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  • 1. Berggren, Ulf
    et al.
    Hägglin, Catharina
    Hallberg, Ulrika
    Halmstad University, School of Social and Health Sciences (HOS), Centre of Research on Welfare, Health and Sport (CVHI).
    Hallberg, Lillemor R.-M.
    Halmstad University, School of Social and Health Sciences (HOS), Centre of Research on Welfare, Health and Sport (CVHI).
    Psychological and Quality of Life Aspects of Edentulousness and Treatment with Dental Implants2005In: The osseointegration book: from calvarium to calcaneus, Berlin: Quintessence Publishing , 2005, p. 157-172Chapter in book (Refereed)
  • 2.
    Bernson, Jenny M.
    et al.
    Department of Behavioral and Community Dentistry, Institute of Odontology, The Sahlgrenska Academy, University of Gothenburg, Sweden.
    Hallberg, Lillemor R.-M.
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
    Elfstrom, Magnus L.
    Department of Psychology, School of Sustainable Development of Society and Technology, Mälardalen University, Eskilstuna, Sweden.
    Hakeberg, Magnus
    Department of Behavioral and Community Dentistry, Institute of Odontology, The Sahlgrenska Academy, University of Gothenburg, Sweden.
    'Making dental care possible - a mutual affair'. A grounded theory relating to adult patients with dental fear and regular dental treatment2011In: European Journal of Oral Sciences, ISSN 0909-8836, E-ISSN 1600-0722, Vol. 119, no 5, p. 373-380Article in journal (Refereed)
    Abstract [en]

    Dental fear is a common and widespread problem, which can cause severe stress. Even so, most patients with dental fear undergo regular dental treatment in spite of their fear and many enjoy good oral health. The aim of this study was to obtain a deeper understanding of how patients with dental fear manage to undergo dental treatment. Fourteen patients with dental fear, who undergo regular dental care, were interviewed. Qualitative analysis of the transcribed interviews was performed according to the principles of grounded theory. A conceptual framework was generated, and the main concern was identified as 'making dental care possible - a mutual affair'. Four additional categories explained how patients handled their dental fear and how dental care became possible. The strategies were labelled 'taking part in a mental wrestling match', 'trust-filled interaction with dental staff', 'striving for control' and 'seeking and/or receiving social support'. The results showed that making dental care possible for patients with dental fear is a mutual challenge that requires interplay between dental staff and patients, involving verbal and non-verbal communication reflecting respect, attention, and empathy. Moreover, a balance between nearness and distance and between professional and personal treatment is required.

  • 3.
    Flemme, Inger
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
    Health-related quality of life in recipients with an implantable cardioverter defibrillator due to life-threatening arrhythmias: a 5 year follow-up2004Licentiate thesis, comprehensive summary (Other academic)
    Abstract [en]

    The general aim of this thesis was to describe self-reported health-related quality of life (HRQoL) in recipients with an implantable cardioverter defibrillator (ICD) due to life-threatening arrhythmias over a S-year period. The design was prospective and longitudinal. Fifty-six patients participated in Paper I, and 35 of these patients, who had survived at least five years, were included in Paper II. All patients had received their ICD as a form of secondary prevention. The Quality of Life Index-Cardiac version (QLI-C), Mishel Uncertainty in Illness Scale-Community version (MUIS-C), and multiple regression analysis were used. Higher scores indicate higher HRQoL and uncertainty. The questionnaires were completed on four occasions: before implantation, at three months and at 1 year and 5 years after implantation. ICD recipients were also asked how many shocks they had perceived. At the S-year data collection, the  average ICD recipient had lived with an ICD for 6 years and 9 months. In general, HRQoL was lower at year 1 than at baseline (p : 0.033). A decrease in the socioeconomic domain was observed at year 1 (p : 0.006) but improved again at year 5 (p : 0.027) although it remained below the baseline value, ICD recipients' satisfaction with the family domain decreased from the time of the ICD implantation (p < 0.001) and from year I (p : 0.039) to year 5 after implantation. Uncertainty related to information had  decreased at year 1 in relation to baseline (p < 0.001). A decrease in overall uncertainty was observed at year 5 in relation to year 1 (p : 0.009) as well as at year 5 in relation to baseline (p : 0.009). The longer the ICD recipient had lived with the device, the greatil the risk of receiving a shock. However, ICD recipients who  received shocks reported being less troubled by them over time. Uncertainty was identified as a predictor of low HRQoL. The recipients reported a higher level of HRQoL at year 5 than at year 1. HRQoL was reasonably good 5 years after implantation, and the ICD recipients felt more secure and perceived their ICD as a lifesaver.

