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  • 1.
    Andersson, Nirina
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Dermatology and Venerology.
    Carré, Helena
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Dermatology and Venerology.
    Janlert, Urban
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Boman, Jens
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Dermatology and Venerology.
    Nylander, Elisabet
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Dermatology and Venerology.
    Gender differences in the well-being of patients diagnosed with Chlamydia trachomatis: a cross-sectional study2018In: Sexually Transmitted Infections, ISSN 1368-4973, E-ISSN 1472-3263, Vol. 94, no 6, p. 401-405Article in journal (Refereed)
    Abstract [en]

    Objectives: We aimed to investigate how an infection with Chlamydia trachomatis (CT) influenced patients' well-being and whether there were differences due to gender, age or relationship status, in an effort to strengthen preventive measures and provide better healthcare for patients with CT.

    Methods: Patients diagnosed with CT in the county of Västerbotten, Sweden, were asked to fill out a questionnaire about their feelings, thoughts and actions after CT diagnosis. The patients were also asked to fill in the validated questionnaires Hospital Anxiety and Depression Scale and Alcohol Use Disorder Identification Test. Between February 2015 and January 2017, 128 patients (74 women and 54 men) were included in the study.

    Results: After being diagnosed with CT, men were generally less worried than women (P<0.001). Women worried more about not being able to have children (P<0.001) and about having other STIs (P=0.001) than men did. Men felt less angry (P=0.001), less bad (P<0.001), less dirty (P<0.001) and less embarrassed (P=0.011) than women did. Nineteen per cent of men and 48% of women reported symptoms of anxiety. The majority of both men (60%) and women (72%) had a risk consumption of alcohol.

    Conclusion: Women and men reacted differently when diagnosed with CT. Women worried more about complications and more often blamed themselves for being infected. Being aware of these gender differences may be important when planning preventive measures and during counselling of CT-infected patients. Persons working with patients with CT must also be aware of the high frequency of harmful alcohol consumption among their patients.

  • 2.
    Asplund, Kjell
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Eliasson, Mats
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Janlert, Urban
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.
    Stegmayr, Birgitta
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    [What the MONICA project has taught us about cardiovascular diseases--society, public health and health care]2006In: Lakartidningen, ISSN 0023-7205, Vol. 103, no 40, p. 3006-11Article in journal (Other academic)
  • 3.
    Boman, Jens
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Dermatology and Venerology.
    Lindqvist, Helena
    Forsberg, Lars
    Janlert, Urban
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Granåsen, Gabriel
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Nylander, Elisabet
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Dermatology and Venerology.
    Brief manual-based single-session Motivational Interviewing for reducing high-risk sexual behaviour in women: an evaluation2018In: International Journal of STD and AIDS (London), ISSN 0956-4624, E-ISSN 1758-1052, Vol. 29, no 4, p. 396-403Article in journal (Refereed)
    Abstract [en]

    The objective of this study was to develop and evaluate brief Motivational Interviewing (MI) to facilitate behaviour change in women at high risk of contracting sexually transmitted infections (STIs). One hundred and seventy-three women (mean age 24.7) at high risk of contracting STIs were randomized to a brief risk-reducing MI counselling intervention (n = 74) or assigned to the control group (n = 99). MI skill was assessed using the Motivational Interviewing Treatment Integrity (MITI) Coding System. Seventeen of 74 (23%) women tested for Chlamydia trachomatis (CT) in the MI intervention group and 22 of 99 (22%) in the control group had a genital CT infection 0-24 months before baseline. All additional CT testing was monitored up to 24 months for all 173 women in the study. None of the 49 CT-retested women in the MI group was CT infected, as compared to 3 of 72 (4%) women in the control group. A generalized estimating equations model with sexual high-risk behaviour measured at baseline and at six-month follow-up produced an adjusted estimated odds ratio of 0.38 (95% confidence interval = 0.158, 0.909), indicating efficacy. Brief manual-based single-session MI counselling seems to be effective in reducing high-risk sexual behaviour in women at high risk of acquiring STIs.

  • 4.
    Boman, Jens
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Dermatology and Venerology.
    Lindqvist, Helena
    Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
    Janlert, Urban
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Brandell Eklund, Astri
    Department of Knowledge Development, Swedish National Institute of Public Health, Östersund, Sweden.
    Forsberg, Lars
    Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
    Nylander, Elisabet
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Dermatology and Venerology.
    Development and evaluation of brief manual-based single-session motivational interviewing for reducing Chlamydia trachomatis infection rates in women with high-risk sexual behaviorManuscript (preprint) (Other academic)
  • 5.
    Boman, Jens
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Dermatology and Venerology.
    Lindqvist, Helena
    Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
    Janlert, Urban
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Brandell Eklund, Astri
    Swedish National Institute of Public Health, Östersund, Sweden.
    Forsberg, Lars
    Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
    Nylander, Elisabet
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Dermatology and Venerology.
    Is single-session motivational interviewing effective to reduce high risk sexual behavior in men?Manuscript (preprint) (Other academic)
  • 6.
    Carré, Helena
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Dermatology and Venerology.
    Lindström, Richard
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Dermatology and Venerology.
    Boman, Jens
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Janlert, Urban
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Lundqvist, Lotta
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Dermatology and Venerology.
    Nylander, Elisabet
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Dermatology and Venerology.
    Asking about condom use: a key to individualized care when screening for chlamydia2011In: International Journal of STD and AIDS (London), ISSN 0956-4624, E-ISSN 1758-1052, Vol. 22, no 8, p. 436-441Article in journal (Refereed)
    Abstract [en]

    Chlamydia trachomatis (CT) infection has been a target for both selective and national screening programmes, and Sweden has an opportunistic approach. A national plan of action states that risk groups should be identified and offered risk reduction counselling. Patients attending a drop-in sexually transmitted infection (STI) clinic reception at the University Hospital, Umeå, Sweden, were invited to complete a questionnaire regarding sociodemographic characteristics, symptoms and sexual risk behaviour; all had a CT test taken. A total of 1305 patients were included, 58% men, mean age 27.8 years. CT prevalence was 11%; 51% of those with CT were ≥ 25 years old. Only 5% used a condom during the entire sexual intercourse with their last new/temporary partner. Sexually active inconsistent condom users comprised 62% of the study population and contributed to 81% of the chlamydia infections. Asking whether a condom was used could quickly triage patients into groups with a 'higher risk' (none or inconsistent use of condoms and at least one new/temporary partners), and 'lower risk' (with more consistent condom use, although not always accurate) allowing for individualized care and counselling when screening for chlamydia. Evaluating whether a condom was used throughout the sexual intercourse did not add any useful information.

  • 7.
    Carré, Helena
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Dermatology and Venerology.
    Lindström, Richard
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Dermatology and Venerology.
    Nordström, Annika
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Boman, Jens
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Janlert, Urban
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Nylander, Elisabet
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Dermatology and Venerology.
    High prevalence of anxiety and hazardous alcohol consumption among patients attending an STI-clinic in northern SwedenManuscript (preprint) (Other academic)
    Abstract [en]

    Introduction: Depression and hazardous alcohol consumption is associated to high-risk sexual behaviours among adolescents and young adults. Is the same true among grownups? The impact of anxiety on sexual risk behaviour is not thoroughly investigated. Our aim was to evaluate the correlation between hazardous alcohol consumption, depression and anxiety to sexual risk taking including Chlamydia infections, among patients attending an STI reception.

