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Pulkki-Brännström, Anni-MariaORCID iD iconorcid.org/0000-0001-8723-8131
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Publications (10 of 54) 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
Abdalla, S., Westborg, I., Pulkki-Brännström, A.-M. & Norberg, H. (2025). Faricimab versus bevacizumab for neovascular age-related macular degeneration: cost analysis based on real-world data from the Swedish Macula Registry. Acta Ophthalmologica, 103(1), 99-108
Open this publication in new window or tab >>Faricimab versus bevacizumab for neovascular age-related macular degeneration: cost analysis based on real-world data from the Swedish Macula Registry
2025 (English)In: Acta Ophthalmologica, ISSN 1755-375X, E-ISSN 1755-3768, Vol. 103, no 1, p. 99-108Article in journal (Refereed) Published
Abstract [en]

Purpose: To analyse the impact on cost if faricimab is used as the first-line treatment for neovascular age-related macular degeneration (nAMD) compared to standard treatment with bevacizumab.

Methods: Retrospective registry study including real-world data from the Swedish Macula Registry between 2017 and 2022. The observed number of injections and visits for bevacizumab during the first two years of treatment was used (n = 437 patients). Number of faricimab injections was obtained from published clinical trial data and unit costs mostly from publicly available Swedish sources. The provider cost included medication and visit cost and societal cost included additionally patient travel cost. Costs are presented in 2023 EUR.

Results: The incremental societal cost of faricimab was 277 EUR per patient compared to bevacizumab in the base case. Medication cost was higher (1516 EUR) while visit cost (−1183 EUR) and patient travel cost (−56 EUR) were lower due to longer injection intervals. Faricimab was of similar cost as bevacizumab for patients residing far from the clinic. The faricimab injection interval and the number of bevacizumab injections were major drivers of uncertainty in the results.

Conclusion: Faricimab represents a cost-effective alternative to bevacizumab for patients with nAMD in Sweden. Its extended treatment interval is particularly beneficial for patients living far from clinics, and if the real-life faricimab injection interval extends beyond 12 weeks. Our findings emphasize faricimab's potential to free up healthcare staff to treat a larger patient population with existing clinic resources.

Place, publisher, year, edition, pages
John Wiley & Sons, 2025
Keywords
AMD, cost minimization analysis, faricimab, real-world data, Swedish Macula Registry
National Category
Ophthalmology
Identifiers
urn:nbn:se:umu:diva-231037 (URN)10.1111/aos.16774 (DOI)001331199400001 ()39400438 (PubMedID)2-s2.0-85206192285 (Scopus ID)
Funder
Umeå University
Available from: 2024-10-24 Created: 2024-10-24 Last updated: 2025-05-28Bibliographically approved
Löfgren, C., Hjelte, J., Ivarsson, A., Lohr, W., Lundahl, L., Sahlen, K.-G. & Pulkki-Brännström, A.-M. (2025). KAMSO – ett hälsoekonomiskt kalkylverktyg när evidens saknas. Socialmedicinsk Tidskrift, 102(2), 157-169
Open this publication in new window or tab >>KAMSO – ett hälsoekonomiskt kalkylverktyg när evidens saknas
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2025 (Swedish)In: Socialmedicinsk Tidskrift, ISSN 0037-833X, E-ISSN 2000-4192, Vol. 102, no 2, p. 157-169Article in journal (Refereed) Published
Abstract [sv]

I stora delar av den offentliga sektorn försvåras prioritering av insatser eftersom forskning om insatsernas kostnadseffektivitet saknas. Ändå måste prioriteringsbesluten fattas. Hur kan beslutsunderlagen i denna situation bli bättre? I artikeln presenteras ett verktyg för att göra en rimlighetsbedömning avseende kostnadseffektiviteten av sådana insatser för barn och unga — Kalkylverktyg för insatser mot social utsatthet (KAMSO). Metoden och ett beräkningsexempel presenteras. Både den samhällsekonomiska kostnadseffektiviteten med vunna goda år som utfallsmått och de finansiella fördelningseffekterna beskrivs. Artikeln avslutas med en diskussion om utvecklingsmöjligheter för KAMSO.

