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Publications (10 of 90) Show all publications
Beeres, D., Galanti, M. R., Nilsson, M. & Pulkki-Brännström, A.-M. (2025). Effect of a multicomponent school-based intervention with parental involvement on socioeconomic inequalities in smoking initiation: equity impact analysis of the TOPAS study. Journal of Epidemiology and Community Health, 79(3), 227-232
Open this publication in new window or tab >>Effect of a multicomponent school-based intervention with parental involvement on socioeconomic inequalities in smoking initiation: equity impact analysis of the TOPAS study
2025 (English)In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 79, no 3, p. 227-232Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: As prevalence of tobacco use falls, socioeconomic inequalities in tobacco use are increasing in many high-income countries. Evidence is lacking on the effect of preventive interventions on socioeconomic inequalities in smoking initiation among adolescents. We evaluated whether a multicomponent school-based prevention programme with parental involvement has differential effects on smoking initiation across socioeconomic groups and affects the magnitude of socioeconomic inequalities in smoking initiation.

METHODS: A secondary analysis of data from a 3-year cluster randomised controlled trial, the TOPAS study, conducted in Sweden from 2018 to 2021. Schools were randomised either to the full programme (Tobacco-Free Duo, T-DUO) or minimal intervention (EDU). The analysis was conducted according to intention to treat for the primary outcome, the probability of remaining a non-user of cigarettes at the end of compulsory school (ages 15-16). Parents' educational attainment was the socioeconomic variable. Differential effects were analysed by comparing adolescents exposed to T-DUO with those exposed to EDU within each socioeconomic group. The effect of the intervention on the magnitude of inequalities was analysed by comparing several measures of absolute and relative inequalities between T-DUO and EDU.

RESULTS: At the end of follow-up, the full programme had a similar, at most moderate effect on smoking initiation in all socioeconomic groups (relative risk 1.13 (95% CI 1.02 to 1.25) in the middle group). The programme did not significantly affect the magnitude of inequalities (Slope Index of Inequality difference 1.49 (95% CI -15.34 to 18.32)).

DISCUSSION: Socioeconomic inequalities in smoking initiation remain substantial. Our results indicate the absence of an effect of the programme T-DUO on these inequalities.

Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2025
Keywords
adolescent, inequalities, prevention, smoking
National Category
Public Health, Global Health and Social Medicine
Identifiers
urn:nbn:se:umu:diva-233046 (URN)10.1136/jech-2024-222463 (DOI)001356578000001 ()39532392 (PubMedID)2-s2.0-85214299146 (Scopus ID)
Funder
Public Health Agency of Sweden , 01346-2017 2.3.2
Available from: 2024-12-18 Created: 2024-12-18 Last updated: 2025-05-28Bibliographically approved
van Daalen, K. R., Kriit, H. K., Chen-Xu, J., Semenza, J. C., Nilsson, M., Dasandi, N., . . . Tonne, C. (2025). Europe's climate leadership in an 'America first' era [Letter to the editor]. The Lancet Regional Health: Europe, 51, Article ID 101257.
Open this publication in new window or tab >>Europe's climate leadership in an 'America first' era
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2025 (English)In: The Lancet Regional Health: Europe, E-ISSN 2666-7762, Vol. 51, article id 101257Article in journal, Letter (Refereed) Published
Place, publisher, year, edition, pages
Elsevier, 2025
National Category
Epidemiology Public Health, Global Health and Social Medicine
Identifiers
urn:nbn:se:umu:diva-236494 (URN)10.1016/j.lanepe.2025.101257 (DOI)001440125500001 ()2-s2.0-85219130447 (Scopus ID)
Available from: 2025-03-18 Created: 2025-03-18 Last updated: 2025-03-18Bibliographically approved
Atusingwize, E., Nilsson, M., Egan Sjölander, A., Tumwesigye, N. M., Musoke, D. & Landstedt, E. (2025). Exploring links - Exposure to alcohol adverts on social media in relation to alcohol use among university students in Uganda. Alcohol and Alcoholism, 60(1), Article ID agae081.
Open this publication in new window or tab >>Exploring links - Exposure to alcohol adverts on social media in relation to alcohol use among university students in Uganda
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2025 (English)In: Alcohol and Alcoholism, ISSN 0735-0414, E-ISSN 1464-3502, Vol. 60, no 1, article id agae081Article in journal (Refereed) Published
Abstract [en]

Aim: This study assessed the association between exposure to alcohol adverts on social media and alcohol use among university students in Uganda since alcohol consumption has severe effects, especially in countries with weak regulations for alcohol marketing.

Methods: In total, 996 undergraduate students at Makerere University responded to a questionnaire assessing exposure to alcohol advertising on social media (independent variable) and alcohol use (dependent variable). Adjusted multinomial logistic regression was used to analyse data.

