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Health and Social Determinants Among Boys and Girls in Sweden: Focusing on Parental Background
Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences. (Studies of children´s and adolescents´ health and welfare)ORCID iD: 0000-0001-5134-4338
2012 (English)Doctoral thesis, comprehensive summary (Other academic)Alternative title
Hälsa och sociala bestämningsfaktorer bland flickor och pojkar i Sverige : med fokus på föräldrahärkomst (Swedish)
Abstract [en]

The majority of Swedish boys and girls have good psychosomatic health. Despite that the risk of mental health problems such as nervousness, feeling low and sleeping difficulties has increased steadily in recent decades. Moreover, previous surveys on health and well-being indicate that boys and girls of foreign extraction in Sweden are at increased risk of ill health compared to boys and girls of Swedish background.

 

The main aim of this thesis was to analyse health and social determinants among boys and girls of foreign extraction in Sweden. The factors explored in papers I–IV include parental background, family affluence and gender and their associations with subjective health complaints, psychosomatic problems or health risk behaviours. Other included risk factors for ill health were involvement in bullying, low participation and discrimination at school. This thesis takes an intersectional perspective, with ambitions to be able to emphasize the interplay between different power relations (i.e. gender, social class and parental background).

 

Two sets of cross-sectional data were used. Three papers were based on the Swedish part of the World Health Organization’s Health Behaviour in School-Aged Children. The sample consisted of 11,972 children (boys n = 6054; girls n = 5918) in grades five, seven and nine from the measurement years 1997/98, 2001/02 and 2005/06. The response rate varied between 85 and 90%. About one fifth of the included children were of foreign extraction. For the fourth paper regional data from Northern Sweden were used. Boys (n = 729) and girls (n = 798) in grades six to nine answered a questionnaire in 2011 and the response rate was 80%. About 14% of the included children were of foreign extraction. Statistical methods used were chi-square test, correlation analyses, logistic regression analyses, cluster analyses and test of mediating factor.

 

The results showed that girls of foreign background were at increased risk of subjective health complaints (SHC) and boys of mixed background were at increased risk of psychosomatic problems (PSP). Increased risk of allocation to the cluster profile of multiple risk behaviour was shown in boys and girls of mixed background, in girls of foreign background and in girls of low family affluence. Increased risk of allocation to the cluster profile of inadequate tooth brushing was shown in boys and girls of foreign background and in girls of low family affluence. General risk factors for increased risk of ill health for boys and girls in Sweden were: any form of bullying involvement, low family affluence, low participation and discrimination at school, of which the latter also was a mediating factor for ill health. Living with a single parent was a risk factor for ill health among girls.

 

The results can function as a basis for developing health promotion programmes at schools that focus on social consequences of foreign extraction, family affluence, participation as well as health risk behaviours and gender.

Abstract [sv]

Majoriteten av flickorna och pojkarna i Sverige har en god psykosomatisk hälsa. Trots det har risken för psykiska hälsosymptom såsom nervositet, att känna sig nere och sömnsvårigheter ökat successivt de senaste årtiondena. Dessutom indikerar tidigare forskning angående hälsa och välmående att flickor och pojkar med utländsk härkomst har ökad risk för ohälsa jämfört med flickor och pojkar med svensk härkomst.

 

Denna avhandlings huvudsyfte var att analysera hälsa och sociala bestämningsfaktorer bland flickor och pojkar i Sverige, med fokus på föräldrabakgrund. Artiklarnas (I–IV) syften inkluderar föräldrahärkomst, familjens materiella tillgångar och genus samt dess samband med subjektiva hälsobesvär, psykosomatiska problem eller hälsoriskbeteenden. Andra riskfaktorer för ohälsa som inkluderades var inblandning i mobbning, lågt deltagande och förekomst av diskriminering på skolan. Denna avhandling beaktar ett intersektionellt perspektiv med ambitionen att kunna tydliggöra samspelet mellan olika maktordningar (dvs. genus, social klass och föräldrabakgrund).