     Method: Patients attending an urban STI reception in Sweden were consecutively included and received questionnaires; screening- and demographic information, Alcohol Use Disorder Identification Test (AUDIT) and Hospital Anxiety and Depression scale (HAD). All patients also had a test for Chlamydia trachomatis taken.

    Results: 539 patients were included in the study, mean age 28 years. 152 (30%) had signs of anxiety and 37 (7%) of depression, of which 30 had also anxiety. Neither anxiety nor depression was correlated to sexual risk behaviour. >50% had hazardous alcohol consumption and it was independently linked to sexual risk behaviours and anxiety.

    Conclusion: Depression is not associated to sexual risk behaviours among adult STI-patients. Health care staff and must consider the high frequency of anxiety and hazardous alcohol consumption at their treatment of STI-clinic patients and in the preventive work. The society must work with lowering the stigmatization that still seems to be connected to STIs.

  • 8.
    Dapi N., Léonie
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Hörnell, Agneta
    Umeå University, Faculty of Social Sciences, Department of Food and Nutrition.
    Janlert, Urban
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Stenlund, Hans
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Larsson, Christel
    Umeå University, Faculty of Social Sciences, Department of Food and Nutrition.
    Energy and nutrient intake in relation to sex and socioeconomic status among adolescents in urban Cameroon, Africa2011In: Public Health Nutrition, ISSN 1368-9800, E-ISSN 1475-2727, Vol. 14, no 5, p. 904-913Article in journal (Other academic)
    Abstract [en]

    OBJECTIVE: To assess energy and nutrient intakes and physical activity of adolescents in urban Cameroon according to sex and socio-economic status (SES).

    DESIGN: Cross-sectional study with adolescents randomly selected from schools in low-, middle- and high-SES areas. Weight and height were measured and information about food intake and physical activity was obtained through repeated individual 24 h recalls. Under- and over-reporting of energy intake and inadequacy of nutrient intake were assessed.

    SETTING: Yaoundé, Cameroon.

    SUBJECTS: Boys and girls aged 12-16 years (n 227).

    RESULTS: Boys had a lower BMI and reported higher energy expenditures and physical activity levels (PAL) than girls. Under-reporting of energy intake was large among boys and girls regardless of PAL; boys under-reported more than girls. Among those with low PAL, over-reporting of energy intake was common. Over 50 % of boys and girls had protein below the recommendations. The intake of fat varied; 26 % of the adolescents were below and 25 % were above the recommendations. Inadequate intakes of vitamin B1, vitamin B3 and Fe were more common among girls, while boys more often had inadequate intake of vitamin A. Adolescents with low SES were more likely to be below the recommendations for fat and vitamins B2, B3, B6 and B12 than those with high SES.

    CONCLUSIONS: A high proportion of boys and girls reported inadequate intakes. However under- and over-reporting were also very common. Boys under-reported energy intake more than girls and inadequate nutrient intake was more frequently reported by adolescents with low SES than by those with high SES.

  • 9.
    Dapi N., Léonie
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.
    Janlert, Urban
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.
    Nouedoui, Christophe
    Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon.
    Håglin, Lena
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Adolescents´ food habits and nutritional status in urban and rural areas in Cameroon, Africa2005In: Scandinavian Journal of Nutrition/Næringsforskning, ISSN 1102-6480, E-ISSN 1651-2359, Vol. 49, no 4, p. 151-158Article in journal (Refereed)
    Abstract [en]

    Background: Food intake in Cameroon is based on three meals daily. The diet in rural areas is based on traditional staple foods, while that of the urban population incorporates more modern foods. The health and nutrition of adolescents is important as their eating behaviour and nutrition will affect their future health.

    Objective: To describe and compare food habits and nutritional status of adolescents in Cameroon.

    Design: A cross-sectional study using an unquantified food frequency questionnaire and anthropometric data, in urban and rural areas. Fifty-two adolescents, 12_/15 years old, were selected from schools.

    Results : Frequencies of consumption of meat, vegetables, cereals, milk products and junk food were significantly higher in urban than in rural adolescents (11.8 vs 4.5, 9.5 vs 3.9, 16.5 vs 11.9, 5.7 vs 0.8, 24.2 vs 8.7, respectively). The frequency of in-between meals was higher in urban than in rural adolescents (4.9 vs 0.9, respectively). Arm muscle area (AMA, mm2) and waist/hip ratio were significantly higher in rural than in urban adolescents (3554 vs 2802 and 0.82 vs 0.79, respectively). Body mass index (BMI, kg m_2) was higher in rural than urban adolescents, although not significant (20.6 vs 19.4, respectively). There was a positive significant correlation between BMI and AMA in urban and rural areas (r_/0.67 and r_/0. 72, respectively).

    Conclusions: Despite a lower frequency of food consumption, rural adolescents had higher AMA and waist/hip ratio than urban adolescents. Less junk food and more traditional food consumption, more manualactivities and walking in rural adolescents could explain these results.

  • 10.
    Dapi N., Léonie
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.
    Janlert, Urban
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.
    Nouedoui, Christophe
    Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon.
    Håglin, Lena
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Socioeconomic and gender differences in adolescents´ nutritional status in urban Cameroon, Africa2009In: Nutrition Research, ISSN 0271-5317, E-ISSN 1879-0739, Vol. 29, no 5, p. 313-319Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to assess adolescents' nutritional status according to socioeconomic status (SES) and sex using anthropometry in urban Cameroon, Africa. Adolescent boys (n = 248) and girls (n = 333) 12 to 16 years old were recruited from randomly selected schools in a cross sectional study in Yaoundé city and grouped according to SES. Weight, height, skinfold thickness, and circumferences were measured, and body mass index, waist/hip ratio, arm muscle, and arm fat areas were calculated. Stunting, underweight, and overweight were determined using international cutoff points. Adolescents with medium and high SES were less likely to be stunted than adolescents with low SES (odds ratio [OR], 0.40; P < .01). Prevalences of stunting (12%, 6%, and 5%) and underweight (3%, 4%, and 1%) were higher among the adolescents with low and medium SES than those with high SES. Overweight prevalence was high among the adolescents with low (8%), medium (11%), and high (9%) SES. The OR for overweight was higher among girls than boys (OR, 4.13; P < .001). Girls were less likely to be stunted and underweight than boys (OR, 0.29 [P < .001] and OR, 0.20 [P < .01], respectively). Prevalences of stunting (15% and 6%) and underweight (5% and 2%) were higher among boys than girls. Pubescent adolescents were less likely to be stunted than nonpubescent (OR, 0.53; P < .05). Adolescents with low and medium SES were more underweight and stunted than adolescents with high SES. Girls were more overweight, less stunted, and underweight than boys.

  • 11.
    Dapi N., Léonie
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.
    Janlert, Urban
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.
    Omoloko, Cécile
    Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon.
    Dahlgren, Lars
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences. Umeå University, Faculty of Social Sciences, Department of Sociology.
    Håglin, Lena
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    "I eat to be happy, to be strong, and to live": perceptions of rural and urban adolescents in Cameroon, Africa2007In: Journal of nutrition education and behavior, ISSN 1499-4046, E-ISSN 1878-2620, Vol. 39, no 6, p. 320-326Article in journal (Refereed)
    Abstract [en]

    Objective: To investigate factors influencing rural and urban adolescents’ food perceptions during a time of nutritional transition in Cameroon, Africa.

