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Lika för alla?: Social position och etnicitet som determinanter för amning, föräldrars rökvanor och kontakter med BVC
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Pediatrics. (Socialpediatrik)
2012 (Swedish)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Child Health Services (CHS) in Sweden are offered free of charge to all Swedish parents with children 0-5 years of age.  The regular service schedule includes home visits, health examinations, vaccinations and participation in parenting groups. The CHS should pay extra attention to disadvantaged families.

The aim of this thesis was to investigate to what extent the CHS reaches groups of families with special needs, e.g. immigrant families, low income families, young and single mothers, with universal or selective measures, as well as to investigate the variation of two determinants of child health, second hand smoke and breastfeeding, in these groups of families. The thesis also aimed at investigating validity of data in the county CHS quality database (Basta). The thesis is based on data from Basta together with several national registers.

The CHS equally reached all families with infants with the universal program except for participation in parenting group. Foreign born, young, single and low-income mothers had lower participation rates. Smoking rates were lower in foreign-born than in Swedish-born mothers and higher for foreign-born than in Swedish-born fathers. Smoking was more common among single and low income parents and young mothers. Young and single mothers had lower breastfeeding rates at 6 months. At 12 months the breastfeeding rates were higher among foreign-born mothers. The validity test of data in the Basta database showed sensitivity values for immunizations, breastfeeding and smoking at 90-100 % and for any home visit, participation in parenting group at any time, a minimum number of 6 visits at the Child Health Centre (CHC) and a minimum number of 11 visits at the CHC at 88 - 96 %. The sensitivity value for the exact match of number of CHC visits (+/- 3 visits) was 88 %.

Conclusions: The universal programme was equally distributed in different immigrant and socio-demographic populations. However, the results did not indicate equality according to the assumption that some families need more input than others in order to achieve equity of outcome.

Individual data routinely collected from CHS records to a quality database provides data of good quality that can be used for both quality surveillance and research.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2012. , p. 125
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 752
Keywords [en]
Ethnic, infants, smoking, socio-economic status, second hand smoke, breastfeeding, child health services, child health care, health services research, mothers, parent participation, supportive care
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Pediatrics
Identifiers
URN: urn:nbn:se:uu:diva-170037ISBN: 978-91-554-8305-0 (print)OAI: oai:DiVA.org:uu-170037DiVA, id: diva2:509814
Public defence
2012-05-04, Sal IX, Universitetshuset, Övre Slottsgatan 2, Uppsala, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2012-04-12 Created: 2012-03-07 Last updated: 2012-04-19
List of papers
1. Parental region of birth, socio-economic status and infants' exposure to second-hand smoke
Open this publication in new window or tab >>Parental region of birth, socio-economic status and infants' exposure to second-hand smoke
2008 (English)In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 97, no 11, p. 1542-1545Article in journal (Refereed) Published
Abstract [en]

AIM: To investigate the impact of parental region of birth on the risk of exposure to second-hand smoke for infants. METHODS: The smoking habits, according to child health records, of parents of 14 431 infants in Uppsala county, Sweden, born during 1997-2001, were investigated with logistic regression in the presence of socio-economic and demographic confounders from national registers. RESULTS: Fathers born outside of Sweden smoked more often than Swedish-born fathers irrespective of region of birth (adjusted odds ratios [ORs] 1.77-3.02). Mothers born in Africa (adjusted OR 0.29, 95% CI 0.15-0.58) and Asia (adjusted OR 0.53, 95% CI 0.40-0.70) smoked less often than Swedish-born mothers. Single parenthood, low income and mother's age <or=24 years increased the risk for parental smoking. CONCLUSION: The present study indicates that the risk of smoking in immigrant parents of infants is influenced by the smoking patterns in the region of birth. Smoke cessation interventions targeting fathers are particularly important in immigrant-dense neighbourhoods in Sweden.

Keywords
Ethnic, Infants, Second-hand smoke, Smoking, Socio-economic status
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-102487 (URN)10.1111/j.1651-2227.2008.00964.x (DOI)000260254100012 ()18702638 (PubMedID)
Available from: 2009-05-07 Created: 2009-05-07 Last updated: 2017-12-13Bibliographically approved
2. Region of birth, income and breastfeeding in a Swedish county
Open this publication in new window or tab >>Region of birth, income and breastfeeding in a Swedish county
2009 (English)In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 98, no 11, p. 1799-1804Article in journal (Refereed) Published
Abstract [en]

