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Bråbäck, Lennart
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Publications (10 of 29) Show all publications
Accordini, S., Calciano, L., Johannessen, A., Portas, L., Benediktsdóttir, B., Bertelsen, R. J., . . . Svanes, C. (2018). A three-generation study on the association of tobacco smoking with asthma. International Journal of Epidemiology, 47(4), 1106-1117
Open this publication in new window or tab >>A three-generation study on the association of tobacco smoking with asthma
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2018 (English)In: International Journal of Epidemiology, ISSN 0300-5771, E-ISSN 1464-3685, Vol. 47, no 4, p. 1106-1117Article in journal (Refereed) Published
Abstract [en]

Background: Mothers' smoking during pregnancy increases asthma risk in their offspring. There is some evidence that grandmothers' smoking may have a similar effect, and biological plausibility that fathers' smoking during adolescence may influence offspring's health through transmittable epigenetic changes in sperm precursor cells. We evaluated the three-generation associations of tobacco smoking with asthma.

Methods: Between 2010 and 2013, at the European Community Respiratory Health Survey III clinical interview, 2233 mothers and 1964 fathers from 26 centres reported whether their offspring (aged ≤51 years) had ever had asthma and whether it had coexisted with nasal allergies or not. Mothers and fathers also provided information on their parents' (grandparents) and their own asthma, education and smoking history. Multilevel mediation models within a multicentre three-generation framework were fitted separately within the maternal (4666 offspring) and paternal (4192 offspring) lines.

Results: Fathers' smoking before they were 15 [relative risk ratio (RRR) = 1.43, 95% confidence interval (CI): 1.01-2.01] and mothers' smoking during pregnancy (RRR = 1.27, 95% CI: 1.01-1.59) were associated with asthma without nasal allergies in their offspring. Grandmothers' smoking during pregnancy was associated with asthma in their daughters [odds ratio (OR) = 1.55, 95% CI: 1.17-2.06] and with asthma with nasal allergies in their grandchildren within the maternal line (RRR = 1.25, 95% CI: 1.02-1.55).

Conclusions: Fathers' smoking during early adolescence and grandmothers' and mothers' smoking during pregnancy may independently increase asthma risk in offspring. Thus, risk factors for asthma should be sought in both parents and before conception.

Place, publisher, year, edition, pages
Oxford University Press, 2018
Keywords
asthma, mothers’ smoking during pregnancy, grandmothers’ smoking during pregnancy, fathers’ smoking during puberty, multilevel mediation model, Ageing Lungs in European Cohorts (ALEC) Study
National Category
Occupational Health and Environmental Health
Identifiers
urn:nbn:se:umu:diva-145740 (URN)10.1093/ije/dyy031 (DOI)000444559900020 ()29534228 (PubMedID)
Funder
EU, Horizon 2020, GA-633212
Available from: 2018-03-16 Created: 2018-03-16 Last updated: 2018-10-05Bibliographically approved
Kuiper, I. N., Svanes, C., Benediktsdottir, B., Bertelsen, R. J., Bråbäck, L., Dharmage, S. C., . . . Johannessen, A. (2018). Agreement in reporting of asthma by parents or offspring - the RHINESSA generation study. BMC Pulmonary Medicine, 18, Article ID 122.
Open this publication in new window or tab >>Agreement in reporting of asthma by parents or offspring - the RHINESSA generation study
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2018 (English)In: BMC Pulmonary Medicine, ISSN 1471-2466, E-ISSN 1471-2466, Vol. 18, article id 122Article in journal (Refereed) Published
Abstract [en]