    Design: Qualitative in-depth interviews.

    Settings: Yaoundé urban and Bandja rural areas.

    Participants: Fifteen adolescents 12 to 15 years old purposely selected from schools in urban and rural areas.

    Analysis: Interviews were audiotaped, transcribed, and analyzed using Grounded Theory method.

    Findings: Factors influencing adolescents’ food perceptions from the rural area were “to live” “health” and “poverty.” Among adolescents from the urban poor area, “health,” “beauty,” and “not enough money” were factors. Among adolescents from the urban rich area, “pleasure” and “beauty” were factors. Rural girls liked “to be fat,” whereas girls from the urban poor wanted “to be a little bit fat,” and girls from the urban rich wanted “to be normal.”

    Conclusions and Implications: Food behavior is changing from a diet composed of traditional food in rural areas to a more westernized diet in urban areas. The relationship between socioeconomic factors and nutrition needs to be examined with a sufficiently large number of adolescents to investigate these factors in a quantitative survey. Healthful local food should be available at home and from vendors. Nutrition education about food and diet-related diseases is needed in school.

  • 12.
    Eliasson, Mats
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Janlert, Urban
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.
    Jansson, Jan-Håkan
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Stegmayr, Birgitta
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Time trends in population cholesterol levels 1986-2004: influence of lipid-lowering drugs, obesity, smoking and educational level. The northern Sweden MONICA study.2006In: J Intern Med, ISSN 0954-6820, Vol. 260, no 6, p. 551-9Article in journal (Refereed)
  • 13.
    Eriksson, Malin
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Dahlgren, Lars
    Janlert, Urban
    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.
    Emmelin, Maria
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Social capital, gender and educational level: impact on self-rated health2010In: The Open Public Health Journal, ISSN 1874-9445, Vol. 3, p. 1-12Article in journal (Refereed)
    Abstract [en]

    Objectives: Social capital has been recognized as one important social determinant for health, but we still have limited knowledge about how it can be used to explain inequality in health. This study investigated the links between individual social capital and self-rated health by gender and educational level, and analyzed if access to social capital might explain the observed disparities in self-rated health between men and women and different educational groups. Study design: A cross-sectional survey in Northern Sweden. Methods: A social capital questionnaire was constructed and mailed to 15 000 randomly selected individuals. Different forms of structural and cognitive social capital were measured. Self-rated health was used as the outcome measure. Crude and adjusted OR and 95% CI were calculated for good selfrated health and access to each form of social capital. Multivariate regression was used to analyze how sociodemographic factors and access to social capital might influence differences in self-rated health by gender and educational level. Results: Access to almost each form of social capital significantly increased the odds for good self-rated health for all groups. A higher education significantly increased the odds for access to each form of social capital, and being a man significantly increased the odds for having access to some forms of social capital. The health advantage for higher educated and men partly decreased when controlling for access to social capital. Conclusions: Access to social capital can partly explain the observed health inequality between men and women and different educational groups. Strengthening social capital might be one way of tackling health inequality. It is important to consider the structural conditions that create unequal opportunities for different groups to access social capital.

  • 14.
    Eriksson, Marie
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Holmgren, L.
    Janlert, Urban
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Jansson, Jan-Håkan
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine. Department of Medicine, Skellefteå Hospital, Skellefteå.
    Lundblad, Dan
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine. Department of Medicine, Sunderby Hospital, Luleå.
    Stegmayr, Birgitta
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine. National Board of Health and Welfare, Stockholm.
    Söderberg, Stefan
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Eliasson, Mats
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine. Department of Medicine, Sunderby Hospital, Luleå.
    Large improvements in major cardiovascular risk factors in the population of northern Sweden: the MONICA study 1986–20092011In: Journal of Internal Medicine, ISSN 0954-6820, E-ISSN 1365-2796, Vol. 269, no 2, p. 219-231Article in journal (Refereed)
    Abstract [en]

    Objectives. The incidence of cardiovascular disease has declined rapidly in Sweden since the 1980s. We explored changes in major cardiovascular risk factors in northern Sweden between 1986 and 2009.

    Design. Since 1986, six population surveys have been carried out in northern Sweden using procedures of the World Health Organization MONICA project. The population age range was 25–64 years in 1986 and 1990, and 25–74 years from 1994. Trends were analysed using generalized linear models.

    Results. A total of 10 586 subjects were included in the surveys. Blood pressure decreased by 4.9/3.9 mmHg in women and 1.8/1.5 mmHg in men aged 25–64 years between 1986 and 2009. In men and women aged 65–74 years, the decrease was 12.6/6.1 mmHg between 1994 and 2009. From 1994, the use of blood pressure‐lowering drugs increased, particularly among the older subgroup. The prevalence of smoking halved between 1986 and 2009; 11% of women and 9% of men were smokers in 2009. Cholesterol levels decreased by 0.9 mmol L−1 in the younger age group (25–64 years), and the use of lipid‐lowering agents increased from 1994. Among subjects aged 25–64 years, one in five was obese in 2009, which was twice as many as in 1986, and body mass index (BMI) increased by 1.5 kg m−2, corresponding to an increase in weight of 4 kg. There was no further increase in BMI from 2004. The prevalence of diabetes did not change between 1986 and 2009. The proportion that received a university education increased markedly in all age groups, especially in women, during the study period.

    Conclusions. Significant improvements were observed in major cardiovascular risk factors in northern Sweden between 1986 and 2009.

  • 15. Feder, Gene
    et al.
    Rohde, Jon E
    San Sebastian, Miguel
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.
    Janlert, Urban
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.
    Jimba, Masamine
    Materia, Enrico
    Hurtig, Anna-Karin
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.
    Goldin, Stephen
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry.
    Stafford, Tom
    Edvardsson, Berit
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.
    Hilt, Bjorn
    Parkinson, Stuart
    Birch, Marion
    Jones, Anna
    Archibald, Kathy
    Pastore, John O
    Reed Elsevier and the international arms trade.2005In: Lancet, ISSN 1474-547X, Vol. 366, no 9489, p. 889; discussion 889-90Article in journal (Refereed)
  • 16.
    Grönblom-Lundström, Lena
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Social medicine. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.
    Janlert, Urban
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.
    Low-back complaints and other complaints as a reason for sick listing: a comparative study regarding work-related factors, socio-demographic factors, leisure-time, social support and perceived healthManuscript (preprint) (Other academic)
    Abstract [en]

    The aim of this study was to investigate in what way people on sick leave due to low-back troubles distinguish as a group from other individuals on sick leave. The population in this study consisted of all individuals 20-64 years of age, who in 1991 belonged to a local health insurance office in northern Sweden. All individuals, born on day 5, 15 and 25, who had been on sick leave due to low-back (LB) complaints (low-back group) and a random sample of individuals, who had been on sick leave due to other kinds of complaints (reference group) constituted the study sample. Information was collected from their sickness records and from a questionnaire sent to each individual comprising questions about education, working environment, perceived health, social support, leisure time activities and smoking habits. There were no differences found regarding the sex of the individuals, leisure time activities or social support between the two studied groups. In the multivariate logistic regression analysis the result revealed that the LB group had longer sick leave periods, more spells and was to greater extent blue-collar workers.

