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  • 1. Almquist, Ylva B
    et al.
    Landstedt, Evelina
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Hammarström, Anne
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Associations between social support and depressive symptoms: social causation or social selection-or both?2017In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 27, no 1, p. 84-89Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Numerous studies have demonstrated an association between social support and health, almost regardless of how social support and health have been conceptualised or measured. Even so, the issue of causality has not yet been sufficiently addressed. This issue is particularly challenging for mental health problems such as depressive symptoms. The aim of the present study is to longitudinally assess structural and functional aspects of social support in relation to depressive symptoms in men and women, through a series of competing causal models that, in contrast to many other statistical methods, allow for bi-directional effects.

    METHODS: Questionnaire data from the Northern Swedish Cohort (n = 1001) were utilised for the years 1995 (age 30) and 2007 (age 42). Associations were analysed by means of gender-specific structural equation modelling, with structural and functional support modelled separately.

    RESULTS: Both structural and functional support were associated with depressive symptoms at ages 30 and 42, for men and women alike. A higher level of support, particularly functional support, was associated with a decrease in depressive symptoms over time among men. Among women, there were bi-directional effects of social support and depressive symptoms over time.

    CONCLUSION: Concerning social support and health, the social causation hypothesis seems relevant for men whereas, for women, the associations appear to be more complex. We conclude that preventive and health promoting work may need to consider that the presence of depressive symptoms in itself impedes on women's capability to increase their levels of social support.

  • 2. Almquist, Ylva B.
    et al.
    Landstedt, Evelina
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Jackisch, J.
    Rajaleid, K.
    Westerlund, H.
    Hammarström, A.
    Growing through asphalt: What counteracts the long-term negative health impact of youth adversity?2017In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 27, no Suppl_3, p. 47-47Article in journal (Other academic)
    Abstract [en]

    Background: Adversity in the family of origin tends to translate into poor health development. Yet, the fact that this is not the always the case has been seen an indicator of resilience. The current study highlights factors outside the context of the family with the potential to counteract the long-term negative influences of social and material adversity in adolescence on general health status.

    Methods: The study was based on the Northern Swedish Cohort born in 1965 (n = 1,001). Measures of social and material adversity, health, and protective factors related to school, peers, and spare time, were derived from questionnaires distributed to the cohort members and their teachers at age 16. Self-rated health was measured at age 43. The main associations were examined by means of ordinal regression analysis, with the role of the protective factors being assessed through interaction analysis.

    Results: Social and material adversity in youth was associated with poorer self-rated health in midlife among males and females alike, net of health status at baseline. However, having an advantaged situation with regard to school, peers, or spare time – particularly in terms of being seen as having good educational and work prospects, as well as a high-quality spare time – appeared to protect against the detrimental influences of disadvantaged circumstances in the family context on subsequent health.

    Conclusions: There are several factors outside the context of the family that seemingly have the potential to buffer against the negative health consequences stemming from having experienced a disadvantaged upbringing. Initiatives targeted at increasing academic motivation and commitment as well as social capital and relationships in youth, may here be of particular relevance.

    Key messages:

    • While the experience of disadvantageous living conditions in adolescence tends to translate into poor health development across the life course, this is not always the case.
    • Advantages related to school, peers, and spare time have the potential of counteracting the negative health impact of an adverse family context.
  • 3.
    Baroudi, Mazen
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Waenerlund, Anna-Karin
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    San Sebastian, Miguel
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Goicolea, Isabel
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Assessing the dimensionality of YFHS-Swe; a new questionnaire to assess youth friendliness2017In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 27, no suppl_3, p. 343-Article in journal (Other academic)
    Abstract [en]

    Background: Ensuring the youth friendliness of health services can increase the utilization of these services and contribute to improve youth’s health. Few validated instruments to assess youth-friendliness exist worldwide and none in Sweden. To assess the youth-friendliness of Swedish youth clinics (differentiated services for youth that exist since the 70s), an adapted version of YFHS WHO+ questionnaire called (YFHS-Swe) was developed. YFHS-Swe proved to have good internal homogeneity and consistency over time. The aim of our study was to perform a psychometric analysis to assure the quality and reliability of the questionnaire, and to assess the dimensionality of YFHS-Swe to identify possible subdomains that might be of importance for policy making.

    Methods: YFHS-Swe was answered by 1,110 youths aged 16 to 25 years visiting 20 youth clinics in Northern Sweden between September 2016 and February 2017. YFHS-Swe was assessed using exploratory and confirmatory factor analysis.

    Results: Thirteen factors could be identified; ability to get contact; access to sexual and reproductive health (SRH) service; access to psychosocial health services; parental support of SRH services; parental support of psychosocial health services; equity with diverse concerns; equity with legal concerns; fear of exposure; respect; privacy and confidentiality; no judgement; quality of consultation and quality of facility. Except for “quality of facility”, all other twelve factors recorded good α reliability ranging from 0.76 to 0.97, good ρ reliability ranging from 0.77 to 0.97 and acceptable measure of fit (SRMR<0.08).

    Conclusions: The YFHS-Swe proved to be credible and suitable for assessing youths-friendliness of the Swedish youth clinics. The identified factors might be of an importance to capture different dimensions of youth friendliness. With some cultural and linguistic adaptations, this instrument can be used in other differentiated youth health services internationally.

    Key messages:

    • YFHS-Swe is credible and suitable instrument in the Swedish context and it can be used as a basis for validating other instruments to assess youth-friendliness in other contexts.
    • The dimensions identified of this novel instrument might be of importance in assessing distinct aspects of friendliness in differentiated health services and might be of importance for policy making.
  • 4.
    Brydsten, Anna
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Hammarström, Anne
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Social medicine.
    Strandh, Mattias
    Umeå University, Faculty of Social Sciences, Department of Social Work. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Johansson, Klara
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Youth unemployment and functional somatic symptoms in adulthood: results from the Northern Swedish cohort2015In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 25, no 5, p. 796-800Article in journal (Refereed)
    Abstract [en]

    Background: Little is known about the possible long-term health consequences of youth unemployment. Research indicates that unemployment may lead to socioeconomic downward mobility and mental health problems, but we still lack knowledge of the long-term health consequences of youth unemployment. This article examines the potential long-term association between youth unemployment and functional somatic symptoms in adulthood. 

    Methods: The ‘Northern Swedish cohort’ was used with data from five data collections, from 1981 (age 16) until 2007 (age 42). Youth unemployment was measured as months in unemployment between age 16 and 21, and health outcome as functional somatic symptoms (an index of 10 items of self-reported symptoms). Linear regression was used to analyse the relationship between months in youth unemployment and functional somatic symptoms at age 21 and age 42, stratified for women and men and adjusted for potential confounders, such as time spent in education at age 21 and later unemployment between age 21 and 42. 

    Results: Youth unemployment was significantly related to functional somatic symptoms at age 21 for men after controlling for confounders, but not for women. Among men, the association remained for functional somatic symptoms at age 42, after controlling for confounders. 

    Conclusions: Adolescence seems to be a sensitive period during which unemployment could have remaining health effects in adulthood, at least for men, though assumptions of causality are tentative and more research is needed.

  • 5.
    Brännström, Inger
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.
    Persson, Lars Åke M.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.
    Wall, Stig
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.
    Towards a framework for outcome assessment of health intervention: Conceptual and methodological considerations1994In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 4, no 2, p. 125-130Article in journal (Refereed)
    Abstract [en]

    We provide a framework for assessing the outcome of community-based intervention programmes for the promotion of cardiovascular health at local level. Particular attention is therefore given to conceptual components connected with community participation in health programmes and to methodological approaches in the evaluation of cardiovascular disease (CVD)-prevention programmes. In a search of the literature covering more than 20 years (1966–1988) in 2 databases (MEDLINE and SOCA), we found that the concepts of ‘community participation’ and ‘community involvement’ have mainly been used during the latter half of the study period. The concepts were often used interchangeably and with no statement as to their precise meanings. The methodological examination of 2 well-known community-based CVO-preventive programmes revealed that most of the scientific papers from these programmes dealt with health behavioural and/or medical effects. The suggested framework presented in this study is designed as a longitudinal process analysis focusing on critical key steps along the path from input to output. The suggested research strategy is problem-orientated, inter-disciplinary and based on a multi-method approach.

  • 6.
    Emmelin, Maria
    et al.
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.
    Lindholm, Lars
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.
    Stenlund, Hans
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.
    Dahlgren, Lars
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.
    Pol-ethical considerations in public health.: The views of Swedish health care politicians1999In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 9, no 2, p. 124-130Article in journal (Refereed)
    Abstract [en]

    Background: Public health policy is often concerned with the conflicting values emanating from the individually formulated ethics for curative care and more collectively oriented ethics. In this study we have focused on the pol-ethical considerations involved in Swedish health care politicians' assessment of public health measures. Methods: We described a hypothetical situation in a questionnaire, where a community has a 50% excess mortality for disease X, compared to the national average. Scientific disagreements were identified and discussed. The respondents gave their preference for a specific intervention strategy and considered, on a graded scale, 17 different value statements related to ethical principles and intervention strategies. Results: Only one out of 451 politicians preferred the alternative ‘no intervention’. The majority preferred an intervention including active involvement of primary health care. There was overall strong support for equity and beneficence. A factor analysis gave a model for the association between ethical values, political affiliation and choice of intervention strategies. The relative weights of autonomy and equity were strongly related to political affiliation. Conclusions: Among Swedish health care politicians there is consensus about the value of performing interventions in public health when the problem is large, even if there is some uncertainty about the consequences. Their overall strong support for equity and beneficence implies that these principles are crucial when formulating policies for interventions. Politicians need to state their ethical standpoint explicitly so that we as citizens can judge their decisions and actions based on our own political ideology and support for basic ethical principles.