Place, publisher, year, edition, pages
Stiftelsen Socialmedicinsk tidskrift, 2025
Keywords
utvärdering, social investering, kostnadseffektivitet, samhällsekonomi, kostnadsbesparing
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:umu:diva-239380 (URN)10.62607/smt.v102i2.52300 (DOI)
Funder
Skandias Stiftelse Idéer för livet
Available from: 2025-05-30 Created: 2025-05-30 Last updated: 2025-06-02Bibliographically 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
Rosenberg, A., Ivarsson, A., Pulkki-Brännström, A.-M., Lindkvist, M., Silfverdal, S.-A. & Vaezghasemi, M. (2024). Intersectional inequalities in child social-emotional health: a case for proportionate universalism. Paper presented at 17th European Public Health Conference 2024 Sailing the Waves of European Public Health: Exploring a Sea of Innovation. Lisbon, Portugal, November 12-15, 2024. European Journal of Public Health, 34(Suppl 3), Article ID ckae144.961.
Open this publication in new window or tab >>Intersectional inequalities in child social-emotional health: a case for proportionate universalism
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2024 (English)In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 34, no Suppl 3, article id ckae144.961Article in journal, Meeting abstract (Other academic) Published
Abstract [en]

Background: Social-emotional difficulties in early childhood are associated with a range of outcomes across the life course and are related to socioeconomic factors. The aim of this study was to examine intersectional inequalities in social-emotional problems in preschool children relating to their parents’ income, education and country of birth in addition to investigating the public health implications.

Methods: This population-based study with a repeated cross-sectional design in the Västerbotten County of Sweden used the Ages and Stages Questionnaires: Social-Emotional (ASQ:SE) for children aged 3 in child health care services over the years of 2014-2018 and socio-economic information from national population registers. The effective sample of 8,823 individuals was analyzed using additive binomial regression in combination with an analysis of individual heterogeneity and discriminatory accuracy (AIHDA) approach to estimate risk differences for social-emotional problems across 27 intersectional groups and discriminatory accuracy.

Results: Average risk differences generally increased in the groups where multiple dimensions of social inequality intersected, with risk differences as high as 18% (95% CI 8 to 28%) and 25% (95% CI 14 to 37%) compared to the most advantaged category. The discriminatory accuracy of all three included regression models was estimated as moderate, but improved in a slight but statistically significant way with the addition of social inequalities.

Conclusions: This study increases our understanding of intersectional and social inequalities in social-emotional problems in preschool children. It supports the need for universal public health policies in addition to policies targeting more vulnerable groups when addressing this issue, consistent with the concept of proportionate universalism. An intersectional research perspective including discriminatory accuracy could increase our knowledge of health inequities and improve public health effectiveness.

Place, publisher, year, edition, pages
Oxford University Press, 2024
Keywords
emotions, heterogeneity, child, preschool child, income, parent, socioeconomic factors, public health medicine, child health, risk, attributable, health disparity, ages and stages questionnaire, vulnerable populations
National Category
Public Health, Global Health and Social Medicine
Identifiers
urn:nbn:se:umu:diva-232056 (URN)10.1093/eurpub/ckae144.961 (DOI)
Conference
17th European Public Health Conference 2024 Sailing the Waves of European Public Health: Exploring a Sea of Innovation. Lisbon, Portugal, November 12-15, 2024
Available from: 2024-11-22 Created: 2024-11-22 Last updated: 2025-02-20Bibliographically approved
Aweesha, H., Hurtig, A.-K., Pulkki-Brännström, A.-M. & San Sebastian, M. (2024). Sudan's health sector partnership: from confined progression to openness and hope to uncertain demise. Development Policy Review, 42(2), Article ID e12757.
Open this publication in new window or tab >>Sudan's health sector partnership: from confined progression to openness and hope to uncertain demise
2024 (English)In: Development Policy Review, ISSN 0950-6764, E-ISSN 1467-7679, Vol. 42, no 2, article id e12757Article in journal (Refereed) Published
Abstract [en]

Motivation: Despite signature of the 2005 Paris Declaration on Aid Effectiveness and subsequent adoption of the effective development cooperation (EDC) principles for better health cooperation, there is a gap in documenting the challenges to implement these commitments at country level. Sudan represents an interesting case study: the country adopted a local health compact in 2014, but for much of the time since the regime was under sanction. Sudan witnessed a revolution in 2018, followed by a counter-coup in 2021.

Purpose: We aim to explore the evolution of Sudan health sector partners’ relationships, perspectives, and adherence to EDC principles of ownership, alignment, and harmonization, while accounting for underlying processes and context changes between 2015 and 2022.