    This may indicate differences in the working situation between the groups, which in turn may aggravate LB problems leading to longer sick leave or more spells. 

  • 17.
    Grönblom-Lundström, Lena
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Social medicine. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.
    Janlert, Urban
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.
    Self-reported low-back complaints in a random population sample: specific versus non-specific complaintsIn: Article in journal (Other academic)
    Abstract [en]

    The purpose of this study was to investigate the distribution of selfreported low-back (LB) complaints in the social structure, and to investigate how the variables - physical work load, physical ability, Activities of Daily Living (ADL), mental job strain, social support, health and smoking - were associated with the different LB complaints. The Survey of Living Conditions carried out by Statistics Sweden 1980-81 has been used as the basis of the investigation. The LB complaints were dichotomised into specific and non-specific LB complaints according to an assumed grade of measurability. The non-specific LB complaints showed a social gradient which specific complaints did not despite the association with some of the variables. People, with a non-specific LB complaint, were besides that associated with a higher risk to become a sickness and disability pensioner than people with a specific LB complaint. This may indicate that either strategies used within the health care system in general are more suitable for specific complaints perhaps due to their higher grade of measurability or that people with a non-specific complaint suffers from an incapacitating illness that cannot be cured.

  • 18.
    Gustafsson, Per E.
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Janlert, Urban
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Theorell, Tores
    Stress Research Institute, Stockholm University, Stockholm, Sweden.
    Westerlund, Hugo
    Stress Research Institute, Stockholm University, Stockholm, Sweden.
    Hammarström, Anne
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Do peer relations in adolescence influence health in adulthood?: Peer problems in the school setting and the metabolic syndrome in middle-age2012In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 7, no 6, p. e39385-Article in journal (Refereed)
    Abstract [en]

    While the importance of social relations for health has been demonstrated in childhood, adolescence and adulthood, few studies have examined the prospective importance of peer relations for adult health. The aim of this study was to examine whether peer problems in the school setting in adolescence relates to the metabolic syndrome in middle-age. Participants came from the Northern Swedish Cohort, a 27-year cohort study of school leavers (effective n = 881, 82% of the original cohort). A score of peer problems was operationalized through form teachers' assessment of each student's isolation and popularity among school peers at age 16 years, and the metabolic syndrome was measured by clinical measures at age 43 according to established criteria. Additional information on health, health behaviors, achievement and social circumstances were collected from teacher interviews, school records, clinical measurements and self-administered questionnaires. Logistic regression was used as the main statistical method. Results showed a dose-response relationship between peer problems in adolescence and metabolic syndrome in middle-age, corresponding to 36% higher odds for the metabolic syndrome at age 43 for each SD higher peer problems score at age 16. The association remained significant after adjustment for health, health behaviors, school adjustment or family circumstances in adolescence, and for psychological distress, health behaviors or social circumstances in adulthood. In analyses stratified by sex, the results were significant only in women after adjustment for covariates. Peer problems were significantly related to all individual components of the metabolic syndrome. These results suggest that unsuccessful adaption to the school peer group can have enduring consequences for metabolic health.

  • 19.
    Gustafsson, Per E
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Janlert, Urban
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Theorell, Töres
    Hammarström, Anne
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Is body size at birth related to circadian salivary cortisol levels in adulthood? Results from a longitudinal cohort study.2010In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 10, no 346Article in journal (Refereed)
    Abstract [en]

    Background

    The hypothesis of fetal origins of adult disease has during the last decades received interest as an explanation of chronic, e.g. cardiovascular, disease in adulthood stemming from fetal environmental conditions. Early programming and enduring dysregulations of the hypothalamic-pituitary-adrenal (HPA axis), with cortisol as its end product, has been proposed as a possible mechanism by which birth weight influence later health status. However, the fetal origin of the adult cortisol regulation has been insufficiently studied. The present study aims to examine if body size at birth is related to circadian cortisol levels at 43 years.

    Methods

    Participants were drawn from a prospective cohort study (n = 752, 74.5%). Salivary cortisol samples were collected at four times during one day at 43 years, and information on birth size was collected retrospectively from delivery records. Information on body mass during adolescence and adulthood and on health behavior, medication and medical conditions at 43 years was collected prospectively by questionnaire and examined as potential confounders. Participants born preterm or < 2500 g were excluded from the main analyses.

    Results

    Across the normal spectrum, size at birth (birth weight and ponderal index) was positively related to total (area under the curve, AUC) and bedtime cortisol levels in the total sample. Results were more consistent in men than in women. Descriptively, participants born preterm or < 2500 g also seemed to display elevated evening and total cortisol levels. No associations were found for birth length or for the cortisol awakening response (CAR).

    Conclusions

    These results are contradictory to previously reported negative associations between birth weight and adult cortisol levels, and thus tentatively question the assumption that only low birth weight predicts future physiological dysregulations.

  • 20.
    Gustafsson, Per E
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Janlert, Urban
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Theorell, Töres
    Stress Research Institute, Stockholm University, Stockholm, Sweden.
    Hammarström, Anne
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Life-course socioeconomic trajectories and diurnal cortisol regulation in adulthood2010In: Psychoneuroendocrinology, ISSN 0306-4530, E-ISSN 1873-3360, Vol. 35, no 4, p. 613-623Article in journal (Refereed)
    Abstract [en]

    Although the health risk of socioeconomic disadvantage over the life-course is fairly established, the mechanisms are less studied. One candidate pathway is long-term dysregulation of cortisol. This study assesses whether socioeconomic trajectories from adolescence to adulthood influences the regulation of cortisol in mid-adulthood, and further investigates the importance of adolescence as a critical period and of accumulation of socioeconomic disadvantage. Participants were drawn from a 27-year prospective cohort study (n = 732, 68% of the original cohort). Information on socioeconomic status (SES) was collected at the ages of 16 (based on parental occupation), 21, 30 and 43 (based on own occupation) years, and at 43 years participants collected one-day salivary cortisol samples at awakening, after 15 min, before lunch and at bedtime. We found that the cortisol awakening response (CAR) differed with respect to SES trajectory; those with stable low or early low/upwardly mobile SES tended to display higher CAR than those with early high/downwardly mobile, highly mobile or stable high trajectories. Further analyses revealed that early low SES was related to higher CAR, and in women low SES was related to lower bedtime cortisol, independently of later SES and potential confounders. We found no support for a linear effect of accumulation of socioeconomic disadvantage. In conclusion, our study gives support for an independent effect of low socioeconomic status early in life, on the regulation of cortisol in adulthood.

  • 21.
    Gustafsson, Per E
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Janlert, Urban
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Theorell, Töres
    Westerlund, Hugo
    Hammarström, Anne
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Fetal and life course origins of serum lipids in mid-adulthood: results from a prospective cohort study2010In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 10, no 484Article in journal (Refereed)
    Abstract [en]

    Background During the past two decades, the hypothesis of fetal origins of adult disease has received considerable attention. However, critique has also been raised regarding the failure to take the explanatory role of accumulation of other exposures into consideration, despite the wealth of evidence that social circumstances during the life course impact on health in adulthood. The aim of the present prospective cohort study was to examine the contributions of birth weight and life course exposures (cumulative socioeconomic disadvantage and adversity) to dyslipidemia and serum lipids in mid-adulthood.