Background: Self-report questionnaires are commonly used in epidemiology, but may be susceptible to misclassification, especially if answers are given on behalf of others, e.g. children or parents. The aim was to determine agreement and analyse predictors of disagreement in parents' reports of offspring asthma, and in offspring reports of parents' asthma. Methods: In the Respiratory Health in Northern Europe, Spain and Australia (RHINESSA) generation study, 6752 offspring (age range 18-51 years) and their parents (age range 39-66 years) reported their own and each other's asthma status. Agreement between asthma reports from offspring and parents was determined by calculating sensitivity, specificity, positive and negative predictive value and Cohen's kappa. The participants' own answers regarding themselves were defined as the gold standard. To investigate predictors for disagreement logistic regression analyses were performed to obtain odds ratios (OR) with 95% confidence intervals (CI) for sex, smoking status, education, comorbidity and severity of asthma. Results: Agreement was good for parental report of offspring early onset asthma (< 10 years, Cohen's kappa 0.72) and moderate for offspring later onset asthma (Cohen's kappa 0.46). Specificity was 0.99 for both, and sensitivity was 0.68 and 0.36, respectively. For offspring report of maternal and paternal asthma the agreement was good (Cohen's kappa 0.69 and 0.68), specificity was 0.96 and 0.97, and sensitivity was 0.72 and 0.68, respectively. The positive predictive value (PPV) was lowest for offspring report of maternal asthma (0.75), and highest for parents' report of early onset asthma in the offspring (0.83). The negative predictive value (NPV) was high for all four groups (0.94-0.97). In multivariate analyses current smokers (OR = 1.46 [95% CI 1.05, 2.02]) and fathers (OR = 1.31 [95% CI 1. 08, 1.59]) were more likely to report offspring asthma incorrectly. Offspring wheeze was associated with reporting parental asthma incorrectly (OR = 1.60 [95% CI 1.21, 2.11]), both under- and over reporting. Conclusions: Asthma reports across generations show moderate to good agreement, making information from other generations a useful tool in the absence of direct reports.

Place, publisher, year, edition, pages
BioMed Central, 2018
Keywords
Agreement, Validation, Asthma, Questionnaire, Self-report, Transgenerational
National Category
Respiratory Medicine and Allergy
Identifiers
urn:nbn:se:umu:diva-150671 (URN)10.1186/s12890-018-0687-4 (DOI)000440024600001 ()30053806 (PubMedID)2-s2.0-85050675097 (Scopus ID)
Available from: 2018-08-17 Created: 2018-08-17 Last updated: 2018-08-17Bibliographically approved
Bråbäck, L., Lowe, A. J., Lodge, C. J., Dharmage, S. C., Olsson, D. & Forsberg, B. (2018). Childhood asthma and smoking exposures before conception - a three-generational cohort study.. Pediatric Allergy and Immunology, 29(4), 361-368
Open this publication in new window or tab >>Childhood asthma and smoking exposures before conception - a three-generational cohort study.
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2018 (English)In: Pediatric Allergy and Immunology, ISSN 0905-6157, E-ISSN 1399-3038, Vol. 29, no 4, p. 361-368Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Some human and animal studies have recently shown that maternal grandmother's smoking during pregnancy increases the risk of asthma in the grandchildren. We have investigated whether sex of the exposed parent and/or grandchild modifies the association between grandmaternal smoking and grandchild asthma.

METHODS: We formed a cohort study based on linkage of national registries with prospectively collected data over three generations. Smoking habits in early pregnancy were registered since 1982 and purchases of prescribed medication since 2005. In all, 10329 children born since 2005 had information on maternal and grandmaternal smoking on both sides and were followed from birth up to 6 years of age. Ages when medication was purchased were used to classify the cohort into never, early transient (0-3 years), early persistent (0-3 and 4-6 years) and late-onset (4-6 years) phenotypes of childhood asthma.

RESULTS: Maternal grandmother's smoking was associated with an increased odds of early persistent asthma after adjustment for maternal smoking and other confounders (odds ratio 1.29, 95% confidence interval 1.10-1.51). Grandchild sex did not modify the association. Paternal grandmother's smoking was not associated with any of the asthma phenotypes.

CONCLUSION: Maternal but not paternal exposure to nicotine before conception was related to an increased risk of early persistent childhood asthma, but not other asthma phenotypes. Our findings are possibly consistent with a sex specific mode of epigenetic transfer. 

