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  • 1. Afshin, Ashkan
    et al.
    Forouzanfar, Mohammad H.
    Reitsma, Marissa B.
    Sur, Patrick
    Estep, Kara
    Lee, Alex
    Marczak, Laurie
    Mokdad, Ali H.
    Moradi-Lakeh, Maziar
    Naghavi, Mohsen
    Salama, Joseph S.
    Vos, Theo
    Abate, Kalkidan H.
    Abbafati, Cristiana
    Ahmed, Muktar B.
    Al-Aly, Ziyad
    Alkerwi, Ala'a
    Al-Raddadi, Rajaa
    Amare, Azmeraw T.
    Amberbir, Alemayehu
    Amegah, Adeladza K.
    Amini, Erfan
    Amrock, Stephen M.
    Anjana, Ranjit M.
    Arnlov, Johan
    Asayesh, Hamid
    Banerjee, Amitava
    Barac, Aleksandra
    Baye, Estifanos
    Bennett, Derrick A.
    Beyene, Addisu S.
    Biadgilign, Sibhatu
    Biryukov, Stan
    Bjertness, Espen
    Boneya, Dube J.
    Campos-Nonato, Ismael
    Carrero, Juan J.
    Cecilio, Pedro
    Cercy, Kelly
    Ciobanu, Liliana G.
    Cornaby, Leslie
    Damtew, Solomon A.
    Dandona, Lalit
    Dandona, Rakhi
    Dharmaratne, Samath D.
    Duncan, Bruce B.
    Eshrati, Babak
    Esteghamati, Alireza
    Feigin, Valery L.
    Fernandes, Joao C.
    Furst, Thomas
    Gebrehiwot, Tsegaye T.
    Gold, Audra
    Gona, Philimon N.
    Goto, Atsushi
    Habtewold, Tesfa D.
    Hadush, Kokeb T.
    Hafezi-Nejad, Nima
    Hay, Simon I.
    Horino, Masako
    Islami, Farhad
    Kamal, Ritul
    Kasaeian, Amir
    Katikireddi, Srinivasa V.
    Kengne, Andre P.
    Kesavachandran, Chandrasekharan N.
    Khader, Yousef S.
    Khang, Young-Ho
    Khubchandani, Jagdish
    Kim, Daniel
    Kim, Yun J.
    Kinfu, Yohannes
    Kosen, Soewarta
    Ku, Tiffany
    Defo, Barthelemy Kuate
    Kumar, G. Anil
    Larson, Heidi J.
    Leinsalu, Mall
    Liang, Xiaofeng
    Lim, Stephen S.
    Liu, Patrick
    Lopez, Alan D.
    Lozano, Rafael
    Majeed, Azeem
    Malekzadeh, Reza
    Malta, Deborah C.
    Mazidi, Mohsen
    McAlinden, Colm
    McGarvey, Stephen T.
    Mengistu, Desalegn T.
    Mensah, George A.
    Mensink, Gert B. M.
    Mezgebe, Haftay B.
    Mirrakhimov, Erkin M.
    Mueller, Ulrich O.
    Noubiap, Jean J.
    Obermeyer, Carla M.
    Ogbo, Felix A.
    Owolabi, Mayowa O.
    Patton, George C.
    Pourmalek, Farshad
    Qorbani, Mostafa
    Rafay, Anwar
    Rai, Rajesh K.
    Ranabhat, Chhabi L.
    Reinig, Nikolas
    Safiri, Saeid
    Salomon, Joshua A.
    Sanabria, Juan R.
    Santos, Itamar S.
    Sartorius, Benn
    Sawhney, Monika
    Schmidhuber, Josef
    Schutte, Aletta E.
    Schmidt, Maria I.
    Sepanlou, Sadaf G.
    Shamsizadeh, Moretza
    Sheikhbahaei, Sara
    Shin, Min-Jeong
    Shiri, Rahman
    Shiue, Ivy
    Roba, Hirbo S.
    Silva, Diego A. S.
    Silverberg, Jonathan I.
    Singh, Jasvinder A.
    Stranges, Saverio
    Swaminathan, Soumya
    Tabares-Seisdedos, Rafael
    Tadese, Fentaw
    Tedla, Bemnet A.
    Tegegne, Balewgizie S.
    Terkawi, Abdullah S.
    Thakur, J. S.
    Tonelli, Marcello
    Topor-Madry, Roman
    Tyrovolas, Stefanos
    Ukwaja, Kingsley N.
    Uthman, Olalekan A.
    Vaezghasemi, Masoud
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Vasankari, Tommi
    Vlassov, Vasiliy V.
    Vollset, Stein E.
    Weiderpass, Elisabete
    Werdecker, Andrea
    Wesana, Joshua
    Westerman, Ronny
    Yano, Yuichiro
    Yonemoto, Naohiro
    Yonga, Gerald
    Zaidi, Zoubida
    Zenebe, Zerihun M.
    Zipkin, Ben
    Murray, Christopher J. L.
    Health Effects of Overweight and Obesity in 195 Countries over 25 Years2017Ingår i: New England Journal of Medicine, ISSN 0028-4793, E-ISSN 1533-4406, Vol. 377, nr 1, s. 13-27Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND Although the rising pandemic of obesity has received major attention in many countries, the effects of this attention on trends and the disease burden of obesity remain uncertain. METHODS We analyzed data from 68.5 million persons to assess the trends in the prevalence of overweight and obesity among children and adults between 1980 and 2015. Using the Global Burden of Disease study data and methods, we also quantified the burden of disease related to high body-mass index (BMI), according to age, sex, cause, and BMI in 195 countries between 1990 and 2015. RESULTS In 2015, a total of 107.7 million children and 603.7 million adults were obese. Since 1980, the prevalence of obesity has doubled in more than 70 countries and has continuously increased in most other countries. Although the prevalence of obesity among children has been lower than that among adults, the rate of increase in childhood obesity in many countries has been greater than the rate of increase in adult obesity. High BMI accounted for 4.0 million deaths globally, nearly 40% of which occurred in persons who were not obese. More than two thirds of deaths related to high BMI were due to cardiovascular disease. The disease burden related to high BMI has increased since 1990; however, the rate of this increase has been attenuated owing to decreases in underlying rates of death from cardiovascular disease. CONCLUSIONS The rapid increase in the prevalence and disease burden of elevated BMI highlights the need for continued focus on surveillance of BMI and identification, implementation, and evaluation of evidence-based interventions to address this problem. 

  • 2. Afshin, Ashkan
    et al.
    Sur, Patrick John
    Fay, Kairsten A.
    Cornaby, Leslie
    Ferrara, Giannina
    Salama, Joseph S.
    Mullany, Erin C.
    Abate, Kalkidan Hassen
    Abbafati, Cristiana
    Abebe, Zegeye
    Afarideh, Mohsen
    Aggarwal, Anju
    Agrawal, Sutapa
    Akinyemiju, Tomi
    Alahdab, Fares
    Bacha, Umar
    Bachman, Victoria F.
    Badali, Hamid
    Badawi, Alaa
    Bensenor, Isabela M.
    Bernabe, Eduardo
    Biryukov, Stan H.
    Biadgilign, Sibhatu Kassa K.
    Cahill, Leah E.
    Carrero, Juan J.
    Cercy, Kelly M.
    Dandona, Lalit
    Dandona, Rakhi
    Dang, Anh Kim
    Degefa, Meaza Girma
    Zaki, Maysaa El Sayed
    Esteghamati, Alireza
    Esteghamati, Sadaf
    Fanzo, Jessica
    Farinha, Carla Sofia E. Sa
    Farvid, Maryam S.
    Farzadfar, Farshad
    Feigin, Valery L.
    Fernandes, Joao C.
    Flor, Luisa Sorio
    Foigt, Nataliya A.
    Forouzanfar, Mohammad H.
    Ganji, Morsaleh
    Geleijnse, Johanna M.
    Gillum, Richard F.
    Goulart, Alessandra C.
    Grosso, Giuseppe
    Guessous, Idris
    Hamidi, Samer
    Hankey, Graeme J.
    Harikrishnan, Sivadasanpillai
    Hassen, Hamid Yimam
    Hay, Simon I.
    Hoang, Chi Linh
    Horino, Masako
    Islami, Farhad
    Jackson, Maria D.
    James, Spencer L.
    Johansson, Lars
    Jonas, Jost B.
    Kasaeian, Amir
    Khader, Yousef Saleh
    Khalil, Ibrahim A.
    Khang, Young-Ho
    Kimokoti, Ruth W.
    Kokubo, Yoshihiro
    Kumar, G. Anil
    Lallukka, Tea
    Lopez, Alan D.
    Lorkowski, Stefan
    Lotufo, Paulo A.
    Lozano, Rafael
    Malekzadeh, Reza
    Marz, Winfried
    Meier, Toni
    Melaku, Yohannes A.
    Mendoza, Walter
    Mensink, Gert B. M.
    Micha, Renata
    Miller, Ted R.
    Mirarefin, Mojde
    Mohan, Viswanathan
    Mokdad, Ali H.
    Mozaffarian, Dariush
    Nagel, Gabriele
    Naghavi, Mohsen
    Nguyen, Cuong Tat
    Nixon, Molly R.
    Ong, Kanyin L.
    Pereira, David M.
    Poustchi, Hossein
    Qorbani, Mostafa
    Rai, Rajesh Kumar
    Razo-Garcia, Christian
    Rehm, Colin D.
    Rivera, Juan A.
    Rodriguez-Ramirez, Sonia
    Roshandel, Gholamreza
    Roth, Gregory A.
    Sanabria, Juan
    Sanchez-Pimienta, Tania G.
    Sartorius, Benn
    Schmidhuber, Josef
    Schutte, Aletta Elisabeth
    Sepanlou, Sadaf G.
    Shin, Min-Jeong
    Sorensen, Reed J. D.
    Springmann, Marco
    Szponar, Lucjan
    Thorne-Lyman, Andrew L.
    Thrift, Amanda G.
    Touvier, Mathilde
    Tran, Bach Xuan
    Tyrovolas, Stefanos
    Ukwaja, Kingsley Nnanna
    Ullah, Irfan
    Uthman, Olalekan A.
    Vaezghasemi, Masoud
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin. Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för socialt arbete.
    Vasankari, Tommi Juhani
    Vollset, Stein Emil
    Vos, Theo
    Vu, Giang Thu
    Vu, Linh Gia
    Weiderpass, Elisabete
    Werdecker, Andrea
    Wijeratne, Tissa
    Willett, Walter C.
    Wu, Jason H.
    Xu, Gelin
    Yonemoto, Naohiro
    Yu, Chuanhua
    Murray, Christopher J. L.
    Health effects of dietary risks in 195 countries, 1990-2017: a systematic analysis for the Global Burden of Disease Study 20172019Ingår i: The Lancet, ISSN 0140-6736, E-ISSN 1474-547X, Vol. 393, nr 10184, s. 1958-1972Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Suboptimal diet is an important preventable risk factor for non-communicable diseases (NCDs); however, its impact on the burden of NCDs has not been systematically evaluated. This study aimed to evaluate the consumption of major foods and nutrients across 195 countries and to quantify the impact of their suboptimal intake on NCD mortality and morbidity.

