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  • 1.
    Hammarström, Anne
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Socialmedicin.
    Westerlund, Hugo
    Kirves, Kaisa
    Nygren, Karina
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Socialmedicin.
    Virtanen, Pekka
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Socialmedicin. School of Health Sciences, University of Tampere, Tampere, Finland.
    Hägglöf, Bruno
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry.
    Addressing challenges of validity and internal consistency of mental health measures in a 27- year longitudinal cohort study–the Northern Swedish Cohort study2016In: BMC Medical Research Methodology, ISSN 1471-2288, E-ISSN 1471-2288, Vol. 16, article id 4Article in journal (Refereed)
    Abstract [en]

    Background:There are inherent methodological challenges in the measurement of mental health problems in longitudinal research. There is constant development in definitions, taxonomies and demands concerning the properties of mental health measurements. The aim of this paper was to construct composite measures of mental health problems (according to today’s standard) from single questionnaire items devised in the early 1980s, and to evaluate their internal consistency and factorial invariance across the life course using the Northern Swedish Cohort.Methods:All pupils in the last year of compulsory school in Luleå in 1981 (n= 1083) form a prospective cohort study where the participants have been followed with questionnaires from the age of 16 (in 1981) until the age of43 (in 2008). We created and tested the following composite measures from self-reports at each follow-up:depressive symptoms, anxiety symptoms, functional somatic symptoms, modified GHQ and positive health. Validity and internal consistency were tested by confirmatory factor analysis, including tests of factorial invariance over time.Results:As an overall assessment, the results showed that the composite measures (based on more than 30-year-old single item questions) are likely to have acceptable factorial invariance as well as internal consistency over time.Conclusions:Testing the properties of the mental health measures used in older studies according to the standards of today is of great importance in longitudinal research. Our study demonstrates that composite measures of mental health problems can be constructed from single items which are more than 30 years old and that these measures seem to have the same factorial structure and internal consistency across a significant part of the life course. Thus, it can be possible to overcome some specific inherent methodological challenges in using historical data in longitudinal research.

  • 2.
    Nygren, Karina
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Adolescent self-reported health in the Umeå region: Associations with behavioral, parental and school factors2012Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

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

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

  • 3.
    Nygren, Karina
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Bergström, Erik
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Janlert, Urban
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Nygren, Lennart
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Adolescent self-reported health in relation to school factors: a multilevel analysis2014In: Journal of School Nursing, ISSN 1059-8405, E-ISSN 1546-8364, Vol. 30, no 2, p. 114-122Article in journal (Refereed)
    Abstract [en]

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

  • 4.
    Nygren, Karina
    et al.
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Bergström, Erik
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Janlert, Urban
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Nygren, Lennart
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Parents matter: but relations to parents do not explain gender differences in self-reported health in adolescents2012In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 26, no 4, p. 643-653Article in journal (Refereed)
    Abstract [en]

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

  • 5.
    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.

  • 6.
    Nygren, Karina
    et al.
    Umeå University, Faculty of Social Sciences, Department of Social Work. Centre for Research on Child and Adolescent Mental Health, Karlstad University, Sweden.
    Hagquist, Curt
    Centre for Research on Child and Adolescent Mental Health, Karlstad University, Sweden.
    Self-reported school demands and psychosomatic problems among adolescents: changes in the association between 1988 and 2011?2019In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 47, p. 174-181Article in journal (Refereed)
    Abstract [en]

    Aims: The aim of the present study was to examine changes over time in the relationship between self-reported school demands and psychosomatic problems, also considering the impact of student influence and teacher support.

    Methods: Data from a cross-sectional study (Young in Värmland) including eight data collections (1988–2011) among Swedish students aged 15–16 were used (n = 20,115). Analyses with multinomial logistic regression and descriptive statistics were applied.

    Results: Between 1988 and 2011, the proportions of students with a higher degree of psychosomatic problems increased, as did the proportion of students experiencing school demands that were too high. Finer-level analyses based on stratification of student groups did not show any associations at the aggregated level between increases of school demands and psychosomatic problems. Similarly, individual level analyses showed that the strength of the association between school demands and psychosomatic problems was not affected by year of investigation.

    Conclusions: Changes in school demands over time could not explain the increasing trend in psychosomatic problems among adolescents. Since the relationship between school demands and psychosomatic problems is strong across time, there is, however, a continued need for school-based interventions. More studies are required to gain further understanding of adolescent mental health from a trend perspective.

  • 7.
    Nygren, Karina
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Hammarstrom, Anne
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Social medicine. Uppsala Univ, Dept Publ Hlth & Caring Sci, Uppsala, Sweden.
    Rolandsson, Olov
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Binge drinking and total alcohol consumption from 16 to 43 years of age are associated with elevated fasting plasma glucose in women: results from the northern Swedish cohort study2017In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 17, article id 509Article in journal (Refereed)
    Abstract [en]

    Background: Studies have indicated that moderate alcohol consumption is associated with lower incidence of diabetes in women. However, not only the amount but also the drinking pattern could be of importance when assessing the longitudinal relation between alcohol and glucose. Also, there is a lack of studies on alcohol use beginning in adolescence on adult glucose levels. The aim was to examine the association between total alcohol consumption and binge drinking between ages 16 and 43 and fasting plasma glucose at age 43. Methods: Data were retrieved from a 27-year prospective cohort study, the Northern Swedish Cohort. In 1981, all 9th grade students (n = 1083) within a municipality in Sweden were invited to participate. There were re-assessments at ages 18, 21, 30 and 43. This particular study sample consisted of 897 participants (82.8%). Fasting plasma glucose (mmol/L) was measured at a health examination at age 43. Total alcohol consumption (in grams) and binge drinking were calculated from alcohol consumption data obtained from questionnaires. Results: Descriptive analyses showed that men had higher levels of fasting plasma glucose as compared to women. Men also reported higher levels of alcohol consumption and binge drinking behavior. Linear regressions showed that total alcohol consumption in combination with binge drinking between ages 16 and 43 was associated with elevated fasting plasma glucose at age 43 in women (beta = 0.14, p = 0.003) but not in men after adjustment for BMI, hypertension and smoking at age 43. Conclusions: Our findings indicate that reducing binge drinking and alcohol consumption among young and middle-aged women with the highest consumption might be metabolically favorable for their future glucose metabolism.