    Methods A cohort (effective n = 824, 77%) was prospectively examined with respect to self-reported socioeconomic status as well as stressors (e.g., financial strain, low decision latitude, separation, death or illness of a close one, unemployment) at the ages of 16, 21, 30 and 43 years; summarized in cumulative socioeconomic disadvantage and cumulative adversity. Information on birth weight was collected from birth records. Participants were assessed for serum lipids (total cholesterol, low- and high-density lipoprotein cholesterol and triglycerides), apolipoproteins (A1 and B) and height and weight (for the calculation of body mass index, BMI) at age 43. Current health behavior (alcohol consumption, smoking and snuff use) was reported at age 43.

    Results Cumulative life course exposures were related to several outcomes; mainly explained by cumulative socioeconomic disadvantage in the total sample (independently of current health behaviors but attenuated by current BMI) and also by cumulative adversity in women (partly explained by current health behavior but not by BMI). Birth weight was related only to triglycerides in women, independently of life course exposures, health behaviors and BMI. No significant association of either exposure was observed in men.

    Conclusions Social circumstances during the life course seem to be of greater importance than birth weight for dyslipidemia and serum lipid levels in adulthood.

  • 22.
    Gustafsson, Per E
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Janlert, Urban
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Theorell, Töres
    Westerlund, Hugo
    Hammarström, Anne
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Social and material adversity from adolescence to adulthood and allostatic load in middle-aged women and men: results from the Northern Swedish cohort2012In: Annals of Behavioral Medicine, ISSN 0883-6612, E-ISSN 1532-4796, Vol. 43, no 1, p. 117-128Article in journal (Refereed)
    Abstract [en]

    Background  Little is known about the theoretically assumed association between adversity exposure over the life course and allostatic load in adulthood.

    Purpose  This study aims to examine whether social and material adversity over the life course is related to allostatic load in mid-adulthood.

    Methods  A 27-year prospective Swedish cohort (N = 822; 77% response rate) reported exposure to social and material adversities at age 16, 21, 30 and 43 years. At age 43, allostatic load was operationalized based on 12 biological parameters.

    Results  Social adversity accumulated over the life course was related to allostatic load in both women and men, independently of cumulative socioeconomic disadvantage. Moreover, social adversity in adolescence (in women) and young adulthood (in men) was related to allostatic load, independently of cumulative socioeconomic disadvantage and also of later adversity exposure during adulthood.

    Conclusion  Exposure to adversities involving relational threats impacts on allostatic load in adulthood and operates according to life course models of cumulative risk and a sensitive period around the transition into adulthood.

  • 23.
    Gustafsson, Per E
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Janlert, Urban
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Theorell, Töres
    Westerlund, Hugo
    Hammarström, Anne
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Socioeconomic status over the life course and allostatic load in adulthood: results from the Northern Swedish Cohort2011In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 65, p. 986-992Article in journal (Refereed)
    Abstract [en]

    Background Although several studies have reported rather consistent associations between socioeconomic status (SES) and allostatic load (AL), so far no study has examined the influence of SES over the life course on AL. The aim of the present study was to investigate the association between SES over the life course and AL in mid-adulthood, guided by the conceptual models of cumulative risk, critical period and social chain of risk.

    Methods The sample comprises a 27-year prospective cohort (n=1071) from northern Sweden. Participants (n=855, 79.8%) completed questionnaires at the ages of 16, 21, 30 and 43 years. A health examination was performed at age 43 years after an overnight fast, including physical examination and blood sampling, and participants completed 1-day salivary cortisol sampling (four samples). SES was based on parental occupation at age 16 years and participants' own occupation at ages 21, 30 and 43 years. Information on daily smoking, snuff use, high alcohol consumption and physical inactivity was reported by the participants. An AL index was constructed from tertiles of 12 biological parameters.

    Results Cumulative socioeconomic disadvantage was related to AL in both women and men. The association was largely explained by health behaviours in men, but was independent of health behaviours in women. In women, an association was observed between AL and SES in adolescence, whereas in men only current SES was related to AL, independently of current health behaviours.

    Conclusions SES over the life course influences the level of multi-systemic dysregulation in mid-adulthood, with the strongest support for the cumulative risk model.

  • 24.
    Gustafsson, Per E.
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Janlert, Urban
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Virtanen, Pekka
    Hammarström, Anne
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    The association between long-term accumulation of temporary employment, the cortisol awakening response and circadian cortisol levels2012In: Psychoneuroendocrinology, ISSN 0306-4530, E-ISSN 1873-3360, Vol. 37, no 6, p. 789-800Article in journal (Refereed)
    Abstract [en]

    Temporary employment is an increasingly common contract type, which has not been investigated in a psychoneuroendocrinological context despite previous observations of associations between adverse work and employment conditions and hypothalamic-pituitary-adrenal (HPA) axis dysregulations. The present study aims to examine whether the 12-year accumulation of temporary employment is related to circadian cortisol levels, and if any association is independent of current employment conditions. Participants were drawn from the prospective Northern Swedish Cohort (n = 791, 74% of the original cohort). At age 43 years, retrospective reports of employments over the last 12 years and of current social conditions were collected by questionnaire, and one-day salivary cortisol profile was measured (at awakening, +15 min post-awakening, pre-lunch, bedtime). Results indicated a gradually higher magnitude of the cortisol awakening response (CAR) in subjects with no (0 months in temporary employment; mean CAR = 34%), moderate (1-25 months in temporary employment; mean CAR = 41%) and heavy (>25 months in temporary employment; mean CAR = 51%) exposure (p = .020), remaining after adjustment for potential confounders and for current employment conditions (p = .028). The higher CAR was explained by lower awakening rather than higher post-awakening cortisol levels. Cortisol levels at all times of the day except post-awakening displayed tendencies to negative relations to temporary employment; as indicated by a lower Area Under of Curve (regression coefficient = 5.0%, p = .038 after adjustment). This study thus suggests that the long-term exposure to temporary employment might confer HPA dysregulations in the form of increased dynamics of the CAR and circadian suppression. (C) 2011 Elsevier Ltd. All rights reserved.

  • 25.
    Gustafsson, Per E.
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    San Sebastian, Miguel
    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.
    Theorell, Töres
    Stress Research Institute, Stockholm University, Stockholm, Sweden.
    Westerlund, Hugo
    Stress Research Institute, Stockholm University, Stockholm, Sweden.
    Hammarström, Anne
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Life-course accumulation of neighborhood disadvantage and allostatic load: empirical integration of three social determinants of health frameworks2014In: American Journal of Public Health, ISSN 0090-0036, E-ISSN 1541-0048, Vol. 104, no 5, p. 904-910Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: We examined if the accumulation of neighborhood disadvantages from adolescence to mid-adulthood were related to allostatic load, a measure of cumulative biological risk, in mid-adulthood, and explored whether this association was similar in women and men.

