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Publications (10 of 16) Show all publications
Högberg, B., Lindgren, J., Johansson, K., Strandh, M. & Petersen, S. (2019). Consequences of school grading systems on adolescent health: evidence from a Swedish school reform. Journal of education policy
Open this publication in new window or tab >>Consequences of school grading systems on adolescent health: evidence from a Swedish school reform
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2019 (English)In: Journal of education policy, ISSN 0268-0939, E-ISSN 1464-5106Article in journal (Refereed) Epub ahead of print
Abstract [en]

Education reforms that entail increased emphasis on high-stakes testing, assessment and grading have spread across education systems in recent decades. Critics have argued that these policies could have consequences for stress, identity, self-esteem and the overall health of pupils. However, these potentially negative consequences have rarely been investigated in a systematic and rigorous way. In this study we use a major education reform in Sweden, which introduced grades and increased the use of testing for pupils in the 6th and 7th school year (aged 12 to 13 years), to study the consequences of grading and assessment for health outcomes. Using data from the Health Behaviours of School-Aged Children Survey, we find that the reform increased school-related stress and reduced the academic self-esteem of pupils in the 7th school year. This, in turn, had an indirect effect on psychosomatic symptoms and life satisfaction for these pupils. Moreover, the negative effects of the reform were generally stronger for girls, thereby widening the already troubling gender differences in health. We conclude that accountability reforms aimed at increased use of testing, assessment and grading can potentially have negative side effects on pupils’ health.

National Category
Educational Sciences Social Work
Identifiers
urn:nbn:se:umu:diva-165211 (URN)10.1080/02680939.2019.1686540 (DOI)000493743800001 ()
Available from: 2019-11-15 Created: 2019-11-15 Last updated: 2019-11-21
Sowe, A. & Johansson, K. (2019). Disentangling the rural-urban immunization coverage disparity in The Gambia: A Fairlie decomposition. Vaccine, 37(23), 3088-3096
Open this publication in new window or tab >>Disentangling the rural-urban immunization coverage disparity in The Gambia: A Fairlie decomposition
2019 (English)In: Vaccine, ISSN 0264-410X, E-ISSN 1873-2518, Vol. 37, no 23, p. 3088-3096Article in journal (Refereed) Published
Abstract [en]

Introduction: Exploring factors underlying disparities in immunization uptake is highly relevant and can contribute to improved immunization interventions globally. The Gambia is an interesting case, since higher immunization coverage in rural areas has been shown for many years, yet the factors explaining this unexpected rural-urban disparity have not been studied. The aim of our study was to quantify the rural-urban disparity in immunization coverage and identify factors that contribute to explaining it.

Methods: Data from the nationally representative Demographic and Health Survey 2013 was used to select children aged 12–23 months (Weighted n = 1644) for the study. The outcome measure was full immunization status, the grouping variable was area of residence. Descriptive statistics were used to analyze the proportions of full immunization and rural-urban residence across the exposure variables. The Fairlie decomposition technique was used to decompose factors contributing to explaining the coverage disparity.

Results: The findings show that there is a disparity of 16.06 percentage points to the advantage of the rural areas and the exposure variables explained 76.49% of the disparity. Material factors explained 92.03% of the explained disparity with maternal occupation and household wealth quintile being the only significant individual material variable contributors to the explained disparity. Lower household wealth quintile and working especially in agriculture were associated with higher immunization coverage and they were more common in rural areas. Religion and mother’s age group e each contributed somewhat to the explained inequality.

Conclusions: There was a large immunization coverage disparity between rural and urban areas in The Gambia. This disparity was mainly explained by mothers working in agriculture and living in the poorest households, being more likely to immunize their children – unexpected findings. Our study showed that the drivers of healthcare disparities differ by setting and deserve more research.