    Methods: By use of a comparative risk assessment approach, we estimated the proportion of disease-specific burden attributable to each dietary risk factor (also referred to as population attributable fraction) among adults aged 25 years or older. The main inputs to this analysis included the intake of each dietary factor, the effect size of the dietary factor on disease endpoint, and the level of intake associated with the lowest risk of mortality. Then, by use of diseasespecific population attributable fractions, mortality, and disability-adjusted life-years (DALYs), we calculated the number of deaths and DALYs attributable to diet for each disease outcome.

    Findings: In 2017, 11 million (95% uncertainty interval [UI] 10-12) deaths and 255 million (234-274) DALYs were attributable to dietary risk factors. High intake of sodium (3 million [1-5] deaths and 70 million [34-118] DALYs), low intake of whole grains (3 million [2-4] deaths and 82 million [59-109] DALYs), and low intake of fruits (2 million [1-4] deaths and 65 million [41-92] DALYs) were the leading dietary risk factors for deaths and DALYs globally and in many countries. Dietary data were from mixed sources and were not available for all countries, increasing the statistical uncertainty of our estimates.

    Interpretation: This study provides a comprehensive picture of the potential impact of suboptimal diet on NCD mortality and morbidity, highlighting the need for improving diet across nations. Our findings will inform implementation of evidence-based dietary interventions and provide a platform for evaluation of their impact on human health annually.

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  • 3.
    Benebo, Faith Owunari
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Schumann, Barbara
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Vaezghasemi, Masoud
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Intimate partner violence against women in Nigeria: a multilevel study investigating the effect of women's status and community norms2018Ingår i: BMC Women's Health, E-ISSN 1472-6874, Vol. 18, artikel-id 136Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Intimate partner violence (IPV) against women has been recognised as a public health problem with far-reaching consequences for the physical, reproductive, and mental health of women. The ecological framework portrays intimate partner violence as a multifaceted phenomenon, demonstrating the interplay of factors at different levels: individual, community, and the larger society. The present study examined the effect of individual- and community-level factors on IPV in Nigeria, with a focus on women's status and community-level norms among men.

    METHODS: A cross-sectional study based on the latest Nigerian Demographic Health Survey (2013) was conducted involving 20,802 ever-partnered women aged 15-49 years. Several multilevel logistic regression models were calibrated to assess the association of individual- and community-level factors with IPV. Both measures of association (fixed effect) and measures of variations (random effect) were reported.

    RESULTS: Almost one in four women in Nigeria reported having ever experienced intimate partner violence. Having adjusted for other relevant covariates, higher women's status reduced the odds of IPV (OR = 0.47; 95% CI = 0.32-0.71). However, community norms among men that justified IPV against women modified the observed protective effect of higher women's status against IPV and reversed the odds (OR = 1.89; 95% CI = 1.26-2.83).

    CONCLUSIONS: Besides women's status, community norms towards IPV are an important factor for the occurrence of IPV. Thus, addressing intimate partner violence against women calls for community-wide approaches aimed at changing norms among men alongside improving women's status.

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  • 4.
    Eurenius, Eva
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Mohamed, Amal Farah
    Eating Disorder Unit, Helsinki University Hospital, Helsinki, Finland.
    Lindkvist, Marie
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Ivarsson, Anneli
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Öhlund, Inger
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Vaezghasemi, Masoud
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Social-Emotional Problems Among 3-Year-Olds Are Associated With an Unhealthy Lifestyle: A Population-Based Study2021Ingår i: Frontiers In Public Health, ISSN 2296-2565, Vol. 9, artikel-id 694832Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Introduction: Little attention has been paid to the association between preschool children’s social-emotional problems and lifestyle at the population level.

    Objective: This study aimed to overcome this knowledge gap by investigating to what extent children’s social-emotional problems are associated with their lifestyle and if there are any gender differences.

    Methods: This cross-sectional, population-based study used data from the regional Salut Register in northern Sweden, including 7,179 3-year-olds during 2014–2017. Parents responded to a questionnaire including the 36-month interval of the Ages and Stages Questionnaires: Social-Emotional (ASQ:SE) and questions regarding family and lifestyle characteristics. Single and multiple logistic regression were used to assess the association between children’s social-emotional problems and multiple family lifestyle characteristics.

    Results: More reports of social-emotional problems were found among children who did not have parents living together or had markers of an unhealthy lifestyle. Children who ate vegetables less frequently, whose parent/-s brushed their teeth less often and did not read to them regularly were more likely to have social-emotional problems. Playing outdoors <3 h during weekdays and >1 h of sedentary screen time during weekends increased the risk of social-emotional problems among boys only, while >1 h of sedentary screen time during weekdays increased the risk among girls. When it comes to lifestyle and gender differences, a high proportion of the 3-year-olds had an unhealthy lifestyle, more so for boys than for girls. The dietary quality and tooth brushing were somewhat more adequate for the girls than for the boys, but boys spent more time playing outdoors compared to the girls.

    Conclusions: This study provides us with an important overview picture of the family life situation of three-year-olds, including those with social-emotional problems. Such problems were significantly associated with markers of unhealthy lifestyle, with significant gender differences. Therefore, this study suggests that in order to maintain children’ssocial-emotional ability and support children at risk of problems, public health interventionprograms should have a broader perspective on improving children’s lifestyle rather thanmerely focusing on their social and emotional problems, and the gender differences foundmay be taken in account.

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  • 5.
    Eurenius, Eva
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Richter Sundberg, Linda
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Vaezghasemi, Masoud
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för socialt arbete. Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Silfverdal, Sven-Arne
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Ivarsson, Anneli
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Lindkvist, Marie
    Umeå universitet, Samhällsvetenskapliga fakulteten, Handelshögskolan vid Umeå universitet, Statistik. Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Social-emotional problems among three-year-olds differ based on the child's gender and custody arrangement2019Ingår i: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 108, nr 6, s. 1087-1095Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    AIM: The aim of this study was to investigate mental health with respect to social-emotional problems among three-year-olds in relation to their gender, custody arrangements and place of residence.

    METHODS: A cross-sectional population-based design was used, encompassing 7,179 three-year-olds in northern Sweden during the period 2014-2017 from the regional Salut Register. Descriptive and comparative analyses were performed based on parents' responses on the Ages and Stages Questionnaires: Social-Emotional (ASQ:SE), supplemented with items on gender, custody arrangement and place of residence.

    RESULTS: Parental-reported social-emotional problems were found in almost 10% of the children. Boys were reported to have more problems (12.3%) than girls (5.6%) (p<0.001). Parents were most concerned about children's eating habits and interactions at mealtimes. Parents not living together reported more problems among their children than those living together (p<0.001). When stratifying by custody arrangement, girls in rural areas living alternately with each parent had more problems compared to those in urban areas (p<0.008).

    CONCLUSION: Gender and custody arrangements appear to be important factors for social-emotional problems among three-year-olds. Thus, such conditions should receive attention during preschool age, preferably by a systematic preventive strategy within Child Health Care.