AIM: To study the relationship between maternal region of birth, disposable income and breastfeeding initiation and duration. METHODS: The study population consisted of 12,197 term born, singleton infants, born 1997-2001 in the county of Uppsala. Data on breastfeeding at 1 week, 6 months and 12 months were collected from the register of statistics of the Child Health Care Unit in Uppsala and socioeconomic indicators from Swedish national registers. Multivariate analysis was conducted using Cox regression. RESULTS: No influence of disposable income or region of birth on breastfeeding initiation was observed. Breastfeeding rates at 6 months were lower for mothers with disposable incomes in quartile 1-3 compared with mothers with the highest incomes in quartile 4 (hazard ratios (HRs) 0.88-0.90, adjusted HRs 0.92). The breastfeeding rates at 12 months were higher for mothers born in all regions compared with mothers born in Sweden (HRs 1.25-2.45, adjusted HRs 1.20-2.14). CONCLUSIONS: The findings in the present study show that disposable income is a strong predictor for breastfeeding at 6 months in the Swedish context. Region of birth of the mother predicted long term breastfeeding, > or =12 months. This calls for professionals in the maternity and child health care to pay extra attention to breastfeeding in low-income mothers in all ethnic groups.

Keywords
Breastfeeding, Ethnic, Infants, Smoking, Socioeconomic status
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-122207 (URN)10.1111/j.1651-2227.2009.01455.x (DOI)000270549700020 ()19732040 (PubMedID)
Available from: 2010-04-07 Created: 2010-04-07 Last updated: 2017-12-12Bibliographically approved
3. Child health care uptake among low-income and immigrant families in a Swedish county
Open this publication in new window or tab >>Child health care uptake among low-income and immigrant families in a Swedish county
2011 (English)In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 100, no 11, p. 1495-1503Article in journal (Refereed) Published
Abstract [en]

AIM: To study the uptake of child health care among low-income and immigrant families in the county of Uppsala, Sweden, to investigate whether these families received extra attention as proposed in the Swedish Child Health Services (CHS) state-of-the-art consensus document from the year 2000.

METHODS: Data were collected for 25,024 infants born 1998-2006 from the database of statistics of the Child Health Care Unit in Uppsala and socio-demographic indicators from Swedish national registers. Disposable income was divided into quartiles. Country of birth of the mother was categorized into four regions with two subgroups each, mothers with or without a Swedish-born partner. Analysis was conducted by Cox regression and linear regression models.

RESULTS: Small differences between Swedish vs. immigrant and high vs. low-income families were detected. Low-income mothers (RR 0.78) as well as mothers born in all country of birth regions with an immigrant partner (RR 0.28-0.95) had lower rates of participation in parental groups.

CONCLUSION: The CHS provided basic child health care to almost all infants including children in immigrant and low-income Swedish families. However, the results did not indicate that disadvantaged families received the extra attention proposed in the consensus document.

National Category
Public Health, Global Health, Social Medicine and Epidemiology Pediatrics
Identifiers
urn:nbn:se:uu:diva-163016 (URN)10.1111/j.1651-2227.2011.02344.x (DOI)000296421300027 ()21535134 (PubMedID)
Available from: 2011-12-07 Created: 2011-12-07 Last updated: 2017-12-08Bibliographically approved
4. Child health care utilization in families with young or single mothers in a Swedish county
Open this publication in new window or tab >>Child health care utilization in families with young or single mothers in a Swedish county
2013 (English)In: Journal of Child Health Care, ISSN 1367-4935, E-ISSN 1741-2889, Vol. 17, no 1, p. 17-29Article in journal (Refereed) Published
Abstract [en]

Background:

Young age and lone parenthood are risk factors for impaired health among mothers and their children. Due to the higher risks of negative influences on physical and mental health, young and single mothers should be of special concern to the Child Health Services (CHS). In the present study, we investigated consumption patterns of child health care services among young and single mothers in Uppsala County, Sweden to study whether they are reached by the universal CHS program and if selective or indicative measures were administered in daily CHS practice.

Methods:

Register data on CHS contacts and socio-demographic indicators were collected for 10,692 infants, born in1998-2006.

Results:

Small differences in contact pattern and immunization status, between young versus older, and single versus cohabiting mothers, were detected. However, both young (RR 0.64) and single (RR 0.80) mothers had significantly lower rates of participation in parental group.

Conclusions:

The CHS were successful in implementing the universal preventive child health programme for all families, including families with young or single mothers. There was no indication, however, of an established selective preventive strategy aimed at these high risk families. Programs for strengthening the support provided to vulnerable families by the CHS are needed.

Keywords
Child health; health services research; infant; mothers; parent participation
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Pediatrics
Identifiers
urn:nbn:se:uu:diva-170029 (URN)10.1177/1367493512450624 (DOI)000315563700003 ()23197384 (PubMedID)
Available from: 2012-03-07 Created: 2012-03-07 Last updated: 2017-12-07Bibliographically approved
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