  • 4.
    Hallberg, Lillemor
    et al.
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
    Hakeberg, Magnus
    Univ Gothenburg, Sahlgrenska Acad, Inst Odontol, Dept Behav & Community Dent, S-40530 Gothenburg, Sweden..
    Hallberg, Ulrika
    Nordic Sch Publ Hlth, Gothenburg, Sweden..
    Facing a moral dilemma - introducing a dental care insurance within the Public Dental Service2012In: Swedish Dental Journal, ISSN 0347-9994, Vol. 36, no 3, p. 149-156Article in journal (Refereed)
    Abstract [en]

    Through the reform entitled "Dental care insurance dental care at a fixed price", patients are offered a dental insurance, a capitation plan, that ensures that they can visit the dentist regularly during a period of three years at a fixed price per month (Frisktandvard). This insurance may be offered to all patients. The aim of this study was to generate a theory explaining the main concern for the staff at the public dental service when they have to introduce and advocate dental care insurance to patients. Interview data from 17 persons, representing different professions within the public dental service, were collected and analyzed simultaneously in line with guidelines for grounded theory. The results indicated that dentists/dental hygienists experienced several difficult standpoints concerning the implementation of the dental insurance, somewhat of a moral dilemma. The staff generally had a "cautiously positive attitude" to the forthcoming dental care insurance, but had perceptions how and when the patients should be offered the insurance and what that may mean to the clinic. The respondents reflected about the economic aspects for the clinic and how the oral health may be affected over time for the patients.

  • 5.
    Hallberg, Ulrika
    et al.
    Halmstad University, School of Social and Health Sciences (HOS), Centre of Research on Welfare, Health and Sport (CVHI).
    Haag, Per
    Nobel Biocare AB, Göteborg, Sweden.
    The subjective meaning of dentition and oral health: Struggling to optimize one's self-esteem2007In: International Journal of Qualitative Studies on Health and Well-being, ISSN 1748-2623, E-ISSN 1748-2631, E-ISSN 1748-2623, Vol. 2, no 2, p. 86-92Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to explore what dentition and oral health mean to adult dental care patients' well-being. Qualitative, taped interviews were conducted with 15 participants (over 20 years of age), who were patients at private and public dental health care units in the western part of Sweden. The constant comparative method of grounded theory was used. The interviews were consecutively analyzed in hierarchical coding processes until saturation was achieved. A conceptual model was generated illuminating the meaning of dentition and oral health for the participant's well-being. The core category of the model, struggling to optimize one's self-esteem, was related to four categories, which further described the psychosocial process of increasing one's self-esteem and contributing to well-being. These categories were labelled investing in oneself, being attractive to others, being able to socialize and showing ones social belonging. People who are satisfied with their teeth in terms of function and appearance seem to have developed an optimized self-esteem, which contributes to the well-being in individuals. Consequently, inequalities in oral health according to social belonging may lead to inequalities in self-esteem and well-being.

  • 6.
    Hallberg, Ulrika
    et al.
    Nordic School of Public Health, Göteborg, Sweden.
    Klingberg, Gunilla
    Mun-H-Center, National Orofacial Resource Centre for Rare Disorders, Göteborg, Sweden.
    Giving low priority to oral health care: Voices from people with disabilities in a grounded theory study2007In: Acta Odontologica Scandinavica, ISSN 0001-6357, E-ISSN 1502-3850, Vol. 65, no 5, p. 265-270Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE.

    Our knowledge of how people with disabilities look upon oral health and dental care is limited. The aim of this study was thus to explore how the people with disabilities experience the encounter with dental health care.

    MATERIAL AND METHODS.

