umu.sePublications
Change search
Refine search result
1234 101 - 150 of 162
CiteExportLink to result list
Permanent link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf
Rows per page
  • 5
  • 10
  • 20
  • 50
  • 100
  • 250
Sort
  • Standard (Relevance)
  • Author A-Ö
  • Author Ö-A
  • Title A-Ö
  • Title Ö-A
  • Publication type A-Ö
  • Publication type Ö-A
  • Issued (Oldest first)
  • Issued (Newest first)
  • Created (Oldest first)
  • Created (Newest first)
  • Last updated (Oldest first)
  • Last updated (Newest first)
  • Disputation date (earliest first)
  • Disputation date (latest first)
  • Standard (Relevance)
  • Author A-Ö
  • Author Ö-A
  • Title A-Ö
  • Title Ö-A
  • Publication type A-Ö
  • Publication type Ö-A
  • Issued (Oldest first)
  • Issued (Newest first)
  • Created (Oldest first)
  • Created (Newest first)
  • Last updated (Oldest first)
  • Last updated (Newest first)
  • Disputation date (earliest first)
  • Disputation date (latest first)
Select
The maximal number of hits you can export is 250. When you want to export more records please use the Create feeds function.
  • 101.
    Lehti, Arja
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Professionell Development.
    Fjellman-Wiklund, Anncristine
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Stålnacke, Britt-Marie
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine.
    Hammarström, Anne
    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 Global Health.
    Wiklund, Maria
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Social medicine. Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Walking down 'Via Dolorosa' from primary health care to the specialty pain clinic: patient and professional perceptions of inequity in rehabilitation of chronic pain2017In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 31, no 1, p. 45-53Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To analyse patient and professional perceptions about (in)equity of care and rehabilitation of chronic pain patients from primary health care to assessment at a specialty rehabilitation clinic.

    SETTING AND METHODS: This qualitative study consists one focus group interview with eight general practitioners who refer patients to pain rehabilitation clinics, 10 individual interviews with patients who were assessed at a pain rehabilitation clinic and seven interviews with professionals participating in multimodal assessment teams at a pain rehabilitation clinic. Interview analysis was conducted by the grounded theory method.

    RESULTS: The core category Via Dolorosa, the way of suffering and pain, captured how gender and sociocultural context may contribute to advantages and disadvantages during patient journeys from primary health care to a pain rehabilitation clinic. Patients and professionals perceived pain as a low-ranking illness, and women and men used different gendered strategies to legitimise the pain and to be taken seriously. Being 'a proper patient ready to change' and having 'likeness' between patients and professionals were viewed as advantageous in rehabilitation of pain patients. Patients with higher educational levels were perceived as easier to interact with and had better access to health care. Professional thoughts about gender norms influenced the rehabilitation options. The rehabilitation programme was seen by several professionals to be better suited for women than men, which could lead to unequal care.

    CONCLUSION: From an equity and gender perspective, our study highlights the complexity in rehabilitation of chronic pain patients - both from patient and professional perspectives. Awareness of gendered and the biased preconceptions and norms is crucial when professionals struggle to offer equitable health care and rehabilitation.

  • 102.
    Lehti, Arja
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Hammarström, Anne
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Mattsson, Bengt
    Göteborgs universitet.
    Recognition of depression in people of different cultures: a qualitative study2009In: BMC Family Practice, ISSN 1471-2296, E-ISSN 1471-2296, Vol. 10, p. 53-Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Many minority group patients who attend primary health care are depressed. To identify a depressive state when GPs see patients from other cultures than their own can be difficult because of cultural and gender differences in expressions and problems of communication. The aim of this study was to explore and analyse how GPs think and deliberate when seeing and treating patients from foreign countries who display potential depressive features.

    METHODS: The data were collected in focus groups and through individual interviews with GPs in northern Sweden and analysed by qualitative content analysis.

    RESULTS: In the analysis three themes, based on various categories, emerged; "Realizing the background", "Struggling for clarity" and "Optimizing management". Patients' early life events of importance were often unknown which blurred the accuracy. Reactions to trauma, cultural frictions and conflicts between the new and old gender norms made the diagnostic process difficult. The patient-doctor encounter comprised misconceptions, and social roles in the meetings were sometimes confused. GPs based their judgement mainly on clinical intuition and the established classification of depressive disorders was discussed. Tools for management and adequate action were diffuse.

    CONCLUSION: Dialogue about patients' illness narratives and social context are crucial. There is a need for tools for multicultural, general practice care in the depressive spectrum. It is also essential to be aware of GPs' own conceptions in order to avoid stereotypes and not to under- or overestimate the occurrence of depressive symptoms.

  • 103.
    Lehti, Arja
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Johansson, Eva E
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Bengs, Carita
    Umeå University, Faculty of Social Sciences, Department of Sociology.
    Danielsson, Ulla
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Hammarström, Anne
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    "The Western gaze": An analysis of medical research publications concerning the expressions of depression, focusing on ethnicity and gender2010In: Health Care for Women International, ISSN 0739-9332, E-ISSN 1096-4665, Vol. 31, no 2, p. 100-112Article in journal (Refereed)
    Abstract [en]

    Our aim of this study was to explore how authors of medical articles wrote about different symptoms and expressions of depression in men and women from various ethnic groups as well as to analyze the meaning of gender and ethnicity for expressions of depression. A database search was carried out using PubMed. Thirty articles were identified and analyzed using qualitative content analysis. Approaches differ with regard to how depression is described and interpreted in different cultures in relation to illness complaints, illness meaning, and diagnosis of depression. Articles often present issues based on a Western point of view. This may lead to “cultural or gender gaps,” which we refer to as “the Western gaze,” which may in turn influence the diagnosis of depression.

  • 104.
    Linander, Ida
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Umeå University, Faculty of Social Sciences, Umeå Centre for Gender Studies (UCGS).
    Alm, Erika
    Hammarström, Anne
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Harryson, Lisa
    Umeå University, Faculty of Social Sciences, Department of Sociology.
    Negotiating the (bio)medical gaze: Experiences of trans-specific healthcare in Sweden2017In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 174, p. 9-16Article in journal (Refereed)
    Abstract [en]

    In Sweden as well as in other western countries persons with trans experiences have to go through a clinical evaluation in order to get access to gender-confirming medical procedures. The aim of this study is to analyse care-users' experiences of navigating and negotiating access to gender-confirming medical procedures in Sweden. Biomedicalisation is used as a theoretical framework in order to analyse how technoscientific and neoliberal developments are parts of constructing specific experiences within trans-specific care. Constructivist grounded theory was used to analyse 14 interviews with persons having experiences of, or considering seeking, trans-specific healthcare. The participants experienced trans-specific healthcare as difficult to navigate because of waiting times, lack of support, provider ignorance and relationships of dependency between healthcare-users and providers. These barriers pushed the users to take responsibility for the care process themselves, through ordering hormones from abroad, acquiring medical knowledge and finding alternative support. Based on the participants' experiences, it can be argued that the shift of responsibility from care-providers to users is connected to a lack of resources within trans-specific care, to neoliberal developments within the Swedish healthcare system, but also to discourses that frame taking charge of the care process as an indicator that a person is in need of or ready for care. Thus, access to gender-confirming medical procedures is stratified, based on the ability and opportunity to adopt a charge-taking role and on economic and geographic conditions. Based on the results and discussion, we conclude that trans-specific care ought to focus on supporting the care-seekers throughout the medical process, instead of the current focus on verifying the need for care. There is also a need for increased knowledge and financial resources. A separation between legal and medical gender reassignment could contribute to a better relationship between care-providers and care-users and increase the quality of care.