 

Två dataset från tvärsnittsstudier har använts. I de tre första artiklarna användes World Health Organization – Health Behaviour in School-Aged Children, som i Sverige heter Svenska skolbarns hälsovanor. Studiepopulationen bestod av 11 972 barn (flickor n = 5918; pojkar n = 6054) i årskurserna fem, sju och nio undersöknings år 1997/98, 2001/02 och 2005/06. Svarsfrekvensen var mellan 85 och 90 %. Ungefär en femtedel av barnen som deltog hade utländsk härkomst. I den fjärde artikeln användes regional data från norra Sverige. Flickor (n = 798) och pojkar (n = 729) i årskurserna sex till nio deltog i studien år 2011, svarsfrekvensen var 80 %. Omkring 14 % av barnen hade utländsk härkomst. De statistiska metoder som användes var sambandstest (chi-två), test av linjära samband så kallade korrelationsanalyser, logistisk regressionsanalys, klusteranalys och test av medierande faktor.

 

Resultaten visade att flickor med utländsk bakgrund hade ökad risk för subjektiva hälsobesvär (SHC) och pojkar av mixbakgrund hade ökad risk för psykosomatiska problem (PSP). Ökad risk för att hamna i klusterprofilen multipelt hälsoriskbeteende hade flickor och pojkar med mixbakgrund, flickor med utländsk bakgrund samt flickor i familjer med låg nivå av materiella tillgångar. Ökad risk för att hamna i klusterprofilen bristande tandborstning hade flickor och pojkar med utländsk bakgrund och flickor i familjer med låg nivå av materiella tillgångar. Generella riskfaktorer för ohälsa bland flickor och pojkar i Sverige var: alla former av inblandning i mobbning, låg nivå av materiella tillgångar i familjen, lågt deltagande och förekomst av diskriminering på skolan, vilken den senare även var en medierande faktor för ohälsa. Att leva med en ensamstående förälder var en riskfaktor för ohälsa bland flickor.

 

Avhandlingens resultat kan ligga till grund för utformande av hälsofrämjande interventioner inom elevhälsan, till exempel interventioner som fokuserar på sociala konsekvenser av utländsk härkomst, familjens materiella tillgångar, deltagande och diskriminering samt hälsoriskbeteenden och genus.

Place, publisher, year, edition, pages
Sundsvall: Kopieringen Mittuniversitetet , 2012. , 70 p.
Series
Mid Sweden University doctoral thesis, ISSN 1652-893X ; 135
Keyword [en]
bullying involvement, discrimination, foreign extraction, gender, WHO-HBSC, intersectional perspective, health risk behaviour, parental background, PSP, SHC, SCOS, socio-demography
Keyword [sv]
mobbning, diskrimination, utländsk härkomst, genus, WHO-HBSC, intersektionalitetsperspektiv, hälsoriskbeteende, föräldrabakgrund, PSP, SHC, SCOS, sociodemografi
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
URN: urn:nbn:se:miun:diva-17247ISBN: 978-91-87103-39-1 (print)OAI: oai:DiVA.org:miun-17247DiVA: diva2:562870
Public defence
2012-11-23, M 108 Lubbesalen, Holmgatan 10, Campus Åkroken, Sundsvall, 10:15 (Swedish)
Opponent
Supervisors
Available from: 2012-10-26 Created: 2012-10-26 Last updated: 2012-11-30Bibliographically approved
List of papers
1. Subjective health complaints among boys and girls in the Swedish HBSC study: focussing on parental foreign background
Open this publication in new window or tab >>Subjective health complaints among boys and girls in the Swedish HBSC study: focussing on parental foreign background
2011 (English)In: International Journal of Public Health, ISSN 1661-8556, E-ISSN 1661-8564, Vol. 56, no 5, 457-464 p.Article in journal (Refereed) Published
Abstract [en]