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  • 6. Kinyoki, Damaris K.
    et al.
    Osgood-Zimmerman, Aaron E.
    Pickering, Brandon V.
    Schaeffer, Lauren E.
    Marczak, Laurie B.
    Lazzar-Atwood, Alice
    Collison, Michael L.
    Henry, Nathaniel J.
    Abebe, Zegeye
    Adamu, Abdu A.
    Adekanmbi, Victor
    Ahmadi, Keivan
    Ajumobi, Olufemi
    Al-Eyadhy, Ayman
    Al-Raddadi, Rajaa M.
    Alahdab, Fares
    Alijanzadeh, Mehran
    Alipour, Vahid
    Altirkawi, Khalid
    Amini, Saeed
    Andrei, Catalina Liliana
    Antonio, Carl Abelardo T.
    Arabloo, Jalal
    Aremu, Olatunde
    Asadi-Aliabadi, Mehran
    Atique, Suleman
    Ausloos, Marcel
    Avila, Marco
    Awasthi, Ashish
    Ayala Quintanilla, Beatriz Paulina
    Azari, Samad
    Badawi, Alaa
    Baernighausen, Till Winfried
    Bassat, Quique
    Baye, Kaleab
    Bedi, Neeraj
    Bekele, Bayu Begashaw
    Bell, Michelle L.
    Bhattacharjee, Natalia V.
    Bhattacharyya, Krittika
    Bhattarai, Suraj
    Bhutta, Zulfiqar A.
    Biadgo, Belete
    Bikbov, Boris
    Briko, Andrey Nikolaevich
    Britton, Gabrielle
    Burstein, Roy
    Butt, Zahid A.
    Car, Josip
    Castaneda-Orjuela, Carlos A.
    Castro, Franz
    Cerin, Ester
    Chipeta, Michael G.
    Chu, Dinh-Toi
    Cork, Michael A.
    Cromwell, Elizabeth A.
    Cuevas-Nasu, Lucia
    Dandona, Lalit
    Dandona, Rakhi
    Daoud, Farah
    Das Gupta, Rajat
    Weaver, Nicole Davis
    De Leo, Diego
    De Neve, Jan-Walter
    Deribe, Kebede
    Desalegn, Beruk Berhanu
    Deshpande, Aniruddha
    Desta, Melaku
    Diaz, Daniel
    Tadese Dinberu, Mesfin
    Doku, David Teye
    Dubey, Manisha
    Duraes, Andre R.
    Dwyer-Lindgren, Laura
    Earl, Lucas
    Effiong, Andem
    Zaki, Maysaa El Sayed
    El Tantawi, Maha
    El-Khatib, Ziad
    Eshrati, Babak
    Fareed, Mohammad
    Faro, Andre
    Fereshtehnejad, Seyed-Mohammad
    Filip, Irina
    Fischer, Florian
    Foigt, Nataliya A.
    Folayan, Morenike Oluwatoyin
    Fukumoto, Takeshi
    Gebrehiwot, Tsegaye Tewelde
    Gezae, Kebede Embaye
    Ghajar, Alireza
    Gill, Paramjit Singh
    Gona, Philimon N.
    Gopalani, Sameer Vali
    Grada, Ayman
    Guo, Yuming
    Haj-Mirzaian, Arvin
    Haj-Mirzaian, Arya
    Hall, Jason B.
    Hamidi, Samer
    Henok, Andualem
    Prado, Bernardo Hernandez
    Herrero, Mario
    Herteliu, Claudiu
    Hoang, Chi Linh
    Hole, Michael K.
    Hossain, Naznin
    Hosseinzadeh, Mehdi
    Hu, Guoqing
    Islam, Sheikh Mohammed Shariful
    Jakovljevic, Mihajlo
    Jha, Ravi Prakash
    Jonas, Jost B.
    Jozwiak, Jacek Jerzy
    Kahsay, Amaha
    Kanchan, Tanuj
    Karami, Manoochehr
    Kasaeian, Amir
    Khader, Yousef Saleh
    Khan, Ejaz Ahmad
    Khater, Mona M.
    Kim, Yun Jin
    Kimokoti, Ruth W.
    Kisa, Adnan
    Kochhar, Sonali
    Kosen, Soewarta
    Koyanagi, Ai
    Krishan, Kewal
    Defo, Barthelemy Kuate
    Kumar, G. Anil
    Kumar, Manasi
    Lad, Sheetal D.
    Lami, Faris Hasan
    Lee, Paul H.
    Levine, Aubrey J.
    Li, Shanshan
    Linn, Shai
    Lodha, Rakesh
    Abd El Razek, Hassan Magdy
    Abd El Razek, Muhammed Magdy
    Majdan, Marek
    Majeed, Azeem
    Malekzadeh, Reza
    Malta, Deborah Carvalho
    Mamun, Abdullah A.
    Mansournia, Mohammad Ali
    Martins-Melo, Francisco Rogerlandio
    Masaka, Anthony
    Massenburg, Benjamin Ballard
    Mayala, Benjamin K.
    Mejia-Rodriguez, Fabiola
    Melku, Mulugeta
    Mendoza, Walter
    Mensah, George A.
    Miazgowski, Tomasz
    Miller, Ted R.
    Mini, G. K.
    Mirrakhimov, Erkin M.
    Moazen, Babak
    Darwesh, Aso Mohammad
    Mohammed, Shafiu
    Mohebi, Farnam
    Mokdad, Ali H.
    Moodley, Yoshan
    Moradi, Ghobad
    Moradi-Lakeh, Maziar
    Moraga, Paula
    Morrison, Shane Douglas
    Mosser, Jonathan F.
    Mousavi, Seyyed Meysam
    Mueller, Ulrich Otto
    Murray, Christopher J. L.
    Mustafa, Ghulam
    Naderi, Mehdi
    Naghavi, Mohsen
    Najafi, Farid
    Nangia, Vinay
    Ndwandwe, Duduzile Edith
    Negoi, Ionut
    Ngunjiri, Josephine W.
    Nguyen, Huong Lan Thi
    Nguyen, Long Hoang
    Nguyen, Son Hoang
    Nie, Jing
    Nnaji, Chukwudi A.
    Noubiap, Jean Jacques
    Shiadeh, Malihe Nourollahpour
    Nyasulu, Peter S.
    Ogbo, Felix Akpojene
    Olagunju, Andrew T.
    Olusanya, Bolajoko Olubukunola
    Olusanya, Jacob Olusegun
    Ortiz-Panozo, Eduardo
    Otstavnov, Stanislav S.
    Mahesh, P. A.
    Pana, Adrian
    Pandey, Anamika
    Pati, Sanghamitra
    Patil, Snehal T.
    Patton, George C.
    Perico, Norberto
    Pigott, David M.
    Pirsaheb, Meghdad
    Piwoz, Ellen G.
    Postma, Maarten J.
    Pourshams, Akram
    Prakash, Swayam
    Quintana, Hedley
    Radfar, Amir
    Rafiei, Alireza
    Rahimi-Movaghar, Vafa
    Rai, Rajesh Kumar
    Rajati, Fatemeh
    Rawaf, David Laith
    Rawaf, Salman
    Rawat, Rahul
    Remuzzi, Giuseppe
    Renzaho, Andre M. N.
    Rios-Gonzalez, Carlos
    Roever, Leonardo
    Ross, Jennifer M.
    Rostami, Ali
    Sadat, Nafis
    Safari, Yahya
    Safdarian, Mahdi
    Sahebkar, Amirhossein
    Salam, Nasir
    Salamati, Payman
    Salimi, Yahya
    Salimzadeh, Hamideh
    Samy, Abdallah M.
    Sartorius, Benn
    Sathian, Brijesh
    Schipp, Megan F.
    Schwebel, David C.
    Senbeta, Anbissa Muleta
    Sepanlou, Sadaf G.
    Shaikh, Masood Ali
    Levy, Teresa Shamah
    Shamsi, Mohammadbagher
    Sharafi, Kiomars
    Sharma, Rajesh
    Sheikh, Aziz
    Shil, Apurba
    Silva, Diego Augusto Santos
    Singh, Jasvinder A.
    Sinha, Dhirendra Narain
    Soofi, Moslem
    Sudaryanto, Agus
    Sufiyan, Mu'awiyyah Babale
    Tabares-Seisdedos, Rafael
    Tadesse, Birkneh Tilahun
    Temsah, Mohamad-Hani
    Terkawi, Abdullah Sulieman
    Tessema, Zemenu Tadesse
    Thorne-Lyman, Andrew L.
    Tovani-Palone, Marcos Roberto
    Tran, Bach Xuan
    Tran, Khanh Bao
    Ullah, Irfan
    Uthman, Olalekan A.
    Vaezghasemi, Masoud
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Vaezi, Afsane
    Valdez, Pascual R.
    Vanderheide, John
    Veisani, Yousef
    Violante, Francesco S.
    Vlassov, Vasily
    Vu, Giang Thu
    Vu, Linh Gia
    Waheed, Yasir
    Walson, Judd L.
    Wang, Yafeng
    Wang, Yuan-Pang
    Wangia, Elizabeth N.
    Werdecker, Andrea
    Xu, Gelin
    Yamada, Tomohide
    Yisma, Engida
    Yonemoto, Naohiro
    Younis, Mustafa Z.
    Yousefifard, Mahmoud
    Yu, Chuanhua
    Bin Zaman, Sojib
    Zamani, Mohammad
    Zhang, Yunquan
    Kassebaum, Nicholas J.
    Hay, Simon I.
    Mapping child growth failure across low- and middle-income countries2020Ingår i: Nature, ISSN 0028-0836, E-ISSN 1476-4687, Vol. 577, nr 7789, s. 231-234Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Childhood malnutrition is associated with high morbidity and mortality globally. Undernourished children are more likely to experience cognitive, physical, and metabolic developmental impairments that can lead to later cardiovascular disease, reduced intellectual ability and school attainment, and reduced economic productivity in adulthood. Child growth failure (CGF), expressed as stunting, wasting, and underweight in children under five years of age (0-59 months), is a specific subset of undernutrition characterized by insufficient height or weight against age-specific growth reference standards. The prevalence of stunting, wasting, or underweight in children under five is the proportion of children with a height-for-age, weight-for-height, or weight-for-age z-score, respectively, that is more than two standard deviations below the World Health Organization's median growth reference standards for a healthy population. Subnational estimates of CGF report substantial heterogeneity within countries, but are available primarily at the first administrative level (for example, states or provinces); the uneven geographical distribution of CGF has motivated further calls for assessments that can match the local scale of many public health programmes. Building from our previous work mapping CGF in Africa, here we provide the first, to our knowledge, mapped highspatial-resolution estimates of CGF indicators from 2000 to 2017 across 105 low- and middle-income countries (LMICs), where 99% of affected children live, aggregated to policy-relevant first and second (for example, districts or counties) administrativelevel units and national levels. Despite remarkable declines over the study period, many LMICs remain far from the ambitious World Health Organization Global Nutrition Targets to reduce stunting by 40% and wasting to less than 5% by 2025. Large disparities in prevalence and progress exist across and within countries; our maps identify high-prevalence areas even within nations otherwise succeeding in reducing overall CGF prevalence. By highlighting where the highest-need populations reside, these geospatial estimates can support policy-makers in planning interventions that are adapted locally and in efficiently directing resources towards reducing CGF and its health implications.