    METHODS: Data were from the participants in the Northern Swedish Cohort (analytical n = 818) at ages 16, 21, 30, and 43 years in 1981, 1986, 1995, and 2008. Personal living conditions were self-reported at each wave. At age 43 years, 12 biological markers were measured to operationalize allostatic load. Registered data for all residents in the cohort participants' neighborhoods at each wave were used to construct a cumulative measure of neighborhood disadvantage. Associations were examined in ordinary least-squares regression models.

    RESULTS: We found that cumulative neighborhood disadvantage between ages 16 and 43 years was related to higher allostatic load at age 43 years after adjusting for personal living conditions in the total sample (B = 0.11; P = .004) and in men (B = 0.16; P = .004), but not in women (B = 0.07; P = .248).

    CONCLUSIONS: Our findings suggested that neighborhood disadvantage acted cumulatively over the life course on biological wear and tear, and exemplified the gains of integrating social determinants of health frameworks.

  • 26.
    Gustafsson, Per E.
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    San Sebastian, Miguel
    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.
    Theorell, Töres
    Westerlund, Hugo
    Hammarström, Anne
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Residential Selection across the Life Course: Adolescent Contextual and Individual Determinants of Neighborhood Disadvantage in Mid-Adulthood.2013In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 8, no 11, article id e80241Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Numerous cross-sectional studies have examined neighborhood effects on health. Residential selection in adulthood has been stressed as an important cause of selection bias but has received little empirical attention, particularly its determinants from the earlier life course. The present study aims to examine whether neighborhood, family, school, health behaviors and health in adolescence are related to socioeconomic disadvantage of one's neighborhood of residence in adulthood.

    METHODS: Based on the prospective Northern Swedish Cohort (analytical N = 971, 90.6% retention rate), information was collected at age 16 years concerning family circumstances, school adjustment, health behaviors and mental and physical health. Neighborhood register data was linked to the cohort and used to operationalize aggregated measures of neighborhood disadvantage (ND) at age 16 and 42. Data was analyzed with linear mixed models, with ND in adulthood regressed on adolescent predictors and neighborhood of residence in adolescence as the level-2 unit.

    RESULTS: Neighborhood disadvantage in adulthood was clustered by neighborhood of residence in adolescence (ICC = 8.6%). The clustering was completely explained by ND in adolescence. Of the adolescent predictors, ND (b = .14 (95% credible interval = .07-.22)), final school marks (b = -.18 (-.26--.10)), socioeconomic disadvantage (b = .07 (.01-.14)), and, with borderline significance, school peer problems (b = .07 (-.00-.13)), were independently related to adulthood ND in the final adjusted model. In sex-stratified analyses, the most important predictors were school marks (b = -.21 (-.32--.09)) in women, and neighborhood of residence (ICC = 15.5%) and ND (b = .20 (.09-.31)) in men.

    CONCLUSIONS: These findings show that factors from adolescence - which also may impact on adult health - could influence the neighborhood context in which one will live in adulthood. This indicates that residential selection bias in neighborhood effects on health research may have its sources in early life.

  • 27.
    Hammarström, Anne
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Gustafsson, Per E
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Strandh, Mattias
    Umeå University, Faculty of Social Sciences, Department of Sociology.
    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.
    It´s no surprise! Men are not hit more than women by the health consequences of unemployment in the Northern Swedish Cohort2011In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 39, no 2, p. 187-193Article in journal (Refereed)
    Abstract [en]

    Aims: Research often fails to ascertain whether men and women are equally hit by the health consequences of unemployment. The aim of this study was to analyze whether men’s self-reported health and health behaviour were hit more by unemployment than women’s in a follow-up of the Northern Swedish Cohort.

    Methods: A follow-up study of a cohort of all school leavers in a middle-sized industrial town in northern Sweden was performed from age 16 to age 42. Of those still alive of the original cohort, 94% (n = 1,006) participated during the whole period. A sample was made of participants in the labour force and living in Sweden (n = 916). Register data were used to assess the length of unemployment from age 40 to 42, while questionnaire data were used for the other variables.

    Results: In multivariate logistic regression analyses significant relations between unemployment and mental health/smoking were found among both women and men, even after control for unemployment at the time of the investigation and indicators of health-related selection. Significant relations between unemployment and alcohol consumption were found among women, while few visits to a dentist was significant among men.

    Conclusions: Men are not hit more by the health consequences of unemployment in a Swedish context, with a high participation rate of women in the labour market. The public health relevance is that the study indicates the need to take gendered contexts into account in public health research.

  • 28.
    Hammarström, Anne
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Janlert, Urban
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.
    An agenda for unemployment research: a challenge for public health.2005In: Int J Health Serv, ISSN 0020-7314, Vol. 35, no 4, p. 765-77Article in journal (Refereed)
  • 29.
    Hammarström, Anne
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Janlert, Urban
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Cohort Profile: The Northern Swedish Cohort2012In: International Journal of Epidemiology, ISSN 0300-5771, E-ISSN 1464-3685, Vol. 41, no 6, p. 1545-1552Article in journal (Refereed)
  • 30.
    Hammarström, Anne
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Janlert, Urban
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.
    Do health consequences of unemployment differ among young men and women?2006In: Unemployment and health: International and interdisciplinary perspectives, Bowen Hills , 2006, p. 135-142Chapter in book (Other academic)
  • 31.
    Hammarström, Anne
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Janlert, Urban
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.
    Health selection in a 14-year follow-up study--a question of gendered discrimination?2005In: Soc Sci Med, ISSN 0277-9536, Vol. 61, no 10, p. 2221-32Article in journal (Refereed)
  • 32.
    Hammarström, Anne
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Stenlund, Hans
    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.
    Mechanisms for the social gradient in health: results from a 14-year follow-up of the northern swedish cohort2011In: Public Health, ISSN 0033-3506, E-ISSN 1476-5616, Vol. 125, no 9, p. 567-576Article in journal (Refereed)
    Abstract [en]

    Objective: Although numerous studies have demonstrated a socio-economic gradient in health, there is still a lack of research about the mechanisms behind this gradient. The aim of this study was to analyse possible mechanisms from adolescence to adulthood to explain the socio-economic gradient in somatic symptoms among men and women in the Northern Swedish Cohort. Study design: A prospective cohort study was performed, in which all pupils (n = 1083) in the last year of compulsory school were followed for 14 years. The response rate was high, with 96.6% still participating after 14 years. The data were mainly collected through repeated comprehensive self-administered questionnaires.

    Methods: The main dependent variable was a combination of socio-economic position and somatic health at 30 years of age. Multivariate multinomial and bivariate logistic regression analyses were undertaken.

    Results: After controlling for parental working-class position and health-related selection, the authors identified mechanisms from adolescence to adulthood for the socio-economic gradient in health that were related to social relations (poor relationship with father and unemployed friends among men, violence among women), labour market experiences (unemployment among men and women, physically heavy work among women), economic hardship (among women) and poor health behaviour.

    Conclusion: These analyses contribute to the development of epidemiological methods for analysing mechanisms for the socio-economic gradient in health. (C) 2011 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

  • 33.
    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.