Objective: The general aim of this study was to explore the associations between foreign extraction and subjective health complaints (SHC) among school-aged children in Sweden. Methods: Data were obtained from the global cross-sectional survey Health Behaviour in School-aged Children (HBSC), 1997/1998, 2001/2002, and 2005/2006. A total of 11,972 pupils in grades 5, 7 and 9 participated in the survey. Logistic regression analyses were used to estimate remaining risk of SHC among the subgroups of pupils. The analyses were adjusted for socio-demographic indicators, grade and measurement year. Results: Parental background: Swedish n = 9,585, mixed n = 1,263, and foreign n = 1,124. The results showed an increased risk of SHC among girls with a foreign background OR 1.27 (95% CI 1.04-1.55) compared with girls with a Swedish background and among girls in single-adult households OR 1.42 (95% CI 1.20-1.67) compared with girls in two-adult households. No such differences were shown among boys. Conclusions: A significantly increased risk of ill health remained in girls of foreign background after adjustment for socio-demographic indicators, grade and measurement year. © 2011 Swiss School of Public Health.

Keyword
Cross-sectional study, FAS, Gender, Intersectional perspective, Socio-demographic
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:miun:diva-14216 (URN)10.1007/s00038-011-0246-8 (DOI)000297369700002 ()21404065 (PubMedID)2-s2.0-80955137711 (Scopus ID)
Available from: 2011-07-19 Created: 2011-07-19 Last updated: 2017-12-08Bibliographically approved
2. Risk behaviour, parental background, and wealth: a cluster analysis among Swedish boys and girls in the HBSC study
Open this publication in new window or tab >>Risk behaviour, parental background, and wealth: a cluster analysis among Swedish boys and girls in the HBSC study
Show others...
2012 (English)In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 40, no 4, 368-376 p.Article in journal (Refereed) Published
Abstract [en]

Aim: To analyse how health risk behaviours (HRB) are clustered and associated with parental background and family wealth among Swedish boys and girls.

Methods: Data were collected from Health Behaviour in School-aged Children (HBSC),a global cross-sectional survey for 1997/98, 2001/02, and 2005/06. A total of 11,972 boys and girls in grades 5, 7, and 9 participated in the study. The pupils were categorised in subgroups according to parental background: Swedish (80.0%), mixed (10.6%), and foreign (9.4%). Cluster analyses were used to identify HRB profiles. Multinomial logistic regression analysis was used to estimate associations between cluster allocation, parental background, and family affluence.

Results: In total 11,232 pupils were identified and allocated to five cluster profiles, half of them in the cluster profile of low-risk behaviour. The most disadvantaged cluster was multiple HRB, which was characterised by high prevalence of smoking, drunkenness, low physical activity, and high soft-drink consumption. The cluster profile of multiple HRB was associated with both mixed background and foreign background in girls and with mixed background in boys.. The cluster profile of inadequate tooth brushing was associated with foreign background in both boys and girls. The cluster profiles of multiple HRB and inadequate tooth brushing were associated with low family affluence in girls.

Conclusions: The cluster profiles of multiple HRB and inadequate tooth brushing were associated with parental foreign extraction in boys and girls and with low family affluence in girls. Prevention programmes based on identified clusters of HRB, including consideration of impact of socio-demographic indicators, are needed.

Keyword
cluster analysis, FAS, intersectional, multiple risk behaviour, socio-demography
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:miun:diva-16932 (URN)10.1177/1403494812449926 (DOI)000306283200009 ()22786922 (PubMedID)2-s2.0-84863845755 (Scopus ID)
Available from: 2012-08-31 Created: 2012-08-31 Last updated: 2017-12-07Bibliographically approved
3. How Bullying Involvement is Associated with the Distribution of Parental Background and With Subjective Health Complaints Among Swedish Boys and Girls
Open this publication in new window or tab >>How Bullying Involvement is Associated with the Distribution of Parental Background and With Subjective Health Complaints Among Swedish Boys and Girls
2013 (English)In: Social Indicators Research, ISSN 0303-8300, E-ISSN 1573-0921, Vol. 111, no 3, 775-783 p.Article in journal (Refereed) Published
Abstract [en]