Results: One in ten students reported hazardous drinking, while three in ten students were low-risk drinkers. Most students (70.1%) reported low exposure to alcohol adverts on social media, followed by high exposure (12.1%), and 17.8% reported no exposure. A key finding was that exposure to alcohol adverts on social media was significantly associated with alcohol use, especially the high exposure and hazardous drinking (odds ratio = 12.62, 95% confidence interval: 4.43-35.96). Students reporting high exposure to alcohol adverts on social media also had higher odds of low-risk drinking (odds ratio = 3.70, 95% confidence interval: 1.88-7.27) than those with low exposure (odds ratio = 1.77, 95% confidence interval: 1.09-2.87), in reference to no exposure.

Conclusion: Among Ugandan university students, exposure to alcohol adverts on social media is common and associated with alcohol use, in a dose-response manner. These findings suggest a need for a design and implementation of alcohol interventions for students using social media.

Place, publisher, year, edition, pages
Oxford University Press, 2025
Keywords
alcohol advert, alcohol marketing, alcohol use, social media, Uganda, university students
National Category
Drug Abuse and Addiction Public Health, Global Health and Social Medicine Media and Communications
Identifiers
urn:nbn:se:umu:diva-236020 (URN)10.1093/alcalc/agae081 (DOI)001373042800001 ()39656669 (PubMedID)2-s2.0-85216204524 (Scopus ID)
Funder
Familjen Erling-Perssons Stiftelse
Available from: 2025-03-07 Created: 2025-03-07 Last updated: 2025-03-07Bibliographically approved
Downey, L. E., Saptaningas, H., Khan, M., van der Meulen, M., Batz, C., Naulumatua, M., . . . Tomson, G. (2025). Power to the people: towards greater social participation in planetary health [Letter to the editor]. The Lancet Planetary Health, 9(5), e348-e349
Open this publication in new window or tab >>Power to the people: towards greater social participation in planetary health
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2025 (English)In: The Lancet Planetary Health, E-ISSN 2542-5196, Vol. 9, no 5, p. e348-e349Article in journal, Letter (Refereed) Published
Place, publisher, year, edition, pages
Elsevier, 2025
National Category
Epidemiology Public Health, Global Health and Social Medicine
Identifiers
urn:nbn:se:umu:diva-239106 (URN)10.1016/S2542-5196(25)00078-6 (DOI)2-s2.0-105004823809 (Scopus ID)
Available from: 2025-05-27 Created: 2025-05-27 Last updated: 2025-05-27Bibliographically approved
Zangerl, K. E., Hoernke, K., Andreas, M., Dalglish, S. L., Kelman, I., Nilsson, M., . . . McMahon, S. A. (2024). Child health prioritisation in national adaptation policies on climate change: a policy document analysis across 160 countries. The Lancet Child and Adolescent Health, 8(7), 532-544
Open this publication in new window or tab >>Child health prioritisation in national adaptation policies on climate change: a policy document analysis across 160 countries
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2024 (English)In: The Lancet Child and Adolescent Health, E-ISSN 2352-4642, Vol. 8, no 7, p. 532-544Article, review/survey (Refereed) Published
Abstract [en]

Integration of child-specific adaptation measures into health policies is imperative given children's heightened susceptibility to the health impacts of climate change. Using a document analysis method, we examined 160 national adaptation policies for inclusion of child-relevant measures and identified 19 child health-related adaptation domains. 44 (28%) of 160 countries' policies that were analysed failed to include any domains, 49 (31%) included at least one child-related domain, 62 (39%) included between two and six domains, and five (3%) included at least seven domains. Predominant domains among child-specific adaptation measures included education and awareness raising, followed by community engagement and nutrition. No country addressed children's direct needs in the domain of mental health. National adaptation policies tend towards overly simple conceptualisations of children across four major lenses: age, social role, gender, and agency. Limited inclusion of child-specific measures in national adaptation policies suggests insufficient recognition of and action on children's susceptibility to climate change effects.

Place, publisher, year, edition, pages
Elsevier, 2024
National Category
Public Health, Global Health and Social Medicine
Identifiers
urn:nbn:se:umu:diva-226965 (URN)10.1016/S2352-4642(24)00084-1 (DOI)001267009300001 ()38848733 (PubMedID)2-s2.0-85196075327 (Scopus ID)
Funder
EU, Horizon 2020, D10093430
Available from: 2024-06-24 Created: 2024-06-24 Last updated: 2025-04-24Bibliographically approved
Beeres, D. T., Pulkki-Brännström, A.-M., Nilsson, M. & Galanti, M. R. (2024). Child–adult contract for prevention of tobacco use: "as-treated" analysis of a cluster randomized controlled trial (the TOPAS study) at 3-year follow-up. Prevention Science, 25, 175-192
Open this publication in new window or tab >>Child–adult contract for prevention of tobacco use: "as-treated" analysis of a cluster randomized controlled trial (the TOPAS study) at 3-year follow-up
2024 (English)In: Prevention Science, ISSN 1389-4986, E-ISSN 1573-6695, Vol. 25, p. 175-192Article in journal (Refereed) Published
Abstract [en]