  • 34.
    Hult, Carl
    et al.
    Umeå University, Faculty of Social Sciences, Department of Sociology.
    Stattin, Mikael
    Umeå University, Faculty of Social Sciences, Department of Sociology.
    Janlert, Urban
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Järvholm, Bengt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Comparing mortality rates and recognizing health selection bias: A response to Wallman and Svärdsudd2010In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 70, no 10, p. 1489-1491Article in journal (Other academic)
  • 35.
    Hult, Carl
    et al.
    Umeå University, Faculty of Social Sciences, Department of Sociology.
    Stattin, Mikael
    Umeå University, Faculty of Social Sciences, Department of Sociology.
    Janlert, Urban
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Järvholm, Bengt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Timing of retirement and mortality: A cohort study of Swedish construction workers2010In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 70, no 10, p. 1480-1486Article in journal (Refereed)
    Abstract [en]

    Recent studies indicate that early retirement per se may have a negative effect on health to such an extent that it increases mortality risk. One type of early retirement often referred to in these studies is retirement with disability pension/benefit. Given the overall objective of disability benefit programmes - to help the disabled live socially and economically satisfactory lives, freed from exposure to employment health hazards and thus avoid further declines in health - the finding is challenging. This paper examined the relationship between timing of retirement and mortality using a cohort of Swedish construction workers. The mortality risk of disability pensioners - excluding those with diagnoses normally connected to increased mortality - was compared with the risk of those continuing to work. Although initial indications were in line with earlier results, it became obvious that the increased mortality risk of disability pensioners did not depend on early retirement per se but on poor health before early retirement not explicitly recognized in the diagnosis on which the disability pension rested. The results indicate that there are no general differences in mortality depending on timing of retirement. Future studies of mortality differences arising from working or not working must sufficiently control for health selection effects into the studied retirement paths.

  • 36. Huong, Dao Lan
    et al.
    Minh, Hoang Van
    Vos, Theo
    Janlert, Urban
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.
    Van, Do Duc
    Byass, Peter
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Burden of premature mortality in rural Vietnam from 1999 - 2003: analyses from a Demographic Surveillance Site2006In: Population Health Metrics, ISSN 1478-7954, E-ISSN 1478-7954, Vol. 4, p. Article nr 9-Article in journal (Refereed)
    Abstract [en]

    Background: Assessing the burden of disease contributes towards evidence-based allocation of limited health resources. However, such measures are not yet commonly available in Vietnam. Taking advantage of the FilaBavi Demographic Surveillance Site (FilaBavi DSS) in Vietnam, this study aimed to establish the feasibility of applying the Years of Life Lost (YLL) technique in the context of a defined DSS, and to estimate the importance of the principal causes of premature mortality in a rural area of Vietnam between 1999 and 2003.

    Methods: Global Burden of Disease methods were applied. Causes of death were ascertained by verbal autopsy.

    Results: In five years, 1,240 deaths occurred and for 1,220 cases cause of death information from verbal autopsy was available. Life expectancy at birth was 71.0 (95% confidence interval 69.9–72.1) in males and 80.9 (79.9–81.9) in females. The discounted, but not age weighted YLL per 1,000 population was 85 and 55 for males and females, respectively. The leading causes of YLL and death counts were cardiovascular diseases, malignant neoplasms, unintentional injuries, and neonatal causes. Males contributed 54% of total deaths and 59% of YLL. Males experienced higher YLL than women across all causes. Filabavi mortality estimates are considerably lower than 2002 WHO country estimates for Vietnam. Also the FilaBavi cause distribution varies considerably from the WHO result.

    Conclusion: The combination of localised demographic surveillance, verbal autopsy and the application of YLL methods enable new insights into the magnitude and importance of significant public health issues in settings where evidence for planning is otherwise scarce. Local mortality data vary considerably from the WHO model-based estimates.

  • 37. Huong, Dao Lan
    et al.
    Van Minh, Hoang
    Janlert, Urban
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.
    Van, Do Duc
    Byass, Peter
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.
    Socio-economic status inequality and major causes of death in adults: a 5-year follow-up study in rural Vietnam.2006In: Public Health, ISSN 0033-3506, E-ISSN 1476-5616, Vol. 120, no 6, p. 497-504Article in journal (Refereed)
  • 38.
    Janlert, Urban
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.
    Economic crisis, unemployment and public health2009In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 37, no 8, p. 783-784Article in journal (Refereed)
  • 39.
    Janlert, Urban
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Long working hours: an avoidable cause of stroke?2015In: The Lancet, ISSN 0140-6736, E-ISSN 1474-547X, Vol. 386, no 10005, p. 1710-1711Article in journal (Refereed)
  • 40.
    Janlert, Urban
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.
    Professurer och professorer i socialmedicin i Sverige2004In: Socialmedicinsk tidskrift, Vol. 81, p. 202-6Article in journal (Other (popular science, discussion, etc.))
  • 41.
    Janlert, Urban
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.
    Socialmedicinen - en pånyttfödd 30-pring2006In: Socialmedicinsk tidskrift, Vol. 83, p. 93-94Article in journal (Other (popular science, discussion, etc.))
  • 42.
    Janlert, Urban
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.
    The population as patient: on public health work.2004In: Scand J Public Health, ISSN 1403-4948, Vol. 32, no 6, p. 401-2Article in journal (Other academic)
  • 43.
    Janlert, Urban
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.
    Hammarström, Anne
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Which theory is best? Explanatory models of the relationship between unemployment and health.2009In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 9, no 235Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: A number of different models have been used in order to explain the links between unemployment and ill-health. The objective of this study was to test different proposed models in an empirical setting. METHODS: A cohort of school-leavers consisting of more than 1000 persons was followed for 14 years up to the age of 30. They have repeatedly been asked questions that could be used to operationalise different proposed models as well as health outcomes. Seven different models explaining the health effect of unemployment were identified: an economic deprivation model, a lack of control model as well as a locus of control model, a stress model, a social support model, a work involvement model and a model of latent functions. Health outcomes used were somatic symptoms, depressive symptoms, self-perceived health and nervous problems. Statistical tests included bivariate correlations and logistic regression. RESULTS: Most of the models correlated fairly well with unemployment measures. The capacity of the models to explain the connection between unemployment and ill-health varied, however. The model of latent functions was most successful, followed by the economic deprivation model. The social support and the control models were also fairly good. The work involvement scale and the stress model demonstrated the smallest explanatory power. CONCLUSION: Studies comparing different explanatory models in the field are rare. Few models apply a multidisciplinary approach. In view of the findings, it should be possible to develop multidisciplinary and better models to explain the links between unemployment and health in more detail.

  • 44.
    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.

  • 45.
    Järvholm, Bengt
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Stattin, Mikael
    Umeå University, Faculty of Social Sciences, Department of Sociology.
    Robroek, Suzan JW
    Janlert, Urban
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Karlsson, Bernt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Burdorf, Alex
    Heavy work and disability pension: a long term follow-up of Swedish construction workers2014In: Scandinavian Journal of Work, Environment and Health, ISSN 0355-3140, E-ISSN 1795-990X, Vol. 40, no 4, p. 335-342Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: The objective of this study was to investigate the occurrence of disability pensions over time among workers with physically demanding jobs.

    METHODS: The occurrence of disability pension was prospectively studied between 1980-2008 among 325 549 Swedish construction workers. The risks for disability pension and years lost of working life were compared among 22 occupational groups, adjusting for age, body mass index, height, and smoking habits.