Keywords
childhood asthma, grandmother, multigenerational study, pregnancy, tobacco smoke
National Category
Respiratory Medicine and Allergy
Identifiers
urn:nbn:se:umu:diva-145533 (URN)10.1111/pai.12883 (DOI)000434155900004 ()29512835 (PubMedID)
Available from: 2018-03-09 Created: 2018-03-09 Last updated: 2018-07-16Bibliographically approved
Lodge, C. J., Bråbäck, L., Lowe, A. J., Dharmage, S. C., Olsson, D. & Forsberg, B. (2018). Grandmaternal smoking increases asthma risk in grandchildren: a nationwide Swedish cohort. Clinical and Experimental Allergy, 48(2), 167-174
Open this publication in new window or tab >>Grandmaternal smoking increases asthma risk in grandchildren: a nationwide Swedish cohort
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2018 (English)In: Clinical and Experimental Allergy, ISSN 0954-7894, E-ISSN 1365-2222, Vol. 48, no 2, p. 167-174Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: There is growing interest in exposures prior to conception as possible risk factors for offspring asthma. Although partially supported by evidence from limited human studies, current evidence is inconsistent, and based on recall of exposure status.

OBJECTIVE: We aimed to investigate grandmaternal smoking during pregnancy and the risk of asthma in grandchildren using prospectively collected population-based data.

METHODS: Information on grandmaternal and maternal smoking during pregnancy and grandchild use of asthma medications was collected from national Swedish registries. Associations between grandmaternal smoking during pregnancy (10-12 weeks), and asthma medication use in grandchildren were investigated using generalized estimating equations. Ages at which asthma medications were prescribed classified childhood asthma into never, early transient (0-3years), late onset (3-6 years) and early persistent (0-3 and 3-6 years) phenotypes.

RESULTS: From 1982 to 1986, 44,583 grandmothers gave birth to 46,197 mothers, who gave birth to 66,271 grandchildren (born 1996-2010). Children aged 1-6 years had an increased asthma risk if their grandmothers had smoked during pregnancy, with a higher risk for more exposure (10+ cigs/day; adjusted OR 1·23; 1·17, 1·30). Maternal smoking did not modify this relationship.

CONCLUSIONS & CLINICAL RELEVANCE: Children had an increased risk of asthma in the first six years of life if their grandmothers smoked during early pregnancy, independent of maternal smoking. Importantly this exhibited a dose-response relationship and was associated with a persistent childhood asthma phenotype. These findings support possible epigenetic transmission of risk from environmental exposures in previous generations. 

Place, publisher, year, edition, pages
John Wiley & Sons, 2018
Keywords
Asthma, Smoking, Transgenerational, cohort, epigenetics
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-140399 (URN)10.1111/cea.13031 (DOI)000423674000007 ()28925522 (PubMedID)
Available from: 2017-10-10 Created: 2017-10-10 Last updated: 2018-06-09Bibliographically approved
Oudin, A., Bråbäck, L., Oudin Åström, D. & Forsberg, B. (2017). Air pollution and dispensed medications for asthma, and possible effect modifiers related to mental health and socio-economy: a longitudinal cohort study of Swedish children and adolescents. International Journal of Environmental Research and Public Health, 14(11), Article ID 1392.
Open this publication in new window or tab >>Air pollution and dispensed medications for asthma, and possible effect modifiers related to mental health and socio-economy: a longitudinal cohort study of Swedish children and adolescents
2017 (English)In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 14, no 11, article id 1392Article in journal (Refereed) Published
Abstract [en]