  • 7.
    Eriksson, Malin
    et al.
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Dahlblom, Kjerstin
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    What constitute health promoting living environments from children's perspectives?2017In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 27, no Suppl_3, p. 508-Article in journal (Other academic)
    Abstract [en]

    Background: Swedish research on the effects of living environment on children's health is limited, and very few studies bring up children’s own views and experiences from their everyday lives. The overall aim of this study is to explore what constitutes health promoting living environments from children’s own perspectives.

    Methods: This is an ongoing qualitative exploratory study, building on children’s active involvement using Photovoice method. Schoolchildren in grade five, living in a medium sized Swedish municipality were equipped with digital cameras to document places of importance for their well-being. These photographs were discussed in sex-stratified focus groups. By discussing their photos, the children could identify and portray their choices of places, which gave valuable insights of how they view their worlds and what they perceive as health promoting in their living environments. Data were initially analyzed thematically.

    Results: Children presented photos from their homes showing mostly their own rooms and their computers, sports- and other facilities for leisure activities as well as photos from playgrounds, forests and neighborhood venues. These places were all perceived as important for their wellbeing. Preliminary analyzes reveal how these places in different ways are characterized as; Places allowing Socializing; Places for Activities; Places for Relaxation, and Places providing a sense of Freedom. Having a Space of one’s own was also perceived as important for well-being.

    Conclusions: A safe environment, allowing positive activities, relaxation, togetherness as well as freedom and a space of one’s own, characterizes health-promoting places for Children in a Swedish context.

    Key messages:

    • Children are active actors in their living environments and are well aware of aspects in their living environments of importance for their well-being.
    • Children’s voices and experiences needs to be taken into account in the planning and design of health promoting living environments.
  • 8.
    Eriksson, Malin
    et al.
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Lindgren, Urban
    Umeå University, Faculty of Social Sciences, Department of Geography and Economic History.
    Ivarsson, Anneli
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Ng, Nawi
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Child health and place: How is neighborhood social capital associated with child health injuries?2017In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 27, no Suppl_3, p. 41-41Article in journal (Other academic)
    Abstract [en]

    Background: Child health inequalities can be explained by social determinants of health, including neighborhood social capital. Swedish research about place effects on children's health is limited. This project aims to contribute to knowledge on how neighborhood social capital may influence child health in the Swedish context. The overall research questions were: What is the incidence rate of child injuries in the living environments among boys and girls? What are the associations between neighborhood social capital and child injuries?

    Methods: Child injury data from the Umeå SIMSAM Lab were utilized, with data from all children 0-12 years of age, living in Umeå municipality during 2006-2009. Individual child injury and residential area data were linked to a neighborhood social capital index, where 49 defined neighborhoods were assigned a score from low- high in social capital, based on people’s perceptions about their neighborhoods. Individual, household and neighborhood demographic and socioeconomic variables (country of birth, educational level, income and family type) were also extracted from the Umeå SIMSAM lab. Logistic regression analyses were conducted to analyze factors associated with child injury.

    Results: We observed 3930 injury events that occurred in the living environments, experienced by 24 000 children who lived in 14 767 households within 49 neighborhoods. The incidence rate of child injuries was about 72.5/1000 for boys and 60/1000 for girls. The odds for child injures was lower in neighborhoods with high social capital compared to neighborhoods with low social capital (OR 0.87 95%CI 0.80-0.95) after controlling for demographic and socioeconomic factors at individual, household and neighborhood level. The protective effects of neighborhood social capital were stronger for girls than boys.

    Conclusions: Neighborhood social capital may have a protective effect on child injuries and especially so for girls.

    Key messages:

    • Neighborhood conditions have a significant influence on child health inequalities in the Swedish context, including inequalities in child injuries.
    • Mobilization of neighborhood social capital might be good investment for reducing child injuries.
  • 9.
    Forsberg, Bertil
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Environmental Medicine.
    Stjernberg, Nils
    Wall, Stig
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.
    Prevalence of respiratory and hyperreactivity symptoms in relation to levels of criteria air pollutants in Sweden1997In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 7, no 3, p. 291-296Article in journal (Refereed)
    Abstract [en]

    Our knowledge of the adverse health effects from exposure to low levels of air pollution is still insufficient. Early indicators, such as respiratory symptoms, need more attention. We made use of the fact that possible weak effects can be detected more easily when the relevant exposure and other determinants are well controlled. A postal questionnaire was sent to random samples of inhabitants registered as residing in the Vicinity of 55 centrally located air quality monitoring stations in Swedish towns. There were 6,109 questionnaires (76%) returned. Multivariate analyses with confounding control were used to examine the effects of different levels of criteria pollutants on the prevalence of symptoms. The ranges of the half year values were 9-32 and 2-16 mu g/m(3) for nitrogen dioxide and sulphur dioxide respectively. Logistic regression analyses showed higher risks for respiratory problems such as coughs, throat irritation and nose irritation among the persons most exposed, The associations were most obvious for nitrogen dioxide exposure among women. The suggested effects of air pollution exposure cannot be medically evaluated today but they are nevertheless interesting since they are found within common levels usually considered to be safe.

  • 10. Gillander Gådin, Katja
    et al.
    Hammarström, Anne
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    A possible contributor to the higher degree of girls reporting psychological symptoms compared with boys in grade nine?2005In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 15, no 4, p. 380-385Article in journal (Refereed)
    Abstract [en]

    Background: It is a recurrent finding that adolescent girls report psychological symptoms in a higher degree compared with boys. The explanations for this difference vary, but the psychosocial school environment has never been a focus in these explanations. The aim of this study was to analyse whether psychosocial factors at school were associated with a high degree of psychological symptoms among boys and girls in grade nine, with a special focus on sexual harassment.

    Methods: The study was based on a cross-sectional study including 336 pupils (175 girls and 161 boys) in grade nine (about 15 years old), who answered an extensive questionnaire. The non-response rate was negligible (< 1%). Logistic regression analysis was used to analyse whether school-related factors (teacher support, classmate support, sexual harassment), body image, and parental support were associated with a high degree of psychological symptoms.

    Results: Sexual harassment at school was associated with a high degree of psychological symptoms among girls.

    Conclusions: Sexual harassment must be acknowledged as a negative psychosocial school environmental factor of importance for the high degree of psychological ill-health symptoms among girls compared with boys.

  • 11.
    Gustafsson, Per E
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Persson, Mats
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Hammarström, Anne
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Socio-economic disadvantage and body mass over the life course in women and men: results from the Northern Swedish Cohort2012In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 22, no 3, p. 322-327Article in journal (Refereed)
    Abstract [en]

    Background: Obesity and body mass in adulthood relate both to current and to childhood socio-economic status, particularly in women, but the underlying life course processes are not known. This study aims at examining whether the life course socio-economic status—body mass association in women and men is explained by the cumulative risk or adolescent sensitive period models whether associations are similar at different life course stages; and whether health behaviours explain the associations.

    Methods: A total of 476 women and 517 men participated in this 27-year prospective cohort study (participation rate 93%). Body mass index was assessed at the age of 16 and 43 years and self-reported at the age of 21 and 30 years. Information on socio-economic status by own or parental (age 16 years) occupation, smoking, snuff, alcohol, physical activity and diet was collected at each age.

    Results: In women, cumulative socio-economic status and socio-economic status in adolescence were related to body mass index at the age of 16, 21, 30 and 43 years and to the 27-year change in body mass, independently of health behaviours and for adolescent socio-economic status also of later socio-economic attainment. Associations were generally stronger for body mass at older age. In men, associations were mostly non-significant, although health behaviours contributed strongly to body mass.

    Conclusions: In women, both the sensitive period (in adolescence) and cumulative risk models explain the socio-economic–body mass link. Efforts to reduce the social inequality in body mass in women should be directed at the early life course, but focusing on unhealthy behaviours might not be a sufficient approach.

  • 12.
    Gustafsson, Per
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Socialmedicin.
    Hammarström, Anne
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Socialmedicin.
    San Sebastian, Miguel
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Cumulative contextual and individual disadvantages over the life course and adult functional somatic symptoms in Sweden2015In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 25, no 4, p. 592-597Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:: Disadvantage, originating in one's residential context or in one's past life course, has been shown to impact on health in adulthood. There is however little research on the accumulated health impact of both neighbourhood and individual conditions over the life course. This study aims to examine whether the accumulation of contextual and individual disadvantages from adolescence to middle-age predicts functional somatic symptoms (FSS) in middle-age, taking baseline health into account.

    METHODS:: The sample is the age 16, 21, 30 and 42 surveys of the prospective Northern Swedish Cohort, with analytical sample size n = 910 (85% of the original cohort). FSS at age 16 and 42, and cumulative socioeconomic disadvantage, social adversity and material adversity between 16 and 42 years were operationalized from questionnaires, and cumulative neighbourhood disadvantage between 16 and 42 years from register data.