To estimate the effect of a 3-year commitment to remain tobacco free on tobacco uptake among high school students in Sweden. The commitment is developed in the form of a contract between a child and a significant adult, constituting the core component of Tobacco-free Duo (T-Duo), a Swedish school-based tobacco prevention program. Secondary analysis of data from a cluster randomized controlled trial. Participants were 586 students in high schools assigned to the intervention arm of T-Duo. At inception, participants attended grade 7 (i.e., age 12–13). Only students who were tobacco naïve at baseline for the respective outcome and participated in all follow-ups were included. The exposure was defined as signing a 3-year contract with a significant adult, categorized as “stable contract” (3 years contract with the same contract partner), “unstable” (signed a contract sometime during follow-up but this was not sustained over time and/or with the same partner), and “no contract” at all during the intervention period. The primary outcome was having never tried cigarette smoking at the end of grade 9. Exposure and outcomes were self-reported in yearly questionnaires. Of 586 students, 321 (55%) held a stable contract, 204 (35%) an unstable contract, and 61 (10%) did not sign a contract at all. At the end of grade 9 (age 15–16), the relative risk (RR) to remain cigarette free was 1.11 (95% CI 1.00–1.22) (Number Needed to Treat = 10) among students in any type of contract compared to students that did not write a contract at all. The RRs for remaining tobacco free (secondary outcomes) ranged from 1.07 (0.98–1.16) for regular snus use to 1.16 (1.00–1.35) for any type of tobacco use. A commitment to remain tobacco free through a child–adult contract seems to exert a preventive effect on the uptake of tobacco use among Swedish adolescents over 3 school years. The current findings apply to a selected sample of both schools and students.

Registration: Current Controlled Trials ISRCTN52858080 Date: January 4, 2019, retrospectively registered.

Place, publisher, year, edition, pages
Springer Nature, 2024
Keywords
Adolescence, As-treated analysis, School-based prevention, Tobacco use
National Category
Public Health, Global Health and Social Medicine
Identifiers
urn:nbn:se:umu:diva-215924 (URN)10.1007/s11121-023-01598-y (DOI)001088082900001 ()37875648 (PubMedID)2-s2.0-85174591704 (Scopus ID)
Funder
Public Health Agency of Sweden , 01346-2017 2.3.2
Available from: 2023-11-02 Created: 2023-11-02 Last updated: 2025-02-20Bibliographically approved
van Daalen, K. R., Tonne, C., Semenza, J. C., Rocklöv, J., Markandya, A., Dasandi, N., . . . Lowe, R. (2024). The 2024 Europe report of the lancet countdown on health and climate change: unprecedented warming demands unprecedented action. The Lancet Public Health, 9(7), e495-e522
Open this publication in new window or tab >>The 2024 Europe report of the lancet countdown on health and climate change: unprecedented warming demands unprecedented action
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2024 (English)In: The Lancet Public Health, ISSN 2468-2667, Vol. 9, no 7, p. e495-e522Article, review/survey (Refereed) Published
Abstract [en]

Record-breaking temperatures were recorded across the globe in 2023. Without climate action, adverse climate-related health impacts are expected to worsen worldwide, affecting billions of people. Temperatures in Europe are warming at twice the rate of the global average, threatening the health of populations across the continent and leading to unnecessary loss of life. The Lancet Countdown in Europe was established in 2021, to assess the health profile of climate change aiming to stimulate European social and political will to implement rapid health-responsive climate mitigation and adaptation actions. In 2022, the collaboration published its indicator report, tracking progress on health and climate change via 33 indicators and across five domains.

This new report tracks 42 indicators highlighting the negative impacts of climate change on human health, the delayed climate action of European countries, and the missed opportunities to protect or improve health with health-responsive climate action. The methods behind indicators presented in the 2022 report have been improved, and nine new indicators have been added, covering leishmaniasis, ticks, food security, health-care emissions, production and consumption-based emissions, clean energy investment, and scientific, political, and media engagement with climate and health. Considering that negative climate-related health impacts and the responsibility for climate change are not equal at the regional and global levels, this report also endeavours to reflect on aspects of inequality and justice by highlighting at-risk groups within Europe and Europe's responsibility for the climate crisis.