  • 8.
    Nygren, Karina
    et al.
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Janlert, Urban
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Lennart, Nygren
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    What happens with local survey findings?: a study of how adolescent school surveys are disseminated and utilized in Swedish schools2013In: Scandinavian Journal of Educational Research, ISSN 0031-3831, E-ISSN 1470-1170, Vol. 57, no 5, p. 526-543Article in journal (Refereed)
    Abstract [en]

    This paper aimed at examining the barriers to and facilitators of disseminating and utilizing the results of a local Swedish school survey. Interviews with 21 school district managers/principals were performed. Results showed that dissemination and utilization of local survey data appeared as two interrelated processes. With those processes, various barriers and facilitators were mentioned. The barriers and facilitators were not merely the opposites of each other; instead they qualitatively differed from each other depending on what phase in the process the manager/principal referred to. The results also showed that the dissemination phase was both a prerequisite for and interwoven with the utilization phase, e.g. dissemination efforts were important for how the survey results were utilized.

  • 9.
    Nygren, Karina
    et al.
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Janlert, Urban
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Nygren, Lennart
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Norm compliance and self-reported health among Swedish adolescents2011In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 39, no 1, p. 44-50Article in journal (Refereed)
    Abstract [en]

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

  • 10.
    Nygren, Karina
    et al.
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Naujaniené, Rasa
    Vytautas Magnus University, Social Work Department.
    Nygren, Lennart
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    The Notion of Family in Lithuanian and Swedish Social Legislation2018In: Social Policy and Society, ISSN 1474-7464, E-ISSN 1475-3073, Vol. 17, no 4, p. 651-663Article in journal (Refereed)
    Abstract [en]

    This study examines the conceptualisation of family in key social legislative documents guiding social workers in two European countries, whose welfare systems have previously been labelled as re-familialised (Lithuania) or de-familialised (Sweden). The focus is on the concept of family as delineated on three legislative levels: the constitutional level, the general family policy level, and the child welfare policy level. ‘Family’ is explicit in Lithuanian law, and the regulation of family formation and responsibility is imperative, while this is much less so in Swedish law. The analysis reveals how general welfare systems (regime-types) are linked to legislative frameworks, which, in turn, provide fundamentally different conditions for social work in different contexts.

  • 11.
    Nygren, Karina
    et al.
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Walsh, Julie
    University of Sheffield, UK.
    Ellingsen, Ingunn T.
    University of Stavanger, Norway.
    Christie, Alastair
    University College Cork, Ireland.
    What about the fathers? The presence and absence of the father in social work practice in England, Ireland, Norway, and Sweden: A comparative study2019In: Child & Family Social Work, ISSN 1356-7500, E-ISSN 1365-2206, Vol. 24, no 1, p. 148-155Article in journal (Refereed)
    Abstract [en]

    Within northern Europe, gendered roles and responsibilities within the family have been challenged through an emergence of different family forms, increasing cultural diversity, and through progressive developments in welfare policies. To varying degrees, welfare policies in different EU countries support a dual-earner model and encourage men to be more active as fathers by reinforcing statutory rights and responsibilities. In child welfare practice, there has traditionally been a strong emphasis on women as mothers being primary carers for the children, while fathers are less active or absence carers. This paper explores, in four national welfare contexts, how child welfare social workers include fathers in practice decisions. Data was collected using focus group interviews with social workers from England, Ireland, Norway and Sweden. Similarities and differences emerge in relation to services and the focus of social work assessments. However, overall, the research suggests that despite gains in policy and legislation that promote gender equality, fathers remain largely absent in child welfare practice decisions about the parenting of their children. From the research, we raise questions for social work practice and the development of welfare policies. 

  • 12.
    Winefield, Helen
    et al.
    School of Psychology, University of Adelaide, Adelaide, Australia.
    Hammarström, Anne
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Nygren, Karina
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Hägglöf, Bruno
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry.
    Internalized symptoms in adolescence as predictors of mental health in adulthood in the Northern Swedish cohort2013In: Health, ISSN 1949-4998, E-ISSN 1949-5005, Vol. 5, no 7, p. 1164-1171Article in journal (Refereed)
    Abstract [en]

    Although mental health symptoms in children and adolescents are shown to predict young adult mental health outcomes, long-term prospective studies of childhood cohorts are few. The aim of the present study was to analyze the prospective importance of internalized mental health symptoms in adolescence for internalized symptoms in adulthood. Methods: A communitybased prospective longitudinal cohort provided information by questionnaire about psychological status at age 16 and 43 (n = 1010, representing 94.3% of those still alive). Socio-demographic variables which were indicative of possible childhood adversity (parental class, absence, illness, unemployment, relationship, crowding, number of moves) were treated as confounders and controlled for in ordinal regression. Results: For both women and men, internalizing mental health symptoms reported at 16 significantly predicted the same outcome at 43 years, after controlling for previous adverse environmental conditions (OR = 1.2 for women, 1.3 for men). Conclusion: In this representative cohort studied over 27 years with excellent retention rates, the occurrence of self-reported worry, panic and sadness in mid-adolescence significantly increased the likelihood of similar states in middle adulthood.

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