  • 105.
    Linander, Ida
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Umeå University, Faculty of Social Sciences, Umeå Centre for Gender Studies (UCGS).
    Goicolea, Isabel
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Alm, Erika
    Hammarström, Anne
    Harryson, Lisa
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    (Un)safe spaces, affective labour and perceived health among people with trans experiences living in Sweden2019In: Culture, Health and Sexuality, ISSN 1369-1058, E-ISSN 1464-5351, Vol. 21, no 8, p. 914-928Article in journal (Refereed)
    Abstract [en]

    Lack of safe space has been connected to ill health among people with trans experiences. This study analyses trans people’s experiences of being in public, semi-public and community spaces using the analytical concept of safety/unsafety in relation to perceived health. The analytic framework draws on the concepts of cisgenderism, orientation, lines and comfort. The material analysed consisted of 18 individual interviews with people with trans experiences, which were analysed using constructivist thematic analysis. The analysis resulted in the identification of three themes: straightening devices creating limited living space, orienting oneself in (cis)gendered spaces and creating safer (?) community spaces for healing. Experiences of unsafety ranged from incidents and fear of different kinds of violence in public and semi-public spaces to the lack of a transpolitically informed agenda in, for example, feminist spaces. Safer spaces helped participants to feel a sense of belonging, to share their experiences and to heal. Experiences of unsafety and discomfort are important as they will help us to understand the health situations of people with trans experiences. It is important to facilitate the creation of safer spaces to improve the health of members of this group.

  • 106.
    Linander, Ida
    et al.
    Umeå University, Faculty of Social Sciences, Umeå Centre for Gender Studies (UCGS). Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Socialmedicin.
    Hammarström, Anne
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Johansson, Klara
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Which socio-economic measures are associated with psychological distress for men and women?: A cohort analysis2015In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 25, no 2, p. 231-236Article in journal (Refereed)
    Abstract [en]

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

  • 107.
    Löfmark, Ulrika
    et al.
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Family Medicine. Allmänmedicin.
    Hammarström, Anne
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Family Medicine. Allmänmedicin.
    Evidence for age-dependent education-related differences in men and women with first-ever stroke: Results from a community-based incidence study in northern Sweden.2007In: Neuroepidemiology, ISSN 0251-5350, E-ISSN 1423-0208, Vol. 28, no 3, p. 135-141Article in journal (Refereed)
  • 108.
    Löfmark, Ulrika
    et al.
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Family Medicine.
    Hammarström, Anne
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Family Medicine.
    [Gender perspective can result in better research on sex differences and revascularization]2001In: Lakartidningen, ISSN 0023-7205, Vol. 98, no 30-31, p. 3306-12Article in journal (Other academic)
  • 109.
    Löfmark, Ulrika
    et al.
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Family Medicine.
    Hammarström, Anne
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Family Medicine.
    Increased risk for stroke in low-educated elderly women - results from a community-based incidence study in northern Sweden.2007In: Neuroepidemiology, ISSN 0251-5350, E-ISSN 1423-0208, Vol. 28, no 3, p. 135-141Article in journal (Refereed)
  • 110.
    Löfmark, Ulrika
    et al.
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Family Medicine.
    Hammarström, Anne
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Family Medicine.
    Kartläggning av nationell folkhälsovetenskaplig genusforskning och genusundervisning.2004Report (Other (popular science, discussion, etc.))
  • 111.
    Löfmark, Ulrika
    et al.
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Family Medicine.
    Hammarström, Anne
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Family Medicine.
    Mapping of gender research and gender teaching in Swedish public health researchReport (Other (popular science, discussion, etc.))
  • 112.
    Löfmark, Ulrika
    et al.
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Family Medicine. Allmänmedicin.
    Hammarström, Anne
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Family Medicine. Allmänmedicin.
    Older stroke patients' negotiations within the hierarchic medical context.2005In: Qualitative Health Research, ISSN 1049-7323, E-ISSN 1552-7557, Vol. 15, no 6, p. 778-790Article in journal (Refereed)
  • 113. Mittendorfer-Rutz, Ellenor
    et al.
    Hensing, Gunnel
    Westerlund, Hugo
    Backheden, Magnus
    Hammarström, Anne
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Determinants in adolescence for adult sickness absence in women and men: a 26-year follow-up of a prospective population based cohort (Northern Swedish cohort)2013In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 13, p. 75-Article in journal (Refereed)
    Abstract [en]

    Background: To date little is known regarding how factors measured in adolescence predict sickness absence in adulthood, and whether different patterns of factors exist for women and men that could contribute to an explanation of adult gender differences in sickness absence. Methods: All pupils in the last year of compulsory school in the municipality of Lulea with complete information from surveys (questionnaires) in 1981 and 1983 (compulsory and upper-secondary schooling; 16 and 18 years of age, N=719) were followed with register data on medically certified sickness absence (1993-2007). Generalised linear models were applied to calculate Risk Ratios with 95% Confidence Intervals (CI) comparing annual mean numbers of sickness absence spells in exposed versus unexposed groups. Results: In the multivariate model, the following factors were found to be predictive of future sickness absence in women: participating in an upper secondary school program in 1983 dominated by women (> 60%): 1.41 (95% CI 1.00 - 1.97); sometimes sickness absence from school in 1981: 1.60 (95% CI 1.18 - 2.17) and low parental socioeconomic status in 1981: 2.20 (95% CI 1.44 - 3.38). In men, low school grades in 1981: 4.36 (95% CI 2.06 - 9.22) and fathers not in gainful employment in 1981: 2.36 (95% CI 1.53 - 3.66) were predictive. Conclusion: The findings suggest that sickness absence in adulthood is predicted by factors measured in adolescence. These predictors may differ for women and men. For women, early life absence and social environmental factors, for men low achievements at school and lack of employment of their father seem to be predictive.

  • 114.
    Månsdotter, Anna
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Nordenmark, Mikael
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Hammarström, Anne
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    The importance of childhood and adulthood aspects of gendered life for adult mental ill-health symptoms: a 27-year follow-up of the Northern Swedish Cohort2012In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 12, p. 493-Article in journal (Refereed)
    Abstract [en]

    Background: The increasing gender equality during the 20th century, mainly in the Nordic countries, represents a major social change. A well-established theory is that this may affect the mental health patterns of women and men. This study aimed at examining associations between childhood and adulthood gendered life on mental ill-health symptoms.

    Methods: A follow-up study of a cohort of all school leavers in a medium-sized industrial town in northern Sweden was performed from age 16 to age 42. Of those still alive of the original cohort, 94% (n = 1007) participated during the whole period. Gendered life was divided into three stages according to whether they were traditional or non-traditional (the latter includes equal): childhood (mother's paid work position), adulthood at age 30 (ideology and childcare), and adulthood at age 42 (partnership and childcare). Mental ill-health was measured by self-reported anxious symptoms ("frequent nervousness") and depressive symptoms ("frequent sadness") at age 42. The statistical method was logistic regression analysis, finally adjusted for earlier mental ill-health symptoms and social confounding factors.

    Results: Generally, parents' gendered life was not decisive for a person's own gendered life, and adulthood gender position ruled out the impact of childhood gender experience on self-reported mental ill-health. For women, non-traditional gender ideology at age 30 was associated with decreased risk of anxious symptoms (76% for traditional childhood, 78% for non-traditional childhood). For men, non-traditional childcare at age 42 was associated with decreased risk of depressive symptoms (84% for traditional childhood, 78% for non-traditional childhood). A contradictory indication was that non-traditional women in childcare at age 30 had a threefold increased risk of anxious symptoms at age 42, but only when having experienced a traditional childhood.

    Conclusion: Adulthood gender equality is generally good for self-reported mental health regardless of whether one opposes or continues one's gendered history. However, the childcare findings indicate a differentiated picture; men seem to benefit in depressive symptoms from embracing this traditionally female duty, while women suffer anxious symptoms from departing from it, if their mother did not.

  • 115.
    Nilsson, Karina
    et al.
    Umeå University, Faculty of Social Sciences, Department of Sociology.
    Hammarström, Anne
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Social medicine.
    Strandh, Mattias
    Umeå University, Faculty of Social Sciences, Department of Social Work. Centre for Research on Child and Adolescent Mental Health, Karlstad University, Sweden.
    The relationship between work and family preferences and behaviors: a longitudinal study of gender differences in Sweden2017In: Acta Sociologica, ISSN 0001-6993, E-ISSN 1502-3869, Vol. 60, no 2, p. 120-133Article in journal (Refereed)
    Abstract [en]

    Proposed theories to explain gender inequality in the labor market and family, such as gender specialization within families and gender segregation in the labor markets, lack consideration for individual preferences. Preference theory accounts for individual choice and gendered preferences but has been substantially criticized, indicating a need for further research. This study uses Swedish longitudinal data to explore how preferences for work and family relate to behavior. We explore three critical issues raised in previous research: gender differences in preferences; the relationship between work and family changes and subsequent preferences; how preferences relate to work and family behaviors. Our results showed small general gender differences in preferences, although women had a stronger preference for both children and work than men. Changes in work status were further related to changes in work preferences, while changes in family status were related to changes in family preferences. Moreover, preferences had poor predictive power in relation to work and family behaviors. Our results indicate that preferences do not explain gender inequality in Sweden. The relationship between preferences and behaviors seems bidirectional and preferences and behavior within the family sphere has little to do with preferences and behavior within the work sphere.