    RESULTS: The risk varied considerably among blue-collar workers. For example, rock workers had double the risk of disability pension [relative risk (RR) 2.16, 95% confidence interval (95% CI) 1.96-2.39] compared to electricians. Most working years lost due to disability pensions (about 75%) were found among men >50 years, mainly due to musculoskeletal and cardiovascular diseases. The years of working life lost due to disability pension varied from 0.7 (salaried employees) to 3.2 years (rock workers) among occupational groups.

    CONCLUSION: Work environment is an important predictor for disability pension among construction workers with those in physically heavy jobs having the highest burden of disability. If the purpose is to increase labor force participation for workers with heavy jobs, strategies to reduce physical demands at work among elderly workers are important.

  • 46.
    Nilsson, Maria
    et al.
    Epidemiologi och global hälsa.
    Stenlund, Hans
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences. Epidemiologi och folkhälsovetenskap.
    Bergström, Erik
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences. Epidemiologi och folkhälsovetenskap.
    Weinehall, Lars
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences. Epidemiologi och folkhälsovetenskap.
    Janlert, Urban
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences. Epidemiologi och folkhälsovetenskap.
    It takes two: reducing adolescent smoking uptake through sustainable adolescent-adult partnership2006In: Journal of Adolescent Health, ISSN 1054-139X, E-ISSN 1879-1972, Vol. 39, no 6, p. 880-886Article in journal (Refereed)
    Abstract [en]

    Purpose To assess the effects of a long-term intervention for tobacco use prevention that targets adolescents (Tobacco Free Duo).

    Methods School-based community intervention combined with repeated cross-sectional surveys over 7 years. The intervention was performed in the County of Västerbotten, Sweden, where survey data were collected in grade seven to nine schools on an annual basis for 7 years. Data for comparison were collected in grade nine on the national level in Sweden. In the intervention area, the annual number of seventh to ninth grade students participating in the study varied between 1300 and 1650. In the reference data, the number of participating ninth grade students approximated 4500 annually.

    Results A significant decrease of nearly 50% was seen in smoking prevalence in the intervention area. The decrease was evident in grades eight and nine (ages 14–15 years) in both boys and girls. At the start of the intervention, smoking prevalence in grade nine was 16.1% in the intervention area and 23% in the national reference group. Although the prevalence in the national sample remained stable, there was a decrease to 9.0% in the intervention area at the end of the study period.

    Conclusions These results suggest that the Tobacco Free Duo program contributed to a reduction in adolescent smoking among both boys and girls. Using a multi-faceted intervention that includes adolescent–adult partnership can reduce adolescent smoking uptake, and the intervention has been proven to be sustainable within communities.

  • 47.
    Nilsson, Maria
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.
    Stenlund, Hans
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.
    Bergström, Erik
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.
    Weinehall, Lars
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.
    Janlert, Urban
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.
    The Authors reply2007In: Journal of Adolescent Health, ISSN 1054-139X, Vol. 41, no 2, p. 214-215Article in journal (Other academic)
  • 48.
    Nilsson, Maria
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.
    Stenlund, Hans
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.
    Weinehall, Lars
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.
    Bergström, Erik
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences. Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Janlert, Urban
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.
    “I would do anything for my child, even quit tobacco”: bonus effects from an intervention that target adolescent tobacco use2009In: Scandinavian Journal of Psychology, ISSN 0036-5564, E-ISSN 1467-9450, Vol. 50, no 4, p. 341-345Article in journal (Refereed)
    Abstract [en]

    This paper aims to assess program bonus effects on adult tobacco use from a long term intervention that targeted adolescent tobacco use. The school-based community intervention started in Västerbotten County in Sweden in 1993 and adults were invited to support adolescents to stay tobacco-free. It was combined with repeated cross-sectional surveys in schools annually 1994-1999 among grades 7-9 and after 1999 every second year. Participating schools were randomly selected before the first survey representing both rural and urban settings. Out of 4,055 students, 1,008 (24.8%) reported that their supporting adult had been a tobacco user who quit tobacco in order to be allowed to participate. Out of these, 13.2% used tobacco daily before joining. The remaining 2,997 students’ adult partners were not tobacco users. Engaging tobacco using adults as partners in interventions targeting adolescent tobacco use seem to have a considerable tobacco-reducing bonus effect in the adults.

  • 49.
    Nilsson, Maria
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.
    Weinehall, Lars
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences. Research Department, National Institute of Public Health, Östersund, Sweden .
    Bergström, Erik
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Stenlund, Hans
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.
    Janlert, Urban
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.
    Adolescent´s perceptions and expectations of parental action on children´s smoking and snus use: national cross sectional data from three decades2009In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 9, no 74Article in journal (Refereed)
    Abstract [en]

    Background: Parents play a vital role as children develop tobacco behaviours. Many parents feel unsure about their possibility to influence their teenager's lifestyle. Knowledge about young people's acceptance for parental intervention could increase parental involvement. The overall objective of this study was to explore adolescents' perceptions and expectations of parental action regarding children's smoking and snus use, and whether they have changed over time. To see if there were differences whether the adolescent was a tobacco user or not the adolescents' tobacco use was followed; and described to put the findings on their perceptions and expectations of parental action in a context.

    Methods: The study used a repeated cross-sectional design, reporting Swedish national data from three decades. Data were collected in 1987, 1994 and 2003 by a questionnaire mailed to homes, in total to 13500 persons. The annual samples, which were random and national representative, consisted of 4500 young people aged 13, 15 and 17 yr, 1500 individuals per age group. The sampling and data collection procedures were done the same way during each survey. Chi2- tests were used to evaluate differences in distributions.

    Results: Adolescents in all age groups became more positive toward parental action over time. In 2003, more then 86% of the adolescents, including both smokers and non-smokers, strongly supported parental action on their children's smoking by trying to persuade them not to smoke (94%), by not smoking themselves (87%) and by not allowing their children to smoke at home (86%). Both non-smokers and smokers supported the idea of parental action in a similar way. Reduced pocket money had a weak support (42%), especially from girls. Eighty-nine percent of the adolescents expected their parents to act against smoking and 85% against snus use.

    Smoking was stable at 8% in 1987 and 1994 but decreased to 4% in 2003. In 1987 the snus use prevalence was 4% and in 2003 it was 3%. Snus users were mostly boys while few girls had done more than tried snus. More young people in all age groups had never tried smoking compared to the previous studies. In 2003 57% stated that they had never tried smoking.

    Conclusion: Adolescent smoking in Sweden has decreased and the proportion who never tried smoking has increased. The results of this study show that a growing majority of adolescents support strong parental intervention to help them refrain from tobacco, but preferably not in a punitive manner. This finding dismisses the notion that adolescents ignore or even disdain parental practices concerning tobacco. Prevention strategies and interventions addressing adolescent tobacco use that involve parents can be improved by using these findings to encourage parents to intervene against their children's tobacco use.

  • 50.
    Norlund, Sofia
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Reuterwall, Christina
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Höög, Jonas
    Umeå University, Faculty of Social Sciences, Department of Sociology.
    Janlert, Urban
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Slunga Järvholm, Lisbeth
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Work situation and self-perceived economic situation as predictors of change in burnout: a prospective population based cohort studyIn: Article in journal (Other academic)
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