    RESULTS:: Results showed accumulation of disadvantages jointly explained 9-12% of FSS variance. In the total sample, cumulative neighbourhood and socioeconomic disadvantage significantly predicted FSS at age 42 in the total sample. In women, neighbourhood disadvantage but not socioeconomic disadvantage contributed significantly, whereas in men, socioeconomic but not neighbourhood disadvantage contributed significantly. In all analyses, associations were largely explained by the parallel accumulation of social and material adversities, but not by symptoms at baseline.

    CONCLUSION:: In conclusion, the accumulation of diverse forms of disadvantages together plays an important role for somatic complaints in adulthood, independently of baseline health.

  • 13.
    Hajdarevic, Senada
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Hvidberg, Line
    Lin, Yulan
    Donnelly, Conan
    Gavin, Anna
    Lagerlund, Magdalena
    Pedersen, Anette F
    Rasmussen, Birgit H
    Runesdotter, Sara
    Vedsted, Peter
    Tishelman, Carol
    Awareness of sunburn in childhood, use of sunbeds and change of moles in Denmark, Northern Ireland, Norway and Sweden2016In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 26, no 1, p. 29-35Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Malignant melanoma (MM) is increasing rapidly in Northern Europe. To reduce incidence and mortality through earlier diagnosis, public awareness of MM is important. Thus, we aim to examine awareness of risk factors and a symptom of MM, and how awareness varies by country and socio-demographic factors in Denmark, Northern Ireland (NI), Norway and Sweden.

    METHODS: Population-based telephone interviews using the 'Awareness and Beliefs about Cancer' measure were conducted in 2011 among 8355 adults ≥50 years as part of the International Cancer Benchmarking Partnership Module 2. Prevalence ratios (PRs) with 95% confidence intervals were calculated.

    RESULTS: In these four countries, lowest awareness was found for 'sunburn in childhood' (63%), whereas awareness was high for 'use of sunbeds' (91%) and 'mole change' (97%). Lack of awareness of 'sunburn in childhood' was more prevalent among respondents from Norway [PR = 1.38 (1.28-1.48)] but less prevalent among respondents from Northern Ireland (NI) [PR = 0.78 (0.72-0.85)] and Sweden [PR = 0.86 (0.79-0.93)] compared with respondents from Denmark. Lack of awareness of 'use of sunbeds' was more prevalent among respondents from Norway [PR = 2.99 (2.39-3.74)], Sweden [PR = 1.57 (1.22-2.00)], and NI [PR = 1.65 (1.30-2.10)] compared with respondents form Denmark. Being a man, age ≥70, living alone, and having lower education, were each independently associated with lack of MM-awareness.

    CONCLUSIONS: The results indicate relatively low awareness of 'sunburn in childhood' as a risk factor for MM, and important disparities in MM-awareness across countries and socio-demographic groups. Improved and more directed initiatives to enhance public MM-awareness, particularly about 'sunburn in childhood', are needed.

  • 14. Hammarström, A.
    et al.
    Korhonen, J.
    Blomqvist, I.
    Hägglöf, Bruno
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry.
    Increase of internalised mental health symptoms over the last 33 years among adolescents2017In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 27, no suppl_3, p. 271-272Article in journal (Other academic)
    Abstract [en]

    Background: Mental health among young people is of increasing public health importance. Several studies comparing the 1990ies with today suggest an increase of internalised mental health problems among adolescent girls. The development among adolescent boys is less clear. The aim of this study was to analyse the development of mental health among adolescence from the early 1980ies until today with regard to internalised and externalised symptoms among both boys and girls.

    Methods: Two cohorts were compared consisting of all pupils in the last year of compulsory school in Luleå (Sweden) in 1981 (n = 1083, response rate 99.7%) and in 2014 (n = 682, response rate 98.3%). The same questionnaire was used with validated questions about symptoms of mental health. Confirmatory factor analysis were performed in order to validate the proposed a priori factor structure of the mental health measures; anxiety symptoms, depression symptoms, functional somatic symptoms and externalised symptoms.

    Results: Symptoms of anxiety, depression and functional somatic symptoms increased among both boys and girls from 1981 until 2014 (p < 0.001 for all symptoms and for both boys and girls). Externalised symptoms decreased, especially among boys (p < 0.001 for both boys and girls). These changes between the cohorts were confirmed using multivariate regression techniques (controlling for parental socioeconomic status and parental country of origin) for each measure of mental health. among boys and girls.

    Conclusions: Symptoms of internalised mental health have increased among 16-year old boys and girls over the last 33 years while externalised symptoms have decreased, especially among boys. Public health actions need to be initiated in order to stop the increase and prevent internalised mental health problems among teenagers.

    Key messages:

    • A longer period than 20 years is needed in order to detect an increase in internalised mental health symptoms among adolescent boys.
    • Adolescent girls have the highest level and the highest increase in these symptoms during a period of 33 years, while externalised mental health symptoms have decreased mostly among adolescent boys.
  • 15.
    Hammarström, Anne
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Virtanen, Pekka
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Janlert, Urban
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Are the health consequences of temporary employment worse among low educated than among high educated?2011In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 21, no 6, p. 756-761Article in journal (Refereed)
    Abstract [en]

    Background: Despite the inconsistent findings of the growing amount of research analysing the possible health consequences of temporary employment, there is a lack of heterogeneous perspectives. The aim of the study was to analyse whether the health consequences of temporary employment are worse among low educated compared with high educated, after control for health-related selection.

    Methods: A 26-year follow-up study of a cohort of all school leavers in a middle-sized industrial town in northern Sweden was performed between 1981 and 2007. Of those still alive of the original cohort, 94% participated during the whole period. For this study, a sample of participants with temporary and permanent employment contracts between the age of 30 and 42 years was selected (n = 660).

    Results: In multivariate logistic regression analyses, an additive synergistic interaction effect was found for low education and high exposure to temporary employment in relation to suboptimal self-rated health, after controlling for health-related selection and sex. An additive antagonistic interaction was found between low education in combination with high exposure to temporary employment in relation to psychological distress, whereas no interaction was found for depressive symptoms.

    Conclusion: Our hypothesis regarding worse health effects of temporary employment among low educated was partly confirmed. Our results indicate the need to analyse temporary employment from a more heterogeneous perspective as well as in relation to different health outcomes.

  • 16.
    Hellström, Olle
    Vansbro Health Care Unit, Linköping University, Linköping, Sweden.
    Health promotion in general practice: on meanings and aims in interaction1994In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 4, no 2, p. 119-124Article in journal (Refereed)
    Abstract [en]

    The enterprise of health promotion in medicine involves a responsibility of distinguishing between the concepts of health and absence of disease and of reflecting on the notions of illness and sickness. In this paper the importance of human dialogue is stressed both as a means and end of the doctor-patient relationship and as the main means of genuine health promotion. The outcome of health work is proposed to depend mainly on the way the patients are encountered. Their efforts to make themselves seen as being sick should not on all occasions be diagnosed and treated. By means of a reflected, dialogic practice patients may be listened to and inspired to reconstruct their symbol-based relationship to the world of meaning. The conception of health primarily includes man&#039;s relationship to himself. Illness is looked upon as the subject&#039;s experience of illhealth, whereas disease is understood as a functional imbalance of bodily organs. There is a tacit meaning in being ill (and found sick) that can be realized and attended to best in close relationship with the patient. Physicians – preferably general practitioners – involved in health promotion should, it is concluded, both assist the patients to give up their sick role and continually elaborate their own professional competence to see and successfully encounter the manifold specifically human issues underlying their patients&#039; presented symptoms. health promotiondisease preventiongeneral practiceinteractionaction research.

  • 17.
    Hitimana, Regis
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Lindholm, Lars
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Krantz, G.
    Nzayirambaho, M.
    Semasaka Sengoma, J. P.
    Condo, J.
    Pulkki-Brännström, Anni-Maria
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Health related quality of life determinants for Rwandan women after delivery2017In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 27, no Suppl_3, p. 436-Article in journal (Other academic)
    Abstract [en]

    Health related quality of life determinants for Rwandan women after delivery. Does Antenatal care utilization matter? Maternal health conditions are still a major problem in most low-income countries. The postpartum health status and the effect of antenatal care utilization on health are relatively under researched. This study aims at (1) assessing whether receipt of antenatal care according to Rwandan guidelines is associated with mother’s health-related quality of life (HRQoL) and (2) exploring determinants associated with mother’s HRQoL in the first year (1-13 months) after delivery in Rwanda. In 2014 a cross-sectional survey was conducted on 922 women from Kigali City and Northern province of Rwanda, who gave birth in the period of 1–13 months prior to survey. The study population was randomly selected and interviewed using a questionnaire. HRQoL was measured using EQ-5D-3L. Average values of HRQoL were computed by demographic and socio-economic characteristics. The effect of adequate antenatal care on HRQoL was tested in two multivariable linear regression models - with EQ-5D weights and the Visual Analogue Scale score as outcomes respectively - with ANC adequacy and socio-demographic and psychosocial variables as predictors. Mean HRQoL was 0.92 using EQ-5D and 69.58 using EQ-VAS. Fifteen per cent reported moderate pain/discomfort and 1% reported extreme pain/discomfort, 16% reported being moderately anxious/depressed and 3% reported being extremely anxious/depressed. Having more than one child and being cohabitant or single/not married was associated with significantly lower HRQoL, while having good social support and belonging to the highest wealth quintile was associated with higher HRQoL. Antenatal care utilization was not associated with HRQoL among postpartum mothers. Policy makers should address the social determinants of health, and promote social networks among women. There is a need to assess the quality of Antenatal care in Rwanda.