It has been suggested that children that are exposed to a stressful environment at home have an increased susceptibility for air pollution-related asthma. The aim here was to investigate the association between air pollution exposure and asthma, and effect modification by mental health and by socio-economic status (as markers of a stressful environment). All individuals under 18 years of age in four Swedish counties during 2007 to 2010 (1.2 million people) were included. The outcome was defined as dispensing at least two asthma medications during follow up. We linked data on NO₂ from an empirical land use regression to data from national registers on outcome and potential confounders. Data was analyzed with logistic regression. There was an odds ratio (OR) of 1.02 (95% Confidence Interval (CI: 1.01-1.03) for asthma associated with a 10 µg·m(-3) increase in NO₂. The association only seemed to be present in areas where NO₂ was higher than 15 µg·m(-3) with an OR of 1.09 (95% CI: 1.07-1.12), and the association seemed stronger in children with parents with a high education, OR = 1.05 (95% CI: 1.02-1.09) and OR = 1.04 (95% CI: 1.01-1.07) in children to mothers and father with a high education, respectively. The association did not seem to depend on medication history of psychiatric disorders. There was weak evidence for the association between air pollution and asthma to be stronger in neighborhoods with higher education levels. In conclusion, air pollution was associated with dispensed asthma medications, especially in areas with comparatively higher levels of air pollution, and in children to parents with high education. We did not observe support for our hypothesis that stressors linked to socio-economy or mental health problems would increase susceptibility to the effects of air pollution on the development of asthma.

Place, publisher, year, edition, pages
Basel: MDPI AG, 2017
Keywords
air pollution, asthma, childhood asthma, mental health, socio-economy, stress
National Category
Occupational Health and Environmental Health
Identifiers
urn:nbn:se:umu:diva-142065 (URN)10.3390/ijerph14111392 (DOI)000416545200108 ()29144419 (PubMedID)
Available from: 2017-11-20 Created: 2017-11-20 Last updated: 2018-06-09Bibliographically approved
Svanes, C., Koplin, J., Skulstad, S. M., Johannessen, A., Bertelsen, R. J., Benediktsdottir, B., . . . Gomez Real, F. (2017). Father's environment before conception and asthma risk in his children: a multi-generation analysis of the respiratory health in northern Europe study. International Journal of Epidemiology, 49(1), 235-245
Open this publication in new window or tab >>Father's environment before conception and asthma risk in his children: a multi-generation analysis of the respiratory health in northern Europe study
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2017 (English)In: International Journal of Epidemiology, ISSN 0300-5771, E-ISSN 1464-3685, Vol. 49, no 1, p. 235-245Article in journal (Refereed) Published
Abstract [en]

Background: Whereas it is generally accepted that maternal environment plays a key role in child health, emerging evidence suggests that paternal environment before conception also impacts child health. We aimed to investigate the association between children’s asthma risk and parental smoking and welding exposures prior to conception. Methods: In a longitudinal, multi-country study, parents of 24 168 offspring aged 2–51 years provided information on their life-course smoking habits, occupational exposure to welding and metal fumes, and offspring’s asthma before/after age 10 years and hay fever. Logistic regressions investigated the relevant associations controlled for age, study centre, parental characteristics (age, asthma, education) and clustering by family. Results: Non-allergic early-onset asthma (asthma without hay fever, present in 5.8%) was more common in the offspring with fathers who smoked before conception {odds ratio [OR] = 1.68 [95% confidence interval (CI) = 1.18–2.41]}, whereas mothers’ smoking before conception did not predict offspring asthma. The risk was highest if father started smoking before age 15 years [3.24 (1.67–6.27)], even if he stopped more than 5 years before conception [2.68 (1.17–6.13)]. Fathers’ pre-conception welding was independently associated with non-allergic asthma in his offspring [1.80 (1.29–2.50)]. There was no effect if the father started welding or smoking after birth. The associations were consistent across countries. Conclusions: Environmental exposures in young men appear to influence the respiratory health of their offspring born many years later. Influences during susceptible stages of spermatocyte development might be important and needs further investigation in humans. We hypothesize that protecting young men from harmful exposures may lead to improved respiratory health in future generations.