    With a focus on dental care and oral health, qualitative interviews with 16 informants with cognitive and/or physical disabilities were analysed in accordance with the qualitative method of grounded theory.

    RESULTS.

    A core category identified and labeled “giving low priority to oral health care” was found to be related to four other categories: “being afraid of losing control”, “having difficulties complying with instructions”, “having a desire for continuity”, and “wishing to be just like everyone else”. The results show that oral health and dental care are important, but are not considered a priority by the people with disabilities. General health issues have much higher priority but do not include oral health, which consequently can affect oral health negatively.

    CONCLUSIONS.

    Of several factors identified that could be improved to make dental visits more pleasant for patients are enhancing a sense of control in the patient and improving continuity.

  • 7.
    Hattne, Kerstin
    et al.
    Public Dental Clinic, Varberg, Sweden.
    Folke, Solgun
    Halmstad University, School of Social and Health Sciences (HOS), Centre of Research on Welfare, Health and Sport (CVHI).
    Twetman, Svante
    University of Copenhagen, Denmark.
    Attitudes to oral health among adolescents with high caries risk2007In: Acta Odontologica Scandinavica, ISSN 0001-6357, E-ISSN 1502-3850, Vol. 65, no 4, p. 206-213Article in journal (Refereed)
    Abstract [en]

    Objective:

    To explore and describe attitudes to oral health among adolescents with high caries risk.

    Material and methods. A strategic selection of 45 subjects (15 to 19 years of age) assessed with high caries risk were invited to participate in the study, and 7 girls and 10 boys gave their informed consent. Semi-structured interviews performed, recorded, and transcribed verbatim were evaluated using qualitative content analysis.

    Results:

    Three categories and seven associated subcategories could be determined, and cognitive consistency in parallel with emotional inconsistency in relation to oral health was disclosed. On a cognitive level, attitudes to oral health were characterized by an awareness of the determinants (diet, plaque, fluoride) for caries. Fresh breath and even, white, teeth were considered signs of good oral health. Breath and esthetic appearance were important inducements for home care. Although toothbrushing was considered the most important activity for maintaining good oral health, forgetfulness and lack of time were the main reasons for not brushing. The provision of adequate information on caries risk was perceived as important. On the emotional level, the three subcategories were: (i) a positive attitude to oral health and clear self-confidence that improved health would be achieved, (ii) an impassive attitude that everything would be all right and fixed by the dentist, and (iii) a negative attitude characterized by frustration and a tendency to give up.

    Conclusions:

    Allowing adolescents with high caries risk to relate their views on oral health is important for dental professionals when encouraging patients at caries risk towards healthy behavior.

  • 8.
    Isaksson, R.
    et al.
    Cent Hosp, Halmstad, Sweden.
    Fridlund, Bengt
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
    Paulsson, Gun
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
    Nederfors, T.
    Cent Hosp, Halmstad, Sweden.
    Evaluation of an oral health programme for nursing personnel in special housing facilities for the elderly. Part II: Clinical aspects.2000In: Journal of Dental Research, ISSN 0022-0345, E-ISSN 1544-0591, Vol. 79, no 5, p. 1291-1291Article in journal (Other academic)
  • 9.
    Johansson, Gunvi
    Halmstad University, School of Social and Health Sciences (HOS), Centre of Research on Welfare, Health and Sport (CVHI).
    Oral health-related quality of life and young adults2009Licentiate thesis, comprehensive summary (Other academic)
    Abstract [en]

    The aims were to describe and analyse measures for oral health-related quality of life (OHRQOL) from a Public Health perspective and to determine young adults' views on dental care. The methods used included one literature review (Paper I) and one empirical study with qualitative design (Paper II). In Paper I, twenty-two measures for oral healthrelated quality of life (OHRQOL) were analysed from a public health perspective as to the mirroring of the health promotion principles empowerment, participation, holism and equity. In Paper II, regular dental attenders in Sweden aged 21-30 were interviewed about their views on dental care. Data from eleven interviews were analysed in accordance with the constant comparative method. The results in Paper I showed, that elements of the public health principles were found in the OHRQOL measures. There were measures developed for different ages but no measures were specifically adapted to young adults. In Paper II, two principal views in young adults’ views on dental care were discerned: patients’ attitudes to dental care costs and attitudes to given functions within dental care. Dental care costs, as well as the patients’ views on the treatment, however not expressed to the dental staff, were deemed important. Young adults were found to have specific views and demands on received dental care that was not mirrored in the instruments. An urgent task would therefore be to explore young adults’needs and expectations regarding their OHRQOL and dental care.

