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Adolescent self-reported health in the Umeå region: Associations with behavioral, parental and school factors
Umeå University, Faculty of Social Sciences, Department of Social Work.
2012 (English)Doctoral thesis, comprehensive summary (Other academic)Alternative title
Självrapporterad hälsa hos ungdomar i Umeåregionen, och dess samband med normrelaterat beteende samt med föräldra- och skolfaktorer (Swedish)
Abstract [en]

This thesis consists of a quantitative and a qualitative study. The quantitative study (articles I-III) aimed to examine how self-reported health in adolescence is associated with behavioral, parental, and school factors. Through a survey directed at all adolescents in grades 7-9, data were collected in 2005 in a region in northern Sweden (n=5060). Statistical methods were used to analyze the survey data: chi2tests, multivariate logistic regressions and multilevel logistic regressions. Results showed that even though most adolescents reported good health, there were also rather large proportions of adolescents who reported headaches, stomach aches and feelings of stress. Girls reported poor health to a higher extent than boys, a difference that was larger in grade 9 than in grade 7. The results also showed that being norm compliant was associated with good self-reported health. Furthermore, perceiving relations and communication with parents as poor was associated with poor self-reported health; however, this relationship could not explain gender differences in self-reported health. Continuing on, analyses showed that there exist greater variations in self-reported health between students (within a school) than between different schools. On an individual level, poor relations to teachers, bullying and truancy were associated with poor general health. The qualitative study  (article IV) sought to examine barriers to and facilitators of utilization of local school survey results within a school setting. In 2011, 21 school district managers and principals within a Swedish municipality were interviewed. Analyses were performed using a qualitative content analysis. The results from the qualitative study showed that the dissemination and utilization of school survey results appeared as two interrelated phases in one process. Barriers and facilitators differed qualitatively depending on the phase, dissemination or utilization.

In conclusion, professionals as well as researchers need to consider the complexity of adolescent health and its social determinants. Adolescent health is a concern for multiple sectors in society, which highlights the need for further development of collaborations between professionals in relevant fields, such as health care, school and social services.

Abstract [sv]

Den här avhandlingen består av en kvantitativ och en kvalitativ studie. Syftet med den kvantitativa studien (artikel I-III) var att undersöka sambandet mellan ungdomars självrapporterade hälsa och deras normrelaterade beteende samt föräldra- och skolfaktorer. Data samlades in under 2005, genom en enkät som riktade sig till alla ungdomar i årskurs 7-9 i en region i norra Sverige (n=5060). De statistiska metoder som användes i den kvantitativa studien var bland annat chi2- test, logistisk regression samt flernivåanalys. Resultaten visade att även om de flesta ungdomar rapporterade en god allmän hälsa, så var det också en relativt stor andel som rapporterade huvudvärk, magont samt upplevelser av stress. Flickor rapporterade sämre hälsa än pojkar, en skillnad som var större i åk 9 jämfört med åk 7. Resultaten visade också att normföljsamhet hade ett signifikant samband med god självrapporterad hälsa. De ungdomar som upplevde relationen och kommunikationen med sina föräldrar som dålig, rapporterade också dålig hälsa i högre utsträckning än övriga. Sambandet mellan självrapporterad hälsa och föräldrarelationer kunde inte förklara skillnaderna i ohälsa mellan pojkar och flickor. Vidare, analyser visade att det fanns större variationer i självrapporterad hälsa mellan ungdomar (inom en skola) än mellan olika skolor. Dåliga relationer med lärare, skolk, samt att bli utsatt för mobbning hade ett signifikant samband med dålig självrapporterad hälsa, på en individuell nivå.

Syftet med den kvalitativa studien (artikel IV) var att undersöka vilka faktorer inom skolan som möjliggör och som utgör barriärer för användningen av enkätresultaten från en lokal skolenkät. 2011 genomfördes 21 intervjuer med skolområdeschefer och rektorer inom en kommun i Sverige. Analyser av intervjumaterialet genomfördes med hjälp av kvalitativ innehållsanalys. Resultaten från denna studie visade att spridningen och användningen av resultaten från skolenkäten kan beskrivas som två relaterade faser i en process. De faktorer som underlättade samt utgjorde barriärer för spridningen och användningen av enkätresultaten var kvalitativt olika varandra beroende på vilken fas i processen respondenterna hänvisade till.

Dessa resultat illustrerar den mångfacetterade komplexitet som inryms i ungdomars hälsa och dess sociala determinanter, en komplexitet som både forskare och professionella behöver ta hänsyn till. Ungdomars hälsa angår ett flertal samhällssektorer, vilket visar på betydelsen av en fortsatt utveckling av samverkan mellan professionella inom exempelvis hälso- och sjukvården, skolan och socialtjänsten.

Place, publisher, year, edition, pages
Umeå: Umeå universitet , 2012.
Studier i socialt arbete vid Umeå universitet : avhandlings- och skriftserie, ISSN 0283-300X ; 71
Keyword [en]
adolescence, school survey, self-reported health, somatic complaints, stress, norm compliance, parent-adolescent relations, compulsory school, school managers, research utilization
Keyword [sv]
ungdomar, skolenkät, självrapporterad hälsa, somatiska besvär, stress, normföljsamhet, föräldrarelationer, skola, skolområdeschefer, forskningsanvändning
National Category
Social Work
URN: urn:nbn:se:umu:diva-54177ISBN: 978-91-7459-377-8OAI: diva2:516382
Public defence
2012-05-11, Samhällsvetarhuset, Hörsal C, Umeå universitet, Umeå, 10:15
Available from: 2012-04-20 Created: 2012-04-18 Last updated: 2015-04-29Bibliographically approved
List of papers
1. Norm compliance and self-reported health among Swedish adolescents
Open this publication in new window or tab >>Norm compliance and self-reported health among Swedish adolescents
2011 (English)In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 39, no 1, 44-50 p.Article in journal (Refereed) Published
Abstract [en]