This study aimed to analyze how bullying involvement is associated with the distribution of parental background and with subjective health complaints (SHC) among Swedish boys and girls. Data were collected from the World Health Organization, Health Behavior in School-aged Children (WHO/HBSC) survey, measurement years 1997/1998, 2001/2002 and 2005/2006. A total of 11,972 boys (50.6 %) and girls (49.4 %) in grades five, seven and nine participated in the study. The adolescents were categorized in subgroups according to parental background: Swedish (80.1 %), mixed (10.5 %) and foreign(9.7 %). Multivariate logistic regressions were used to estimate remaining risk of SHC in the categories of bullying involvement. The frequencies of bullying involvement once or more were: none involved (74.8 %), victims (10.6 %), bullies (10.3 %) and bully/victims (4.4 %). Six out of ten involved in bullying were boys. Boys of foreign background were more involved as bullies compared to boys of mixed or Swedish background. Girls of foreign background were more involved in all three categories of bullying than girls of mixed or Swedish background. Increased risk of SHC was estimated among all adolescents involved in bullying, with highest OR in the category of bully/victims, OR 3.95 (CI 3.13–4.97) for the boys and OR 4.51 (CI 4.51–6.40) for the girls. The multivariate models were stable even after adjustment for socio-demographics. There are some associations between bullying involvement and parental background. Regardless of parental background, family affluence, family structure and gender, all adolescents involved in bullying are at increased risk of SHC.

Keyword
Bullying involvement, FAS, Gender, HBSC, Parental background, SHC
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:miun:diva-16933 (URN)10.1007/s11205-012-0033-9 (DOI)000316876900008 ()2-s2.0-84875504474 (Scopus ID)
Available from: 2012-08-31 Created: 2012-08-31 Last updated: 2017-12-07Bibliographically approved
4. How discrimination and participation are associated with psychosomatic problems among boys and girls in northern Sweden
Open this publication in new window or tab >>How discrimination and participation are associated with psychosomatic problems among boys and girls in northern Sweden
2012 (English)In: Health, ISSN 1949-5005, Vol. 4, no 10, 866-872 p.Article in journal (Refereed) Published
Abstract [en]

Background: Negative impact on health from school disturbance due to asymmetric power relations such as discrimination and offensive treatment are frequent problems among students. This study sought to analyze associations between occurrence of discrimination at school, participation and psychosomatic problems. Methods: Pupils in grades 6–9 in ten schools in a northern Swedish municipality participated in the study. The frequency of discrimination at school was measured by six items: sex; culture or ethnicity; disability; religion beliefs; sexual preferences; and any other form of discrimination. The Social and Civic Objectives Scale (SCOS) was used for an estimation of the level of participation. The pupils’ health was measured by the PsychoSomatic Problem (PSP) scale. Multivariate logistic regression models were used for estimation of increased risk of PSP. The formula Z=d/s (d)was used to test mediation. Results: Two thirds of the boys and three fourths of the girls reported occurrences of discrimination at schools (p = 0.001). Discrimination was a mediating factor between participation and PSP among boys and girls as the mediating formula Z=d/s (d) was > + 2 SD, –2.59 for boys and –39.27 for girls. Independent of each other, low participation and discrimination were associated with increased risk of PSP. Conclusion: Discrimination was a mediating factor between participation and PSP. The mediating effectwas stronger in girls than in boys. There is a need for school health promotion programsfocusing on participation in terms of democratic processes, communication and cooperation in the classroom.

Keyword
Discrimination, Participation, Psychosocial school environment, PsychoSomatic
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:miun:diva-16934 (URN)10.4236/health.2012.410132 (DOI)
Available from: 2012-08-31 Created: 2012-08-31 Last updated: 2013-03-17Bibliographically approved

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