  • 116.
    Norström, Fredrik
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Virtanen, Pekka
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Hammarström, Anne
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Social medicine.
    Gustafsson, Per E.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Social medicine.
    Janlert, Urban
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    How does unemployment affect self-assessed health?: A systematic review focusing on subgroup effects2014In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 14, no 1, article id 1310Article, review/survey (Refereed)
    Abstract [en]

    BACKGROUND: Almost all studies on the effect on health from unemployment have concluded that unemployment is bad for your health. However, only a few review articles have dealt with this relation in recent years, and none of them have focused on the analysis of subgroups such as age, gender, and marital status. The objective of our article is to review how unemployment relates to self-assessed health with a focus on its effect on subgroups.

    METHODS: A search was performed in Web of Science to find articles that measured the effect on health from unemployment. The selection of articles was limited to those written in English, consisting of original data, and published in 2003 or later. Our definition of health was restricted to self-assessed health. Mortality- and morbidity-related measurements were therefore not included in our analysis. For the 41 articles included, information about health measurements, employment status definitions, other factors included in the statistical analysis, study design (including study population), and statistical method were collected with the aim of analysing the results on both the population and factor level.

    RESULTS: Most of the studies in our review showed a negative effect on health from unemployment on a population basis. Results at the factor levels were most common for gender (25 articles), age (11 articles), geographic location (8 articles), and education level (5 articles). The analysis showed that there was a health effect for gender, age, education level, household income, and geographic location. However, this effect differed between studies and no clear pattern on who benefits or suffers more among these groups could be determined. The result instead seemed to depend on the study context. The only clear patterns of association found were for socioeconomic status (manual workers suffer more), reason for unemployment (being unemployed due to health reasons is worse), and social network (a strong network is beneficial).

    CONCLUSIONS: Unemployment affects groups of individuals differently. We believe that a greater effort should be spent on specific groups of individuals, such as men or women, instead of the population as a whole when analysing the effect of unemployment on health.

  • 117.
    Novak, Masuma
    et al.
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Family Medicine.
    Ahlgren, Christina
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine.
    Hammarström, Anne
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Family Medicine.
    A gender and social class inequity in obesity. the role of behavioural, social and psychosocial factors from adolescence until early adulthood: a propective cohort study.2006In: International Journal of Obesity, Vol. 30, p. 191-200Article in journal (Other academic)
  • 118.
    Novak, Masuma
    et al.
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Family Medicine. Umeå University, Faculty of Medicine, Public Health and Clinical Medicine.
    Ahlgren, Christina
    Umeå University, Faculty of Medicine, Community Medicine and Rehabilitation. Umeå University, Faculty of Medicine, Community Medicine and Rehabilitation, Physiotherapy.
    Hammarström, Anne
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Family Medicine. Umeå University, Faculty of Medicine, Public Health and Clinical Medicine.
    A life-course approach in explaining social inequity in obesity among young adult men and women.2006In: International Journal of Obesity, ISSN 0307-0565, E-ISSN 1476-5497, Vol. 30, no 1, p. 191-200Article in journal (Refereed)
    Abstract [en]

    Objective: To examine the cumulative influence of adverse behavioural, social, and psychosocial circumstances from adolescence to young adulthood in explaining social differences in overweight and obesity at age 30 years and if explanations differ by gender.

    Design: A 14-year longitudinal study with 96.4% response rate.

    Subject: Data from 547 men and 497 women from a town in north Sweden who were baseline examined at age 16 years and prospectively followed up to age 30 years.

    Measurements: Overweight and obesity were ascertained at ages 16 and 30 years. Occupation and education were used to measure socioeconomic status. The explanatory measurements were: age at menarche, smoking, physical activity, alcohol consumption, TV viewing, home and school environment, social support, social network, and work environment.

    Results: No gender or social difference in overweight was observed at age 16 years. At age 30 years, significantly more men than women (odds ratio (OR)¼2.81, 95% confidence interval (CI) 2.14–3.68) were overweight or obese. Educational level was associated with overweight at age 30 years, but not occupational class. Both men (OR¼1.55, 95% CI 1.10–2.19) and women (OR¼1.78, 95% CI 1.16–2.73) with low education (p11 years) were at risk of overweight. The factors that explained the educational gradient in overweight among men were low parental support in education during adolescence, and physical inactivity, alcohol consumption, and nonparticipation in any association during young adulthood. The educational gradient in overweight in women was explained mostly by adolescence factors, which include early age at menarche, physical inactivity, parental divorce, not being popular in school, and low school control. Restricted financial resource during young adulthood was an additional explanatory factor for women. All these factors were significantly more common among men and women with low education than with high education.

    Conclusion: Social inequities in overweight reflect the cumulative influence of multiple adverse circumstances experienced from adolescence to young adulthood. Underlying pathways to social inequity in overweight differ between men and women. Policy implications to reduce social inequity in overweight include reduction of social differences in health behaviours and social circumstances that take place at different life stages, particularly psychosocial circumstances during adolescence.

  • 119.
    Novak, Masuma
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Ahlgren, Christina
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Hammarström, Anne
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Inequalities in smoking: influence of social chain of risks from adolescence to young adulthood: a prospective population-based cohort study.2007In: International Journal of Behavioral Medicine, ISSN 1070-5503, E-ISSN 1532-7558, Vol. 14, no 3, p. 181-7Article in journal (Refereed)
  • 120.
    Novak, Masuma
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Ahlgren, Christina
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    Hammarström, Anne
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Social and health-related correlates of intergenerational and intragenerational social mobility among Swedish men and women2012In: Public Health, ISSN 0033-3506, E-ISSN 1476-5616, Vol. 126, no 4, p. 349-357Article in journal (Refereed)
    Abstract [en]

    Background: The present study explored the pattern and the determinants of social mobility among men and women both at inter and intragenerational transitional periods. Specifically the study addressed what impact do the various health related measures, health-behaviours, psychosocial environments at home and school, material resources, and ethnicity have on the chances and the direction of social mobility.

    Methods: A Swedish 14-year prospective longitudinal study with 96.5% response rate. Detail information on 546 men and 495 women regarding their occupation, health status, health-related behaviour, psychosocial environment at home and school, material recourses and ethnicity prior to mobility were available from ages 16, 21 and 30. Odds Ratios and 99% confidence interval were calculated using logistic regression to determine social mobility.

    Results: At the inter-generational analyses, being liked in school (liked by the teachers and students) predicted upward mobility in men and women. Additionally, being taller predicted upward mobility in women. Downward mobility was predicted by being less liked in school and smoking for both men and women. Additionally, having an unemployed family member for men and not having an own room for women predicted downward mobility. At the intra-generational analyses, less alcohol consumption for men and better financial resources for women predicted upward mobility. Downward mobility among men was predicted by smoking and having restricted financial resources. The chances and the directions of mobility were not influenced by ethnic background.

    Conclusions: Except height among women, health status was not associated with mobility in this cohort for men or for women neither internor intra-generationally, however material deprivation, economical deprivation, poor health behaviours, and unfavourable school environment were.