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  • 7. LBD Double Burden of Malnutrition Collaborators,
    Mapping local patterns of childhood overweight and wasting in low- and middle-income countries between 2000 and 20172020Ingår i: Nature Medicine, ISSN 1078-8956, E-ISSN 1546-170X, Vol. 26, nr 5, s. 750-759Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    A double burden of malnutrition occurs when individuals, household members or communities experience both undernutrition and overweight. Here, we show geospatial estimates of overweight and wasting prevalence among children under 5 years of age in 105 low- and middle-income countries (LMICs) from 2000 to 2017 and aggregate these to policy-relevant administrative units. Wasting decreased overall across LMICs between 2000 and 2017, from 8.4% (62.3 (55.1–70.8) million) to 6.4% (58.3 (47.6–70.7) million), but is predicted to remain above the World Health Organization’s Global Nutrition Target of <5% in over half of LMICs by 2025. Prevalence of overweight increased from 5.2% (30 (22.8–38.5) million) in 2000 to 6.0% (55.5 (44.8–67.9) million) children aged under 5 years in 2017. Areas most affected by double burden of malnutrition were located in Indonesia, Thailand, southeastern China, Botswana, Cameroon and central Nigeria. Our estimates provide a new perspective to researchers, policy makers and public health agencies in their efforts to address this global childhood syndemic.

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  • 8.
    Lindvall, Kristina
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Vaezghasemi, Masoud
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Feldman, Inna
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa. Department of Public Health and Caring Science, Uppsala University, Uppsala, Sweden.
    Ivarsson, Anneli
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Stevens, Katherine J.
    School of Health and Related Research, The University of Sheffield, Sheffield, United Kingdom.
    Petersen, Solveig
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Feasibility, reliability and validity of the health-related quality of life instrument Child Health Utility 9D (CHU9D) among school-aged children and adolescents in Sweden2021Ingår i: Health and Quality of Life Outcomes, E-ISSN 1477-7525, Vol. 19, nr 1, artikel-id 193Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: This study was conducted in a general population of schoolchildren in Sweden, with the aim to assess the psychometric properties of a generic preference-based health related quality of life (HRQoL) instrument, the Swedish Child Health Utility 9D (CHU9D), among schoolchildren aged 7–15 years, and in subgroups aged 7–9, 10–12 and 13–15 years.

    Methods: In total, 486 school aged children, aged 7–15 years, completed a questionnaire including the CHU9D, the Pediatric quality of life inventory 4.0 (PedsQL), KIDSCREEN-10, questions on general health, long-term illness, and sociodemographic characteristics. Psychometric testing was undertaken of feasibility, internal consistency reliability, test–retest reliability, construct validity, factorial validity, concurrent validity, convergent validity and divergent validity.

    Results: The CHU9D evidenced very few missing values, minimal ceiling, and no floor effects. The instrument achieved satisfactory internal consistency (Cronbach’s Alfa > 0.7) and strong test–retest reliability (r > 0.6). Confirmatory factor analyses supported the proposed one-factor structure of the CHU9D. For child algorithm, RMSEA = 0.05, CFI = 0.95, TLI = 0.94, and SRMR = 0.04. For adult algorithm RMSEA = 0.04, CFI = 0.96, TLI = 0.95, and SRMR = 0.04. The CHU9D utility value correlated moderately or strongly with KIDSCREEN-10 and PedsQL total scores (r > 0.5–0.7). The CHU9D discriminated as anticipated on health and on three of five sociodemographic characteristics (sex, age, and custody arrangement, but not socioeconomic status and ethnic origin).

    Conclusions: This study provides evidence that the Swedish CHU9D is a feasible, reliable and valid measure of preference-based HRQoL in children. The study furthermore suggests that the CHU9D is appropriate for use among children 7–15 years of age in the general population, as well as among subgroups aged 7– 9, 10–12 and 13–15 years.

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  • 9.
    Lwin, Min Wai
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Timby, Erika
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Obstetrik och gynekologi.
    Ivarsson, Anneli
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Eurenius, Eva
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Vaezghasemi, Masoud
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Silfverdal, Sven-Arne
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Lindkvist, Marie
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Abnormal birth weights for gestational age in relation to maternal characteristics in Sweden: a five year cross-sectional study2023Ingår i: BMC Public Health, E-ISSN 1471-2458, Vol. 23, nr 1, artikel-id 976Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Abnormal birth weight - small for gestational age (SGA) and large for gestational age (LGA) - are important indicators for newborn health. Due to changes in lifestyle in recent decades, it is essential to keep up-to-date with the latest information on maternal factors linked to abnormal birth weight. The aim of this study is to investigate SGA and LGA in relation to maternal individual, lifestyle and socioeconomic characteristics.

    Methods: This is a register-based cross-sectional study. Self-reported data from Sweden's Salut Programme maternal questionnaires (2010-2014) were linked with records in the Swedish Medical Birth Register (MBR). The analytical sample comprised 5089 singleton live births. A Swedish standard method using ultrasound-based sex-specific reference curves defines the abnormality of birth weight in MBR. Univariable and multivariable logistic regressions were used to examine crude and adjusted associations between abnormal birth weights and maternal individual, lifestyle and socioeconomic characteristics. A sensitivity analysis, using alternative definitions of SGA and LGA under the percentile method, was undertaken.

    Results: In multivariable logistic regression, maternal age and parity were associated with LGA (aOR = 1.05, CI = 1.00, 1.09) and (aOR = 1.31, CI = 1.09, 1.58). Maternal overweight and obesity were strongly associated with LGA (aOR = 2.28, CI = 1.47, 3.54) and (aOR = 4.55, CI = 2.85, 7.26), respectively. As parity increased, the odds of delivering SGA babies decreased (aOR = 0.59, CI = 0.42, 0.81) and preterm deliveries were associated with SGA (aOR = 9.46, CI = 5.67, 15.79). The well-known maternal determinants of abnormal birthweight, such as unhealthy lifestyles and poor socioeconomic factors, were not statistically significant in this Swedish setting.

    Conclusions: The main findings suggest that multiparity, maternal pre-pregnancy overweight and obesity are strong determinants for LGA babies. Public health interventions should address modifiable risk factors, especially maternal overweight and obesity. These findings suggest that overweight and obesity is an emerging public health threat for newborn health. This might also result in the intergenerational transfer of overweight and obesity. These are important messages for public health policy and decision making.

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  • 10.
    Ng, Nawi
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Kusnato, Hari
    Yogyakarta, Indonesia.
    Wall, Stig
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Weinehall, Lars
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Vaezghasemi, Masoud
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Schröders, Julia
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Inequities in child health and nutrition in Indonesia: Policy brief2013Ingår i: Evidence for Policy and Implementation, EPI-4, Stockholm: Swedish Agency for International Development Cooperation (SIDA), 2013Konferensbidrag (Övrigt vetenskapligt)
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  • 11.
    Santosa, Ailiana
    et al.
    Umeå universitet, Samhällsvetenskapliga fakulteten, Enheten för demografi och åldrandeforskning (CEDAR). Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Schröders, Julia
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Vaezghasemi, Masoud
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa. Umeå universitet, Samhällsvetenskapliga fakulteten, Umeå centrum för genusstudier (UCGS).
    Ng, Nawi
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa. Umeå universitet, Samhällsvetenskapliga fakulteten, Enheten för demografi och åldrandeforskning (CEDAR).
    Inequality in disability-free life expectancies among older men and women in six countries with developing economies2016Ingår i: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 70, nr 9, s. 855-861Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: It is unclear whether the increase in life expectancy (LE) globally is coupled with a postponement of morbidity and disability. Evidence on trends and determinants of disability-free life expectancies (DFLEs) are available in high-income countries but less in low and middle-income countries (LMICs). This study examines the levels of and inequalities in LE, disability and DFLE between men and women across different age groups aged 50 years and over in six countries with developing economies.