  • 10.
    Johansson, Gunvi
    et al.
    Halmstad University, School of Social and Health Sciences (HOS), Centre of Research on Welfare, Health and Sport (CVHI).
    Söderfeldt, Björn
    Department of Oral Public Health, Centre for Oral Health Sciences, Malmö University, Malmö, Sweden.
    Wärnberg Gerdin, Elisabeth
    Centre for Public Health Sciences, Östergötland County Council, Linköping, Sweden.
    Halling, Arne
    Department of Health Sciences, Kristianstad University, Kristianstad, Sweden.
    Axtelius, Björn
    Department of Oral Public Health, Centre for Oral Health Sciences, Malmö University, Malmö, Sweden.
    Ostberg, Anna-Lena
    Department of Health and Environmental Sciences, University of Karlstad, Karlstad, Sweden.
    Measuring oral health from a public health perspective2008In: Swedish Dental Journal, ISSN 0347-9994, Vol. 32, no 3, p. 125-137Article in journal (Refereed)
    Abstract [en]

    The paper aims to analyse measures of oral health-related quality of life (OHQOL) from a Public Health perspective. Twenty-two measures were analysed conceptually as to their mirroring of the Public Health principles: empowerment, participation, holism and equity. Elements of empowerment were found in connection with application of the measures. Participation was found in using lay opinions during development in 12 measures. All measures analysed had elements of a holistic approach so far that they were not wholly biological. Two measures captured positive health effects. Measures were available for all ages, various languages and populations, an element of equity. No measure was wholly compatible with Public Health. They were based on a utilitarian theory not in full accordance with modern health promotion. There is a need to develop measures that more obviously capture the positive aspects of health and health as a process, as well as the personal perspective of oral health.

  • 11.
    Johansson, Gunvi
    et al.
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
    Söderfeldt, Björn
    Odontologiska fakulteten, Malmö högskola, Sverige.
    Östberg, Anna-Lena
    Göteborgs universitet, Sverige.
    Young Swedish adults' views on measures of oral health related quality of life2011In: Abstract book: European Association of Dental Public Health, 16th annual meeting, Rome, 22-24 September 2011 / [ed] Andrea Salvati, Roma: CIC Edizioni internazionali , 2011, Vol. 2, p. 33-Conference paper (Refereed)
    Abstract [en]

    The aim of the study was to describe Swedish young adults’ views on three measures of OHRQOL.

    Background: Many measures have been developed to estimate the impact of oral health on quality of life (OHRQOL). However no measure has been especially developed för young adults. This study describes how young adults consider the appropriateness of three available validated and translated measures of OHRQOL.

    Methods: The study had a qualitative approach. Sixteen informants (eight woman and eight men) aged 21-29 years were interviewed during 2010-2011 about their views on the Oral Health Impact Profile (OHIP), the Oral Health-Related Quality of Life-UK (OHRQoL-UK) and the Oral Impacts on Daily Performances (OIDP). The sampling of informants was strategic with reference to age (21-25 yrs, 26-29 yrs), education (compulsory school vs more). Two of the measures were sent to the informants two weeks before the day for the interview, and they were asked to fill in and bring them to the interview. The third measure (OIDP) was presented and the informants answered it orally in connection with the interview. Data was collected by thematic, open-ended interviews. The data analysis was performed by manifest and latent content analysis. The study was approved by the Ethics Committee of Lund University, Lund, Sweden (Dnr 209/124).

    Results: The informants considered the measures to contain relevant and important aspects concerning the oral health related quality of life in young adults. The questionnaires were not to time-consuming to fill in. Furthermore, the young adults were most concerned about their oral health and especially the aesthetics.

    Conclusions: The content in the analysed measures was deemed relevant to the informants but highlighting aspects important to the agegroup would be useful for research and in clinical praxis.