  • 121.
    Nygren, Karina
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Socialmedicin.
    Gong, Weidan
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Hammarström, Anne
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Socialmedicin.
    Is hypertension in adult age related to unemployment at a young age?: Results from the Northern Swedish Cohort2015In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 43, no 1, p. 52-58Article in journal (Refereed)
    Abstract [en]

    Aim: The aim of this study was to analyse the relationship between early unemployment (ages 16-21 years) and adult hypertension after controlling for earlier hypertension, unemployment in adult life, risk factors for hypertension and confounders. Methods: A cohort of 927 (86.6% of the original cohort) 9th grade school-leavers was followed from 1981 until 2008. Data were collected through questionnaires, health examinations, and national registers. Univariate and multivariate logistic regression were used as primary statistical methods. Results: At ages 21 and 43, hypertension was significantly more prevalent among men than women (p < .001). Unemployment between the ages of 16 and 21 was related to hypertension at age 43 among women but not men. The odds ratio (OR) was persistently high (OR 3.16 [95% confidence interval 1.45-6.89]) after controlling for late unemployment, hypertension at age 16, risk factors for hypertension and confounders. There was no significant relationship between exposure to early unemployment and hypertension at age 21 for women or men. Conclusions: From a public health perspective, youth unemployment is a societal problem in need of more attention and intervention in order to prevent long-term adverse health outcomes.

  • 122. Peter, Richard
    et al.
    Hammarström, Anne
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Family Medicine.
    Hallqvist, Johan
    Siegrist, Johannes
    Theorell, Töres
    Does occupational gender segregation influence the association of effort-reward imbalance with myocardial infarction in the SHEEP study?2006In: Int J Behav Med, ISSN 1070-5503, Vol. 13, no 1, p. 34-43Article in journal (Refereed)
  • 123. Phillips, Susan P.
    et al.
    Hammarstrom, Anne
    Umeå University, Faculty of Social Sciences, Umeå Centre for Gender Studies (UCGS). Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Relative Health Effects of Education, Socioeconomic Status and Domestic Gender Inequity in Sweden: A Cohort Study2011In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 6, no 6, article id e21722Article in journal (Refereed)
    Abstract [en]

    Introduction: Limited existing research on gender inequities suggests that for men workplace atmosphere shapes wellbeing while women are less susceptible to socioeconomic or work status but vulnerable to home inequities. Methods: Using the 2007 Northern Swedish Cohort (n = 773) we identified relative contributions of perceived gender inequities in relationships, financial strain, and education to self-reported health to determine whether controlling for sex, examining interactions between sex and other social variables, or sex-disaggregating data yielded most information about sex differences. Results and Discussion: Men had lower education but also less financial strain, and experienced less gender inequity. Overall, low education and financial strain detracted from health. However, sex-disaggregated data showed this to be true for women, whereas for men only gender inequity at home affected health. In the relatively egalitarian Swedish environment where women more readily enter all work arenas and men often provide parenting, traditional primacy of the home environment (for women) and the work environment (for men) in shaping health is reversing such that perceived domestic gender inequity has a significant health impact on men, while for women only education and financial strain are contributory. These outcomes were identified only when data were sex-disaggregated.

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

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

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

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

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

  • 125.
    Reine, Ieva
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Novo, Mehmed
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine.
    Hammarström, Anna
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Unemployment and ill health - a gender analysis: results from a 14-year follow-up of the Northern Swedish cohort2013In: Public Health, ISSN 0033-3506, E-ISSN 1476-5616, Vol. 127, no 3, p. 214-222Article in journal (Refereed)
    Abstract [en]

    Objectives. To investigate the experience of suicidal expressions (death wishes, life weariness, ideation, plans and attempts) in young Swedish Sami, their attitudes toward suicide (ATTS), and experience of suicidal expressions and completed suicide in significant others and to compare with Swedes in general. Methods. A cross-sectional study comprising 516 Swedish Sami, 18-28 years of age together with an age and geographically matched reference group (n = 218). Parts of the ATTS questionnaire have been used to cover different aspects of the suicidal complex. Data were analysed with regard to gender, occupation, counties and experience of negative societal treatment due to Sami background. Results. Both young Sami and young Swedes reported suicidal ideation, life weariness, and death wishes in a high degree (30-50%), but it was more common among the Sami. Having had plans to commit suicide showed a significant gender difference only in the Sami. The prevalence of suicide attempts did not differ significantly between Sami and Swedes. Subgroups of the Sami reported a higher degree of suicidal behaviour, Sami women and reindeer herders reported a 3, 5-fold higher odds of suicide attempts and a 2-fold higher odds having had plans committing suicide. Sami living in Vasterbotten/Jamtland/Vasternorrland and Sami with experience of ethnicity related bad treatment 2-fold higher odds of suicidal plans compared to those living in other counties. Conclusion. An increased occurrence of suicidal ideation/death wishes/life weariness in young Sami compared to young majority Swedes was found, but not an increased prevalence of suicide attempts and positive attitudes together with an increased awareness to handle suicide problems could be a contributing factor. Severe circumstances and experience of ethnicity-related bad treatment seems to contribute to increased levels of suicidal plans and attempts in subgroups of Sami.

  • 126.
    Reine, Ieva
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Novo, Mehmed
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine.
    Hammarström, Anne
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Is participation in labour market programmes related to mental health?: results from a 14-year follow-up of the Northern Swedish cohort2011In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 39, no 1, p. 26-34Article in journal (Refereed)
    Abstract [en]

    Aims: There is a lack of empirical studies assessing the possible impact of active labour market programmes (ALMP) on health. The aim of this study was to analyze whether participation in ALMP, in contrast to being unemployed and not participating in ALMP (UNALMP), was related to mental health at different ages.

    Methods: The study was carried out in a medium-sized industrial town in the north of Sweden. The cohort, consisting of all 1,083 pupils who attended or should have attended the last year of compulsory school in 1981, was followed up at the ages of 16, 18, 21 and 30. Data on 381 individuals at age 21, and 281 at age 30 were used in the study. The main health measurement was psychological symptoms among participants of ALMP in contrast to UNALMP at ages 21 and 30, and was analyzed by propensity score matching method (PSM) and multivariate logistic regression.

    Results: Generally, ALMP had higher scores of psychological symptoms than UNALMP. Nevertheless, participation in ALMP was not related to mental health. Due to methodological shortages our results have to be interpreted with caution. Adjustment for either all background selection variables or the propensity score in multivariate logistic regression showed similar associations, suggesting that propensity score could be used to adjust for background selection variables.

    Conclusions: There is a need for more well-designed studies, using a theoretical framework, within the field, that are based on larger samples.

  • 127. Samuelsson, Åsa
    et al.
    Houkes, Inge
    Verdonk, Petra
    Hammarström, Anne
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Types of employment and their associations with work characteristics and health in Swedish women and men2012In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 40, no 2, p. 183-190Article in journal (Refereed)
    Abstract [en]

    Aim: To investigate whether type of employment was related to work characteristics and health status at age 42 adjusted for health status at age 30 and whether gender moderates the associations.

    Methods: Questionnaire data was used from a 27-year follow-up study of school-leavers carried out in Lulea in the north of Sweden (response rate 94%). The study population consisted of 877 (47.8% women) working respondents. Data were analysed by means of t-tests, ANOVAs, and multiple linear regression analyses.

    Results: Men were more often self-employed, while more women had temporary types of employment. Moreover, men reported more control over work and less emotional exhaustion than women. Compared to permanently employed, self-employed (men and women) perceived more control over work and better health status (p<0.01). Self-employed men also reported more demands and social support (p<0.05). People in temporary types of employment, however, reported less job control, as well as lower health status (only men) (p<0.01). Poor self-reported health and emotional exhaustion were significantly (p<0.05) associated with poor work characteristics (more demands, lower job control, and lower support).

    Conclusions: No direct associations between type of employment and health were found for women and men. However we find indications of an influence of type of employment on work and thereupon health, with job control playing an important role.