    METHODS: This study utilised the cross-sectional data (n=32 724) from the WHO Study on global AGEing and adult health (SAGE) in China, Ghana, India, Mexico, the Russian Federation and South Africa in 2007-2010. Disability was measured with the activity of daily living (ADL) instrument. The DFLE was estimated using the Sullivan method based on the standard period life table and ADL-disability proportions.

    RESULTS: The disability prevalence ranged from 13% in China to 54% in India. The prevalence of disability was highest and occurred at younger age in both sexes in India. Women were more disadvantaged with higher prevalence of disability across all age groups, and the situation was worst among older women in Mexico and the Russian Federation. Though women had higher LE, their proportion of remaining LE free from disability was lower than men.

    CONCLUSIONS: There are inequalities in the levels of disability and DFLE among men and women in different age groups among people aged over 50 years in these six countries. Countermeasures to decrease intercountry and gender gaps in DFLE, including improvements in health promotion and healthcare distribution, with a gender equity focus, are needed.

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  • 12.
    Vaezghasemi, Masoud
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Nutrition transition and the double burden of malnutrition in Indonesia: a mixed method approach exploring social and contextual determinants of malnutrition2017Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    Abstract [en]

    Introduction

    Nutrition transition concerns the broad changes in the human diet that have occurred over time and space. In low- to middle-income countries such as Indonesia, nutrient transition describes shifts from traditional diets high in cereal and fibre towards Western pattern diets high in sugars, fat, and animal-source foods. This causes a swift increase in the prevalence of overweight and obesity while undernutrition remains a great public health concern. Thus a double burden of malnutrition occurs in the population. The main aim of this investigation was to explore social and contextual determinants of malnutrition in Indonesia. The specific objectives were: (i) to examine body mass index (BMI) changes at the population level, and between and within socioeconomic groups; (ii) to estimate which context (i.e., household or district) has a greater effect on the variation of BMI; (iii) to assess the prevalence of double burden households (defined as the coexistence of underweight and overweight individuals residing in the same household) and its variation among communities as well as its determining factors; and (iv) to explore and understand what contributes to a double burden of malnutrition within a household by focusing on gender relations.

    Methods

    A mixed method approach was adopted in this study. For the quantitative analyses, nationally representative repeated cross-sectional survey data from four Indonesian Family Life Surveys (IFLS; 1993, 1997, 2000, 2007) were used. The IFLS contains information about individual-level, household-level and area-level characteristics. The analyses covered single and multilevel regressions. Data for the qualitative component were collected from sixteen focus group discussions conducted in Central Java and in the capital city Jakarta among 123 rural and urban men and women. Connell’s relational theory of gender and Charmaz’s constructive grounded theory were used to analyse the qualitative data.

    Results

    Greater increases in BMI were observed at higher percentiles compared to the segment of the population at lower percentiles. While inequalities in mean BMI decreased between socioeconomic groups, within group dispersion increased over time. Households were identified as an important social context in which the variation of BMI increased over time. Ignoring the household level did not change the relative variance contribution of districts on BMI in the contextual analysis. Approximately one-fifth of all households exhibited a double burden of malnutrition. Living in households with a higher socioeconomic status resulted in higher odds of double burden of malnutrition with the exception of women-headed households and communities with high social capital. The qualitative analysis resulted in the construction of three categories: capturing the significance of gendered power relations, the emerging obesogenic environment, and generational relations for child malnutrition.

    Conclusion

    At the population level, greater increases in within-group inequalities imply that growing inequalities in BMI were not merely driven by socioeconomic factors. This suggests that other under-recognised social and contextual factors may have a greater effect on the variation in BMI. At the contextual level, recognition of increased variation among households is important for creating strategies that respond to the differential needs of individuals within the same household. At the household level, women’s empowerment and community social capital should be promoted to reduce inequalities in the double burden of malnutrition across different socioeconomic groups. Ultimately community health and nutrition programmes will need to address gender empowerment and engage men in the fight against the emerging obesogenic environment and increased malnutrition that is evident within households, especially overweight and obesity among children.

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  • 13.
    Vaezghasemi, Masoud
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Eurenius, Eva
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Ivarsson, Anneli
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Richter Sundberg, Linda
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Silfverdal, Sven-Arne
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Lindkvist, Marie
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Social-emotional problems among Swedish three-year-olds: an Item Response Theory analysis of the Ages and Stages Questionnaires: Social-Emotional2020Ingår i: BMC Pediatrics, E-ISSN 1471-2431, Vol. 20, nr 1, artikel-id 149Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: There is enough evidence to believe that young children's social-emotional problems can have a long-term effect if extra support is not given early. Therefore, early identification of such problems and any differences between boys and girls are of importance. We utilized the 36-month interval of the Ages and Stages Questionnaires: Social-Emotional (ASQ:SE) among 3-year-olds aiming: 1) to report the normative values of social-emotional problems for Swedish boys and girls; 2) to identify ASQ:SE items that are most commonly endorsed by children with high level of social-emotional problems (high score on ASQ:SE); 3) to assess whether certain ASQ:SE items differ between boys and girls at the same level of social-emotional problems; and 4) to examine whether ASQ:SE performs well in identifying children with high level of social-emotional problems (high score on ASQ:SE).

    Method: During 2014–2017, data were collected from 7179 three-year-old children (boys = 3719, girls = 3460) through Child Health Care in the Region Västerbotten in the northern part of Sweden. Unidimensionality was assessed by Confirmatory Factor Analysis and goodness-of-fit was reported. Item Response Theory was used to answer the aims of the study.

    Results: Items regarding interest in sexual words, too little sleep, disinterest in things around, unhappiness and self-injury were more commonly endorsed by children with high levels of social-emotional problems, as reported by their parents. For the same level of social-emotional problem, girls were more likely to demonstrate difficulties in occupying themselves, clinging behaviour and repetitive behaviour. On the other hand, boys were more likely to score high in items regarding destruction of things on purpose, difficulty to name friends and to express feelings. We have also found that the ASQ:SE is suitable for identifying children with high level of social-emotional problems.

    Conclusion: The salient point of our study was to increase knowledge about Swedish children's social-emotional problems at 3-years of age based on the psychometric characteristics of the ASQ:SE using Item Response Theory model. The gender differences as well as those items that occurred at high levels of social-emotional problems should be of concern for everyday practice in Child Health Care.

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  • 14.
    Vaezghasemi, Masoud
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Eurenius, Eva
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Ivarsson, Anneli
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Richter Sundberg, Linda
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Silfverdal, Sven-Arne
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Lindkvist, Marie
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    The Ages and Stages Questionnaire: Social-Emotional—What Is the Optimal Cut-Off for 3-Year-Olds in the Swedish Setting?2022Ingår i: Frontiers in Pediatrics , E-ISSN 2296-2360, Vol. 10, artikel-id 756239Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective: Expressions of emotional and behavioral symptoms in preschool age can predict mental health problems in adolescence and adulthood. The Ages and Stages Questionnaires: Social-Emotional (ASQ:SE) has been successful in detecting social and emotional problems in young children in some countries but had not been tested in Sweden. The objective of this study was to determine the optimal cut-off for the ASQ:SE instrument when administered to 3-year-old children in a northern Swedish setting, using the Strengths and Difficulties Questionnaire (SDQ) as the reference.

    Methods: The ASQ:SE (36-month interval, first edition) was administered at routine 3-year-olds' visits to Child Health Care centers in Region Västerbotten, Sweden. During the study period (September 2017 to March 2018) parents were invited to also fill out the SDQ (2–4 year version). In the final analyses 191 children fulfilled the criteria for inclusion in the study sample. Non-parametric Receiver Operating Characteristic analysis was performed to quantify the discriminatory accuracy of ASQ:SE based on SDQ.

    Results: The Pearson correlation between ASQ:SE and SDQ indicated strong correlation between the two instruments. The Receiver Operating Characteristic curve showed good accuracy of ASQ:SE in relation to SDQ. However, our results suggest that the existing ASQ:SE cut-off score of 59 was not optimal in the Swedish context. Changing the cut-off from 59 to 50 would allow us to detect 100% (n = 14) of children with problems according to SDQ, compared to 64% (n = 9) when the cut-off was 59. However, the proportion of false positives would be higher (9% compared to 3%).

    Conclusion: The main finding was that for 3-year-olds in Sweden a decreased ASQ:SE cut-off score of 50 would be optimal. This would increase the detection rate of at-risk children according to SDQ (true positive), thus prioritizing sensitivity. Our conclusion is that, although this change would result in more false positives, this would be justifiable.