    Key messages:

    • Health related quality of life among postpartum mothers is high. Pain or discomfort and anxiety of depression are most prevalent problems.
    • Antenatal care utilization was not associated with HRQoL among postpartum mothers. Rather social determinants of health are important in determining mother's HRQoL
  • 18.
    Högberg, Ulf
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynaecology.
    Ian Dowbiggin, The sterilization movement and global fertility in the twentieth century.2008In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 19, no 1, p. 121-Article in journal (Other (popular science, discussion, etc.))
  • 19.
    Janlert, Urban
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Winefield, Anthony H.
    Hammarström, Anne
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Social medicine.
    Length of unemployment and health-related outcomes: a life-course analysis2015In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 25, no 4, p. 662-667Article in journal (Refereed)
    Abstract [en]

    Background: Most previous studies on the effects of length of unemployment on health have focused on the duration of continuous spells of unemployment rather than on the cumulative length of intermittent spells. This study analysed the relationship between the cumulative length of intermittent spells of unemployment and different health-related outcomes using data from a longitudinal study of school leavers. Methods: All pupils who completed compulsory schooling in 1981 in a medium-sized town in northern Sweden (N=1083) were followed for 14 years with repeated questionnaires including questions about unemployment, health and health behaviour. Results: Men tended to react with a steady state or a levelling off of health symptoms with increased unemployment, whereas women showed deteriorating health symptoms. For health behaviour the reverse occurred. Women's health behaviour was less connected with increased unemployment while men's health behaviour tended to deteriorate. Conclusion: Cumulative length of unemployment is correlated with deteriorated health and health behaviour. Long-term unemployment, even as a result of cumulated shorter employment spells over a number of years should be an urgent target for policy makers.

  • 20.
    Johansson, Helene
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Weinehall, Lars
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Sorensen, J.
    Dalton, J.
    Jenkins, P.
    Jerden, L.
    Lifestyle counseling in primary care: The views of family physicians in United States and Sweden2017In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 27, no suppl_3, p. 333-Article in journal (Other academic)
    Abstract [en]

    Background: The role of primary care professionals in lifestyle counseling is receiving attention at the national level in many countries. The U.S. and Sweden are two countries currently establishing priorities in these areas. A study comparing the countries demonstrates large differences between the extents that family physicians report being engaged in counseling on lifestyle issues, and how important they perceive it to be (Weinehall et al. Counseling on lifestyle habits in the United States and Sweden. BMC Family Practice 2014;15:83).

    With the overall aim of facilitating lifestyle counselling in primary care, the objective of the present qualitative study was to explore further the views of American and Swedish family physicians about lifestyle counseling, in order to clarify the differences in attitudes and practices in the two countries.

    Methods: In total, twenty-nine semi-structured interviews were conducted with family physicians representing the county councils of Stockholm and Dalarna in Sweden, and the Bassett Healthcare Network, Upstate New York, U. S. Data were analyzed using qualitative content analysis.

    Results/Conclusions: Preliminary results show that the majority of the informants in both countries believe that addressing lifestyle issues is important and a natural part of their work. However, the study indicates that the U.S. physicians to a higher extent work in a more systematic way with risk factor management and routinely ask about lifestyle habits as part of existing work processes. They also expressed to a higher extent that they themselves, despite lack of time, must engage in lifestyle counseling, due to limited access to collegial support and referral services. The Swedish doctors, on the other hand, are able to limit their own role and responsibility due to support from other professions in the health care center/access to referral services.

    Key messages:

    • This study provide insight into how Swedish and U.S family physicians view the role of behavioral risk factor management in their clinical practice.
    • Understanding professionals ‘take’ on lifestyle interventions, is invaluable, as they serve on the ‘front line’ in the battle to improve health outcomes in both countries.
  • 21.
    Johansson, Klara
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Wennberg, Patrik
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Hammarström, Anne
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Parental leave and increased physical activity of fathers and mothers-results from the Northern Swedish Cohort2014In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 24, no 6, p. 935-940Article in journal (Refereed)
    Abstract [en]

    Background: Physical activity is an important public health issue. Factors shown to be associated with physical activity are parenthood and country-level gender equality, while the importance of individual gender equality (in parenthood or in general) remains to explore. In Scandinavia, where parental leave can be shared equally between mothers and fathers, parental leave is one dimension of gender equality in parenthood. The aim of this study was to investigate parental leave in relation to increased physical activity among men and women. Methods: Participants in the Northern Swedish Cohort with a child born 1993-2005 (n = 584) were investigated with questionnaires at ages 21 and 42; register data on parental leave between ages 28 and 42 were obtained from Statistics Sweden. The relationships between parental leave between ages 28 and 42 and meeting WHO guidelines for physical activity at age 42, as well as changes in physical activity between ages 21 and 42, were tested with multinomial regression, controlling for socio-economic status and birth year of the child. Results: For women, the length of parental leave was not associated with increased physical activity or with meeting WHO guidelines at age 42. For men, parental leave was associated with increased physical activity, controlling for socio-economic status and age of the child, but not with meeting WHO guidelines for physical activity at age 42. Conclusions: A gender non-traditional out-take of parental leave might be associated with an increase in physical activity among men at the lower end of the physical activity spectrum, but not among women.

  • 22.
    Kardakis, Therese
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Weinehall, Lars
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Jerdén, Lars
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Nyström, Monica E
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Johansson, Helene
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Lifestyle interventions in primary health care: professional and organizational challenges2014In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 24, no 1, p. 79-84Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Interventions that support patient efforts at lifestyle changes that reduce tobacco use, hazardous use of alcohol, unhealthy eating habits and insufficient physical activity represent important areas of development for health care. Current research shows that it is challenging to reorient health care toward health promotion. The aim of this study was to explore the extent of health care professional work with lifestyle interventions in Swedish primary health care, and to describe professional knowledge, attitudes and perceived organizational support for lifestyle interventions.

    METHODS: The study is based on a cross-sectional Web-based survey directed at general practitioners, other physicians, residents, public health nurses and registered nurses (n = 315) in primary health care.

    RESULTS: Fifty-nine percent of the participants indicated that lifestyle interventions were a substantial part of their duties. A majority (77%) would like to work more with patient lifestyles. Health professionals generally reported a thorough knowledge of lifestyle intervention methods for disease prevention. Significant differences between professional groups were found with regard to specific knowledge and extent of work with lifestyle interventions. Alcohol was the least addressed lifestyle habit. Management was supportive, but structures to sustain work with lifestyle interventions were scarce, and a need for national guidelines was identified.

    CONCLUSIONS: Health professionals reported thorough knowledge and positive attitudes toward lifestyle interventions. When planning for further implementation of lifestyle interventions in primary health care, differences between professional groups in knowledge, extent of work with promotion of healthy lifestyles and lifestyle issues and provision of organizational support such as national guidelines should be considered.

  • 23.
    Linander, Ida
    et al.
    Umeå University, Faculty of Social Sciences, Umeå Centre for Gender Studies (UCGS). Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Socialmedicin.
    Hammarström, Anne
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Johansson, Klara
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Which socio-economic measures are associated with psychological distress for men and women?: A cohort analysis2015In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 25, no 2, p. 231-236Article in journal (Refereed)
    Abstract [en]

    Background: There are contradictory results regarding whether there is a social gradient in common mental disorders or not, or if this relation differs for different indicators or by gender. We analysed the relation between various measures of socio-economic position and later psychological distress among men and women in a Swedish context. Methods: The study is based on data from the Northern Swedish Cohort (N= 1001, 93.5% response rate), a 27-year prospective study. Logistic regression was used to explore the relation between various indicators of socio-economic position at age 30 (occupation, education, financial strain, cash margin, unemployment and living primarily on social welfare or unemployment insurance) and psychological distress (age 42), controlling for earlier psychological distress (age 21) and parental occupational class. Register data were used to measure unemployment. All other variables were self-reported, and measured by a questionnaire. Results: Financial strain and living on social welfare or unemployment insurance at age 30 were associated with psychological distress at age 42 for men and women. Poor cash margin and unemployment were only associated with psychological distress in women, after controlling for potential confounders. Low occupational class and low education were not significantly related to later psychological distress. Conclusion: The two most commonly used measures of socio-economic position, occupation and education, were not significantly associated with psychological distress while other, less studied measures were. This study highlights the importance of measuring socio-economic position in several ways when studying common mental disorders, as well as to take gender into account.

  • 24.
    Lindholm, Lars
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Health economic evaluation of the Västerbotten Intervention Programme2017In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 27, no suppl_3, p. 205-Article in journal (Other academic)
    Abstract [en]

    Results from a study that calculated the cost-effectiveness ofthe VIP intervention based on prevented deaths, transformedto QALYs gained, will be shown. The intervention isexceptionally cost-effective both in health care and societalperspectives.

