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  • 1.
    Jonsson, Frida
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    The presence of the past: a life course approach to the social determinants of health and health inequalities in northern Sweden2018Doktoravhandling, med artikler (Annet vitenskapelig)
    Abstract [en]

    Background: Positioned at the intersection between the social and life course epidemiological sub-fields, this thesis builds on the idea that the health implications of life and living conditions can extend over years and decades before becoming expressed in the population patterns of ill-health. The overall purpose was to assess how multiple types of social determinants of health across the life course may contribute to ill-health and health inequalities in midlife. Several gaps in knowledge served as the basis for four research questions that focused on: 1) the intermediate role of socio-economic, material and psychosocial factors in young adulthood, in the long-term association between adolescent socio-economic position and midlife ill-health; 2) the implications of poor social capital in adolescence and accumulated over the life course for midlife ill-health; 3) the consequences of intra-generational social mobility for midlife ill-health and 4) the contribution of socio-economic, material and psychosocial circumstances in adolescence, young adulthood and middle-age to midlife neighbourhood deprivation inequalities in ill-health.

    Methods: The setting of the thesis is Sweden spanning over nearly three decades, from the early 1980s and until the mid-2010s. With information drawn from the Northern Swedish Cohort the study population consists of 1,083 pupils (506 girls and 577 boys) who attended, or should have attended, the last year of compulsory school in 1981. The data used came from questionnaires answered by the participants in the follow-ups at the ages of 16 (in 1981), 21 (in 1986), 30 (in 1995) and 42 (in 2007). The attrition rate was low with 1,010 out of the 1,071 students who were alive over the 26-years participated in all waves (94.3%). Data was also included from the Swedish registers for the same ages as the surveys on the participants’ neighbourhoods and sociodemographic characteristics on all other residents in these areas. The health outcome was functional somatic symptoms, referring to the occurrence of common physical complaints such as musculoskeletal pain, headache, palpitations and fatigue. To capture various social determinants of health, socio-economic, material and psychosocial factors were operationalised as main exposures. The research questions were analysed using: 1) path analysis, 2) multiple linear regression, 3) diagonal reference models and 4) a decomposition analysis.

    Results: With regard to the four research questions, the results firstly indicated that the long-term association between adolescent socio-economic position and midlife ill-health was linked by socio-economic position in young adulthood and further via material and psychosocial factors in middle-age. Secondly, that poor social capital in adolescence also could play a role in the development of adult illhealth, but that this influence seem to be largely dependent on recent or current conditions in adulthood. Thirdly, that downward mobility in the socio-economic hierarchy during middle-age may have little to no health implications, while upward movements could have a small positive effect on health. Fourthly, that ill-health was concentrated in more socio-economically deprived neighbourhoods and that this inequality was to a small extent attributed to conditions in earlier life period and mainly to factors in adulthood.

    Conclusions: Based on patterns cutting across the original research questions, the findings from this thesis indicate broadly that socio-economic, material and psychosocial conditions may be meaningful for midlife ill-health and health disparities, jointly and independently from each other. The results also suggests that determinants in the present on the surface appear to be more important for midlife ill-health and health inequalities than those of the past, but at the same time that life circumstances in the earlier life course may not be irrelevant. Rather than representing permanent or resilient health implications, however, the long-term influence of adolescent conditions seem to reflect mainly social processes that are conditional on recent or concurrent adult factors. In sum, the results indicate that a continuum of various life and living conditions may be a key phenomenon underlying ill-health and health disparities in midlife. Specifically, this thesis illustrates how the past may become part of the present through the accumulation and chains of unfavourable circumstances over the life course and conversely, how the present health reflects and embodies a life-long past.

  • 2.
    Jonsson, Frida
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Goicolea, Isabel
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    San Sebastian, Miguel
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Rural-urban differences in health among youth in northern Sweden: an outcome-wide epidemiological approach2019Inngår i: International Journal of Circumpolar Health, ISSN 1239-9736, E-ISSN 2242-3982, Vol. 78, artikkel-id 1640015Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The aim of this research was to contribute knowledge about rural-urban differences in health among young northern Swedish women and men. This study was based on the 2014 "Health on Equal Terms" survey, distributed in the four northernmost counties of Sweden, with complementary information on areas of residence classified as rural, semi-urban and urban from total population registers. The analytical sample included 2,691 individuals who were selected using a probabilistic sampling method. Prevalence ratios were calculated in multivariable log-binomial regression analyses to measure the association between place of residence and nine outcomes covering three health dimensions (general, mental and lifestyle behaviours). The results indicated that daily smoking and being overweight were more common, while feelings of stress and psychological distress were less prevalent, among youths in rural as compared to urban areas. After including covariates, this pattern appeared stronger for young women, although the direction of the results also applied to young men, albeit without revealing significant differences. In conclusion, the findings from this study indicate that for youths - particularly young women - the rural setting may imply an increased risk of poor general health and lifestyle behaviours, while simultaneously playing a partially protective role for mental health.

  • 3.
    Jonsson, Frida
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    Hammarström, Anne
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    Gustafsson, Per E.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    Social capital across the life course and functional somatic symptoms in mid-adulthood2014Inngår i: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 42, nr 7, s. 581-588Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Aim: To examine social capital across life and functional somatic symptoms in middle-age, according to life-course models of cumulative risk and sensitive periods.

    Methods: Data from the 26-year prospective study the Northern Swedish Cohort enabled complete case analyses on 940 individuals (451 women and 489 men) participating in questionnaire surveys at ages 16, 21, 30 and 42. Social capital was operationalized at the individual level, comprising items on social participation, social influence and social support. Functional somatic symptoms were a summary measure of self-reported physical symptoms, palpitation and sleeping difficulties occuring during the 12 months prior to the data collection. Linear regression was used as the main statistical method, examining the relationship between functional somatic symptoms at age 42 and social capital across life.