    Acknowledgements: The study was supported by Malmö University, Malmö and Halmstad University, Halmstad, Sweden.

  • 12.
    Josefsson, Eva
    et al.
    Högskolan i Jönköping. Hälsohögskolan.
    Lindsten, Rune
    Högskolan i Jönköping. Hälsohögskolan. Odontologiska institutionen.
    Hallberg, Lillemor R-M
    Halmstad University, School of Social and Health Sciences (HOS), Centre of Research on Welfare, Health and Sport (CVHI).
    A qualitative study of the influence of poor dental aesthetics on the lives of young adults2010In: Acta Odontologica Scandinavica, ISSN 0001-6357, E-ISSN 1502-3850, Vol. 68, no 1, p. 19-26Article in journal (Refereed)
    Abstract [en]

    Objective

    Although many countries offer some publicly funded orthodontic treatment for children, not all conditions receive treatment and some adolescents enter adulthood with persisting poor dental aesthetics or malocclusions. The aim of this study was to generate a theory highlighting the main concerns of young adults, either native-born or of immigrant background, with poor dental aesthetics and the measures they adopt to manage their condition in everyday life.

    Material and methods

    A qualitative method, classic grounded theory, was applied in order to generate a substantive theory highlighting the main concerns and managing mechanisms of 13 strategically selected 19- and 20-year-olds with poor dental aesthetics. Open interviews were conducted with each participant, the topics covering different aspects of social and dental conditions.

    Results

    A core category and three conceptual categories were generated. The core category was labelled "Being under the pressure of social norms" and was related to categories explaining three different ways in which these young adults handle their main concern: (1) avoiding showing their teeth; (2) minimizing the importance of appearance; and (3) seeking orthodontic treatment. The theory offers the potential for improved understanding of young adults who, despite poor dental aesthetics, are managing well with life, and also of those who have not adjusted well.

    Conclusions

    In early adolescence it may be problematic to make decisions about orthodontic treatment. Undisclosed dental fear can be an important barrier. Some of the young adults in the present study would probably benefit from treatment.

  • 13.
    Nederfors, T.
    et al.
    Cent Hosp, Dept Hosp Dent, Halmstad, Sweden.
    Isaksson, R.
    Cent Hosp, Dept Hosp Dent, Halmstad, Sweden.
    Paulsson, Gun
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
    Fridlund, Bengt
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
    Attitudes to the importance of preserving own teeth in an adult Swedish population1998In: Journal of Dental Research, ISSN 0022-0345, E-ISSN 1544-0591, Vol. 77, no 5, p. 1335-1335Article in journal (Other academic)
  • 14.
    Nederfors, T.
    et al.
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
    Paulsson, Gun
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
    Isaksson, R.
    Oral Health Centre, Central Hospital, Halmstad, Sweden.
    Fridlund, Bengt
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
    Ability to estimate oral health status and treatment need in elderly receiving home nursing - a comparison between a dental hygienist and a dentist2000In: Journal of Dental Research, ISSN 0022-0345, E-ISSN 1544-0591, Vol. 79, no 5, p. 1291-1291Article in journal (Other academic)
  • 15.
    Nederfors, Tommy
    et al.
    Oral Health Centre, Central Hospital, Halmstad, Sweden.
    Paulsson, Gun
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
    Isaksson, Rita
    Oral Health Centre, Central Hospital, Halmstad, Sweden.
    Fridlund, Bengt
    Halmstad University, School of Social and Health Sciences (HOS).
    Ability to estimate oral health status and treatment need in elderly receiving home nursing: a comparison between a dental hygienist and a dentist2000In: Swedish Dental Journal, ISSN 0347-9994, Vol. 24, no 3, p. 105-116Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to compare the estimation ability of a dental hygienist to that of a dentist when, independently, recording the oral health status and treatment need in a population of elderly, receiving home nursing. Seventy-three persons, enrolled in a home nursing long-time care programme, were recruited. For the oral examination a newly developed protocol with comparatively blunt measurement variables was used. The oral examination protocol was tested for construct validity and for internal consistency reliability. Statistical analyses were performed using Wilcoxon matched pairs signed rank sum test for testing differences, while inter-examiner agreement was estimated by calculating the kappa-values. Comparing the two examiners, good agreement was demonstrated for all mucosal recordings, colour, form, wounds, blisters, mucosal index, and for the palatal but not the lingual mucosa. For the latter, the dental hygienist recorded significantly more changes. The dental hygienist also recorded significantly higher plaque index values. Also regarding treatment intention and treatment need, the dental hygienist's estimation was somewhat higher. In conclusion, when comparing the dental hygienist's and the dentist's ability to estimate oral health status, treatment intention, and treatment need, some differences were observed, the dental hygienist tending to register "on the safe side", calling attention to the importance of inter-examiner calibration. However, for practical purpose the inter-examiner agreement was acceptable, constituting a promising basis for future out-reach activities.