Place, publisher, year, edition, pages
Elsevier, 2019
Keywords
Immunization inequalities, Immunization coverage, Fairlie decomposition, Full immunization, Healthcare disparities
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-160300 (URN)10.1016/j.vaccine.2019.04.062 (DOI)000469160300016 ()31036454 (PubMedID)
Available from: 2019-06-17 Created: 2019-06-17 Last updated: 2019-06-17Bibliographically approved
Högberg, B., Strandh, M., Petersen, S. & Johansson, K. (2019). Education system stratification and health complaints among school-aged children. Social Science and Medicine, 220, 159-166
Open this publication in new window or tab >>Education system stratification and health complaints among school-aged children
2019 (English)In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 220, p. 159-166Article in journal (Refereed) Published
Abstract [en]

Research shows that the school environment is an important social determinant of health among children and adolescents. However, we know virtually nothing of the health consequences of national education systems and policies, for example the stratification of pupils by academic ability. This study aimed to investigate if education system stratification is related to self-reported psychological and somatic health complaints of pupils aged 11 to 15, and social inequalities in such health complaints.

Survey data from the Health Behaviors of School-aged Children (HBSC) survey, covering 33 countries and more than 180 000 pupils in primary and lower secondary school, were used. Multilevel models showed that education system stratification was not associated with the average levels of health complaints of pupils, but cross-level interaction effects showed that stratification moderated the relationship between social background and health complaints, such that inequalities in health complaints were smaller in countries with more stratified systems. Moreover, this moderating effect was mediated by the school learning environmentand social relations in school. Specifically, social inequalities in school pressure, academic self-concept, school climate, and school satisfaction were smaller in more stratified education systems, which in turn accounted for smaller inequalities in health complaints in these countries.

Place, publisher, year, edition, pages
Elsevier, 2019
Keywords
Health complaints, Health inequalities, Education systems, Schools Children, Adolescents, Multilevel, Comparative research
National Category
Public Health, Global Health, Social Medicine and Epidemiology Social Work
Identifiers
urn:nbn:se:umu:diva-155320 (URN)10.1016/j.socscimed.2018.11.007 (DOI)000456222400017 ()30445341 (PubMedID)
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2015-00048Swedish Research Council, 2018-03870_3
Available from: 2019-01-11 Created: 2019-01-11 Last updated: 2019-02-26Bibliographically approved
Assarsson, R., Petersen, S., Högberg, B., Strandh, M. & Johansson, K. (2019). Gender inequality and adolescent suicide ideation across Africa, Asia, the South Pacific and Latin America: a cross-sectional study based on the Global School Health Survey (GSHS). Global Health Action, 11, Article ID 1663619.
Open this publication in new window or tab >>Gender inequality and adolescent suicide ideation across Africa, Asia, the South Pacific and Latin America: a cross-sectional study based on the Global School Health Survey (GSHS)
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2019 (English)In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 11, article id 1663619Article in journal (Refereed) Published
Abstract [en]

Background: Suicide ideation is a health issue affecting adolescents worldwide. There are significant variations in suicide ideation between countries and genders, which have not been fully explained. Research is especially lacking in countries outside Europe and North America. Gender equality has been shown to matter in other aspects of adolescent mental health, such as life satisfaction, but has not been researched in relation to suicide ideation at national level.

Objective: To investigate how national gender inequality is related to self-reported suicide ideation among adolescents, and whether this association differs between boys and girls.

Methods: This is a cross-national, cross-sectional study using individual survey data from the Global School-based Student Health Survey, a survey in Africa, Asia, Latin America and the South Pacific, developed and supported by among others the WHO and the CDC; connecting this to national data: the gender inequality index from the UNDP; controlling for GDP per capita and secondary school enrolment. The data was analysed using a multilevel logistic regression method and included 149,306 students from 37 countries.

Results: Higher national gender inequality, as measured by the gender inequality index, was significantly associated with a higher likelihood of suicide ideation in both girls and boys (odds ratio: 1.38 p-value: 0.015), but for girls and both sexes this was only after adjusting for selection bias due to secondary school enrolment (as well as GDP/capita). Interaction models showed that this association was stronger in boys than in girls.

Conclusions: National gender inequality seems to be associated with higher levels of suicide ideation among adolescents in mainly low- and middle-income countries, especially among boys.