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  • 15.
    Vaezghasemi, Masoud
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Eurenius, Eva
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Richter Sundberg, Linda
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Ivarsson, Anneli
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Silfverdal, Sven-Arne
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Lindkvist, Marie
    Umeå universitet, Samhällsvetenskapliga fakulteten, Handelshögskolan vid Umeå universitet, Statistik. Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Social-emotional problems among Swedish three-year-olds: an Item Response Theory Analysis2019Ingår i: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 29, nr Suppl 4, s. 367-368Artikel i tidskrift (Övrigt vetenskapligt)
    Abstract [en]

    Background: Young children’s social-emotional problems can have a long-term effect if not treated early. In order to deepen our knowledge about children’s social and emotional functioning, we utilized the Ages and Stages Questionnaires: Social-Emotional (ASQ:SE) among 3-year-olds in Sweden aiming: 1) to identify ASQ:SE items that are most commonly endorsed by children with high level of social-emotional problems; and 2) to assess whether certain ASQ:SE items differs between boys and girls at the same level of social-emotional problems.

    Methods: During 2014-2017 data was collected from 7179 three-year-old children through Child Health Care in a northern county of Sweden within the Salut Child Health Promotion Programme. Item Characteristic Curve (ICC) and Differential Item Functioning (DIF) were used to identify the characteristics of children with high social-emotional problems and to determine whether an item exhibit uniform between boys and girls at the same level of social-emotional problems.

    Results: Items regarding interest in sexual words, too little sleep, disinterest in things around, unhappiness and self-injury were more commonly endorsed by children with high levels of social-emotional problems. Additionally, on the same level of social-emotional problem girls were more likely to score high in items regarding difficulties to occupy herself, clinging behaviour and repetitive behaviour while boys were more likely to score high in items regarding difficulty to name friends, difficulty to express feelings and destruction of things on purpose.

    Conclusions: This study has increased our knowledge about Swedish young children’s social emotional functioning already at the age of three by detecting which items are most closely connected to high level of social-emotional problems and differences between boys and girls. However, whether the results detected in this analysis are reflecting their parents’ expectations more than child behaviour requires further investigations.

    Key messages

    • Children with high level of social-emotional problems were rated high on items regarding interest in sexual words, too little sleep, disinterest in things around, unhappiness and self-injury.

    • On equal levels of social-emotional problems, girls were more often reported with internalizing problematic behaviours and boys were more often reported with externalizing problematic behaviours.

  • 16.
    Vaezghasemi, Masoud
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Lindkvist, Marie
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa. Umeå universitet, Samhällsvetenskapliga fakulteten, Handelshögskolan vid Umeå universitet, Statistik.
    Ivarsson, Anneli
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Eurenius, Eva
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Overweight and lifestyle among 13-15 year olds: A cross-sectional study in northern Sweden.2012Ingår i: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 40, nr 3, s. 221-228Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Aim: To increase knowledge of self-rated health and lifestyle in relation to overweight/obesity among 13-15 year olds in northern Sweden. Methods: All 6768 13-15 year olds in nine out of 15 municipalities in Västerbotten County were asked to complete a cross-sectional school-based on-line survey in 2007. Eighty-two per cent participated in the study. Responses were considered reliable for 74% of the participants (2517 boys/2470 girls). The survey addressed demography, self-rated health, self-reported weight, height, and lifestyle characteristics. Simple and multiple logistic regression analyses were used. Results: Overweight/obesity (ISO body mass index ≥25 kg/m(2)) was more prevalent among boys (20%) than girls (11%), but more girls (19%) than boys (9%) reported fair or bad health. Overweight/obese boys and girls were more often physically inactive. For the boys, overweight/obesity was also associated with skipping breakfast, insufficient tooth brushing, and using snuff. For the girls, overweight/obesity was also associated with living with one parent and more television watching. Boys reported healthier habits concerning sleep duration, physical activity, eating breakfast, and smoking compared to the girls. On the other hand, girls reported better dietary and tooth brushing habits. Conclusions: This study uncovered two alarming findings: a fifth of the boys were overweight/obese and a fifth of the girls reported fair or bad health. Girls living with a single parent and boys and girls with unhealthy lifestyles were more likely to be overweight. Our findings emphasise the need for developing and implementing effective health promotion strategies for school-aged children to prevent an overweight and obesity epidemic that could continue into adulthood.

  • 17.
    Vaezghasemi, Masoud
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa. Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för socialt arbete.
    Mosquera, Paola
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Gustafsson, Per E.
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Nilsson, Karina
    Umeå universitet, Samhällsvetenskapliga fakulteten, Sociologiska institutionen.
    Strandh, Mattias
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för socialt arbete. Centre for Research on Child and Adolescent Mental Health, Karlstad University, Karlstad, Sweden.
    Decomposition of income-related inequality in upper secondary school completion in Sweden by mental health, family conditions and contextual characteristics.2020Ingår i: SSM - Population Health, ISSN 2352-8273, Vol. 11, artikel-id 100566Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: While previous research has evidently and extensively acknowledged socioeconomic gradients in children's education, we know very little about the determinants of socioeconomic-related inequality in children's education at the population level in Sweden. Therefore, we aimed: (i) to assess the extent of income inequality in upper secondary school completion in Sweden; (ii) to examine the contribution of mental health and other determinants to income inequality; and (iii) to explore gender differences in the magnitude and determinants of the inequalities.

    Method: We utilised data from a population-based cohort available in Umeå SIMSAM Lab, linked with several national registries in Sweden. The dataset includes all children who were born in Sweden in 1991 and completed or not completed their upper secondary education in 2010, n = 116,812 (56,612 girls and 60,200 boys). We analysed the data using a Wagstaff-type decomposition method.

    Results: The results first show substantial income-related inequality in upper secondary school incompletion concentrated among the poor in the Swedish setting. Second, these inequalities were in turn to a large degree explained jointly by parental, family and child factors; primarily parents' income and education, number of siblings and child's poor mental health. Third, these inferences remained when boys and girls were considered separately, although the determinants explained a greater share of the inequalities in boys than in girls.

    Conclusion: Our results highlighted substantial income-related inequality in upper secondary school incompletion concentrated among the poor in the Swedish setting. Apart from family level characteristics, which explained a large portion of the inequalities, mental health problems appeared to be of particular importance as they represent a central target for both increasing the population average in upper secondary school completion and for reducing the gap in income-related inequalities in Sweden.

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  • 18.
    Vaezghasemi, Masoud
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa. Umeå universitet, Samhällsvetenskapliga fakulteten, Umeå centrum för genusstudier (UCGS).
    Ng, Nawi
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Eriksson, Malin
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Subramanian, S. V.
    Households, the omitted level in contextual analysis: disentangling the relative influence of households and districts on the variation of BMI about two decades in Indonesia2016Ingår i: International Journal for Equity in Health, E-ISSN 1475-9276, Vol. 15, artikel-id 102Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Most of the research investigating the effect of social context on individual health outcomes has interpreted context in terms of the residential environment. In these studies, individuals are nested within their neighbourhoods or communities, disregarding the intermediate household level that lies between individuals and their residential environment. Households are an important determinant of health yet they are rarely included at the contextual level in research examining association between body mass index (BMI) and the social determinants of health. In this study, our main aim was to provide a methodological demonstration of multilevel analysis, which disentangles the simultaneous effects of households and districts as well as their associated predictors on BMI over time.

    Methods: Using both two- and three-level multilevel analysis, we utilized data from all four cross-sections of the Indonesian Family life Survey (IFLS) 1993 to 2007-8.

    Results: We found that: (i) the variation in BMI attributable to districts decreased from 4.3 % in 1993 to 1.5 % in 1997-98, and remained constant until 2007-08, while there was an alarming increase in the variation of BMI attributable to households, from 10 % in 2000 to 15 % in 2007-08; (ii) ignoring the household level did not change the relative variance contribution of districts on BMI, but ignoring the district level resulted in overestimation of household effects, and (iii) households' characteristics (socioeconomic status, size, and place of residence) did not attenuate the variation of BMI at the household-level.

    Conclusions: Estimating the relative importance of multiple social settings allows us to better understand and unpack the variation in clustered or hieratical data in order to make valid and robust inferences. Our findings will help direct investment of limited public health resources to the appropriate context in order to reduce health risk (variation in BMI) and promote population health.

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  • 19.
    Vaezghasemi, Masoud
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Pulkki-Brännström, Anni-Maria
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Lindkvist, Marie
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Silfverdal, Sven-Arne
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Lohr, Wolfgang
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Ivarsson, Anneli
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Social inequalities in social-emotional problems among preschool children: a population-based study in Sweden2023Ingår i: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 16, nr 1, artikel-id 2147294Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Social-emotional ability is important for overall health and wellbeing in early childhood. Recognizing preschool children in need of extra support, especially those living in unfavourable conditions, can have immediate positive effects on their health and benefit their wellbeing in the long-term.

    OBJECTIVES: The aim of this study is to investigate whether there are social inequalities in preschool children's social-emotional problems, and whether inequalities differ between boys and girls.

    METHOD: This study utilized repeated measures from cross-sectional population-based surveys of three-year old children (2014-2018). The final study population comprised of 9,099 children which was 61% of all the eligible children in Västerbotten County during the study period. The Ages and Stages Questionnaires: Social-Emotional (ASQ:SE) 36-month interval was used to measure children's social-emotional ability. Social inequalities were studied with respect to parents' income, education, and place of birth, for which data was obtained from Statistics Sweden. Multiple logistic and ordered regressions were used.