Methods and approach: We collected data through two rounds of interviews, in 2015 (16) and 2022 (8), with stakeholders within the Sudan Health Sector Partnership. We used the framework method for data analysis where responses are coded then sorted into themes.

Findings: Prior to the 2019 revolution cooperation was progressive but restricted, with civil society marginalized and a dominating government. The principles, especially ownership, were misused and misaligned with national priorities driven by donors’ interests and conditions.

The transitional (post-revolution) period witnessed partners’ openness and influx, but unstable leadership and subsequent changes in priorities led to wasted opportunities.

Following the coup, donors adopted a no-contact policy towards the de facto government. Instead, the expectation was that civil society organizations would replace the government as the main implementers. Overall, limited coordination capacity and no sustainability measures were present throughout.

Policy implications: Much of what was observed was down to the often complicated and difficult context of the governance of Sudan. That said, general issues arose including the government's ability to coordinate policy and implementation; the need for stable, legitimate arrangements; and the need to define the role of civil society and to empower civil society organizations. Within a complex and volatile context, revisiting partners’ commitments through joint compact reviews and transparent EDC progress monitoring is crucial.

Place, publisher, year, edition, pages
John Wiley & Sons, 2024
Keywords
alignment, coordination, effective development cooperation, framework analysis, harmonization, health sector, ownership, partnership, Sudan
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:umu:diva-216479 (URN)10.1111/dpr.12757 (DOI)001155272200001 ()2-s2.0-85184249903 (Scopus ID)
Funder
Familjen Erling-Perssons Stiftelse
Available from: 2023-11-13 Created: 2023-11-13 Last updated: 2024-07-02Bibliographically approved
Sampaio, F., Häggström, J., Ssegonja, R., Eurenius, E., Ivarsson, A., Pulkki-Brännström, A.-M. & Feldman, I. (2023). Health and economic outcomes of a universal early intervention for parents and children from birth to age five: evaluation of the Salut Programme using a natural experiment. Cost Effectiveness and Resource Allocation, 21(1), Article ID 29.
Open this publication in new window or tab >>Health and economic outcomes of a universal early intervention for parents and children from birth to age five: evaluation of the Salut Programme using a natural experiment
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2023 (English)In: Cost Effectiveness and Resource Allocation, E-ISSN 1478-7547, Vol. 21, no 1, article id 29Article in journal (Refereed) Published
Abstract [en]

Background: The aim of this study was to investigate the health and economic outcomes of a universal early intervention for parents and children, the Salut Programme, from birth to when the child completed five years of age.

Methods: This study adopted a retrospective observational design using routinely collected linked register data with respect to both exposures and outcomes from Västerbotten county, in northern Sweden. Making use of a natural experiment, areas that received care-as-usual (non-Salut area) were compared to areas where the Programme was implemented after 2006 (Salut area) in terms of: (i) health outcomes, healthcare resource use and costs around pregnancy, delivery and birth, and (ii) healthcare resource use and related costs, as well as costs of care of sick child. We estimated total cumulative costs related to inpatient and specialised outpatient care for mothers and children, and financial benefits paid to mothers to stay home from work to care for a sick child. Two analyses were conducted: a matched difference-in difference analysis using the total sample and an analysis including a longitudinal subsample.

Results: The longitudinal analysis on mothers who gave birth in both pre- and post-measure periods showed that mothers exposed to the Programme had on average 6% (95% CI 3–9%) more full-term pregnancies and 2% (95% CI 0.03-3%) more babies with a birth weight ≥ 2500 g, compared to mothers who had care-as-usual. Savings were incurred in terms of outpatient care costs for children of mothers in the Salut area ($826). The difference-in-difference analysis using the total sample did not result in any significant differences in health outcomes or cumulative resource use over time.

Conclusions: The Salut Programme achieved health gains, as a health promotion early intervention for children and parents, in terms of more full-term pregnancies and more babies with a birth weight ≥ 2500 g, at reasonable cost, and may lead to lower usage of outpatient care. Other indicators point towards positive effects, but the small sample size may have led to underestimation of true differences.