Place, publisher, year, edition, pages
Elsevier, 2024
National Category
Public Health, Global Health and Social Medicine
Identifiers
urn:nbn:se:umu:diva-225866 (URN)10.1016/S2468-2667(24)00055-0 (DOI)001272896800001 ()38749451 (PubMedID)2-s2.0-85194578887 (Scopus ID)
Funder
Wellcome trust, 209734/Z/17/ZEU, Horizon Europe, 101057131EU, Horizon Europe, 101057554EU, Horizon Europe, 101086109Academy of Finland, 329215Wellcome trust, 205212/Z/16/ZWellcome trust, 225318/Z/22/ZAcademy of Finland, 334798EU, Horizon Europe, 101003890EU, Horizon Europe, 820655EU, Horizon Europe, 101003966
Note

This online publication has been corrected.

Errata: Correction to Lancet Public Health 2024; 9: e495–522. The Lancet Public Health, 2024;9(7): e420. DOI: 10.1016/S2468-2667(24)00129-4

Available from: 2024-06-10 Created: 2024-06-10 Last updated: 2025-04-24Bibliographically approved
van Daalen, K. R., Tonne, C., Borrell, C., Nilsson, M. & Lowe, R. (2023). Approaching unsafe limits: climate-related health inequities within and beyond Europe [Letter to the editor]. The Lancet Regional Health: Europe, 31, Article ID 100683.
Open this publication in new window or tab >>Approaching unsafe limits: climate-related health inequities within and beyond Europe
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2023 (English)In: The Lancet Regional Health: Europe, E-ISSN 2666-7762, Vol. 31, article id 100683Article in journal, Letter (Refereed) Published
Place, publisher, year, edition, pages
Elsevier, 2023
National Category
Public Health, Global Health and Social Medicine
Identifiers
urn:nbn:se:umu:diva-212223 (URN)10.1016/j.lanepe.2023.100683 (DOI)2-s2.0-85164449135 (Scopus ID)
Available from: 2023-07-21 Created: 2023-07-21 Last updated: 2025-02-20Bibliographically approved
Helldén, D., Ndejjo, R., Sturm, A., Persson, I., Wanyenze, R., Ebi, K. L., . . . Alfvén, T. (2023). Climate change adaptation across the life-course - from pregnancy to adolescence – it’s time to advance the field of climate change and child health. Environmental Research. Health, 1(2), Article ID 023001.
Open this publication in new window or tab >>Climate change adaptation across the life-course - from pregnancy to adolescence – it’s time to advance the field of climate change and child health
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2023 (English)In: Environmental Research. Health, E-ISSN 2752-5309, Vol. 1, no 2, article id 023001Article in journal (Other academic) Published
Abstract [en]

Children are bearing and will continue to bear a high burden from climate change, through directand indirect pathways. Climate change adaptation interventions are essential to limit the currentand projected impacts of climate change on child health. However, the perspective of children andtheir health with regards to adaptation in research and policy is limited. Ensuring that adaptationinterventions are context specific, consider interrelated barriers to implementation and leverageexisting structures including multisectoral collaboration is vital. Further, a life-course perspectiveon child health and well-being could serve as a template for tailoring adaptation interventions tothe specific vulnerabilities and needs of specific development periods of the child. A meaningfulengagement of children and young persons in the design and implementation of adaptationinterventions is essential to increase effectiveness and uptake. With climate change effectingmillions of children worldwide, it is high time to put child health at the center of adaptation.

Place, publisher, year, edition, pages
Institute of Physics (IOP), 2023
Keywords
climate change adaptation, child health, life-course approach
National Category
Public Health, Global Health and Social Medicine
Identifiers
urn:nbn:se:umu:diva-206980 (URN)10.1088/2752-5309/acc2dd (DOI)
Available from: 2023-04-24 Created: 2023-04-24 Last updated: 2025-02-20Bibliographically approved
Romanello, M., Napoli, C. d., Green, C., Kennard, H., Lampard, P., Scamman, D., . . . Costello, A. (2023). The 2023 report of the Lancet Countdown on health and climate change: the imperative for a health-centred response in a world facing irreversible harms. The Lancet, 402(10419), 2346-2394
Open this publication in new window or tab >>The 2023 report of the Lancet Countdown on health and climate change: the imperative for a health-centred response in a world facing irreversible harms
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2023 (English)In: The Lancet, ISSN 0140-6736, E-ISSN 1474-547X, Vol. 402, no 10419, p. 2346-2394Article, review/survey (Refereed) Published
Place, publisher, year, edition, pages
Elsevier, 2023
National Category
Public Health, Global Health and Social Medicine
Identifiers
urn:nbn:se:umu:diva-217013 (URN)10.1016/S0140-6736(23)01859-7 (DOI)001273316700001 ()37977174 (PubMedID)2-s2.0-85176578543 (Scopus ID)
Funder
Wellcome trust, 209734/Z/17/Z
Available from: 2023-11-24 Created: 2023-11-24 Last updated: 2025-04-24Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-00033036-8546

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