  • 128.
    San Sebastian, Miguel
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Hammarström, Anne
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Gustafsson, Per E.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Socioeconomic inequalities in functional somatic symptoms by social and material conditions at four life course periods in Sweden: a decomposition analysis2015In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 5, no 8, p. 1-10, article id e006581Article in journal (Refereed)
    Abstract [en]

    Objective: Socioeconomic inequalities in health are deemed a worldwide public health problem, but current research is lacking on key points including determinants of socioeconomic differences in health, and not the least variations of these determinants over the life course. Using a 26-year prospective Swedish community-based cohort, we aim at decomposing socioeconomic inequalities in functional somatic symptoms by social and material life circumstances, at 4 periods of the life course. Design: Repeated cross-sectional study. Setting: Participants came from the Northern Swedish Cohort (n= 1001), who completed questionnaires about occupational class, social and material living conditions, and symptoms at ages 16, 21, 30 and 42. Socioeconomic inequalities were estimated and decomposed using the Blinder-Oaxaca decomposition analysis. Results: Inequalities in symptoms between blue-collar and white-collar socioeconomic groups increased along the life course in the sample. In the decomposition analysis, a high proportion of the gap between socioeconomic groups could be explained by social and material living conditions at ages 16 (84% explained), 30 (45%) and 42 (68%), but not at age 21. Specific social (parental illness at age 16 and violence at ages 30 and 42) and material (parental unemployment at age 16, and own unemployment and financial strain at ages 30 and 42) factors contributed jointly to the health gaps. Conclusions: Socioeconomic inequalities in functional somatic symptoms increased along the life course in this Swedish cohort. A considerable portion of the social gaps in health was explained by concurrent social and material conditions, and the importance of specific adversities was dependent on the life course stage. Our findings suggest that socioeconomic inequalities in functional somatic symptoms may be reduced by addressing both social and material living conditions of disadvantaged families, and also that the life course stage needs to be taken into consideration.

  • 129.
    Schéle, Ingrid A.
    et al.
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Hedman, Leif R.
    Umeå University, Faculty of Social Sciences, Department of Psychology. Center for Advanced Medical Simulation and Training, Karolinska Institutet, Stockholm.
    Hammarström, Anne
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    A model of psychosocial work environment, stress, and satisfaction among dental students in Sweden2012In: Journal of Dental Education, ISSN 0022-0337, E-ISSN 1930-7837, Vol. 76, no 9, p. 1206-1217Article in journal (Refereed)
    Abstract [en]

    Dental students are often described as stressed. The stress has, among other things, been connected to stressors in their psychosocial environment and inconsistent feedback. The hypothesis of this study was that the psychosocial work environment in dental schools leads to stress and affects the satisfaction of dental students and that tolerance for ambiguity shields students from stress. A web-based survey was sent to the entire Swedish dental student population in clinical training (N=805); the response rate was 40 percent. Structural equation modeling used in the analyses contains four main constructs: psychosocial work environment, tolerance for ambiguity, perceived stress, and student satisfaction (χ2=267.437, d.f.=174, p<0.001, Normed χ2=1.537, RMSEA= 0.041, CFI=0.98). Psychosocial work environment influenced both perceived stress and satisfaction: it accounted for almost all of the explained variance in perceived stress for women, while about half of the variance for the men was explained by tolerance for ambiguity. This study concluded that about 40 percent of the total perceived stress of these female dental students was related to their psychosocial work environment. Tolerance for ambiguity shielded men but not women from stress. An improved psychosocial work environment in dental schools would decrease the stress of both male and female dental students.

  • 130.
    Schéle, Ingrid
    et al.
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Hedman, Leif
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Hammarström, Anne
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Shared ambiguity but different experiences and demands among dental students: a gender perspective2011In: Qualitative Research in Psychology, Vol. 8, no 1, p. 1-25Article in journal (Refereed)
    Abstract [en]

    This study explores how dental students experience their clinical semesters from a gender perspective.

    Twelve students (seven women and five men) and three teachers (two women and one man) at the Umeå dentistry programme participated in semi-structured interviews that were analysed with Grounded Theory methodology.

    The model we propose consists of the core category Experiencing ambiguity and the three categories Experiencing pressure and stress, Assessing your own performance, and Passing through the eye of the needle and also includes four subcategories. At the core of our findings lies ambiguity, captured in the student dilemmas What’s enough/When’s enough. The answers to these dilemmas are further complicated by the gendered dimension and the dimension of unequal treatment, which provide students with different and contradicting sets of rules and roles. A comparison with recent findings from the U.S. shows that their experiences are not unique.

    Our Experiencing ambiguity model constitutes a platform for future research on how students experience clinical education, as well as potential predictors and consequences in relation to performance and well-being.

  • 131.
    Schéle, Ingrid
    et al.
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Hedman, Leif R
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Hammarström, Anne
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Social medicine. Umeå University, Faculty of Social Sciences, Umeå Centre for Gender Studies (UCGS).
    The Blurring between Strictand Fluid demands at theUmeå Dentistry Programme2008In: Abstracts of the XXIX International Congress of Psychology, July 21- 25, 2008, 2008Conference paper (Refereed)
    Abstract [en]

    The objective was to study elements forming students’ professional identity and experience ofdental education. Focus was on how students cope with conflicting demands and the interaction between a male dentist norm and predominantly female students. Semi-structured interviews were conducted with three teachers and ten students from the Umeå dentistry programme. The Grounded Theory method used generated a model centred on ‘‘Experiencing ambiguity’’ – ambiguity about actual effort needed and actual demands to be met. Also central were ‘‘Experiencing stress’’, time related as well as strain related, and ‘‘Demands lead to quality’’. The consequences of this ambiguity will be further explored.

  • 132.
    Strandh, Mattias
    et al.
    Umeå University, Faculty of Social Sciences, Department of Sociology.
    Hammarström, Anne
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Nilsson, Karina
    Umeå University, Faculty of Social Sciences, Department of Sociology.
    Nordenmark, Mikael
    Rehabiliteringsvetenskap vid Institutionen för hälsovetenskap, Mittuniversitetet.
    Russel, Helen
    Econ & Social Res Inst, Dublin, Ireland.
    Unemployment, gender and mental health: the role of the gender regime2013In: Sociology of Health and Illness, ISSN 0141-9889, E-ISSN 1467-9566, Vol. 35, no 5, p. 649-665Article in journal (Refereed)
    Abstract [en]

    Existing research suggests that gender differences in the effect of unemployment on mental health are related to the different positions and roles that are available for men and women in society and the family; roles that are connected with their different psychosocial and economic need for employment. The aim of this article is to analyse the role of gender in the relationship between unemployment and mental wellbeing in Sweden, representing a gender regime with a similar need for employment among women and men, and Ireland, representing a gender regime in which the need for employment differs between women and men. The results, based on longitudinal data from the two countries, show that unemployment was more negatively related to mental health among men than among women in Ireland, while men and women were equally affected by unemployment in Sweden. Factors related to the family and economic situation, as well as gendered selection into the unemployment population, explains the difference in mental health between unemployed men and women in Ireland. The overall conclusion is that the context has a major influence on the relationship between unemployment, gender and mental health.

  • 133.
    Strandh, Mattias
    et al.
    Umeå University, Faculty of Social Sciences, Department of Social Work. Centre for Research on Child and Adolescent Mental Health, Karlstad University, SE-651 88 Karlstad, Sweden.
    Nilsson, Karina
    Umeå University, Faculty of Social Sciences, Department of Sociology.
    Nordlund, Madelene
    Umeå University, Faculty of Social Sciences, Department of Sociology.
    Hammarström, Anne
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Social medicine.
    Do open youth unemployment and youth programs leave the same mental health scars?: Evidence from a Swedish 27-year cohort study2015In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 15, article id 1151Article in journal (Refereed)
    Abstract [en]

    Background: Recent findings suggest that the mental health costs of unemployment are related to both short- and long-term mental health scars. The main policy tools for dealing with young people at risk of labor market exclusion are Active Labor Market Policy programs for youths (youth programs). There has been little research on the potential effects of participation in youth programs on mental health and even less on whether participation in such programs alleviates the long-term mental health scarring caused by unemployment. This study compares exposure to open youth unemployment and exposure to youth program participation between ages 18 and 21 in relation to adult internalized mental health immediately after the end of the exposure period at age 21 and two decades later at age 43.

    Methods: The study uses a five wave Swedish 27-year prospective cohort study consisting of all graduates from compulsory school in an industrial town in Sweden initiated in 1981. Of the original 1083 participants 94.3 % of those alive were still participating at the 27-year follow up. Exposure to open unemployment and youth programs were measured between ages 18–21. Mental health, indicated through an ordinal level three item composite index of internalized mental health symptoms (IMHS), was measured pre-exposure at age 16 and post exposure at ages 21 and 42.

    Ordinal regressions of internalized mental health at ages 21 and 43 were performed using the Polytomous Universal Model (PLUM). Models were controlled for pre-exposure internalized mental health as well as other available confounders.