Place, publisher, year, edition, pages
BioMed Central (BMC), 2023
Keywords
Child health, Early intervention, Health care costs, Maternal health costs, Universal prevention
National Category
Public Health, Global Health and Social Medicine
Identifiers
urn:nbn:se:umu:diva-208946 (URN)10.1186/s12962-023-00439-7 (DOI)000980523200001 ()37143113 (PubMedID)2-s2.0-85157979665 (Scopus ID)
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2017-00912
Available from: 2023-06-02 Created: 2023-06-02 Last updated: 2025-02-20Bibliographically approved
Prabowo, M. H., Febrinasari, R. P., Pamungkasari, E. P., Mahendradhata, Y., Pulkki-Brännström, A.-M. & Probandari, A. (2023). Health-related quality of life of patients with diabetes mellitus measured with the Bahasa Indonesia version of EQ-5D in primary care settings in Indonesia. Journal of Preventive Medicine and Public Health, 56(5), 467-474
Open this publication in new window or tab >>Health-related quality of life of patients with diabetes mellitus measured with the Bahasa Indonesia version of EQ-5D in primary care settings in Indonesia
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2023 (English)In: Journal of Preventive Medicine and Public Health, ISSN 1975-8375, E-ISSN 2233-4521, Vol. 56, no 5, p. 467-474Article in journal (Refereed) Published
Abstract [en]

Objectives: Diabetes mellitus (DM) is a serious public health issue that places a heavy financial, social, and health-related burden on individuals, families, and healthcare systems. Self-reported health-related quality of life (HRQoL) is extensively used for monitoring the general population's health conditions and measuring the effectiveness of interventions. Therefore, this study investigated HRQoL and associated factors among patients with type 2 DM at a primary healthcare center in Indonesia.

Methods: A cross-sectional study was conducted in Klaten District, Central Java, Indonesia, from May 2019 to July 2019. In total, 260 patients with DM registered with National Health Insurance were interviewed. HRQoL was measured with the EuroQol Group's validated Bahasa Indonesia version of the EuroQoL 5-Dimension 5-Level (EQ-5D-5L) with the Indonesian value set. Multivariate regression models were used to identify factors influencing HRQoL.

Results: Data from 24 patients were excluded due to incomplete information. Most participants were men (60.6%), were aged above 50 years (91.5%), had less than a senior high school education (75.0%), and were unemployed (85.6%). The most frequent health problems were reported for the pain/discomfort dimension (64.0%) followed by anxiety (28.4%), mobility (17.8%), usual activities (10.6%), and self-care (6.8%). The average EuroQoL 5-Dimension (EQ-5D) index score was 0.86 (95% confidence interval [CI], 0.83 to 0.88). In the multivariate ordinal regression model, a higher education level (coefficient, 0.08; 95% CI, 0.02 to 0.14) was a significant predictor of the EQ-5D-5L utility score.

Conclusions: Patients with diabetes had poorer EQ-5D-5L utility values than the general population. DM patients experienced pain/discomfort and anxiety. There was a substantial positive relationship between education level and HRQoL.

Place, publisher, year, edition, pages
Korean Society for Preventive Medicine, 2023
Keywords
Diabetes mellitus, EQ-5D-5L, Indonesia, Quality of life
National Category
Public Health, Global Health and Social Medicine Endocrinology and Diabetes
Identifiers
urn:nbn:se:umu:diva-215869 (URN)10.3961/jpmph.23.229 (DOI)001100704500009 ()37828874 (PubMedID)2-s2.0-85174347456 (Scopus ID)
Available from: 2023-11-01 Created: 2023-11-01 Last updated: 2025-04-24Bibliographically approved
Vaezghasemi, M., Vogt, T., Lindkvist, M., Pulkki-Brännström, A.-M., Richter Sundberg, L., Lundahl, L., . . . Ivarsson, A. (2023). Multifaceted determinants of social-emotional problems in preschool children in Sweden: An ecological systems theory approach. SSM - Population Health, 21, Article ID 101345.
Open this publication in new window or tab >>Multifaceted determinants of social-emotional problems in preschool children in Sweden: An ecological systems theory approach
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2023 (English)In: SSM - Population Health, ISSN 2352-8273, Vol. 21, article id 101345Article in journal (Refereed) Published
Abstract [en]