Place, publisher, year, edition, pages
Oxford University Press, 2017
Keywords
asthma, epidemiology, smoking, occupational exposure, epigenesis
National Category
Occupational Health and Environmental Health
Identifiers
urn:nbn:se:umu:diva-125053 (URN)10.1093/ije/dyw151 (DOI)000402724100034 ()27565179 (PubMedID)
Available from: 2016-09-05 Created: 2016-09-05 Last updated: 2018-06-07Bibliographically approved
Oudin, A., Bråbäck, L., Oudin Åström, D., Strömgren, M. & Forsberg, B. (2016). Association between neighbourhood air pollution concentrations and dispensed medication for psychiatric disorders in a large longitudinal cohort of Swedish children and adolescents. BMJ Open, 6(6), Article ID e010004.
Open this publication in new window or tab >>Association between neighbourhood air pollution concentrations and dispensed medication for psychiatric disorders in a large longitudinal cohort of Swedish children and adolescents
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2016 (English)In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 6, no 6, article id e010004Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: To investigate associations between exposure to air pollution and child and adolescent mental health.

DESIGN: Observational study.

SETTING: Swedish National Register data on dispensed medications for a broad range of psychiatric disorders, including sedative medications, sleeping pills and antipsychotic medications, together with socioeconomic and demographic data and a national land use regression model for air pollution concentrations for NO2, PM10 and PM2.5.

PARTICIPANTS: The entire population under 18 years of age in 4 major counties. We excluded cohort members whose parents had dispensed a medication in the same medication group since the start date of the register. The cohort size was 552 221.

MAIN OUTCOME MEASURES: Cox proportional hazards models to estimate HRs and their 95% CIs for the outcomes, adjusted for individual-level and group-level characteristics.

RESULTS: The average length of follow-up was 3.5 years, with an average number of events per 1000 cohort members of ∼21. The mean annual level of NO2 was 9.8 µg/m(3). Children and adolescents living in areas with higher air pollution concentrations were more likely to have a dispensed medication for a psychiatric disorder during follow-up (HR=1.09, 95% CI 1.06 to 1.12, associated with a 10 µg/m(3) increase in NO2). The association with NO2 was clearly present in 3 out of 4 counties in the study area; however, no statistically significant heterogeneity was detected.

CONCLUSION: There may be a link between exposure to air pollution and dispensed medications for certain psychiatric disorders in children and adolescents even at the relatively low levels of air pollution in the study regions. The findings should be corroborated by others.

Keywords
Epidemiology, Public health
National Category
Occupational Health and Environmental Health
Identifiers
urn:nbn:se:umu:diva-121686 (URN)10.1136/bmjopen-2015-010004 (DOI)000380237100010 ()27259522 (PubMedID)
Available from: 2016-06-07 Created: 2016-06-07 Last updated: 2018-06-07Bibliographically approved
Dratva, J., Bertelsen, R., Janson, C., Johannessen, A., Benediktsdóttir, B., Bråbäck, L., . . . Real, F. G. (2016). Validation of self-reported figural drawing scales against anthropometric measurements in adults. Public Health Nutrition, 19(11), 1944-1951
Open this publication in new window or tab >>Validation of self-reported figural drawing scales against anthropometric measurements in adults
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2016 (English)In: Public Health Nutrition, ISSN 1368-9800, E-ISSN 1475-2727, Vol. 19, no 11, p. 1944-1951Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: The aim of the present study was to validate figural drawing scales depicting extremely lean to extremely obese subjects to obtain proxies for BMI and waist circumference in postal surveys.

DESIGN: Reported figural scales and anthropometric data from a large population-based postal survey were validated with measured anthropometric data from the same individuals by means of receiver-operating characteristic curves and a BMI prediction model.

SETTING: Adult participants in a Scandinavian cohort study first recruited in 1990 and followed up twice since.

SUBJECTS: Individuals aged 38-66 years with complete data for BMI (n 1580) and waist circumference (n 1017).