  • 25. Lipsicas, Cendrine Bursztein
    et al.
    Makinen, Ilkka Henrik
    Wasserman, Danuta
    Apter, Alan
    Bobes, Julio
    Kerkhof, Ad
    Michel, Konrad
    Salander Renberg, Ellinor
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    van Heeringen, Kees
    Vaernik, Airi
    Schmidtke, Armin
    Immigration and recommended care after a suicide attempt in Europe: equity or bias?2014In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 24, no 1, p. 63-65Article in journal (Refereed)
    Abstract [en]

    This report describes the investigation of care recommendations in the medical system across European countries to immigrants who attempted suicide. Data from seven European countries with 8865 local and 2921 immigrant person-cases were derived from the WHO/EURO Multicentre Study on Suicidal Behaviour and ensuing MONSUE (Monitoring Suicidal Behaviour in Europe) project. The relationship between immigrant status and type of aftercare recommended was analysed with binary logistic regression, adjusting for gender, age, method of attempt and the Centre collecting the data. Clear disparities were identified in the care recommendation practices toward immigrants, compared with hosts, over and above differing policies by the European Centres.

  • 26. Lipsicas, Cendrine Bursztein
    et al.
    Makinen, Ilkka Henrik
    Wasserman, Danuta
    Apter, Alan
    Kerkhof, Ad
    Michel, Konrad
    Salander Renberg, Ellinor
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    van Heeringen, Kees
    Varnik, Airi
    Schmidtke, Armin
    Gender distribution of suicide attempts among immigrant groups in European countries-an international perspective2013In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 23, no 2, p. 279-284Article in journal (Refereed)
    Abstract [en]

    Background: Studies report high rates of suicide attempts for female immigrants. This study assesses variations in the distribution of suicide attempts across gender in immigrant and non-immigrant groups in Europe. Method: Data on 64 native and immigrant groups, including 17 662 local and 3755 immigrant person-cases collected, between 1989 and 2003, in 24 million person-years were derived from the WHO/EURO Multicentre Study on Suicidal Behaviour. Female-to-male ratios of suicide attempt rates (SARs) were calculated for all groups. Results: The cases were combined into four major categories: hosts; European and other Western immigrants; non-European immigrants; and Russian immigrants. The non-European immigrants included higher female SARs than the Europeans, both hosts and immigrants. Unlike the other groups, the majority of suicide attempters among the Russian immigrants in Estonia and Estonian hosts were male. This was also true for immigrants from Curacao, Iran, Libya and Sri Lanka. When the single groups with a male majority were excluded, the correlation between female and male SARs was relatively high among the European immigrants (r = 0.74, P < 0.0005) and lower among the non-European immigrants (r = 0.55, P < 0.03). Generalized estimating equation analysis yielded a highly significant difference (P < 0.0005) in gender ratios of suicide attempts between hosts (ratio 1.52) and both non-European immigrants (ratio 2.32) and Russian immigrants (0.68), but not the European immigrants. Conclusions: The higher suicide attempt rates in non-European immigrant females compared with males may be indicative of difficulties in the acculturation processes in Europe. Further understanding of factors underlying suicidal behaviour in immigrant and minority groups is necessary for planning effective prevention strategies.

  • 27. Maquibar, A.
    et al.
    Hurtig, A. K.
    Vives-Cases, C.
    Estalella, I.
    Goicolea, Isabel
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Mapping training about Gender Based Violence in nurse education programmes in Spain2017In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 27, no suppl_3, p. 269-Article in journal (Other academic)
    Abstract [en]

    Background: Health care professionals, and nurses especially among them, play an essential role in the health sector response to Gender Based Violence. To be able to successfully address this major public health issue they need specific training in the topic. Therefore, the World Health Organization as well as Spanish institutions and policies, strongly recommend the inclusion of this topic in nursing undergraduate programmes. This study aims to assess how this recommendation has been implemented in the nursing undergraduate programmes offered in all Spanish universities.

    Methods: A systematic review of each subjects’ study guide of the 91 nurse education programmes existing in Spain was conducted searching for the term “violence” to include references under different terminology as “violence against women”, “gender based violence” or “intimate partner violence”.

    Results: Sixty-nine out of the ninety-one nurse education programmes taught in Spain have contents related to violence. Thirty-eight grades included Gender Based Violence in the content of one subject, 21 in two, eight in three and two in four. Only three programmes had a specific subject named “Nursing in Gender Based Violence”. Otherwise, gender violence was part of subjects mainly related with gender and culture (22%), psychology (20%), public health (20%) and women’s health (13%). When analysing results by Autonomous Region, four out of seventeen were found to have gender based violence included in all the grades offered in their area, while two had not any training in the topic. In the remaining regions inclusion varied between these two poles.

    Conclusions: Gender Based Violence has been included in a great percentage of the nursing undergraduate education programmes taught in Spain. Assessing the effect this undergraduate training has on nurses’ response to gender based violence as well as differences in the effect depending on the training programme becomes a challenge for the next years.

    Key messages:

    • Most of the Spanish universities have included training in Gender Based Violence in their nurse education programmes, which might positively affect the Health Sector's response to this health issue.
    • Assessing the effect these different undergraduate training programmes have on nurses’ response to Gender Based Violence becomes a challenge for the next years.
  • 28.
    Mosquera, Paola A
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    San Sebastian, Miguel
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Ivarsson, Anneli
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Weinehall, Lars
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Gustafsson, Per E.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Are health inequalities rooted in the past? Income inequalities in metabolic syndrome decomposed by childhood conditions2017In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 27, no 2, p. 223-233Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Early life is thought of as a foundation for health inequalities in adulthood. However, research directly examining the contribution of childhood circumstances to the integrated phenomenon of adult social inequalities in health is absent. The present study aimed to examine whether, and to what degree, social conditions during childhood explain income inequalities in metabolic syndrome in mid-adulthood.

    METHODS: The sample (N = 12 481) comprised all 40- and 50-year-old participants in the Västerbotten Intervention Program in Northern Sweden 2008, 2009 and 2010. Measures from health examinations were used to operationalize metabolic syndrome, which was linked to register data including socioeconomic conditions at age 40-50 years, as well as childhood conditions at participant age 10-12 years. Income inequality in metabolic syndrome in middle age was estimated by the concentration index and decomposed by childhood and current socioeconomic conditions using decomposition analysis.

    RESULTS: Childhood conditions jointed explained 7% (men) to 10% (women) of health inequalities in middle age. Adding mid-adulthood sociodemographic factors showed a dominant contribution of chiefly current income and educational level in both gender. In women, the addition of current factors slightly attenuated the contribution of childhood conditions, but with paternal income and education still contributing. In contrast, the corresponding addition in men removed all explanation attributable to childhood conditions.

    CONCLUSIONS: Despite that the influence of early life conditions to adult health inequalities was considerably smaller than that of concurrent conditions, the study suggests that early interventions against social inequalities potentially could reduce health inequalities in the adult population for decades to come.

  • 29.
    Namatovu, Fredinah N.
    Umeå University, Faculty of Arts, Department of historical, philosophical and religious studies.
    Disability and family formation2017In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 27, no Suppl_3, p. 352-Article in journal (Other academic)
    Abstract [en]

    Few studies have investigated family formation among people with disabilities. Available evidence on disability and family formation shows people with disabilities to have a low propensity of finding a life partner. Being married or cohabiting has been associated with improved health in children. There is a general lack of investigations on how family formation among people with disability has changed in recent decades. Important to note, there is scanty of evidence of how the situation of disability and family formation looks like in Sweden today.

    Methods: Using Swedish national register data obtained from the Umeå SIMSAM Lab, the study applies statistical life course techniques such as Cox regression and sequence analysis to identify factors affecting the relationship between disability and family formation. We follow the life courses of persons with disability born in 1973-1977 up to when they are aged 16-37 years, which is in 1990 and 2010. The selected age interval represents the time when crucial transitioning often takes place i.e. transition into education, independent living, work and family formation. Disability based on having received early retirement pension during the follow-up period.

    Results: Out of 700000 individuals born during 1973-1977, the study shows differences in partnership chances for people with disability and not.

    Conclusions: There is need for further investigations on why people with work related disability have lower rates of cohabitation and marriage compared to the general population.

    Key messages:

    • Despite the major improvements in the lives of people with disability.
    • There is need for to look into ways of increasing their chances of finding a partner.
  • 30.
    Ng, Nawi
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Santosa, Ailiana
    Umeå University, Faculty of Social Sciences, Centre for Demographic and Ageing Research (CEDAR).
    Kowal, P.
    Sitting time and obesity among older adults in low- and middle-income countries2017In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 27, no Suppl_3, p. 415-416Article in journal (Other academic)
    Abstract [en]

    Background: Global industrialisation and economic development lead to changes in physical activity patterns with more sedentary behaviours and increasing sitting time, which are related to obesity. This study aims to identify the association between sedentary behaviour and obesity among older people aged 50+ in six low- and middle-income countries.

    Methods: This study utilises data from the WHO's Study on Global Ageing and Adult Health in China, Ghana, India, Mexico, the Russian Federation and South Africa. Physical activity level was measured using the Global Physical Activity Questionnaire Version 2 and daily sitting time was recorded in hour. Overweight and obesity was measured through height and weight, with BMI > =25. We conducted logistic regression to analyse the association between physical activity level and total daily sitting time and obesity, controlling for age, sex, highest education level, and living area.