    RESULTS: Among 3-year-olds, social-emotional problems were more common in the most vulnerable social groups, i.e. parents in the lowest income quintile (OR: 1.45, p < 0.001), parents with education not more than high school (OR: 1.51, p < 0.001), and both parents born outside Sweden (OR: 2.54, p < 0.001). Notably, there was a larger difference in social-emotional problems between the lowest and highest social categories for girls compared to boys. Higher odds of social-emotional problems were associated with boys not living with both parents and girls living in the areas of Skellefteå and Umeå, i.e. more populated geographical areas.

    CONCLUSION: Already at 3-years of age social-emotional problems were more common in children with parents in the most vulnerable social groups. This does not fulfil the ambition of an equitable start in life for every child and might contribute to reproduction of social inequalities across generations.

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  • 20.
    Vaezghasemi, Masoud
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa. Umeå universitet, Samhällsvetenskapliga fakulteten, Umeå centrum för genusstudier (UCGS).
    Razak, Fahad
    Ng, Nawi
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Subramanian, S.V.
    Inter-individual inequality in BMI: an analysis of Indonesian Family LifeSurveys (1993–2007)2016Ingår i: SSM - Population Health, ISSN 2352-8273, Vol. 2, s. 876-888Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Widening inequalities in mean Body Mass Index (BMI) between social and economic groups are well documented. However, whether changes in mean BMI are followed by changes in dispersion (or variance) and whether these inequalities are also occurring within social groups or across individuals remain understudied. In addition, a substantial body of literature exists on the global increase in mean BMI and prevalence of overweight and obesity. However, whether this weight gain is shared proportionately across the whole spectrum of BMI distribution, also remains understudied. We examined changes in the distribution of BMI at the population level over time to understand how changes in the dispersion reflect between-group compared to within-group inequalities in weight gain. Moreover, we investigated the entire distribution of BMI to determine in which percentiles the most weight gain is occurring over time. Utilizing four waves (from 1993 to 2007) of Indonesian Family Life Surveys (IFLS), we estimated changes in the mean and the variance of BMI over time and across various socioeconomic groups based on education and households’ expenditure per capita in 53,648 men and women aged 20–50 years. An increase in mean and standard deviation was observed among men (by 4.3% and 25%, respectively) and women (by 7.3% and 20%, respectively) over time. Quantile-Quantile plots showed that higher percentiles had greater increases in BMI compared to the segment of the population at lower percentiles. While between socioeconomic group differences decreased over time, within-group differences increased and were more prominent among individuals with poor education and lower per capita expenditures. Population changes in BMI cannot be fully described by average trends or single parameters such as the mean BMI. Moreover, greater increases in within-group dispersion compared with between-group differences imply that growing inequalities are not merely driven by these socioeconomic factors at the population level.

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  • 21.
    Vaezghasemi, Masoud
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Sundberg, Linda
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Ivarsson, Anneli
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Eurenius, Eva
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Silfverdal, Sven Arne
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Lindkvist, Marie
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin.
    Psychometric analysis of Age and Stages Questionnaire: Social-Emotional (ASQ:SE) among 3-year-olds2017Ingår i: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 27, nr Suppl_3, s. 173-174Artikel i tidskrift (Övrigt vetenskapligt)
    Abstract [en]

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

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

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

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

    Key messages:

    • The ASQ:SE instrument is a valuable asset within CHC to increase awareness about 3-year-olds social-emotional health.
    • The ASQ:SE instrument is a promising tool for low-cost screening of early social-emotional vulnerability.
  • 22.
    Vaezghasemi, Masoud
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Vogt, Thomas
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Lindkvist, Marie
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Pulkki-Brännström, Anni-Maria
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Richter Sundberg, Linda
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Lundahl, Lisbeth
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för tillämpad utbildningsvetenskap.
    Silfverdal, Sven-Arne
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Feldman, Inna
    Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Ivarsson, Anneli
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Multifaceted determinants of social-emotional problems in preschool children in Sweden: An ecological systems theory approach2023Ingår i: SSM - Population Health, ISSN 2352-8273, Vol. 21, artikel-id 101345Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Social-emotional problems occurring early in life can place children at future risk of adverse health, social and economic outcomes. Determinants of social-emotional problems are multi-layered and originate from different contexts surrounding children, though few studies consider them simultaneously. We adopted a holistic approach by using Bronfenbrenner's process-person-context-time model as a structuring device. We aimed to assess what characteristics of families and children from pregnancy, over birth, and up to 3 years of age are associated with social-emotional problems in boys and girls. This study used regional data from the Salut Programme, a universal health promotion programme implemented in Antenatal and Child Health Care, and data from national Swedish registers. The study population included 6033 3-year-olds and their parents during the period 2010–2018. Distinct logistic regression models for boys and girls were used to assess associations between the family social context, parents' lifestyle, parent's mental health, children's birth characteristics, and indicators of proximal processes (the independent variables); and children's social-emotional problems as measured by the parent-completed Ages and Stages Questionnaire: Social-Emotional between 33 and 41 months of age (the outcome). Overall, a less favourable family social context, detrimental lifestyle of the parents during pregnancy, and parents' mental illness from pregnancy onwards were associated with higher odds of social-emotional problems in 3-year-olds. Higher screentime and infrequent shared book-reading were associated with higher odds of social-emotional problems. The multifaceted determinants of children's social-emotional problems imply that many diverse targets for intervention exist. Additionally, this study suggests that Bronfenbrenner's process-person-context-time theoretical framework could be relevant for public health research and policy.

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  • 23.
    Vaezghasemi, Masoud
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa. Umeå universitet, Samhällsvetenskapliga fakulteten, Umeå centrum för genusstudier (UCGS).
    Öhman, Ann
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa. Umeå universitet, Samhällsvetenskapliga fakulteten, Umeå centrum för genusstudier (UCGS).
    Eriksson, Malin
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Hakimi, Mohammad
    Weinehall, Lars
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Kusnanto, Hari
    Ng, Nawi
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    The effect of gender and social capital on the dual burden of malnutrition: a multilevel study in indonesia2014Ingår i: PLOS ONE, E-ISSN 1932-6203, Vol. 9, nr 8, s. e103849-Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    INTRODUCTION: The paradoxical phenomenon of the coexistence of overweight and underweight individuals in the same household, referred to as the "dual burden of malnutrition", is a growing nutrition dilemma in low- and middle-income countries (LMICs).

    AIMS: The objectives of this study were (i) to examine the extent of the dual burden of malnutrition across different provinces in Indonesia and (ii) to determine how gender, community social capital, place of residency and other socio-economic factors affect the prevalence of the dual burden of malnutrition.

    METHODS: The current study utilized data from the fourth wave of the Indonesian Family Life Survey (IFLS) conducted between November 2007 and April 2008. The dataset contains information from 12,048 households and 45,306 individuals of all ages. This study focused on households with individuals over two years old. To account for the multilevel nature of the data, a multilevel multiple logistic regression was conducted.

    RESULTS: Approximately one-fifth of all households in Indonesia exhibited the dual burden of malnutrition, which was more prevalent among male-headed households, households with a high Socio-economic status (SES), and households in urban areas. Minimal variation in the dual burden of malnutrition was explained by the community level differences (<4%). Living in households with a higher SES resulted in higher odds of the dual burden of malnutrition but not among female-headed households and communities with the highest social capital.

    CONCLUSION: To improve household health and reduce the inequality across different SES groups, this study emphasizes the inclusion of women's empowerment and community social capital into intervention programs addressing the dual burden of malnutrition.

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  • 24.
    Vaezghasemi, Masoud
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Öhman, Ann
    Umeå universitet, Samhällsvetenskapliga fakulteten, Umeå centrum för genusstudier (UCGS).
    Ng, Nawi
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa. Umeå universitet, Samhällsvetenskapliga fakulteten, Enheten för demografi och åldrandeforskning (CEDAR).
    Hakimi, Mohammad
    Centre for Health and Nutrition Research Laboratory, Faculty of Medicine, Gadjah Mada University, Yogyakarta, Indonesia; Department of Health Behaviour, Environment and Social Medicine, Faculty of Medicine, Gadjah Mada University, Yogyakarta, Indonesia.
    Eriksson, Malin
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för socialt arbete.
    Concerned and conscious, but defenceless - the intersection of gender and generation in child malnutrition in Indonesia: a qualitative grounded theory study2020Ingår i: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 13, nr 1, artikel-id 1744214Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Several studies in Indonesia have shown the protective effect of women-headed households on the double burden of malnutrition (coexistence of undernutrition and overnutrition in a household). Many other studies have presented a positive impact on children’s health and conditions when women are educated, have higher social capital and have control of income and its intra-household allocation. However, how women’s status affects the nutritional status of a household and, in particular, of children still remains understudied.

    Objective: In this study, our aim was to explore the role of gender relations and contextual factors for overnutrition and undernutrition among children within a household.