Place, publisher, year, edition, pages
Taylor & Francis, 2019
Keywords
Gender equality, adolescents, suicide ideation, global health, mental health, child, inequality, low income populations, gender, suicide
National Category
General Practice Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Family Medicine
Identifiers
urn:nbn:se:umu:diva-164000 (URN)10.1080/16549716.2019.1663619 (DOI)2-s2.0-85072558412 (Scopus ID)
Note

SPECIAL ISSUE: Gender and Health Inequality

Available from: 2019-10-11 Created: 2019-10-11 Last updated: 2019-10-15Bibliographically approved
García-Moya, I., Johansson, K., Ragnarsson, S., Bergström, E. & Petersen, S. (2019). School experiences in relation to emotional and conduct problems in adolescence: a 3-year follow up study. European Journal of Public Health, 29(3), 436-441
Open this publication in new window or tab >>School experiences in relation to emotional and conduct problems in adolescence: a 3-year follow up study
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2019 (English)In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 29, no 3, p. 436-441Article in journal (Refereed) Published
Abstract [en]

Background: Mental health in adolescents has become a major public health issue. This study examined school experiences in relation to mental health (emotional problems and conduct problems) from early to middle adolescence.

Methods: This longitudinal 3-year follow up study used data from the Swedish Study of Health in School Children in Umeå. Analyses were conducted in 1379 participants that were attending grade six in 2003 or 2006 (age 12 years). KIDSCREEN-52 was used to assess school experiences and the Strengths and Difficulties Questionnaire for emotional and conduct problems. Statistical analyses included repeated measures ANOVA and multiple linear regressions.

Results: Positive school experiences decreased while emotional and conduct problem scores increased from grades six to nine. Positive school experiences were negatively associated with emotional and conduct problem scores and contributed to the explanation of mental health scores in middle adolescence after controlling for background factors. When baseline mental health problem scores were taken into account the association with early school experiences disappeared (except for conduct problems in boys). However, incorporating concurrent school experiences in the analysis increased the levels of explanation for emotional and conduct problem scores further.

Conclusions: The results of this study confirm that school experiences are linked to emotional and conduct problems. That link may be stronger for conduct problems. In addition, the association of school experiences in early adolescence with later mental health may be overridden by concurrent school experiences in middle adolescence.

Place, publisher, year, edition, pages
Oxford University Press, 2019
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-154112 (URN)10.1093/eurpub/cky244 (DOI)000486962600013 ()30496393 (PubMedID)2-s2.0-85066839483 (Scopus ID)
Available from: 2018-12-12 Created: 2018-12-12 Last updated: 2019-12-19Bibliographically approved
Johansson, K., Petersen, S., Högberg, B., Stevens, G. W., De Clercq, B., Frasquilho, D., . . . Strandh, M. (2019). The interplay between national and parental unemployment in relation to adolescent life satisfaction in 27 countries: analyses of repeated cross-sectional school surveys. BMC Public Health, 19, Article ID 1555.
Open this publication in new window or tab >>The interplay between national and parental unemployment in relation to adolescent life satisfaction in 27 countries: analyses of repeated cross-sectional school surveys
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2019 (English)In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 19, article id 1555Article in journal (Refereed) Published
Abstract [en]

Background: Previous research shows that parental unemployment is associated with low life satisfaction in adolescents. It is unclear whether this translates to an association between national unemployment and adolescent life satisfaction, and whether such a contextual association is entirely explained by parental unemployment, or if it changes as a function thereof. For adults, associations have been shown between unemployment and mental health, including that national unemployment can affect mental health and life satisfaction of both the employed and the unemployed, but to different degrees. The aim of this paper is to analyse how national unemployment levels are related to adolescent life satisfaction, across countries as well as over time within a country, and to what extent and in what ways such an association depends on whether the individual’s own parents are unemployed or not.

Methods: Repeated cross-sectional data on adolescents’ (aged 11, 13 and 15 years, n = 386,402) life satisfaction and parental unemployment were collected in the Health Behaviour in School-aged Children (HBSC) survey, in 27 countries and 74 country-years, across 2001/02, 2005/06 and 2009/10 survey cycles. We linked this data to national harmonised unemployment rates provided by OECD and tested their associations using multilevel linear regression, including interaction terms between national and parental unemployment.