    Results: Overweight and obesity prevalence ranged from 14% in India to 76% in the Russian Federation, and was significantly higher among women. The prevalence of low-to-moderate physical activity ranged from 36% in Ghana to 76% in South Africa. About 25% of the Russian population sat 2 hours or less daily, in contrast to 83% of the Mexican population who did so. Sitting more than 2 hours a day increased the odds of overweight and obesity (odds ratio 1.18; 95% confidence interval 1.09-1.29). The associated odds were 1.21 (95%CI 1.08-1.35) and 1.41 (95%CI 1.27-1.56) for those with moderate and low physical activity, compared to those who were more active.

    Conclusions: Independent of physical activity level during work, leisure and transport, longer daily sitting time is significantly associated with obesity among older adults. Public health intervention to promote physical activity among older people is crucial in preventing premature chronic disease deaths and promoting active and healthy ageing.

    Key messages:

    • The levels of sedentary behaviours among older people in low-and middle-income country are worrying, and are significantly associated with the level of obesity.
    • Reducing sitting time and promoting physical activity among older people are essential strategies to prevent obesity and its impacts on chronic disease and ensuring an active and healthy ageing.
  • 31.
    Norberg, Margareta
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    VIP - structure and support. And why Cochrane evaluations of CVD prevention programs not are applicable on this Swedish concept for CVD prevention2017In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 27, no Suppl_3, p. 204-205Article in journal (Other academic)
    Abstract [en]

    The idea behind and use of the so called star profile in Västerbotten Intervention Programme (VIP) will be highlighted. The role of politicians and stake holders for development and sustainability of the VIP, the organized structure for support to the staff who provides VIP, as well as the scientific back-up and adaption of the program according to current medical evidence will be described. Results in terms of participation rates and standardized total and CVD mortality rates in the target population for VIP (participants and non-participants taken together) and among only participants will be reported. Whether for those who are eligible for participation in VIP twice, it is better to participate twice or if participation only once is enough, will be discussed. The Habo and the Västerbotten programs for prevention of CVD will be compared to trials included in Cochrane evaluations of programs for CVD prevention. We will also discuss why these Cochrane evaluations are not applicable to this Swedish concept for population based targeted cardiovascular prevention.

  • 32. Ntaganira, J.
    et al.
    Edvardsson, K.
    Semasaka Sengoma, J. P.
    Hussein, K.
    Ngarina, M.
    Small, R.
    Mogren, Ingrid
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynecology.
    Holmlund, Sofia
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynecology.
    Health professionals' experiences and views of obstetric ultrasound in Rwanda2017In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 27, no Suppl_3, p. 367-Article in journal (Other academic)
    Abstract [en]

    Background: The World Health Organizatiońs new recommendations for antenatal care (ANC) include one ultrasound examination before 24 weeks of gestation. Implementation of ultrasound in ANC in low resource countries has been shown to increase pregnant women’s compliance to ANC visits, and facilitate detection of high-risk pregnancies. The aim of this study was to explore Rwandan health professionals’ experiences and views of obstetric ultrasound in relation to clinical management, resources and skills.

    Methods: A cross-sectional questionnaire study involving physicians (n = 222), obstetricians (n = 29), nurses (n = 387) and midwives (n = 269) managing pregnant women in RWANDA was performed, as part of the CROss Country Ultrasound Study (CROCUS). Data were collected at 106 health facilities from November 2016 – March 2017.

    Preliminary results: One third of the participants performed ultrasound examinations (32.3%) and the majority on a daily basis (60.1%). The ultrasound examination where most participants reported high level skills was evaluation of the fetal heart rate (69.0%). A majority reported no skills or low level skills (79.9%) for ultrasound examination of the fetal heart, aorta and pulmonary artery. A majority (65.0%) reported that lack of ultrasound training of the ultrasound operator sometimes led to suboptimal pregnancy management. Almost all participants (91.3%) agreed that ANC would be improved if midwives were qualified to perform basic ultrasound examinations.

    Conclusions: The vast majority of health professionals in the study believed that maternity care can be improved if midwives learn to perform basic ultrasound examinations. Additional training of physicians performing obstetric ultrasound was also suggested to increase the quality of obstetric ultrasound surveillance and to further improve maternal and fetal health outcomes.

    Key messages:

    • Physicians managing pregnant women need more training in obstetric ultrasound.
    • Midwives need to be educated in performing obstetric ultrasounds.
  • 33.
    Olsson, Cecilia
    et al.
    Umeå University, Faculty of Social Sciences, Department of Food and Nutrition.
    Hörnell, Agneta
    Umeå University, Faculty of Social Sciences, Department of Food and Nutrition.
    The importance of school meal systems on overall healthiness of the diet and learning in a Nordic context - the ProMeal project2013In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 23, no 1, p. 73-73Article in journal (Other academic)
  • 34. Palm, Anna
    et al.
    Danielsson, Ingela
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynaecology.
    Skalkidou, Alkistis
    Olofsson, Niclas
    Högberg, Ulf
    Violence victimisation: a watershed for young women's mental and physical health2016In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 26, no 5, p. 861-867Article in journal (Refereed)
    Abstract [en]

    PPurpose: The association between victimisation and adverse health in children is well established but few studies have addressed the effect of victimisation, especially multiple victimisations, in older adolescents and young adults. The aim of this study was to assess self-reported health in young women (15-22 years) victimised to one or more types of violence, compared with non-victimised.aEuro integral Methods: Young women visiting youth health centres in Sweden answered a questionnaire constructed from standardised instruments addressing violence victimisation (emotional, physical, sexual and family violence), socio-demographics, substance use and physical and mental health. Adjusted odds ratio (AOR) with 95% confidence interval (CI) and attributable risk (AR) were assessed.aEuro integral Results: Of 1051 women (73% of eligible women), 25% were lifetime victims of one type of violence and 31% of two or more types of violence. Sexual-minority young women were more victimised than heterosexual women. Violence victimisation increased the risk for adverse health outcomes, especially evident for those multiply victimised. Victims of two or more types of violence had AOR 11.8 (CI 6.9-20.1) for post-traumatic stress symptoms, 6.3 (CI 3.9-10.2) for anxiety symptoms and 10.8 (CI 5.2-22.5) for suicide ideation. The AR of victimisation accounted for 41% of post-traumatic stress symptoms, 30% of anxiety symptoms and 27% of suicide ideation. Stratified analyses showed that lower economic resources did not influence health negatively for non-victimised, whereas it multiplicatively reinforced ill-health when combined with violence victimisation.aEuro integral Conclusion: Violence victimisation, and particularly multiple victimisations, was strongly associated with mental ill-health in young women, especially evident in those with low economic resources.

  • 35.
    Pérez-Urdiales, Iratxe
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Goicolea, Isabel
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    How do immigrant women access the public healthcare services in the Basque Country (Spain)?2017In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 27, no Suppl_3, p. 477-478Article in journal (Other academic)
    Abstract [en]

    Background: Immigrant women face diverse barriers in order to access the public healthcare services in Spain. Furthermore, in 2012, a legislative change made the access conditions more difficult to fulfil for immigrants. Besides the public healthcare system, “free clinics” exist, which provide health attention to immigrant men and women who are not eligible for accessing it.

    Objective: To explore the perception of healthcare professionals working in free clinics in regards to the barriers and facilitators that immigrant women face to access the public healthcare general services and sexual and reproductive health services in the Basque Country (Spain).

    Methods: Qualitative study based on 11 individual interviews with healthcare professionals working in four different free clinics. A qualitative content analysis was done identifying meaning units, codes and categories.

    Results: Four categories emerged from the analysis that represent how the personal characteristics of the immigrant women (Tell me who you are and I will let you know how you will access); the attitude of the staff at the healthcare system (“Once they have been attended, everything is fine. The problem is with the administrative staff”); the organization of the healthcare system (The healthcare system is bureaucratic and passive), and health policies (“If you do not fulfil the requirements, you are just out. The law is the law”) influence the access of immigrant women to the public healthcare services.

    Conclusions: The results of this study show that there are a great number of barriers and few facilitators for the access of immigrant women to the public healthcare general services and sexual and reproductive health services in the Basque Country. The barriers based on the personal characteristics of the immigrant women, which vary based on their origin, were the most largely recognized, whereas the legal barriers were considered the most restrictive ones and difficult to overcome.