    Results: Results show strong and significant relationships between exposure to open youth unemployment and IMHS at age 21 (OR = 2.48, CI = 1.57–3.60) as well as at age 43 (OR = 1.71, CI = 1.20–2.43). No such significant relationship is observed for exposure to youth programs at age 21 (OR = 0.95, CI = 0.72–1.26) or at age 43 (OR = 1.23, CI = 0.93–1.63).

    Conclusions: A considered and consistent active labor market policy directed at youths could potentially reduce the short- and long-term mental health costs of youth unemployment.

  • 134.
    Strandh, Mattias
    et al.
    Umeå University, Faculty of Social Sciences, Department of Sociology.
    Nilsson, Karina
    Umeå University, Faculty of Social Sciences, Department of Sociology.
    Winefield, Anthony
    Centre for Applied Psychological Research, School of Psychology, Social Work and Social Policy, University of South Australia, Australia .
    Hammarström, Anne
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Unemployment and mental health scarring during the life course2014In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 24, no 3, p. 440-445Article in journal (Refereed)
    Abstract [en]

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

  • 135.
    Strandh, Mattias
    et al.
    Umeå University, Faculty of Social Sciences, Department of Sociology.
    Nordlund, Madelene
    Umeå University, Faculty of Social Sciences, Department of Sociology.
    Hammarström, Anne
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Youth unemployment, youth programs and mental health scarring in Sweden - long term mental health effects of two different forms of unemployment experiences2012In: A comparison of effects on capabilities in transitions to the labour market: EU Collaborative Project "WorkAble": Making Capabilities Work (2009-2012) Work Package 5: Effects on transitional trajectories of young people Deliverable 5.2: Final report, Bielefeld: Workable Research Consortium , 2012, p. 137-164Chapter in book (Refereed)
  • 136.
    Strandh, Mattias
    et al.
    Umeå University, Faculty of Social Sciences, Department of Sociology.
    Novo, Mehmed
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    Hammarström, Anne
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Mental health among the unemployed and the unemployment rate in the municipality2011In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, ISSN ISSN 1101-1262, Vol. 21, no 6, p. 799-805Article in journal (Refereed)
    Abstract [en]

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

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

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

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

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

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

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

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

  • 137.
    Stålnacke, Britt-Marie
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine.
    Haukenes, Inger
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine. Bergen, Norway.
    Lehti, Arja
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine. Umeå University, Faculty of Medicine, Department of Clinical Sciences, Professionell Development.
    Wiklund, Anncristine Fjellman
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Wiklund, Maria
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Hammarström, Anne
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Social medicine. Umeå University, Faculty of Social Sciences, Umeå Centre for Gender Studies (UCGS).
    Is there a gender bias in recommendations for further rehabilitation in primary care of patients with chronic pain after an interdisciplinary team assessment?2015In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 47, no 4, p. 365-371Article in journal (Refereed)
    Abstract [en]

    Objective: To examine potential gender bias in recommendations of further examination and rehabilitation in primary care for patients with chronic musculoskeletal pain after an interdisciplinary team assessment. Methods: The population consisted of consecutive patients (n=589 women, 262 men) referred during a 3-year period from primary healthcare for assessment by interdisciplinary teams at a pain specialist rehabilitation clinic. Patient data were collected from the Swedish Quality Registry for Pain Rehabilitation. The outcome was defined as the examination or rehabilitation that was specified in the patient's record. Results: Men had a significantly higher likelihood than women of being recommended physiotherapy and radiological examination, and the gender difference was not explained by confounding variables and covariates (age, marital status, ethnicity, education, working status, pain severity, pain interference, pain sites, anxiety and depression). There was no significant gender difference in recommendations to treatment by specialist physician, occupational therapist, psychologist or social worker. Conclusion: Our findings indicate that the interdisciplinary teams in specialist healthcare may discriminate against women with chronic pain when physiotherapy and radiological investigation are recommended. The team's choice of recommendations might be influenced by gendered attitudes, but this field of research needs to be studied further.

  • 138. Theorell, Töres
    et al.
    Hammarström, Anne
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Socialmedicin.
    Aronsson, Gunnar
    Bendz, Lil Träskman
    Grape, Tom
    Hogstedt, Christer
    Marteinsdottir, Ina
    Skoog, Ingmar
    Hall, Charlotte
    A systematic review including meta-analysis of work environment and depressive symptoms2015In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 15, article id 738Article, review/survey (Refereed)
    Abstract [en]

    Background: Depressive symptoms are potential outcomes of poorly functioning work environments. Such symptoms are frequent and cause considerable suffering for the employees as well as financial loss for the employers. Accordingly good prospective studies of psychosocial working conditions and depressive symptoms are valuable. Scientific reviews of such studies have pointed at methodological difficulties but still established a few job risk factors. Those reviews were published some years ago. There is need for an updated systematic review using the GRADE system. In addition, gender related questions have been insufficiently reviewed. Method: Inclusion criteria for the studies published 1990 to June 2013: 1. European and English speaking countries. 2. Quantified results describing the relationship between exposure (psychosocial or physical/chemical) and outcome (standardized questionnaire assessment of depressive symptoms or interview-based clinical depression). 3. Prospective or comparable case-control design with at least 100 participants. 4. Assessments of exposure (working conditions) and outcome at baseline and outcome (depressive symptoms) once again after follow-up 1-5 years later. 5. Adjustment for age and adjustment or stratification for gender. Studies filling inclusion criteria were subjected to assessment of 1.) relevance and 2.) quality using predefined criteria. Systematic review of the evidence was made using the GRADE system. When applicable, meta-analysis of the magnitude of associations was made. Consistency of findings was examined for a number of possible confounders and publication bias was discussed. Results: Fifty-nine articles of high or medium high scientific quality were included. Moderately strong evidence (grade three out of four) was found for job strain (high psychological demands and low decision latitude), low decision latitude and bullying having significant impact on development of depressive symptoms. Limited evidence (grade two) was shown for psychological demands, effort reward imbalance, low support, unfavorable social climate, lack of work justice, conflicts, limited skill discretion, job insecurity and long working hours. There was no differential gender effect of adverse job conditions on depressive symptoms Conclusion: There is substantial empirical evidence that employees, both men and women, who report lack of decision latitude, job strain and bullying, will experience increasing depressive symptoms over time. These conditions are amenable to organizational interventions.

  • 139. Theorell, Töres
    et al.
    Hammarström, Anne
    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.
    Magnusson Hanson, Linda
    Janlert, Urban
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Westerlund, Hugo
    Job strain and depressive symptoms in men and women: a prospective study of the working population in Sweden2014In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 68, no 1, p. 78-82Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Several prospective studies have indicated increased risk of developing depressive symptoms in employees who report psychologically demanding and uncontrollable work (job strain). There are diverging findings regarding gender differences in this relationship. The aim was to analyse whether men and women differ with regard to the prospective relationship between adverse psychosocial work environment and depressive symptoms during a 2-year period.

    METHOD: The Swedish Longitudinal Occupational Survey of Health cohort based on representative recruitment of working men and women in Sweden was used. 2731 men and 3446 women had answered questions regarding work environment and mental health in 2008 and 2010. Psychological demands, decision authority, age and income as well as depressive symptoms in 2008 were used as predictors of depressive symptoms in 2010.

    RESULTS: Women reported less decision authority at work and their demand level developed more unfavourably than did men's-resulting in increased job strain gap between men and women from 2008 to 2010. The relationship between demand and decision authority (and job strain) on one hand and depressive symptoms on the other hand was not statistically different in men and women.

    CONCLUSIONS: Overall, women reported higher levels of job strain than men. In Sweden, job strain was as strongly related to depressive symptoms among men as among women.