Social-emotional problems occurring early in life can place children at future risk of adverse health, social and economic outcomes. Determinants of social-emotional problems are multi-layered and originate from different contexts surrounding children, though few studies consider them simultaneously. We adopted a holistic approach by using Bronfenbrenner's process-person-context-time model as a structuring device. We aimed to assess what characteristics of families and children from pregnancy, over birth, and up to 3 years of age are associated with social-emotional problems in boys and girls. This study used regional data from the Salut Programme, a universal health promotion programme implemented in Antenatal and Child Health Care, and data from national Swedish registers. The study population included 6033 3-year-olds and their parents during the period 2010–2018. Distinct logistic regression models for boys and girls were used to assess associations between the family social context, parents' lifestyle, parent's mental health, children's birth characteristics, and indicators of proximal processes (the independent variables); and children's social-emotional problems as measured by the parent-completed Ages and Stages Questionnaire: Social-Emotional between 33 and 41 months of age (the outcome). Overall, a less favourable family social context, detrimental lifestyle of the parents during pregnancy, and parents' mental illness from pregnancy onwards were associated with higher odds of social-emotional problems in 3-year-olds. Higher screentime and infrequent shared book-reading were associated with higher odds of social-emotional problems. The multifaceted determinants of children's social-emotional problems imply that many diverse targets for intervention exist. Additionally, this study suggests that Bronfenbrenner's process-person-context-time theoretical framework could be relevant for public health research and policy.

Place, publisher, year, edition, pages
Elsevier, 2023
Keywords
Social-emotional health, Mental health, Preschool children, Ecological systems theory:sweden
National Category
Public Health, Global Health and Social Medicine Pediatrics
Identifiers
urn:nbn:se:umu:diva-204344 (URN)10.1016/j.ssmph.2023.101345 (DOI)001058450100001 ()2-s2.0-85147123061 (Scopus ID)
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2021-00155
Available from: 2023-02-02 Created: 2023-02-02 Last updated: 2025-04-24Bibliographically approved
Vaezghasemi, M., Pulkki-Brännström, A.-M., Lindkvist, M., Silfverdal, S.-A., Lohr, W. & Ivarsson, A. (2023). Social inequalities in social-emotional problems among preschool children: a population-based study in Sweden. Global Health Action, 16(1), Article ID 2147294.
Open this publication in new window or tab >>Social inequalities in social-emotional problems among preschool children: a population-based study in Sweden
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2023 (English)In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 16, no 1, article id 2147294Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Social-emotional ability is important for overall health and wellbeing in early childhood. Recognizing preschool children in need of extra support, especially those living in unfavourable conditions, can have immediate positive effects on their health and benefit their wellbeing in the long-term.

OBJECTIVES: The aim of this study is to investigate whether there are social inequalities in preschool children's social-emotional problems, and whether inequalities differ between boys and girls.

METHOD: This study utilized repeated measures from cross-sectional population-based surveys of three-year old children (2014-2018). The final study population comprised of 9,099 children which was 61% of all the eligible children in Västerbotten County during the study period. The Ages and Stages Questionnaires: Social-Emotional (ASQ:SE) 36-month interval was used to measure children's social-emotional ability. Social inequalities were studied with respect to parents' income, education, and place of birth, for which data was obtained from Statistics Sweden. Multiple logistic and ordered regressions were used.

RESULTS: Among 3-year-olds, social-emotional problems were more common in the most vulnerable social groups, i.e. parents in the lowest income quintile (OR: 1.45, p < 0.001), parents with education not more than high school (OR: 1.51, p < 0.001), and both parents born outside Sweden (OR: 2.54, p < 0.001). Notably, there was a larger difference in social-emotional problems between the lowest and highest social categories for girls compared to boys. Higher odds of social-emotional problems were associated with boys not living with both parents and girls living in the areas of Skellefteå and Umeå, i.e. more populated geographical areas.

CONCLUSION: Already at 3-years of age social-emotional problems were more common in children with parents in the most vulnerable social groups. This does not fulfil the ambition of an equitable start in life for every child and might contribute to reproduction of social inequalities across generations.

Place, publisher, year, edition, pages
Taylor & Francis, 2023
Keywords
Ages and Stages Questionnaires: Social-Emotional (ASQ:SE), Population-based, mental health, preschool children, social inequality
National Category
Public Health, Global Health and Social Medicine Pediatrics
Identifiers
urn:nbn:se:umu:diva-204345 (URN)10.1080/16549716.2022.2147294 (DOI)000923029200001 ()36722260 (PubMedID)2-s2.0-85147186828 (Scopus ID)
Funder
Public Health Agency of Sweden Region Västerbotten
Available from: 2023-02-02 Created: 2023-02-02 Last updated: 2025-04-15Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0001-8723-8131

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