    Key messages:

    • Immigrant women face personal, institutional and legal barriers to access public health services.
    • Legal requirements are considered the main barriers to access public health services.
  • 36. Rahman, S.
    et al.
    Mittendorfer-Rutz, E.
    Alexanderson, K.
    Jokinen, Jussi
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry. Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
    Tinghog, P.
    Disability pension due to common mental disorders and healthcare use before and after policy changes: a nationwide stud2017In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 27, no 1, p. 90-96Article in journal (Refereed)
    Abstract [en]

    Background: Despite common mental disorders (CMDs) being a main reason for preterm exit from the labour market, there is limited knowledge regarding healthcare use around the time of being granted disability pension (DP) due to CMD. The aim was to study specialized healthcare use before and after being granted DP due to CMD and whether these trajectories differed before and after changes in DP granting criteria in Sweden in 2008. Methods: Included individuals lived in Sweden, aged 19-64 years with incident DP due to CMD before (wave 1, 2005-06, n = 24 298) or after (wave 2, 2009-10, n = 4056) the changes in 2008. Healthcare trajectories during a 7-year window were assessed by generalized estimating equations. Between-and within-wave differences were examined by interaction models. Results: Psychiatric healthcare increased until the year preceding DP and declined thereafter, with one exception; such outpatient care kept increasing in wave 1 following DP. In the year preceding DP, 4.6 and 19.2% of the individuals in wave 1 had psychiatric in-and specialized outpatient care, respectively, compared with 7.9 and 46.6% in wave 2. No clear pattern was observed regarding somatic healthcare. The slopes of the different DP waves differed mainly during DP granting years (1 year prior to 1 year after), showing a sharper decline in wave 2. Conclusion: Transition to DP due to CMD seems to be associated with changes in psychiatric healthcare use, with higher rates in the year preceding DP. Outpatient healthcare patterns somewhat differed among those granted DP after stricter rules were introduced.

  • 37. Rajaleid, Kristiina
    et al.
    Nummi, Tapio
    Westerlund, Hugo
    Virtanen, Pekka
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Socialmedicin. Institute for Advanced Social Research, University of Tampere, FI-33014 Tampere, Finland.
    Gustafsson, Per E
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Socialmedicin.
    Hammarström, Anne
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Socialmedicin.
    Social adversities in adolescence predict unfavourable trajectories of internalized mental health symptoms until middle age: results from the Northern Swedish Cohort.2016In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 26, no 1, p. 23-29Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Experiencing adversities during upbringing has short-term and long-term effects on mental health. This study aims to explore how social adversities in adolescence predict trajectories of internalized mental health symptoms (IMHS), from adolescence and onward until middle age.

    METHODS: Based on 1040 individuals from the Northern Swedish Cohort Study, a community-based cohort with 27 years of follow-up. We applied latent class growth analysis to extract trajectories of IMHS between ages 16 and 43. Multinomial logistic regression was used to study the association of social adversities (residential mobility, residential crowding, parental loss, unemployment of a parent, physical illness of a parent, mental illness or alcohol problems of a parent) in adolescence with IMHS trajectories.

    RESULTS: Five trajectory classes were identified: 'very low stable' (26% of the sample), 'low stable' (58%), 'moderate stable' (5%), 'increasing' (8%) and 'high decreasing' (3%). Both in men and women, reporting social adversities at the age of 16 increased the risk of belonging to the classes with less favourable development of IMHS. Reporting adversities was positively associated with the initial level of the IMHS trajectories. Thus it seems that the influence of adversities is more pronounced during the early years of follow-up and is attenuated over time.

    CONCLUSION: Experiencing social adversities in adolescence increases the risk of entering unfavourable developmental trajectories of mental health until middle age.

  • 38.
    San Sebastian, Miguel
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Mosquera, Paola
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Gustafsson, Per E.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Mine, yours or ours?: Income inequality and mental health in Northern Sweden2017In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 27, no suppl_3, p. 40-41Article in journal (Other academic)
    Abstract [en]

    Background: The relationship between income and population health has received considerable attention in the last decades. Three main explanations of the relationship have been identified: the absolute, the contextual, and the relative income effects hypotheses. The evidence about their relevance, particularly in egalitarian societies like the Scandinavian one, is however inconsistent. The present study aimed to test the three hypotheses in relation to psychological distress in northern Sweden.

    Methods: Data come from the 2014 cross sectional survey “Health on equal terms”, from the four northern-most counties in Sweden, and included people 25-84 years (n = 21,004). Psychological distress was measured by the General Health Questionnaire-12 and information on disposable income came from population registers. Absolute income was operationalized by individual disposable income, contextual income as the municipal-level Gini coefficient and relative income by the Yitzaki index. The research questions were tested by log-binomial regression analysis.

    Results: First, a strong individual income gradient in mental ill health was observed, with the very poor more likely to report poor health (PR = 1.56; 95% CI = 1.19, 2.04) compared to the highest income quintile. Second, municipalities in the quintiles 2-4 of the Gini coefficient had a better mental health than those municipalities in the extremes of the distribution. Third, a clear statistically significant gradient in the association of relative deprivation and ill mental health was also found (PR = 1.37 95% CI = 1.06, 1.76).

    Conclusions: This study suggests a strong, moderate and lack of support for the absolute, relative and contextual income effect hypotheses, respectively. Interventions targeting a reduction in the individual income gap are probably necessary in order to reduce psychosocial distress differences in this population of northern Sweden.

    Key messages:

    • A strong, moderate and lack of support for the absolute, relative and contextual income effect hypotheses, respectively was found in northern Sweden.
    • A reduction in the individual income gap is probably necessary in order to decrease the psychosocial distress differences observed.
  • 39.
    San Sebastián, Miguel
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Department of Nursing I, University of Basque Country, Bilbao, Spain.
    Mosquera, Paola A
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Ng, Nawi
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Gustafsson, Per E
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Health care on equal terms?: assessing horizontal equity in health care use in northern Sweden2017In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 27, no 4, p. 637-643Article in journal (Refereed)
    Abstract [en]

    Background: The Swedish health care system has successively moved toward increased market-orientation, which has raised concerns as to whether Sweden still offers health on equal terms. To explore this issue, this study aimed (i) to assess if the principles of horizontal equity (equal access for equal need regardless of socio-economic factors) are met in Northern Sweden 2006-14; and (ii) to explore the contribution of different factors to the inequalities in access along the same period. Data came from cross sectional surveys known in 2006, 2010 and 2014 targeting 16-84-year-old residents in the four northern-most counties in Sweden. The horizontal inequity index was calculated based on variables representing (i) the individual socioeconomic status, (ii) the health care needs, (iii) non-need factors as well as (iv) health care utilization: general practitioner (GP), specialist doctors, hospitalization. Decomposition analysis of the concentration index for need-standardized health care utilization was applied. Adjusting for needs, there was a higher use of GP services by rich people during the two last surveys, a roughly equal use of specialists, and hospitalization concentrated among the poor but with a clear time trend toward equality. The pro-rich inequalities in GP use were to a large part explained by the income gap. While health care utilization can be considered equitable regarding specialist and hospital use, the increasing pro-rich trend in the use of GP is a concern. Further studies are required to investigate the reasons and a constant monitoring of socioeconomic differences in health care access is recommended.

  • 40.
    Strandh, Mattias
    et al.
    Umeå University, Faculty of Social Sciences, Department of Sociology.
    Nilsson, Karina
    Umeå University, Faculty of Social Sciences, Department of Sociology.
    Winefield, Anthony
    Centre for Applied Psychological Research, School of Psychology, Social Work and Social Policy, University of South Australia, Australia .
    Hammarström, Anne
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Unemployment and mental health scarring during the life course2014In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 24, no 3, p. 440-445Article in journal (Refereed)
    Abstract [en]

    There has been little research on the long-term relationship between unemployment experiences and mental health over the life course. This article investigates the relationship between youth unemployment as well as that of unemployment experiences during later periods and mental health at ages 16, 21, 30 and 42 years. Methods: The study makes use of the 'Northern Swedish Cohort' (NSC), a 27-year prospective cohort study. The cohort, investigated at ages 16, 18, 21, 30 and 42 years, consisted of all graduates from compulsory school in an industrial town in Sweden. Of the original 1083 participants, 94.3% of those still alive were still participating at the 27-year follow up. Mental health, measured through a three-item index of nervous symptoms, depressive symptoms and sleeping problems, was analysed using a repeated measures linear mixed models approach using ages 16, 21, 30 and 43 years. Unemployment exposure was measured as exposure to at least a 6-month spell during three periods; 18-21, 21-30 and 30-42 years. Results: Youth unemployment was shown to be significantly connected with poorer mental health at all three target ages, 21, 30 and 42 years. Later singular unemployment experiences did not appear to have the same long-term negative effects. There was however an accumulation in poorer mental health among respondents with unemployment experiences during two, and even more so three, of the periods. Conclusion: There are long-term mental health scarring effects of exposure to youth unemployment and multiple exposure to unemployment during the life course

  • 41.
    Strandh, Mattias
    et al.
    Umeå University, Faculty of Social Sciences, Department of Sociology.
    Novo, Mehmed
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    Hammarström, Anne
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Mental health among the unemployed and the unemployment rate in the municipality2011In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, ISSN ISSN 1101-1262, Vol. 21, no 6, p. 799-805Article in journal (Refereed)
    Abstract [en]

    Background: Previous research has shown that unemployment experiences increase the risk of poor mental health and that this effect differs depending on individual characteristics. Relatively little is known, however, about how the unemployment rate and labour market conditions impact the relationship. This study investigates how municipal unemployment rates and vacancy rates affect mental health in a nationally representative longitudinal survey of initially unemployed Swedish respondents.

    Methods: The study uses a nationally representative longitudinal survey of currently and recently unemployed people in Sweden, in which respondents were re-interviewed one year after the initial interview. Mental health was measured using the GHQ-12. The present article uses multilevel models (hierarchical linear models) to combine municipal-level information on unemployment levels and vacancy rates with individual-level control variables.

    Results: Higher municipal vacancy rates improved mental health among the unemployed. However, no coherent effect of municipal unemployment rate on the relationship between unemployment and mental health was found.