  • 140.
    Virtanen, P.
    et al.
    Tampere School of Public Health, University of Tampere, Medisiinarinkatu, Tampere, Finland.
    Janlert, Urban
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Hammarström, Anne
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Health status and health behaviour as predictors of the occurrence of unemployment and prolonged unemployment2013In: Public Health, ISSN 0033-3506, E-ISSN 1476-5616, Vol. 127, no 1, p. 46-52Article in journal (Refereed)
    Abstract [en]

    Objectives: Earlier research on health-related selection into unemployment has been based on relatively severe health problems, leaves questions unanswered about particular problems, follow-up times have been short and the measurement of unemployment utilised has been crude. The present study explores the effects of suboptimal health on employment in the long term, with statistics that enable assessment of the occurrence and extent of unemployment. Study design: Employment status of a population cohort (n = 1083) was measured half-yearly from 18 to 42 years of age with four follow-up surveys. Methods: Health status at 30 years of age was assessed with nine indicators. Their associations with the occurrence of a period of unemployment during the subsequent 12 years were analysed with Cox proportional hazard models, and generalized linear models were applied in assessing their associations with prolonged unemployment. Results: Suboptimal self-rated health and suboptimal mood were the most robust predictors of both occurrence of unemployment {hazard rates 1.48 [95% confidence interval (CI) 1.13-1.94] and 1.59 (95% CI 1.19-2.12), respectively} and prolonged unemployment [risk ratios 1.95 (95% CI 1.66-2.29) and 1.44 (95% CI 1.24-1.67), respectively]. Significant associations, particularly with prolonged unemployment, were also seen for musculoskeletal pain, suboptimal sense functions and sleep quality, and smoking and risky alcohol intake. Conclusions: There is health-related selection into unemployment in early middle age, irrespective of unemployment earlier in the life course. High risk ratios for prolonged unemployment suggest that selection takes place, in particular, at re-employment. The findings indicate the need for policies to prevent those with a history of health problems being at a disadvantage in terms of future employment. (C) 2012 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

  • 141.
    Virtanen, Pekka
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Social medicine. University of Tampere, School of Health Sciences, Tampere 33014, Finland..
    Hammarström, Anne
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Social medicine.
    Janlert, Urban
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Children of boom and recession and the scars to the mental health: a comparative study on the long term effects of youth unemployment2016In: International Journal for Equity in Health, ISSN 1475-9276, E-ISSN 1475-9276, Vol. 15, article id 14Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Earlier research shows that there is an association between unemployment and poor mental health, and that recovery from the damages to mental health obtained during unemployment remains incomplete over a long period of time. The present study relates this 'mental health scarring' to the trade cycle, exploring if those exposed to youth unemployment during boom differ from those exposed during recession with respect to mental health in the middle age.

    METHODS: The sample consists of two cohorts from the same industrial town in Northern Sweden: the cohort born in 1965 and the cohort born in 1973 included all pupils attending the last grade of compulsory school, respectively, in 1981 and in 1989. Their depressiveness and anxiousness were assessed by questionnaires at age 21 and again at age 43/39. Mental health at follow-up was related to exposure to unemployment during age years 21-25. Statistical significance of the cohort*exposure interactions from binary logistic regression analyses were used to assess the cohort differences in the mental health between Cohort65 and Cohort73, entering the labour market, respectively, during a boom and a recession.

    RESULTS: Compared to the unexposed, high exposure to unemployment at the age from 21 to 25 was associated to increased probability of poor mental health in the middle age in both in Cohort65 (odds ratio 2.19 [1.46-3.30] for anxiousness and 1.85 [1.25-2.74]for depressiveness) and in Cohort73 (odds ratio 2.13 [1.33-3.39] for anxiousness and 1.38 [0.89-2.14] for depressiveness). The differences between the cohorts also turned out as statistically non-significant.

    CONCLUSIONS: The scars of unemployment exposure onto future health seem to be rather insensitive to economic trades. Thus, at the population level this would mean that the long-term health costs that can be attributed to youth unemployment are more widespread in the generation that suffers of recession around the entry to the work life.

  • 142. Virtanen, Pekka
    et al.
    Janlert, Urban
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Hammarström, Anne
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Exposure to nonpermanent employment and health: analysis of the associations with 12 health indicators2011In: Journal of Occupational and Environmental Medicine, ISSN 1076-2752, E-ISSN 1536-5948, Vol. 53, no 6, p. 653-657Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To clarify the associations of nonpermanent employment with poor health in longitudinal setting with different health outcomes.

    METHODS: A population cohort (n = 1071) was surveyed at the age of 30 and then again at the age of 42. They were classified according to exposure to nonpermanent employment. The outcomes included indicators of mental and somatic health and health behavior.

    RESULTS: When adjusted for baseline level of the outcome under study, the odds ratio of the heavily exposed was 1.90 (1.25 to 2.88) for nervous symptoms, 1.77 (1.03 to 2.05) for psychological distress, and 1.52 (1.03 to 2.25) for suboptimal mood. Among the lightly exposed, the odds ratio for psychological distress was 1.94 (1.10 to 2.10).

    CONCLUSIONS: Psychological distress is particularly sensitive to exposure to nonpermanent employment. The effects on somatic health or health behavior should be studied only with carefully specified hypotheses.

  • 143.
    Virtanen, Pekka
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Univ Tampere, Tampere Sch Publ Hlth, Tampere, Finland.
    Janlert, Urban
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Hammarström, Anne
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Exposure to temporary employment and job insecurity: a longitudinal study of the health effects2011In: Occupational and Environmental Medicine, ISSN 1351-0711, E-ISSN 1470-7926, Vol. 68, no 8Article in journal (Refereed)
    Abstract [en]

    Objective This study analysed interactions between job insecurity and temporary employment and health. We tested the violation hypothesis (whether permanent employment increases the health risk associated with job insecurity) and the intensification hypothesis (whether temporary employment increases the health risk associated with job insecurity) in a longitudinal setting. Previous research on this topic is scarce and based on cross-sectional data.

    Methods A population cohort (n=1071) was surveyed at age 30 and age 42. Exposure to temporary employment during this 12-year period was elicited with a job-time matrix and measured as the score of 6-month periods. Exposure to job insecurity was measured according to the perceived threat of unemployment. Health at follow-up was assessed as optimal versus suboptimal self-rated health, sleep quality and mental health. In addition to sociodemographics and baseline health, the analyses were adjusted for exposure to unemployment, non-employment and self-employment during the 12-year period.

    Results 26% of participants had been exposed to temporary employment. The effect of job insecurity on health was the same in the exposed and unexposed groups, that is the violation hypothesis was not supported. Non-significant interactions between the exposures and all health outcomes also indicated null findings regarding the intensification hypothesis.

    Conclusions These findings suggest that perceived job insecurity can lead to adverse health effects in both permanent and temporary employees. Policies should aim to improve work-related well-being by reducing job insecurity. Efforts towards 'flexicurity' are important, but it is equally important to remember that a significant proportion of employees with a permanent contract experience job insecurity.

  • 144.
    Virtanen, Pekka
    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.
    Hammarström, Anne
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Suboptimal health as a predictor of non-permanent employment in middle age: a 12-year follow-up study of the Northern Swedish Cohort2013In: International Archives of Occupational and Environmental Health, ISSN 0340-0131, E-ISSN 1432-1246, Vol. 86, no 2, p. 139-145Article in journal (Refereed)
    Abstract [en]

    Earlier research on health-related selection in the labour market has concentrated on selection of those with poor health into unemployment. The purpose of the present study was to investigate if suboptimal health also predicts non-permanent employment. A population cohort of 517 men and 477 women was surveyed at age 30 and at age 43 about their health and yearly employment. Non-permanent employment during the follow-up was assessed for its occurrence with Cox regression and for the amount (accumulation in months) with generalised linear models. Suboptimal self-rated health, sense functioning and sleep quality in women and suboptimal mood in men predicted high accumulation of non-permanent employment. By contrast, in men, suboptimal self-rated health and sense functioning predicted low accumulation. The gender differences were statistically significant. Smoking predicted high occurrence and accumulation of non-permanent employment equally in men and women, whereas no associations were seen with overweight and alcohol consumption. Selection into non-permanent employment was shown for several indicators of suboptimal health. A gendered pattern was found, with more health selection among women. The findings of this pioneering study should be tested with further research.

  • 145.
    Virtanen, Pekka
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine. University of Tampere, Institute for Advanced Social Research and School of Health Sciences, Tampere, Finland.
    Lintonen, Tomi
    Westerlund, Hugo
    Nummi, Tapio
    Janlert, Urban
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Hammarström, Anne
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Unemployment in the teens and trajectories of alcohol consumption in adulthood2016In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 6, no 3, article id e006430Article in journal (Refereed)
    Abstract [en]

    Objectives The unemployed are assumed to adopt unhealthy behaviours, including harmful use of alcohol. This study sought to elucidate the relations between unemployment before age 21years and consumption of alcohol from 21 to 42years. The design was based on the conception of youth as a sensitive period for obtaining drinking scars' that are visible up to middle age.