    Method: We conducted a qualitative study in two provinces of Indonesia: Central Java (urban and rural) and Jakarta (central and suburban) among 123 community members (59 men and 64 women). We utilised principles of constructivist grounded theory in conducting this study, and focus group discussions were chosen as a tool to collect data.

    Results: Three categories were constructed, capturing the significance of: (i) the man is dominant within the family (gendered power relations), (ii) the environment that makes the unhealthy choice the easy choice (the emerging obesogenic environment) and (iii) parents’ being concerned but unable to control their children’s eating habits (intersection of gender and generational relations) in child malnutrition.

    Conclusion: Community health and nutrition programmes should help both women and men within the context of households to acknowledge and respect women’s status. More importantly, these programmes should involve men when it comes to children’s nutritional habits and consider them as an important factor in the realisation of gender equality and empowerment. Furthermore, it is increasingly important to recognise the implication of the availability and accessibility of junk food among children.

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  • 25.
    Vogt, Thomas
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Lindkvist, Marie
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Ivarsson, Anneli
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Silfverdal, Sven-Arne
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Vaezghasemi, Masoud
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Temporal trends and educational inequalities in obesity, overweight and underweight in pre-pregnant women and their male partners: a decade (2010–2019) with no progress in Sweden2024Ingår i: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, artikel-id ckae052Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Trends in overweight and obesity among expectant parents can provide useful information about the family environment in which children will grow up and about possible social inequalities that may be passed on to them. Therefore, we aimed to assess whether the prevalence of underweight, overweight and obesity changed over time in pre-pregnant women and their male partners in northern Sweden, and if there were any educational inequalities.

    Methods: This study is based on cross-sectional data from a repeated survey of the population in Västerbotten, Sweden. The study population included 18,568 pregnant women and 18,110 male partners during the period 2010–2019. Multinomial logistic regression models were fitted separately for pregnant women and male partners to assess whether the prevalence of age-adjusted underweight, normal weight, overweight and obesity had evolved between 2010 and 2019, and whether trends differed by educational level.

    Results: Among women, obesity prevalence increased from 9.4% in 2010 to 11.7% in 2019. Among men, it went from 8.9 to 12.8%. Educational inequalities were sustained across the study period. In 2019, the prevalence of obesity was 7.8 percentage points (pp) (CI = 4.4–11.3) higher among women with low compared to high education. The corresponding figure for men was 6.4 pp (CI = 3.3–9.6).

    Conclusions: It is not obvious that the prevalence of obesity among parents-to-be will decrease under current dispositions. Public health policies and practice should therefore be strengthened.

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  • 26. Wang, Haidong
    et al.
    Vaezghasemi, Masoud
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Murray, Christopher J. L.
    Global, regional, national, and selected subnational levels of stillbirths, neonatal, infant, and under-5 mortality, 1980-2015: a systematic analysis for the Global Burden of Disease Study 20152016Ingår i: The Lancet, ISSN 0140-6736, E-ISSN 1474-547X, Vol. 388, nr 10053Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Established in 2000, Millennium Development Goal 4 (MDG4) catalysed extraordinary political, financial, and social commitments to reduce under-5 mortality by two-thirds between 1990 and 2015. At the country level, the pace of progress in improving child survival has varied markedly, highlighting a crucial need to further examine potential drivers of accelerated or slowed decreases in child mortality. The Global Burden of Disease 2015 Study (GBD 2015) provides an analytical framework to comprehensively assess these trends for under-5 mortality, age-specific and cause-specific mortality among children under 5 years, and stillbirths by geography over time.

    METHODS: Drawing from analytical approaches developed and refined in previous iterations of the GBD study, we generated updated estimates of child mortality by age group (neonatal, post-neonatal, ages 1-4 years, and under 5) for 195 countries and territories and selected subnational geographies, from 1980-2015. We also estimated numbers and rates of stillbirths for these geographies and years. Gaussian process regression with data source adjustments for sampling and non-sampling bias was applied to synthesise input data for under-5 mortality for each geography. Age-specific mortality estimates were generated through a two-stage age-sex splitting process, and stillbirth estimates were produced with a mixed-effects model, which accounted for variable stillbirth definitions and data source-specific biases. For GBD 2015, we did a series of novel analyses to systematically quantify the drivers of trends in child mortality across geographies. First, we assessed observed and expected levels and annualised rates of decrease for under-5 mortality and stillbirths as they related to the Soci-demographic Index (SDI). Second, we examined the ratio of recorded and expected levels of child mortality, on the basis of SDI, across geographies, as well as differences in recorded and expected annualised rates of change for under-5 mortality. Third, we analysed levels and cause compositions of under-5 mortality, across time and geographies, as they related to rising SDI. Finally, we decomposed the changes in under-5 mortality to changes in SDI at the global level, as well as changes in leading causes of under-5 deaths for countries and territories. We documented each step of the GBD 2015 child mortality estimation process, as well as data sources, in accordance with the Guidelines for Accurate and Transparent Health Estimates Reporting (GATHER).

    FINDINGS: Globally, 5·8 million (95% uncertainty interval [UI] 5·7-6·0) children younger than 5 years died in 2015, representing a 52·0% (95% UI 50·7-53·3) decrease in the number of under-5 deaths since 1990. Neonatal deaths and stillbirths fell at a slower pace since 1990, decreasing by 42·4% (41·3-43·6) to 2·6 million (2·6-2·7) neonatal deaths and 47·0% (35·1-57·0) to 2·1 million (1·8-2·5) stillbirths in 2015. Between 1990 and 2015, global under-5 mortality decreased at an annualised rate of decrease of 3·0% (2·6-3·3), falling short of the 4·4% annualised rate of decrease required to achieve MDG4. During this time, 58 countries met or exceeded the pace of progress required to meet MDG4. Between 2000, the year MDG4 was formally enacted, and 2015, 28 additional countries that did not achieve the 4·4% rate of decrease from 1990 met the MDG4 pace of decrease. However, absolute levels of under-5 mortality remained high in many countries, with 11 countries still recording rates exceeding 100 per 1000 livebirths in 2015. Marked decreases in under-5 deaths due to a number of communicable diseases, including lower respiratory infections, diarrhoeal diseases, measles, and malaria, accounted for much of the progress in lowering overall under-5 mortality in low-income countries. Compared with gains achieved for infectious diseases and nutritional deficiencies, the persisting toll of neonatal conditions and congenital anomalies on child survival became evident, especially in low-income and low-middle-income countries. We found sizeable heterogeneities in comparing observed and expected rates of under-5 mortality, as well as differences in observed and expected rates of change for under-5 mortality. At the global level, we recorded a divergence in observed and expected levels of under-5 mortality starting in 2000, with the observed trend falling much faster than what was expected based on SDI through 2015. Between 2000 and 2015, the world recorded 10·3 million fewer under-5 deaths than expected on the basis of improving SDI alone.

    INTERPRETATION: Gains in child survival have been large, widespread, and in many places in the world, faster than what was anticipated based on improving levels of development. Yet some countries, particularly in sub-Saharan Africa, still had high rates of under-5 mortality in 2015. Unless these countries are able to accelerate reductions in child deaths at an extraordinary pace, their achievement of proposed SDG targets is unlikely. Improving the evidence base on drivers that might hasten the pace of progress for child survival, ranging from cost-effective intervention packages to innovative financing mechanisms, is vital to charting the pathways for ultimately ending preventable child deaths by 2030.

    FUNDING: Bill & Melinda Gates Foundation.

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  • 27.
    Yusuf, Fethi Mohammed
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    San Sebastián, Miguel
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Vaezghasemi, Masoud
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Explaining gender inequalities in overweight people: a Blinder-Oaxaca decomposition analysis in northern Sweden2023Ingår i: International Journal for Equity in Health, E-ISSN 1475-9276, Vol. 22, nr 1, artikel-id 159Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Being overweight and obesity are considered serious public health concerns worldwide. At the population level, factors contributing to overweight as well as the differences in overweight between men and women in terms of prevalence or associated factors are relatively well-known. What is less known is what explains the inequalities in overweight between men and women. In this study, we examined the contribution of material, behavioural, and psychosocial factors in explaining the gender differences in overweight among adults in northern Sweden.

    Methods: This study was based on the 2018 Swedish Health on Equal Terms survey, which was carried out in Sweden’s four northernmost regions. The analytical sample consisted of 20,855 participants (47% men) aged 20–84 years. Overweight (including obesity) was the outcome, and the selected explanatory variables were grouped according to three theoretical perspectives: material, behavioural and psychosocial. Descriptive statistics and Blinder-Oaxaca decomposition were applied for analysing the data.

    Results: Our study showed that the prevalence of overweight was 64% and 52% among men and women, respectively. It, therefore, revealed a gender gap in overweight people of 11.7% points with explanatory factors accounting for 39% of that gap. This gender gap in overweight people was mostly explained by behavioural variables (19.3%), followed by the materialistic variables and age accounting for 16.2% and 3.1%, respectively. Specifically, having low education, being in the lowest income quintile, alcohol drinking and snus usage contributed to explain 8.4%, 8.9%, 2.8% and 6.3% of the gender difference, respectively.

    Conclusions: We found a considerable gender inequality in overweight between men and women. The findings highlight that future overweight prevention initiatives would benefit from targeting the uncovered contributing factors to reduce gender inequalities in overweight people.

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