RESULTS: Median BMI and waist circumference increased exponentially with increasing figural scales. Receiver-operating characteristic curve analyses showed a high predictive ability to identify individuals with BMI > 25·0 kg/m2 in both sexes. The optimal figural scales for identifying overweight or obese individuals with a correct detection rate were 4 and 5 in women, and 5 and 6 in men, respectively. The prediction model explained 74 % of the variance among women and 62 % among men. Predicted BMI differed only marginally from objectively measured BMI.

CONCLUSIONS: Figural drawing scales explained a large part of the anthropometric variance in this population and showed a high predictive ability for identifying overweight/obese subjects. These figural scales can be used with confidence as proxies of BMI and waist circumference in settings where objective measures are not feasible.

Place, publisher, year, edition, pages
Cambridge University Press, 2016
Keywords
Anthropometric, Figural scale, BMI, Figural stimuli, Waist circumference, Observational study, Obesity, Overweight, Validation
National Category
Occupational Health and Environmental Health Nutrition and Dietetics
Identifiers
urn:nbn:se:umu:diva-117125 (URN)10.1017/S136898001600015X (DOI)000380897300004 ()26879067 (PubMedID)
Available from: 2016-02-22 Created: 2016-02-22 Last updated: 2018-06-07Bibliographically approved
Thorén, A., Werner, B., Lundholm, C., Bråbäck, L. & Silfverdal, S.-A. (2015). A rapid growth rate in early childhood is a risk factor for becoming overweight in late adolescence.. Acta Paediatrica, 104(11)
Open this publication in new window or tab >>A rapid growth rate in early childhood is a risk factor for becoming overweight in late adolescence.
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2015 (English)In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 104, no 11Article in journal (Refereed) Published
Abstract [en]

AIM: We evaluated whether body mass index (BMI) and rapid growth in early life were associated with an increased risk of becoming overweight at 16 and 18 years of age.

METHODS: The study population comprised all children born in Sweden on the 15th of each month in 1981. Individuals born on the 5th, 10th and 20th of every month were added for counties with low population densities. Information on weight and height was collected from birth up to 18 years of age for 98.6% of the 3537 children identified.

RESULTS: Weight at 12 months of age was associated with being overweight at both 16 and 18 years of age. Rapid weight gain from birth to 12 months was associated with higher odds for being overweight later in life, and the weight gain between 18 months and four years of age was the strongest risk factor for being overweight in late adolescence in both sexes. There was no association between a birthweight of <2500 g or >4500 g and being overweight at 16 or 18 years of age.

CONCLUSION: Fast growth during early childhood was associated with an increased risk of being overweight later in life, emphasising the importance of early prevention.

Keywords
Adolescent, Body mass index, Child; Overweight, Weight gain
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-111612 (URN)10.1111/apa.13106 (DOI)000363866200028 ()26173008 (PubMedID)2-s2.0-84945439611 (Scopus ID)
Available from: 2015-11-18 Created: 2015-11-18 Last updated: 2018-06-07Bibliographically approved
Koplin, J., Svanes, C., Dharmage, S., Schlunssen, V., Gislason, T., Holm, M., . . . Real, G. F. (2015). Father's smoking and welding prior to conception and asthma risk in his children: a multi-generational analysis of the respiratory health in northern Europe study. Respirology (Carlton South. Print), 20, 42-42
Open this publication in new window or tab >>Father's smoking and welding prior to conception and asthma risk in his children: a multi-generational analysis of the respiratory health in northern Europe study
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2015 (English)In: Respirology (Carlton South. Print), ISSN 1323-7799, E-ISSN 1440-1843, Vol. 20, p. 42-42Article in journal, Meeting abstract (Other academic) Published
Keywords
Asthma, smoking, occupational welding, paternal exposure
National Category
Respiratory Medicine and Allergy
Identifiers
urn:nbn:se:umu:diva-102237 (URN)000351464400109 ()
Note

Volume: 20, Pages: 42-42, Supplement: 2, Special Issue: SI, Meeting Abstract: TO072

Available from: 2015-05-04 Created: 2015-04-22 Last updated: 2018-06-07Bibliographically approved
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