Results: Higher national unemployment rates were related to lower adolescent life satisfaction, cross-sectionally between countries but not over time within countries. The verified association was significant for adolescents with and without unemployed parents, but stronger so in adolescents with unemployed fathers or both parents unemployed. Having an unemployed father, mother och both parents was in itself related to lower life satisfaction.

Conclusion: Living in a country with higher national unemployment seems to be related to lower adolescent life satisfaction, whether parents are unemployed or not, although stronger among adolescents where the father or both parents are unemployed. However, variation in unemployment over the years did not show an association with adolescent life satisfaction.

Place, publisher, year, edition, pages
BioMed Central, 2019
Keywords
Adolescents, HBSC, Health behaviour in school-aged children, Life satisfaction, National factors, Unemployment
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-166569 (URN)10.1186/s12889-019-7721-1 (DOI)31775833 (PubMedID)2-s2.0-85075743099 (Scopus ID)
Available from: 2019-12-18 Created: 2019-12-18 Last updated: 2019-12-20Bibliographically approved
Johansson, K., Ingemarsdotter Persson, K., Deogan, C. & El-Khatib, Z. (2018). Factors associated with condom use and HIV testing among young men who have sex with men: a cross-sectional survey in a random online sample in Sweden. Sexually Transmitted Infections, 94(6), 427-433
Open this publication in new window or tab >>Factors associated with condom use and HIV testing among young men who have sex with men: a cross-sectional survey in a random online sample in Sweden
2018 (English)In: Sexually Transmitted Infections, ISSN 1368-4973, E-ISSN 1472-3263, Vol. 94, no 6, p. 427-433Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: The objectives are to analyse social determinants of sexual health behaviour (condom use and HIV testing) among young, internet-active, cis men who have sex with men (MSM) in a high-income country. The aspects of sexual health behaviour analysed here are condomless anal intercourse with one or more new or casual partner(s), condomless anal intercourse during the most recent sex with a man and HIV testing.

METHODS: A randomised sample of men active on Sweden's main online community for Lesbian, Gay, Bisexual and Trans people responded to an online survey (response rate 19%). A subsample of young people, aged 15-29, was analysed (effective sample 597-669) using multivariable logistic regression with respect to factors associated with condomless anal intercourse with one or more new or casual partner(s), condomless anal intercourse at most recent sex and not having had a test for HIV.

RESULTS: Low education, being single and living in a metropolitan area were found to be independently associated with condomless anal intercourse with new or casual partner(s). Sex with a steady partner was associated with condomless anal intercourse during the most recent sex. Knowledge of where to get tested, high education, being born outside Sweden and condomless anal intercourse with new or casual sex partner(s) were independently associated with having been tested for HIV.

CONCLUSIONS: The factors associated with sexual health behaviour among young MSM are complex, and preventive messages need to be tailored accordingly.

Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2018
Keywords
HIV testing, adolescent, condoms, gay men, public health
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-150588 (URN)10.1136/sextrans-2017-053369 (DOI)000443606300012 ()29773663 (PubMedID)
Available from: 2018-08-13 Created: 2018-08-13 Last updated: 2018-11-01Bibliographically approved
Johansson, K. & El-Khatib, Z. (2016). Killar som har sex med killar: en studie i Sverige om sexuell hälsa och hiv bland internetaktiva unga killar som har sex med killar - fördjupade analyser på MSM-enkäten 2013 i åldersgruppen 15-25. Umeå: Instituti onen för folkhälsa och klinisk medicin, Umeå universitet
Open this publication in new window or tab >>Killar som har sex med killar: en studie i Sverige om sexuell hälsa och hiv bland internetaktiva unga killar som har sex med killar - fördjupade analyser på MSM-enkäten 2013 i åldersgruppen 15-25
2016 (Swedish)Report (Other academic)
Place, publisher, year, edition, pages
Umeå: Instituti onen för folkhälsa och klinisk medicin, Umeå universitet, 2016. p. 50
Keywords
MSM, män som har sex med män, ungdomar, sexuell hälsa, hiv, sexualitet
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-120281 (URN)978-­91-­7601-­490‐5 (ISBN)
Available from: 2016-05-13 Created: 2016-05-13 Last updated: 2018-06-07Bibliographically approved
Landstedt, E., Gustafsson, P. E., Johansson, K. & Hammarström, A. (2016). Longitudinal associations between social relationships at age 30 and internalising symptoms at age 42: findings from the Northern Swedish Cohort.. International Journal of Public Health, 61(1), 75-81
Open this publication in new window or tab >>Longitudinal associations between social relationships at age 30 and internalising symptoms at age 42: findings from the Northern Swedish Cohort.
2016 (English)In: International Journal of Public Health, ISSN 1661-8556, E-ISSN 1661-8564, Vol. 61, no 1, p. 75-81Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: Little is known on long-term consequences of poor social relationships in adulthood. The study aimed to examine associations between social relationships at age 30 and internalising symptoms at age 42.