Aims: This study examines the relationship between norm compliance and self-reported health in adolescents, and how this differs between genders. Our specific aim was to investigate if extremely high norm compliance revealed any particular health patterns. Methods: This empirical study used a web-based survey from 2005, which was distributed to all students (n = 5,066) in years 7—9 of compulsory school within six municipalities in northern Sweden. The respondents answered questions about their general health as well as specific health problems such as headaches, stomach ache, sleeping difficulties and stress. Compliance was measured according to different norm-related behaviour, such as truancy, crime and use of tobacco, alcohol and narcotics. Results: The majority of respondents reported good health and norm-compliant behaviour. Girls reported more health problems than boys, a difference that increased with age. Those who were more norm compliant reported better health, fewer somatic complaints and less stress, which goes against our initial hypothesis that extremely high norm compliance and self-reported ill-health are related. There seemed to be a stronger relationship between self-reported health and norm compliance for girls than boys, in absolute terms. Conclusions: The results clearly show a relationship between norm compliance and health, and suggest inequalities between genders.

Gender, norm-breaking, self assessment, somatic complaints, stress
National Category
Social Work
urn:nbn:se:umu:diva-39505 (URN)10.1177/1403494810389846 (DOI)
Available from: 2012-03-29 Created: 2011-01-28 Last updated: 2016-10-04Bibliographically approved
2. Parents matter: but relations to parents do not explain gender differences in self-reported health in adolescents
Open this publication in new window or tab >>Parents matter: but relations to parents do not explain gender differences in self-reported health in adolescents
2012 (English)In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 26, no 4, 643-653 p.Article in journal (Refereed) Published
Abstract [en]

The aim of the study was to explore whether parent-adolescent relations are associated to self-reported health of adolescents. Logistic regression analyses were performed on a cross-sectional data set consisting of 5060 adolescents, grades 7-9, from six municipalities in the northern part of Sweden. The study was approved by the Regional Ethical Review Board in Umeå, Sweden. Results showed that, in both boys and girls, experiencing low parental demands as well as perceiving the relationship quality and the communication with parents as poor were significantly associated with having poor general health, somatic complaints and feelings of stress. In general, girls scored lower on self-reported health than boys, but our findings indicate that these gender differences could not be explained by relations to parents. In conclusion, relations to parents play an important role for self-reported health of adolescents. Although no causal-effect statements can be determined in this study, it is implied that there is a need for health professionals, such as school nurses, school welfare officers, etc., to pay special attention to parent-adolescent relations in their work with adolescents.

National Category
Social Work
urn:nbn:se:umu:diva-53100 (URN)10.1111/j.1471-6712.2012.00973.x (DOI)
Available from: 2012-03-29 Created: 2012-03-13 Last updated: 2016-10-04Bibliographically approved
3. Adolescent self-reported health in relation to school factors: a multilevel analysis
Open this publication in new window or tab >>Adolescent self-reported health in relation to school factors: a multilevel analysis
2014 (English)In: Journal of School Nursing, ISSN 1059-8405, E-ISSN 1546-8364, Vol. 30, no 2, 114-122 p.Article in journal (Refereed) Published
Abstract [en]

The aim of the study was to examine school-related determinants of self-reported health among adolescents. Questionnaire survey data comprising 4,972 students, Grades 7 through 9, from 20 schools in northern Sweden were used. Also, complimentary data about each school were collected from the Swedish National Agency for Education. Using multilevel logistic regression analyses, results showed that most variation in self-reported health was explained by individual-level differences. Truancy, bullying, and poor relations with teachers significantly increased the odds ratio of reporting poor general health, for boys and for girls. Most variables at the school level, for example, school size and student-teacher ratio, did not render significant associations with students' self-reported health. In conclusion, this study indicates that health promotion at school, including school health services, may benefit from focusing primarily on individual-level determinants of health, that is, students' relations to peers and teachers, without ignoring that bullying and weak student-teacher relationships also may induce school-level interventions.

Place, publisher, year, edition, pages
Sage Publications, 2014
adolescent health, compulsory school, logistic regression, multilevel modeling
National Category
Family Medicine
urn:nbn:se:umu:diva-71408 (URN)10.1177/1059840513489709 (DOI)000332846700005 ()23674554 (PubMedID)2-s2.0-84896262537 (ScopusID)
Forte, Swedish Research Council for Health, Working Life and Welfare, 2007-0595
Available from: 2013-05-28 Created: 2013-05-28 Last updated: 2016-05-23Bibliographically approved
4. What happens with local survey findings?: A study of how adolescent school surveys are disseminated and utilized in Swedish schools
Open this publication in new window or tab >>What happens with local survey findings?: A study of how adolescent school surveys are disseminated and utilized in Swedish schools
2013 (English)In: Scandinavian Journal of Educational Research, ISSN 0031-3831, E-ISSN 1470-1170, Vol. 57, no 5, 526-543 p.Article in journal (Refereed) Published
Place, publisher, year, edition, pages
Taylor & Francis Group, 2013
National Category
Social Work
urn:nbn:se:umu:diva-54179 (URN)10.1080/00313831.2012.696209 (DOI)
Available from: 2012-04-18 Created: 2012-04-18 Last updated: 2016-10-04Bibliographically approved

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