    Conclusions: The effect of municipal vacancy rates can be understood in terms of the impact of perceived opportunity on the sense of life-course predictability. That there was no effect of municipal unemployment rate indicates that high local unemployment levels do not reduce the sense of shame and perceived stigma among the unemployed. Taken together, our findings would seem to present a rather bleak picture of the current dramatic labour market situation. The unemployed will be negatively affected by the extremely low demand for labour, while they will not be able to take comfort from their growing numbers.

    Background: Previous research has shown that unemployment experiences increase the risk of poormental health and that this effect differs depending on individual characteristics. Relatively little is known, however, about how the unemployment rate and labour market conditions impact the relationship. This study investigates how municipal unemployment rates and vacancy rates affect mental health in a nationally representative longitudinal survey of initially unemployed Swedish respondents.

    Methods: The study uses a nationally representative longitudinal survey of currently and recently unemployed people in Sweden, in which respondents were re-interviewed one year after the initial interview. Mental health was measured using the GHQ-12. The present article uses multilevel models (hierarchical linear models) to combine municipal-level information on unemployment levels and vacancy rates with individual-level control variables.

    Results: Higher municipal vacancy rates improved mental health among the unemployed. However, no coherent effect of municipal unemployment rate on the relationship between unemployment and mental health was found.

    Conclusions: The effect of municipal vacancy rates can be understood in terms of the impact of perceived opportunity on the sense of life-course predictability. That there was no effect of municipal unemployment rate indicates that high local unemployment levels do not reduce the sense of shame and perceived stigma among the unemployed. Taken together, our findings would seem to present a rather bleak picture of the current dramatic labour market situation. The unemployed will be negatively affected by the extremely low demand for labour, while they will not be able to take comfort from their growing numbers.

  • 42. Theorell, Tores
    et al.
    Jood, Katarina
    Slunga-Järvholm, Lisbeth
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Vingard, Eva
    Perk, Joep
    Ostergren, Per Olov
    Hall, Charlotte
    A systematic review of studies in the contributions of the work environment to ischaemic heart disease development2016In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 26, no 3, p. 470-477Article, review/survey (Refereed)
    Abstract [en]

    Background: There is need for an updated systematic review of associations between occupational exposures and ischaemic heart disease (IHD), using the GRADE system.

    Methods: Inclusion criteria: (i) publication in English in peer-reviewed journal between 1985 and 2014, (ii) quantified relationship between occupational exposure (psychosocial, organizational, physical and other ergonomic job factors) and IHD outcome, (iii) cohort studies with at least 1000 participants or comparable case-control studies with at least 50 + 50 participants, (iv) assessments of exposure and outcome at baseline as well as at follow-up and (v) gender and age analysis. Relevance and quality were assessed using predefined criteria. Level of evidence was then assessed using the GRADE system. Consistency of findings was examined for a number of confounders. Possible publication bias was discussed.

    Results: Ninety-six articles of high or medium high scientific quality were finally included. There was moderately strong evidence (grade 3 out of 4) for a relationship between job strain and small decision latitude on one hand and IHD incidence on the other hand. Limited evidence (grade 2) was found for iso-strain, pressing work, effort-reward imbalance, low support, lack of justice, lack of skill discretion, insecure employment, night work, long working week and noise in relation to IHD. No difference between men and women with regard to the effect of adverse job conditions on IHD incidence.

    Conclusions: There is scientific evidence that employees, both men and women, who report specific occupational exposures, such as low decision latitude, job strain or noise, have an increased incidence of IHD.

  • 43.
    Vaezghasemi, Masoud
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Sundberg, Linda
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Ivarsson, Anneli
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Eurenius, Eva
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Silfverdal, Sven Arne
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Lindkvist, Marie
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Psychometric analysis of Age and Stages Questionnaire: Social-Emotional (ASQ:SE) among 3-year-olds2017In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 27, no Suppl_3, p. 173-174Article in journal (Other academic)
    Abstract [en]

    Background: Mental health is an urgent public health challenge, and for some individuals the problem starts already in pre-school age. Increased knowledge is needed to guide evidence-based health-promoting interventions and early identification for adequate parental support. Valid and reliable instruments to measure children’s mental health are called for. Our aim is to analyze psychometric properties of the Ages and Stages Questionnaire: Social-Emotional (ASQ:SE) among 3-year-olds.

    Methods: Within Child Health Care (CHC) in Västerbotten (Sweden) the 3-year-olds’ health check-up includes parent-rated socio-emotional health by scoring the ASQ:SE. This instrument has seven psychological domains (self-regulation, compliance, communication, adaptive functioning, autonomy, affect, and interaction); built up by 31 items, responded on a 3-point Likert scale with total scores 0-465. Item scores are combined into a total score with high values indicating social-emotional vulnerability. Most parents give informed consent for research and the study has ethical approval.

    Results: During 2014-2016 we have ASQ:SE responses for 5434 children having had their 3-year health check-up (boys=2802, girls=2632), with total scores 0-215. Generally, boys scored higher (mean 31, SD 24; median 25) than girls (mean 25, SD 21; median 20), and 12% of boys, compared to 6% of girls, scored above the cut-off value (59). The internal consistency based on Cronbach’s alpha was 0.78. Confirmatory factor analysis was done and normative values were also reported for the ASQ:SE.

    Conclusions: Our psychometric analyses of ASQ:SE among 3-year-olds indicates the relevance of an instrument for screening pre-school children’s social and emotional health. This is promising for future use of the instrument within ordinary CHC in Västerbotten and elsewhere.

    Key messages:

    • The ASQ:SE instrument is a valuable asset within CHC to increase awareness about 3-year-olds social-emotional health.
    • The ASQ:SE instrument is a promising tool for low-cost screening of early social-emotional vulnerability.
  • 44.
    Waenerlund, Anna-Karin
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Goicolea, Isabel
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Jonsson, F.
    Does youth clinics in northern Sweden offer person-centered care?2017In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 27, no Suppl_3, p. 528-Article in journal (Other academic)
    Abstract [en]

    Background: It is especially important for youth that the care is person-centered, responding to the need of the individual which usually will be broader and more complex than the specific health problem they consult in the first place. That in terms of youth health care everything is connected and health care services can be an opportunity to discuss sexual & reproductive SRS issues and mental health issues. The literature show that with young people the reason for consultation can only be an excuse to come to a health care professional. To examine this issue and in an attempt to increase our understanding about youths’s experiences of visiting youth clinics in Sweden overall, the present study compared reasons for the consultation at the youth clinic to the topics attended at the consultation, and by doing so also measuring the level of person-centered care.

    Methods: Data from a cross-sectional survey sent out in September 2016 collected from twenty-two youth clinics in the four northern most counties in Sweden, was used in the present study. In total 1223 youth responded to the survey. Chi2 was used to determine significant differences.

    Results: Preliminary results shows that of the youth participating in the survey 63.9% got a balanced response to what they asked for, 27.7% were offered more than their initial asked for and 8.4% were offered less than what they asked for. Being offered more than you asked for was not depending on gender, sexual orientation or trans identification. However, on county-level there were differences, where Västernorrland offered more to 35.5%, Jämtland 28.2%, Norrbotten 22.1% and Västerbotten 21.5% of the youth.

    Conclusions: The results could be interpreted as a sign that youth clinics offers person-centered care (responding to the needs beyond the specific reason for consultations). In between county difference may be related to differences in organizational systems between counties.

    Key messages:

    • Youth clinics in northern Sweden offers person-centred care to young people, by responding to the needs beyond the specific reason for consultation.
    • The level of person centred care offered is dependent on county but not on gender or sexual orientation.
  • 45.
    Weinehall, Lars
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Background and development of the Västerbotten Intervention Programme (VIP)2017In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 27, no Suppl_3, p. 204-204Article in journal (Other academic)
    Abstract [en]

    During the 1950's, knowledge grow of the role of life style habits for cardiovascular disease (CVD) development. With increasing mortality, preventive actions were expected in the Western World. In Sweden, however, this interest was modest. Researchers were far more keen to study the natural process of CVD, why major cohort studies were conducted in Malmö and Gothenburg.

    Not until the beginning of the 1980s, did Swedish scientists seriously start discussing the possibilities to prevent CVD, using population efforts. One inspiration source was regional data on dramatically increased death rates in cardiovascular disease, especially in the North, presented by researchers from Umeå University. The Northern Sweden public was seriously concerned.

    In 1982, the Swedish Parliament adopted a new Health and Medical Services Act, stating that the health care mission both was to provide good medical care and good health for the entire population.

    Based on this, the Västerbotten County Council decided to go from talk to action and developed the first large-scale population-oriented CVD intervention program ever in Sweden. National experts were invited to give their input. In 1984 a program was decided combining individual-oriented initiatives (a health survey at 30, 40, 50 and 60 years of age and an individual health dialogue) and community oriented health promoting components. As a first step, a pilot study was developed locally in close collaboration between primary care, municipality boards, NGOs, health planers and researchers.

    During the second step, the upscaling phase, local responsibility and ownership were of major importance. Once the model was implemented in all municipalities, the project was transformed into an operational phase. Thus, the VIP health survey/health dialogue was decided to be a part of the primary care's regular assignment, with similar content regardless of health centre, while local community-oriented activities could vary based on local context.

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