  • 16.
    Paulsson, Gun
    et al.
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI). Oral Health Centre, Central Hospital, Halmstad, Sweden.
    Söderfeldt, Björn
    Department of Oral Public Health, Malmö University, Malmö, Sweden.
    Fridlund, Bengt
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
    Nederfors, Tommy
    Oral Health Centre, Central Hospital, Halmstad, Sweden.
    Recall of an oral health education programme by nursing personnel in special housing facilities for the elderly2001In: Gerodontology, ISSN 0734-0664, E-ISSN 1741-2358, Vol. 18, no 1, p. 7-14Article in journal (Refereed)
    Abstract [en]

    Objectives: To investigate the recall of oral health knowledge and confidence by nursing personnel in special housing facilities for the elderly, three years after an education programme.

    Design: A cross sectional design using a questionnaire.

    Sample: All nursing personnel, a total of 2,901 subjects, in five municipalities in south-western Sweden; of whom 950 had attended the programme. The response rate was 67% (1930 subjects).

    Intervention: An oral health education programme consisting of four one-hour lessons.

    Results: The oral health education programme still had an effect on the participants' attitudes towards oral health three years later. When comparing the trained group (OHEP+) which attended the programme with those who did not have training (OHEP-), the perceived ability, opportunity and the knowledge of oral health were significantly better in the former group, p<0.01 Eurther, within the OHEP- group who did not attend the programme there was a significant difference in the perceived ability, opportunity and the knowledge of oral health between those with a higher level of health care education, p<0.01.

    Conclusions: The effect of an oral health education programme on the participants' attitudes towards oral health persists at least for three years. The data indicate that trainees with a low level of health care education benefit most.

  • 17.
    Rolandsson, Margot
    et al.
    Division for Health and Caring Sciences, Karlstad University, Karlstad, Sweden.
    Hallberg, Lillemor R.-M.
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
    Hugoson, Anders
    Department of Natural Science and Biomedicine School of Health Science, Jönköping, Sweden.
    Influence of the ice-hockey environment on taking up snuff: an interview study among young males2006In: Acta Odontologica Scandinavica, ISSN 0001-6357, E-ISSN 1502-3850, Vol. 64, no 1, p. 47-54Article in journal (Refereed)
    Abstract [en]

    In Sweden, snuff-use is an established and accepted phenomenon in society, especially in connection with certain sports. The aim of this qualitative study was to analyze and describe the psychosocial environment influencing young male ice-hockey players into starting to use snuff. The study sample comprised 16 male participants between 15 and 32 years of age strategically selected for being active or having been active as ice-hockey players-snuff-users and non-users alike. A grounded theory design, including in-depth interviews, was used to generate a theory from data and thereby create theoretical concepts explaining social phenomena, human behavior, and process. An interview guide containing different themes was used to cover the study area. Five higher-order categories were developed and labeled: having a role model, residing in a consenting environment, experiencing performance demands, experiencing a sense of community and creating an image. Socialization in and through psychosocial norms of the ice-hockey environment was identified as a core category describing the central meaning of the informants' experiences of snuff in the ice-hockey environment. In the present study, the identified categories that integrate within the environment in which the young people reside and pursue their sports activities have been interpreted as factors enhancing the commencement of snuff-use. We suggest health promotion activities within the ice-hockey environment based on a health psychology model of planned behavior.

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