    Results: Lower levels of social capital accumulated over the life course were associated with higher levels of functional somatic symptoms at age 42, for both women and men. Social capital was, especially among adolescent men, related to functional somatic symptoms at age 42, independently of social capital later in life and baseline material circumstances.

    Conclusions: The health impact of poor social capital may be due to accumulation across the life course and to adolescence being a particularly sensitive period. It is relevant for preventive work to acknowledge effects of social capital throughout life.

  • 4.
    Jonsson, Frida
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    San Sebastian, Miguel
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Hammarström, Anne
    Gustafsson, Per E.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Are neighbourhood inequalities in adult health explained by socio-economic and psychosocial determinants in adolescence and the subsequent life course in northern Sweden?: A decomposition analysis2018Inngår i: Health and Place, ISSN 1353-8292, E-ISSN 1873-2054, Vol. 52, s. 127-134Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    This study explains neighbourhood deprivation inequalities in adult health for a northern Swedish cohort by examining the contribution of socio-economic and psychosocial determinants from adolescence (age 16), young adulthood (age 21) and midlife (age 42) to the disparity. Self-reported information from 873 participants was drawn from questionnaires, with complementary neighbourhood register data. The concentration index was used to estimate the inequality while decomposition analyses were run to attribute the disparity to its underlying determinants. The results suggest that socio-economic and psychosocial factors in midlife explain a substantial part, but also that the inequality can originate from conditions in adolescence and young adulthood.

  • 5.
    Jonsson, Frida
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    San Sebastian, Miguel
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Stromsten, Lotta M. J.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Hammarstrom, Anne
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Socialmedicin.
    Gustafsson, Per E
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Life Course Pathways of Adversities Linking Adolescent Socioeconomic Circumstances and Functional Somatic Symptoms in Mid-Adulthood: A Path Analysis Study2016Inngår i: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 11, nr 5, artikkel-id e0155963Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    While research examining the health impact of early socioeconomic conditions suggests that effects may exist independently of or jointly with adult socioeconomic position, studies exploring other potential pathways are few. Following a chain of risk life course model, this prospective study seeks to examine whether pathways of occupational class as well as material and social adversities across the life course link socioeconomic disadvantage in adolescent to functional somatic symptoms in mid-adulthood. Applying path analysis, a multiple mediator model was assessed using prospective data collected during 26 years through the Northern Swedish Cohort. The sample contained 987 individuals residing in the municipality of Lulea, Sweden, who participated in questionnaire surveys at age 16, 21, 30 and 42. Socioeconomic conditions (high/low) in adolescence (age 16) were operationalized using the occupation of the parents, while occupational class in adulthood (manual/nonmanual) was measured using the participant's own occupation at age 21 and 30. The adversity measurements were constructed as separate age specific parcels at age 21 and 30. Social adversity included items pertaining to stressful life events that could potentially harm salient relationships, while material adversity was operationalized using items concerning unfavorable financial and material circumstances. Functional somatic symptoms at age 42 was a summary measure of self-reported physical symptoms, palpitation and sleeping difficulties that had occurred during the last 12 months. An association between socioeconomic conditions at age 16 and functional somatic symptoms at age 42 (r = 0.068) which was partially explained by people's own occupational class at age 21 and then material as well as social adversity at age 30 was revealed. Rather than proposing a direct and independent health effect of the socioeconomic conditions of the family, the present study suggests that growing up in an unfavorable socioeconomic environment might be a source for a chain of adverse material and social living situations, which in turn affects adult health.

  • 6.
    Jonsson, Frida
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Sebastian, Miguel San
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Hammarström, Anne
    Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Gustafsson, Per E.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Intragenerational social mobility and functional somatic symptoms in a northern Swedish context: analyses of diagonal reference models2017Inngår i: International Journal for Equity in Health, ISSN 1475-9276, E-ISSN 1475-9276, Vol. 16, artikkel-id 1Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: Research indicate that social class mobility could be potentially important for health, but whether this is due to the movement itself or a result of people having been integrated in different class contexts is, to date, difficult to infer. In addition, although several theories suggest that transitions between classes in the social hierarchy can be stressful experiences, few studies have empirically examined whether such movements may have health effects, over and above the implications of "being" in these classes. In an attempt to investigate whether intragenerational social mobility is associated with functional somatic symptoms in mid-adulthood, the current study tests three partially contrasting theories.

    METHOD: The dissociative theory suggests that mobility in general and upward mobility in particular may be linked to psychological distress, while the falling from grace theory indicates that downward mobility is especially stressful. In contrast, the acculturation theory holds that the health implications of social mobility is not due to the movement itself but attributed to the class contexts in which people find themselves. Diagonal Reference Models were used on a sample of 924 individuals who in 1981 graduated from 9(th) grade in the municipality of Luleå, Sweden. Social mobility was operationalized as change in occupational class between age 30 and 42 (measured in 1995 and 2007). The health outcome was functional somatic symptoms at age 42, defined as a clustering self-reported physical symptoms, palpitation and sleeping difficulties during the last 12 months.

    RESULTS: Overall mobility was not associated with higher levels of functional somatic symptoms compared to being immobile (p = 0.653). After controlling for prior and current class, sex, parental social position, general health, civil status, education and unemployment, the association between downward mobility was borderline significant (p = 0.055) while upward mobility was associated with lower levels of functional somatic symptoms (p = 0.03).

    CONCLUSION: The current study did not find unanimous support for any of the theories. Nevertheless, it sheds light on the possibility that upward mobility may be beneficial to reduce stress-related health problems in mid-life over and above the exposure to prior and current class, while downward mobility can be of less importance for middle-age health complaints.

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