerned parents who took the initiative or responded positively to the information about obesity facilitated prevention activities.

  • 28.
    Regber, Susann
    et al.
    Nordic School of Public Health NHV, Gothenburg, Sweden.
    Novak, M.
    Department of Emergency and Cardiovascular Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Eiben, G.
    Department of Public Health and Community Medicine, Public Health Epidemiology Unit, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Bammann, K.
    Institute for Public Health and Nursing Research, University of Bremen, Bremen, Germany & BIPS-Institute for Epidemiology and Prevention Research, Bremen, Germany.
    De Henauw, S.
    Department of Movement and Sport Sciences, Ghent University, Ghent, Belgium.
    Fernández-Alvira, J. M.
    GENUD (Growth Exercise, Nutrition and Development) Research Group, University School of Health Sciences (EUCS), University of Zaragoza, Zaragoza, Spain.
    Gwozdz, W.
    Department of Intercultural Communication & Management, Copenhagen Business School, Frederiksberg, Denmark.
    Kourides, Y.
    Research & Education Institute of Child Health/Strovolos, Cyprus.
    Moreno, L. A.
    GENUD (Growth Exercise, Nutrition and Development) Research Group, University School of Health Sciences (EUCS), University of Zaragoza, Zaragoza, Spain.
    Molnár, D.
    Department of Pediatrics, University of Pécs, Pécs, Hungary.
    Pigeot, I.
    Department of Biometry and Data Management, BIPS-Institute for Epidemiology and Prevention Research, Faculty 03 Mathematics and Computer Science, University of Bremen, Bremen, Germany.
    Reisch, L.
    Department of Intercultural Communication & Management, Copenhagen Business School, Frederiksberg, Denmark.
    Russo, P.
    Epidemiology & Population Genetics, Institute of Food Sciences, CNR, Avellino, Italy.
    Veidebaum, T.
    National Institute for Health Development, Tallinn, Estonia.
    Borup, I.
    Nordic School of Public Health NHV, Gothenburg, Sweden.
    Mårild, S.
    Department of Paediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Parental perceptions of and concerns about child's body weight in eight European countries – the IDEFICS study2013In: Pediatric Obesity, ISSN 2047-6302, E-ISSN 2047-6310, Vol. 8, no 2, p. 118-129Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: To evaluate parental perceptions of and concern about child's body weight and general health in children in a European cohort.

    DESIGN: Cross-sectional multi-centre study in eight European countries.

    PARTICIPANTS: 16,220 children, ages 2-9 years.

    METHODS: Parents completed a questionnaire regarding children's health and weight and concern about overweight and underweight. Objective children's weight categories from the International Obesity Task Force were used. Logistic regression models were utilized to identify predictors of accurate weight perception.

    RESULTS: Parental weight perception corresponded overall to children's mean body mass index (BMI) z-scores, with important exceptions. About one-third of the total indicated concern about underweight, paradoxically most often parents of children in the overweight or obesity categories. In 63%, parents of children in the overweight category marked 'proper weight'. The strongest predictor for accurate parental weight perception for children with overweight and obesity was BMI z-score (odds ratio [OR] = 7.2, 95% confidence interval [CI] 6.1-8.7). Compared to Southern Europe, ORs for accurate parental weight perception were 4.4 (95% CI 3.3-6.0) in Northern Europe and 3.4 (95% CI 2.7-4.2) in Central Europe.

    CONCLUSION: Parents of children categorized as being overweight or obese systematically underestimated weight. Parents differed regionally regarding accurate weight perception and concern about overweight and underweight.

  • 29.
    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.

  • 30.
    Regber, Susann
    et al.
    Dept. of Public Health and Community Medicine, University of Gothenburg, Gothenburg, Sweden.
    Novak, Masuma
    Dep. of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden.
    Gwozdz, Wencke
    Dep. of Intercultural Communication & Management, Copenhagen Business School, Frederiksberg, Denmark.
    Lissner, Lauren
    Dept. of Public Health and Community Medicine, University of Gothenburg, Gothenburg, Sweden.
    Hense, Sabrina
    Dep. of Epidemiological Methods and Etiologic Research, (BIPS), Bremen, Germany.
    Zverkova Sandström, Tatiana
    Nordic School of Public Health NHV, Gothenburg, Sweden.
    Ahrens, Wolfgang
    Dep. of Epidemiological Methods and Etiologic Research, (BIPS), Bremen, Germany.
    Mårild, Staffan
    Dep. of Paediatrics, Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden.
    Family Socioeconomic Status and Participation Bias in the Swedish IDEFICS Health Survey of Young Children: Implications for Health Promoting Interventions?2014In: / [ed] Professor David York, Chichester: Wiley-Blackwell, 2014, Vol. 15, no Suppl. S2, p. 208-209Conference paper (Refereed)
    Abstract [en]

    Background: Childhood obesity has an uneven socioeconomic distribution. In health interventions, equity aspects are crucial. In 2007–2008, the IDEFICS/Sweden health survey (Identification and prevention of dietary- and lifestyle-induced health effects in children and infants) was performed in children aged 2–9 years, followed by a health promoting community intervention.

    Aims: To assess if families with disadvantageous socioeconomic and -demographic backgrounds and children with obesity were underrepresented.

    Methods:  IDEFICS participants (N = 1,825) were compared with a referent child matched for age, gender and municipality (N = 1,825) by using registers from Statistics Sweden. Longitudinal growth data from birth to 8 years was collected from local health services (n = 3,650) to compare children's BMI standard deviation score (SDS) at age of inclusion in the IDEFICS study (BMI SDS-index) and the children's BMI-categories during the age-span between the groups.

    Results: The referent population had significantly lower education and income, more often foreign backgrounds, single parenthood and mother-smokers than the IDEFICS population. BMI SDS-index at inclusion did not differ between groups but the obesity prevalence differed significantly at age 8 years (referents: 4.5% vs. IDEFICS: 2.9%). In the multivariate adjusted model, parental Swedish background showed the strongest association to participation (odds ratio = 1.91, 95% confidence interval (1.48–2.47).

    Conclusion:  Children with disadvantageous socioeconomic and -demographic backgrounds were underrepresented in the Swedish IDEFICS study. BMI at inclusion had no selection effect, but developing obesity was significantly greater among referents. Selection biases are important to consider when interpreting results from health surveys and in planning intervention programmes.

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