METHODS: Data was drawn from four waves of the Northern Swedish cohort (n = 1001, 94 % response rate). The outcome internalising symptoms was measured by a composite index of depressiveness and anxiety. A cumulative measure was constructed to reflect various aspects of social relationships. Multivariate ordinal logistic regressions were used, controlling for socioeconomic indicators and previous level of internalising symptoms.

RESULTS: An accumulation of poor social relationships indicators at age 30 is related to internalising symptoms at age 42 in women (OR 1.30; CI 1.11-1.52) and men (OR 1.17; CI 1.02-1.36). The associations remained significant after adjustment for covariates.

CONCLUSIONS: Poor quality of social relationships at age 30 can predict internalising symptoms 12 years later in both men and women even when previous mental health as well as financial disadvantage is accounted for. More research is required to further examine pathways and mechanisms as well as suitable interventions.

Keywords
Mental health, Prospective study, Social network, Social integration, Non-work factors
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-103802 (URN)10.1007/s00038-015-0691-x (DOI)000367692400009 ()26024816 (PubMedID)
Available from: 2015-06-01 Created: 2015-06-01 Last updated: 2018-06-07Bibliographically approved
Johansson, K., San Sebastian, M., Hammarström, A. & Gustafsson, P. E. (2015). Neighbourhood disadvantage and individual adversities in adolescence and total alcohol consumption up to mid-life: Results from the Northern Swedish Cohort. Health & place, 33, 187-194
Open this publication in new window or tab >>Neighbourhood disadvantage and individual adversities in adolescence and total alcohol consumption up to mid-life: Results from the Northern Swedish Cohort
2015 (English)In: Health & place, ISSN 1873-2054, Vol. 33, p. 187-194Article in journal (Refereed) Published
Abstract [en]

This study tests if neighbourhood socioeconomic disadvantage and family social and material adversities during adolescence are independently related to total alcohol consumption from adolescence through to mid-life. Self-reports from the Northern Swedish Cohort (effective sample=950) at ages 16, 18, 21, 30 and 42 was combined with register data on the socioeconomic composition of neighbourhoods at age 16. Total volume of alcohol consumed between age 16-42 was estimated based on the five survey waves, and self-reported social and material adversities were computed as composite variables. Neighbourhood socioeconomic disadvantage at age 16 was associated with alcohol consumption age 16-42 for men but not for women. Social adversities at age 16 were associated with alcohol consumption age 16-42 for both women and men, but material adversity or parental class was not. In conclusion, neighbourhood socioeconomic disadvantage in adolescence has a significant relationship with later alcohol consumption among men, even independently from individual factors. On family level, social factors but not socioeconomic factors in adolescence independently predict later alcohol consumption.

National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-101829 (URN)10.1016/j.healthplace.2015.03.005 (DOI)000353346600023 ()25841093 (PubMedID)
Funder
Swedish Research Council Formas, 259-2012-37
Available from: 2015-04-14 Created: 2015-04-14 Last updated: 2018-06-07Bibliographically approved
Projects
Adolescent mental health in relation to macroeconomic factors: protective and risk factors [2015-00048_Forte]; Umeå University
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-3749-998x

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