    Setting The Northern Swedish Cohort Study has followed up a population sample from 1981 to 2007 with five surveys.

    Participants All pupils (n=1083) attending the last year of compulsory school in Lulea participated in the baseline survey in classrooms, and 1010 of them (522 men and 488 women) participated in the last follow-up survey that was conducted at classmate reunions or by post or by phone.

    Outcome measure The trajectory of alcohol consumption from 21 to 43years, obtained with latent class growth analyses, was scaled.

    Results Men were assigned to five and women to three consumption trajectories. The trajectory membership was regressed on accumulation of unemployment from 16 to 21years, with multinomial logistic regression analyses. The trajectory of moderate consumption was preceded by lowest exposure to unemployment in men and in women. With reference to this, the relative risk ratios for high-level trajectory groups were 3.49 (1.25 to 9.79) in men and 1.41 (0.74 to 2.72) in women, but also the trajectories of low-level consumption were more probable (relative risk ratio 3.18 (1.12 to 9.02) in men and 2.41 (1.24 to 4.67) in women).

    Conclusions High-level alcohol consumption throughout adulthood is, particularly among men, partly due to scars' from youth unemployment, particularly in men, but there are also groups of men and women where unemployment in the teens predicts a trajectory of low consumption.

  • 146.
    Virtanen, Pekka
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Lipiainen, Liudmila
    Hammarström, Anne
    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.
    Saloniemi, Antti
    Nummi, Tapio
    Tracks of labour market attachment in early middle age: A trajectory analysis over 12 years2011In: ADVANCES IN LIFE COURSE RESEARCH, ISSN 1040-2608, Vol. 16, no 2, p. 55-64Article in journal (Refereed)
    Abstract [en]

    The predominant aim of this study was to contribute to the methodology in research on work trajectories as essential element of the life course in adulthood. Data on the labour market attachment of a population cohort (n = 1005) from age 30 to age 42 were collected with a questionnaire. We applied trajectory analysis in order to define different attachment tracks. According to the information criteria, six tracks were discerned: in addition to those who are in permanent employment (high-level attachment), in temporary employment (medium-level attachment) and out of work (poor-level attachment) throughout early middle age, we were able to define subgroups that move from temporary to permanent employment (strengthening attachment) or vice versa (weakening attachment), and also some who enter working life and attain permanent employment at a relatively high age (delayed attachment). On average, attachment was high and strengthened with time, indicating that no major de-standardization of employment occurred during the follow-up years (1995-2007) in the studied labour market and age cohort. Given longitudinal data with at least ordinal scale variables, the applied trajectory analysis may be recommended as a "method of choice" in clustering the diverse and non-standard work-life courses into a meaningful set of tracks. (C) 2011 Elsevier Ltd. All rights reserved.

  • 147.
    Virtanen, Pekka
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Socialmedicin. Institute for Advanced Social Research and School of Health Sciences, University of Tampere, Tampere, Finland.
    Nummi, Tapio
    Lintonen, Tomi
    Westerlund, Hugo
    Hägglöf, Bruno
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Hammarström, Anne
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Mental health in adolescence as determinant of alcohol consumption trajectories in the Northern Swedish Cohort2015In: International Journal of Public Health, ISSN 1661-8556, E-ISSN 1661-8564, Vol. 63, no 3, p. 335-342Article in journal (Refereed)
    Abstract [en]

    The study aimed to analyze whether poor mental health in adolescence predicts heavy alcohol consumption over the long term. Alcohol consumption in the population cohort (n = 1010) was surveyed at the ages of 16, 18, 21, 30 and 42. Utilizing latent class growth analysis, six consumption trajectories ranging from 'Late Onset Low' to 'Early Onset High' were defined and analyzed with respect to internalization (depressiveness and anxiousness) and externalization (truancy and vandalism) at age 16. Poor mental health predicted the Early Onset High trajectory (risk ratios in relation to the compliant trajectory 3.59 for anxiousness, 2.85 for depressiveness, 5.69 for truancy and 7.75 for externalized vandalism). Moreover, significant associations were found for the Early Onset Moderate and Early Onset Low trajectories. This is the first study to show an association between internalized mental health problems in adolescence and lifelong heavy drinking. The study also confirmed a strong association between externalized behavior and heavy drinking, indicating a need of preventive measures in this group. Nevertheless, the analyses demonstrated that most teenagers with mental health problems continue along a reasonable drinking trajectory.

  • 148.
    Waenerlund, Anna-Karin
    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.
    Hammarström, Anne
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Virtanen, Pekka
    School of Health Sciences, University of Tampere, Finland.
    Are changes in labour market attachment over 12 years related to health status?: An analysis of the Northern Swedish Cohort.Manuscript (preprint) (Other academic)
  • 149.
    Waenerlund, Anna-Karin
    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.
    Virtanen, Pekka
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Hammarström, Anne
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Is the core-periphery labour market structure related to perceived health? Findings of the Northern Swedish Cohort.2011In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 11, p. 956-Article in journal (Refereed)
    Abstract [en]

    Background: There is controversy as to whether peripheral employment is related to poor health status or not. This study aims at examining whether 1) the accumulation of time in peripheral labour market positions is associated with psychological distress and poor or average self-rated health; 2) the proposed association is different among women than among men.

    Method: Participants in the 1995 and 2007 follow-up surveys of the Northern Swedish Cohort (n = 985) completed self-administered questionnaires about psychological and general health and about employment positions during the follow-up years. Associations between 12 year peripheral labour market positions (no, low, medium and high exposure) and health were examined using logistic regression.

    Results: Exposure to peripheral employment was positively related to psychological distress in both women and men (p-values for trend < 0.001). Adjustment for sociodemographics and psychological distress at baseline, as well as for unemployment and being out of the labour market at the follow-up, resulted in attenuation of the odds ratios, particularly in the group with high exposure to peripheral employment, although results remained significant in men in the fully adjusted model. Women and men with high exposure to peripheral employment had high odds of poor or average self-rated health, but the association was rendered non-significant after adjustment for the covariates.

    Conclusions: Our findings suggest that exposure to peripheral employment positions has an impact particularly on mental health, partly due to the over-representation of other unfavourable social and employment conditions among those with substantial exposure to peripheral employment.

  • 150.
    Waenerlund, Anna-Karin
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Gustafsson, Per
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Hammarström, Anne
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Virtanen, Pekka
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    History of labour market attachment as a determinant of health status: a 12-year follow-up of the Northern Swedish Cohort2014In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 4, no 2, p. e004053-Article in journal (Refereed)
    Abstract [en]

    Objective The present study aims at using trajectory analysis to measure labour market attachment (LMA) over 12years and at examining whether labour market tracks relate to perceived health status.

    Design Data were retrieved from a 26-year prospective cohort study, the Northern Swedish Cohort.

    Setting and participants All ninth grade students (n=1083) within the municipality of Lulea in northern Sweden were included in the baseline investigation in 1981. The vast majority (94%) of the original cohort participated at the fourth follow-up. In this study, 969 participants were included.

    Measures Perceived health status (psychological distress and non-optimal self-rated health) at age 42 and the data obtained from questionnaires.

    Results We have identified four tracks in relation to LMA across the 12-year period: permanent', high level', strengthening' and poor level' of attachment. LMA history relates to psychological distress. High level (OR 1.55 (95% CI 1.06 to 2.27)), strengthening (OR 1.95 (95% CI 1.29 to 2.93)) and poor attachment (OR 3.14 (95% CI 2.10 to 4.70) involve higher OR for psychological distress compared with permanent attachment. The overall p value remained significant in the final model (p=0.001). Analyses regarding non-optimal self-rated health displayed a similar pattern but this was not significant in the final model.

    Conclusions Our results suggest that health status in mid-life, particularly psychological distress, is related to patterns of LMA history, to a large part independently of other social risk factors and previous health. Consideration of heterogeneity and time in LMA might be important when analysing associations with perceived health.

1234 101 - 150 of 162
CiteExportLink to result list
Permanent link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf