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  • 1.
    Beckley, Amber L.
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Sociology. Duke University, USA .
    Palmer, Rohan H.
    Rocque, Michael
    Whitfield, Keith E.
    Health and criminal justice system involvement among African American siblings2019In: SSM - Population Health, ISSN 2352-8273, Vol. 7, article id 100359Article in journal (Refereed)
    Abstract [en]

    Importance

    Health disparities between African Americans and Whites have persisted in the United States. Researchers have recently hypothesized that the relatively poor health of African Americans may be caused, in part, by African American overrepresentation in the criminal justice system.

    Objectives

    To test the hypothesis that criminal justice system involvement is associated with poor health and greater health risk when controlling for unobserved family factors through a discordant sibling design.

    Methods

    Subjects were drawn from the Carolina African American Twin Study of Aging (CAATSA). Criminal conviction records were extracted from North Carolina’s Department of Public Safety. Six measures of health and one measure of health risk were analyzed. The health of convicted respondents was compared to that of unrelated non-convicted respondents matched on childhood and demographic factors (“matched sample”). Convicted respondents were also compared to non-convicted siblings (“discordant sibling sample”).

    Results

    The matched sample included 134 CAATSA respondents. On average, convicted CAATSA respondents, compared to matched non-convicted respondents, were in worse health. Convicted respondents had worse mean self-reported health, worse lung function, more depressive symptoms, and smoked more. The discordant sibling sample included 74 respondents. Convicted siblings and non-convicted siblings had similar self-reported health, depressive symptoms, and smoking. In general, non-convicted siblings were in worse health than non-convicted respondents from the matched sample, implying that poor health runs in families.

    Conclusions

    This study provided preliminary evidence that some of the association between a criminal record and poor health is confounded by family factors. Though more research is needed to support these results, the study suggests that criminal involvement may not be associated with the surfeit of health problems observed among African Americans. The criminal justice system, nonetheless, could be used to decrease the health disparity.

  • 2. Beller, Johannes
    et al.
    Miething, Alexander
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Regidor, Enrique
    Lostao, Lourdes
    Epping, Jelena
    Geyer, Siegfried
    Trends in grip strength: Age, period, and cohort effects on grip strength in older adults from Germany, Sweden, and Spain2019In: SSM - Population Health, ISSN 2352-8273, Vol. 9, article id 100456Article in journal (Refereed)
    Abstract [en]

    Grip strength is seen as an objective indicator of morbidity and disability. However, empirical knowledge about trends in grip strength remains incomplete. As trends can occur due to effects of aging, time periods and birth cohorts, we used hierarchical age-period-cohort models to estimate and disentangle putative changes in grip strength. To do this, we used population-based data of older adults, aged 50 years and older, from Germany, Sweden, and Spain from the SHARE study (N = 22500) that encompassed multiple waves of first-time respondents. We found that there were contrasting changes for different age groups: Grip strength improved over time periods for the oldest old, whereas it stagnated or even decreased in younger older adults. Importantly, we found strong birth cohort effects on grip strength: In German older adults, birth cohorts in the wake of the Second World War exhibited increasingly reduced grip strength, and in Spanish older adults, the last birth cohort born after 1960 experienced a sharp drop in grip strength. Therefore, while grip strength increased in the oldest old aged 80 years and older, grip strength stagnated or decreased in comparatively younger cohorts, who might thus be at risk to experience more morbidity and disability in the future than previous generations. Future studies should investigate factors that contribute to this trend, the robustness of the observed birth cohort effects, and the generalizability of our results to other indicators of functional health.

  • 3.
    Bortes, Christian
    et al.
    Umeå University, Sweden.
    Strandh, Mattias
    Karlstad University, Faculty of Arts and Social Sciences (starting 2013), Centre for Research on Child and Adolescent Mental Health (from 2013). Umeå University, Sweden.
    Nilsson, Karina
    Umeå University, Sweden.
    Is the effect of ill health on school achievement among Swedish adolescents gendered?2019In: SSM - Population Health, ISSN 2352-8273, Vol. 8, p. 1-8, article id 100408Article in journal (Refereed)
    Abstract [en]

    This study investigates why the relationship between health problems requiring hospitalization between the ages of 13 and 16 and school achievement (school grades in 9th grade) in Sweden was stronger for girls than for boys. We reviewed previous research on gender differences in subjective health, health care utilization and medical drug treatment to identify mechanisms responsible for this gendered effect. The relationship was analysed using retrospective observational data from several national full-population registers of individuals born in 1990 in Sweden (n = 115 196), and ordinary least squares techniques were used to test hypotheses. We found that girls had longer stays when hospitalized, which mediated 15% of the interaction effect. Variability in drug treatment between boys and girls did not explain the gendered effect of hospitalization. The main mediator of the gendered effect was instead differences in diagnoses between boys and girls. Girls’ hospitalizations were more commonly related to mental and behavioural diagnoses, which have particularly detrimental effects on school achievement. © 2019 The Authors

  • 4.
    Bortes, Cristian
    et al.
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Strandh, Mattias
    Umeå University, Faculty of Social Sciences, Department of Social Work. Centre for Research on Child and Adolescent Mental Health, Karlstad University, Sweden.
    Nilsson, Karina
    Umeå University, Faculty of Social Sciences, Department of Sociology.
    Is the effect of ill health on school achievement among Swedish adolescents gendered?2019In: SSM - Population Health, ISSN 2352-8273, Vol. 8, article id 100408Article in journal (Refereed)
    Abstract [en]

    This study investigates why the relationship between health problems requiring hospitalization between the ages of 13 and 16 and school achievement (school grades in 9th grade) in Sweden was stronger for girls than for boys. We reviewed previous research on gender differences in subjective health, health care utilization and medical drug treatment to identify mechanisms responsible for this gendered effect. The relationship was analysed using retrospective observational data from several national full-population registers of individuals born in 1990 in Sweden (n = 115 196), and ordinary least squares techniques were used to test hypotheses. We found that girls had longer stays when hospitalized, which mediated 15% of the interaction effect. Variability in drug treatment between boys and girls did not explain the gendered effect of hospitalization. The main mediator of the gendered effect was instead differences in diagnoses between boys and girls. Girls’ hospitalizations were more commonly related to mental and behavioural diagnoses, which have particularly detrimental effects on school achievement.

  • 5. Canivet, Catarina
    et al.
    Aronsson, Gunnar
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Work and organizational psychology.
    Bernhard-Oettel, Claudia
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Work and organizational psychology.
    Leineweber, Constanze
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Moghaddassi, Mahnaz
    Stengård, Johanna
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Work and organizational psychology.
    Westerlund, Hugo
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Östergren, Per-Olof
    The negative effects on mental health of being in a non-desired occupation in an increasingly precarious labour market2017In: SSM - Population Health, ISSN 2352-8273, Vol. 3, p. 516-524Article in journal (Refereed)
    Abstract [en]

    Precarious employment has been associated with poor mental health. Moreover, increasing labour market precariousness may cause individuals to feel ‘locked-in’, in non-desired workplaces or occupations, out of fear of not finding a new employment. This could be experienced as a ‘loss of control’, with similar negative health consequences. It is plausible that the extent to which being in a non-desired occupation (NDO) or being in precarious employment (PE) has a negative impact on mental health differs according to age group. We tested this hypothesis using data from 2331 persons, 18–34, 35–44, and 45–54 years old, who answered questionnaires in 1999/2000, 2005, and 2010. Incidence rate ratios (IRR) were calculated for poor mental health (GHQ-12) in 2010, after exposure to NDO and PE in 1999/2000 or 2005. NDO and PE were more common in the youngest age group, and they were both associated with poor mental health. In the middle age group the impact of NDO was null, while in contrast the IRR for PE was 1.7 (95% CI: 1.3–2.3) after full adjustment. The pattern was completely the opposite in the oldest age group (adjusted IRR for NDO 1.6 (1.1–2.4) and for PE 0.9 (0.6–1.4)). The population attributable fraction of poor mental health was 14.2% and 11.6%, respectively, for NDO in the youngest and oldest age group, and 17.2% for PE in the middle age group. While the consequences of PE have been widely discussed, those of NDO have not received attention. Interventions aimed at adapting work situations for older individuals and facilitating conditions of job change in such a way as to avoid risking unemployment or precarious employment situations may lead to improved mental health in this age group.

  • 6.
    Juárez, Sol P.
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS). Stockholm University, Faculty of Social Sciences, Department of Sociology.
    Drefahl, Sven
    Stockholm University, Faculty of Social Sciences, Department of Sociology.
    Dunlavy, Andrea
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Rostila, Mikael
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    All-cause mortality, age at arrival, and duration of residence among adult migrants in Sweden: A population-based longitudinal study2018In: SSM - Population Health, ISSN 2352-8273, Vol. 6, p. 16-25Article in journal (Refereed)
    Abstract [en]

    Background: A mortality advantage has been observed among recently arrived immigrants in multiple national contexts, even though many immigrants experience more social disadvantage compared to natives. This is the first study to investigate the combined influence of duration of residence and age at arrival on the association between region of origin and all-cause mortality among the adult immigrant population in Sweden.

    Methods: Using population-based registers, we conducted a follow-up study of 1,363,429 individuals aged 25-64 years from 1990 to 2008. Gompertz parametric survival models were fitted to derive hazard ratios (HR) for all-cause mortality.

    Results: Compared to native Swedes, we observed a health advantage in all group of immigrants, with the exception of individuals from Finland. However, when information on age at arrival and duration of residence was combined, an excess mortality risk was found among immigrants who arrived before age 18, which largely disappeared after 15 years of residence in Sweden. Non-European immigrants over age 18 showed similar or lower mortality risks than natives in all categories of age at arrival, regardless of duration of residence.

    Conclusions: The findings suggest that the mortality advantage commonly observed among immigrants is not universal. Combined information on age at arrival and duration of residence can be used to identify sensitive periods and to identify possible selection bias. The study also suggests that young immigrants are a vulnerable subpopulation. Given the increased number of unaccompanied minors arriving in Europe, targeted health or integration policies should be developed or reviewed.

  • 7.
    Karhina, Kateryna
    et al.
    Umeå University, Faculty of Social Sciences, Centre for Demographic and Ageing Research (CEDAR). Umeå University, Faculty of Arts, Department of historical, philosophical and religious studies. Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Eriksson, Malin
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Ghazinour, Mehdi
    Umeå University, Faculty of Social Sciences, Police Education Unit at Umeå University.
    Ng, Nawi
    Umeå University, Faculty of Social Sciences, Centre for Demographic and Ageing Research (CEDAR). Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    What determines gender inequalities in social capital in Ukraine?2019In: SSM - Population Health, ISSN 2352-8273, Vol. 8, article id 100383Article in journal (Other academic)
    Abstract [en]

    Background

    Social capital is a social determinant of health that has an impact on equity and well-being. It may be unequally distributed among any population. The aims of this study are to investigate the distribution of different forms of social capital between men and women in Ukraine and analyse how potential gender inequalities in social capital might be explained and understood in the Ukrainian context.

    Method

    The national representative cross-sectional data from the European Social Survey (wave 6) was used with a sample of 1377 women and 797 men. Seven outcomes that represent cognitive and structural social capital were constructed i.e. institutional trust, generalised trust, reciprocity, safety, as well as bonding, bridging and linking forms. Multivariate logistic regression and post-regression Fairlies decompositions were used for the analyses.

    Results

    There are several findings that resulted from the analyses i), access to institutional trust, linking and bridging social capital is very limited; ii), the odds for almost all forms of social capital (besides safety) are lower for men; iii), feeling about income and age explain most of the gender differences and act positively, as well as offsetting the differences.

    Conclusion

    Social capital is unequally distributed between different population groups. Some forms of social capital have a stronger buffering effect on women than on men in Ukraine. Reducing gender and income inequalities would probably influence the distribution of social capital within the society.

  • 8.
    Kim, Yunhwan
    et al.
    Karlstad University, Faculty of Arts and Social Sciences (starting 2013), Centre for Research on Child and Adolescent Mental Health (from 2013).
    Hagquist, Curt
    Karlstad University, Faculty of Arts and Social Sciences (starting 2013), Centre for Research on Child and Adolescent Mental Health (from 2013).
    Mental health problems among economically disadvantaged adolescents in an increasingly unequal society: A Swedish study using repeated cross-sectional data from 1995 to 20112018In: SSM - Population Health, ISSN 2352-8273, Vol. 6, p. 44-53Article in journal (Refereed)
    Abstract [en]

    Increasing inequality in many societies highlights the importance of paying attention to differences in mental health between the economically disadvantaged adolescents and the non-disadvantaged adolescents. Also important is to understand how changing inequality in society over time influences adolescents’ mental health at the population- and individual-level. The current study examined to what extent increased societal-level income inequality over time, individual-level experiences of economic disadvantage and the cross-level interaction between the two explained Swedish adolescents’ mental health problems from 1995 to 2011. We used repeated cross-sectional data collected 6 times between 1995 and 2011 in Sweden. Each time, approximately 2,500 students in grade 9 completed a questionnaire during the spring semester. The adolescents provided self-report data on the frequency of their experiences of unaffordability of daily leisure activities (concert, movie, sports, and dance). They also reported their psychosomatic symptoms, which was used as a measure of mental health problems. We used the household equalised disposable income Gini coefficient as an indicator of societal income inequality. A real gross domestic product (GDP) per capita was controlled for in order to rule out potential effects of economic growth in the society over time. Multilevel regression analyses were conducted in which students were nested in years of investigations. Adolescents who experienced unaffordability of daily leisure activities reported more mental health problems. Societal income inequality was not directly associated with the adolescents’ mental health. However, among girls the effects of experiences of unaffordability on mental health were stronger for all but one (sports) activities, and among boys for one activity (sports) when societal-level inequality was greater. Individual-level economic disadvantage are detrimental for adolescents’ mental health, both directly and interactively with societal-level economic inequality. Some suggestions for practice and future studies are made for mental health among adolescents in societies where increasing inequality is observed.

  • 9. Klein, Raymond M.
    et al.
    Christie, John
    Parkvall, Mikael
    Stockholm University, Faculty of Humanities, Department of Linguistics, General Linguistics.
    Does multilingualism affect the incidence of Alzheimer’s disease?: A worldwide analysis by country2016In: SSM - Population Health, ISSN 2352-8273, Vol. 2, p. 463-467Article in journal (Refereed)
    Abstract [en]

    It has been suggested that the cognitive requirements associated with bi- and multilingual processing provide a form of mental exercise that, through increases in cognitive reserve and brain fitness, may delay the symptoms of cognitive failure associated with Alzheimer′s disease and other forms of dementia. We collected data on a country-by-country basis that might shed light on this suggestion. Using the best available evidence we could find, the somewhat mixed results we obtained provide tentative support for the protective benefits of multilingualism against cognitive decline. But more importantly, this study exposes a critical issue, which is the need for more comprehensive and more appropriate data on the subject.

  • 10.
    Klöfvermark, Josefin
    et al.
    Stockholm University/Karolinska Institute/Karolinska University Hospital.
    Hjern, Anders
    Stockholm University/Karolinska Institute/Karolinska University Hospital.
    Juárez, Sol Pía
    Stockholm University/Karolinska Institute.
    Acculturation or unequal assimilation?: Smoking during pregnancy and duration of residence among migrants in Sweden2019In: SSM - Population Health, ISSN 2352-8273, Vol. 8, article id 100416Article in journal (Refereed)
    Abstract [en]

    A growing corpus of evidence reveals that smoking patterns of migrant women tend to converge with that of the host population over time (‘acculturation paradox’). In this paper we aim to adopt a health equity perspective by studying the extent to which this pattern reflects a convergence with the group of natives who are more socioeconomically disadvantaged. Using population-based registers, we study 1,194,296 women who gave birth in Sweden between 1991 and 2012. Using logistic regression, we estimated odds ratios to assess the effect of duration of residence on the association between smoking during pregnancy and women's origin (classified according to inequality-adjusted Human Development Index (iHDI) of the country of birth). Sibling information and multilevel models were used to assess the extent to which our results might be affected by the cross-sectional nature of the data. Smoking during pregnancy increases with duration of residence among migrants from all levels of iHDI to such an extent that they tend to converge or increase in relation to the levels of the Swedish population with low education and low income, leaving behind the native population with high education and income. The results are robust to possible selection bias related to the cross-sectional nature of the data. Ourfindings indicate the need of a health equity perspective and suggest the use of ‘unequal assimilation’ rather than ‘acculturation paradox’ as a more suitable framework to interpret these findings.

  • 11.
    Klöfvermark, Josefin
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS). Karolinska Institutet, Sweden.
    Hjern, Anders
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS). Karolinska Institutet, Sweden.
    Juárez, Sol Pía
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Acculturation or unequal assimilation? Smoking during pregnancy and duration of residence among migrants in Sweden2019In: SSM - Population Health, ISSN 2352-8273, Vol. 8, article id 100416Article in journal (Refereed)
    Abstract [en]

    A growing corpus of evidence reveals that smoking patterns of migrant women tend to converge with that of the host population over time (‘acculturation paradox’). In this paper we aim to adopt a health equity perspective by studying the extent to which this pattern reflects a convergence with the group of natives who are more socioeconomically disadvantaged. Using population-based registers, we study 1,194,296 women who gave birth in Sweden between 1991 and 2012. Using logistic regression, we estimated odds ratios to assess the effect of duration of residence on the association between smoking during pregnancy and women's origin (classified according to inequality-adjusted Human Development Index (iHDI) of the country of birth). Sibling information and multilevel models were used to assess the extent to which our results might be affected by the cross-sectional nature of the data. Smoking during pregnancy increases with duration of residence among migrants from all levels of iHDI to such an extent that they tend to converge or increase in relation to the levels of the Swedish population with low education and low income, leaving behind the native population with high education and income. The results are robust to possible selection bias related to the cross-sectional nature of the data. Our findings indicate the need of a health equity perspective and suggest the use of ‘unequal assimilation’ rather than ‘acculturation paradox’ as a more suitable framework to interpret these findings.

  • 12.
    Lennartsson, Carin
    et al.
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Eyjólfsdóttir, Harpa Sif
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Celeste, Roger Keller
    Fritzell, Johan
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Social class and infirmity. The role of social class over the life-course2018In: SSM - Population Health, ISSN 2352-8273, Vol. 4, p. 169-177Article in journal (Refereed)
    Abstract [en]

    In an aging society, it is important to promote the compression of poor health. To do so, we need to know more about how life-course trajectories influence late-life health and health inequalities. In this study, we used a life-course perspective to examine how health and health inequalities in late-midlife and in late-life are influenced by socioeconomic position at different stages of the life course. We used a representative sample of the Swedish population born between 1925 and 1934 derived from the Swedish Level of Living Survey (LNU) and the Swedish Panel Study of Living Conditions of the Oldest Old (SWEOLD) to investigate the impact of socioeconomic position during childhood (social class of origin) and of socioeconomic position in young adulthood (social class of entry) and late-midlife (social class of destination) on infirmity in late-midlife (age 60) and late-life (age 80). The results of structural equation modelling showed that poor social class of origin had no direct effect on late-midlife and late-life infirmity, but the overall indirect effect through chains of risks was significant. Thus, late-midlife and late-life health inequalities are the result of complex pathways through different social and material conditions that are unevenly distributed over the life course. Our findings suggest that policies that break the chain of disadvantage may help reduce health inequalities in late-midlife and in late-life.

  • 13.
    Merlo, Juan
    et al.
    Lund Univ, Fac Med, Dept Clin Sci, Unit Social Epidemiol,CRC, Jan Waldenstroms St 35, SE-21421 Malmo, Sweden.;Ctr Primary Hlth Care Res, Malmo, Sweden..
    Wagner, Philippe
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland. Lund Univ, Fac Med, Dept Clin Sci, Unit Social Epidemiol,CRC, Jan Waldenstroms St 35, SE-21421 Malmo, Sweden..
    Austin, Peter C.
    Inst Clin Evaluat Sci, Toronto, ON, Canada..
    Subramanian, S. , V
    Leckie, George
    Lund Univ, Fac Med, Dept Clin Sci, Unit Social Epidemiol,CRC, Jan Waldenstroms St 35, SE-21421 Malmo, Sweden.;Univ Bristol, Ctr Multilevel Modelling, Bristol, Avon, England..
    General and specific contextual effects in multilevel regression analyses and their paradoxical relationship: A conceptual tutorial2018In: SSM - Population Health, ISSN 2352-8273, Vol. 5, p. 33-37Article in journal (Refereed)
    Abstract [en]

    To be relevant for public health, a context (e.g., neighborhood, school, hospital) should influence or affect the health status of the individuals included in it. The greater the influence of the shared context, the higher the correlation of subject outcomes within that context is likely to be. This intra-context or intra-class correlation is of substantive interest and has been used to quantify the magnitude of the general contextual effect (GCE). Furthermore, ignoring the intra-class correlation in a regression analysis results in spuriously narrow 95% confidence intervals around the estimated regression coefficients of the specific contextual variables entered as covariates and, thereby, overestimates the precision of the estimated specific contextual effects (SCEs). Multilevel regression analysis is an appropriate methodology for investigating both GCEs and SCEs. However, frequently researchers only report SCEs and disregard the study of the GCE, unaware that small GCEs lead to more precise estimates of SCEs so, paradoxically, the less relevant the context is, the easier it is to detect (and publish) small but "statistically significant" SCEs. We describe this paradoxical situation and encourage researchers performing multilevel regression analysis to consider simultaneously both the GCE and SCEs when interpreting contextual influences on individual health.

  • 14. Mortensen, Laust H.
    et al.
    Torssander, Jenny
    Stockholm University, Faculty of Social Sciences, The Swedish Institute for Social Research (SOFI).
    Family of origin and educational inequalities in mortality: Results from 1.7 million Swedish siblings2017In: SSM - Population Health, ISSN 2352-8273, Vol. 3, p. 192-200Article in journal (Refereed)
    Abstract [en]

    Circumstances in the family of origin have short- and long-term consequences for people's health. Family background also influences educational achievements – achievements that are clearly linked to various health outcomes. Utilizing population register data, we compared Swedish siblings with different levels of education (1,732,119 individuals within 662,095 sibships) born between 1934 and 1959 and followed their death records until the end of 2012 (167,932 deaths).

    The educational gradient in all-cause mortality was lower within sibships than in the population as a whole, an attenuation that was strongest at younger ages (< 50 years of age) and for those with a working class or farmer background. There was substantial variation across different causes of death with clear reductions in educational inequalities in, e.g., lung cancer and diabetes, when introducing shared family factors, which may indicate that part of the association can be ascribed to circumstances that siblings have in common. In contrast, educational inequalities in suicide and, for women, other mental disorders increased when adjusting for factors shared by siblings.

    The vast variation in the role of childhood conditions for the education-mortality association may help us to further understand the interplay between family background, education, and mortality. The increase in the education gradient in suicide when siblings are compared may point towards individually oriented explanations (‘non-shared environment’), perhaps particularly in mental disorders, while shared family factors primarily seem to play a more important role in diseases in which health behaviors are most significant.

  • 15.
    Rajaleid, Kristiina
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS). Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Vågerö, Denny
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Stress resilience in young men mediates the effect of childhood trauma on their offspring's birth weight: An analysis of 250,000 families2019In: SSM - Population Health, ISSN 2352-8273, Vol. 8Article in journal (Refereed)
    Abstract [en]

    Experiencing the death of a parent during childhood is a severe trauma that seems to affect the next generation's birth weight. We studied the consequences of parental loss during childhood for men's psychological and physiological characteristics at age 18, and whether these were important for their first-born offspring's birth outcomes. We used a structured life-course approach and four-way decomposition analysis to analyse data for 250,427 three-generation families retrieved from nationwide Swedish registers and found that psychological resilience was impaired and body mass index was higher in men who had experienced parental death. Both characteristics were linked to offspring birth weight. This was lower by 18.0 g (95% confidence interval: 5.7, 30.3) for men who lost a parent at ages 8-17 compared to other ages. Resilience mediated 40% of this influence. Mediation by body mass index, systolic and diastolic blood pressure was negligible, as was the effect of parental loss on length of gestation. There was no mediation by the education of the men's future spouse. Previous literature has indicated that the period before puberty, the "slow growth period", is sensitive. Our evidence suggests that this may be too narrow a restriction: boys aged 8-17 appear to be particularly likely to respond to parental loss in a way which affects their future offspring's birth weight. We conclude that the observed transgenerational influence on birth weight is mediated by the father's psychological resilience but not by his body mass index or blood pressure.

  • 16.
    Rehnberg, Johan
    et al.
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Fritzell, Johan
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    The shape of the association between income and mortality in old age: A longitudinal Swedish national register study2016In: SSM - Population Health, ISSN 2352-8273, Vol. 2, p. 750-756Article in journal (Refereed)
    Abstract [en]

    This study used data on the total population to examine the longitudinal association between midlife income and mortality and late-life income and mortality in an aging Swedish cohort. We specifically examined the shape of the associations between income and mortality with focus on where in the income distribution that higher incomes began to provide diminishing returns. The study is based on a total Swedish population cohort between the ages of 50 and 60 years in 1990 (n=801,017) followed in registers for up to 19 years. We measured equivalent disposable household income in 1990 and 2005 and mortality between 2006 and 2009. Cox proportional hazard models with penalized splines (P-spline) enabled us to examine for non-linearity in the relationship between income and mortality. The results showed a clear non-linear association. The shape of the association between midlife (ages 50-60) income and mortality was curvilinear; returns diminished as income increased. The shape of the association between late-life (ages 65-75) income and mortality was also curvilinear; returns diminished as income increased. The association between late-life income and mortality remained after controlling for midlife income. In summary, the results indicated that a non-linear association between income and mortality is maintained into old age, in which higher incomes give diminishing returns.

  • 17.
    Santavirta, Torsten
    Stockholm University, Faculty of Social Sciences, The Swedish Institute for Social Research (SOFI). Uppsala University, Sweden.
    Invited commentary: The long term impact of forced migration during childhood  on adult health2016In: SSM - Population Health, ISSN 2352-8273, Vol. 2, p. 914-916Article in journal (Refereed)
    Abstract [en]

    Saarela and Elo (SSM-Population Health; Volume 2, December 2016, Pages 813–823) provide new evidence of early life forced displacement not being adversely associated with adult health. Their study highlights some of the challenges to identifying a causal effect of childhood exposure on adult health in the context of complex emergencies. Importantly, it opens up for future research that can address commonly recognized sources of bias and identify intervening pathways linking forced migration with adult health outcomes.

  • 18.
    Torssander, Jenny
    et al.
    Stockholm University, Faculty of Social Sciences, The Swedish Institute for Social Research (SOFI).
    Moustgaard, Heta
    Peltonen, Riina
    Kilpi, Fanny
    Martikainen, Pekka
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). University of Helsinki, Finland; Max Planck Institute for Demographic Research, Germany; Karolinska Institutet, Sweden.
    Partner resources and incidence and survival in two major causes of death2018In: SSM - Population Health, ISSN 2352-8273, Vol. 4, p. 271-279Article in journal (Refereed)
    Abstract [en]

    Because people tend to marry social equals – and possibly also because partners affect each other’s health – the social position of one partner is associated with the other partner’s health and mortality. Although this link is fairly well established, the underlying mechanisms are not fully identified. Analyzing disease incidence and survival separately may help us to assess when in the course of the disease a partner’s resources are of most significance. This article addresses the importance of partner’s education, income, employment status, and health for incidence and survival in two major causes of death: cancer and cardiovascular diseases (CVD). Based on a sample of Finnish middle-aged and older couples (around 200,000 individuals) we show that a partner’s education is more often connected to incidence than to survival, in particular for CVD. Once ill, any direct effect of partner’s education seems to decline: The survival chances after being hospitalized for cancer or CVD are rather associated with partner’s employment status and/or income level when other individual and partner factors are adjusted for. In addition, a partner’s history of poor health predicted higher CVD incidence and, for women, lower cancer survival. The findings suggest that various partner’s characteristics may have different implications for disease and survival, respectively. A wider focus on social determinants of health at the household level, including partner’s social resources, is needed.

  • 19. van Hedel, Karen
    et al.
    Martikainen, Pekka
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. University of Helsinki, Finland; Max Planck Institute for Demographic Research, Germany; Karolinska Institutet, Sweden.
    Moustgaard, Heta
    Myrskylä, Mikko
    Cohabitation and mental health: Is psychotropic medication use more common in cohabitation than marriage?2018In: SSM - Population Health, ISSN 2352-8273, Vol. 4, p. 244-253Article in journal (Refereed)
    Abstract [en]

    Marriage is associated with better mental health. While research on the mental health of cohabiting individuals has increased in recent years, it has yielded mixed results thus far. We assessed whether the mental health of cohabiters is comparable to that of married individuals or those living alone using longitudinal data on psychotropic medication purchases. Panel data from an 11% random sample of the population residing in Finland for the years 1995 to 2007, with annual measurements of all covariates, were used. Ordinary least squares (OLS) models were applied to disentangle the relation between cohabitation and psychotropic medication purchases while controlling for relevant time-varying factors (age, education, economic activity, and number of children), and individual fixed effects (FE) models to further account for unobserved time-invariant individual factors. Our sample consisted of 63,077 men and 61,101 women aged 25 to 39 years in 1995. Descriptive results and the OLS model indicated that the likelihood of purchasing psychotropic medication was lowest for married individuals, higher for cohabiters, and highest for individuals living alone. This difference between cohabiting and married individuals disappeared after controlling for time-varying covariates (percent difference [% diff] for men: 0.3, 95% confidence interval [CI]: -0.0, 0.6; % diff for women: -0.2, 95% CI: -0.6, 0.2). Further controlling for unobserved confounders in the FE models did not change this non-significant difference between cohabiting and married individuals. The excess purchases of psychotropic medication among individuals living alone compared to those cohabiting decreased to 1.2 (95% CI: 1.0, 1.4) and 1.4 (95% CI: 1.1, 1.6) percentage-points in the fully-adjusted FE model for men and women, respectively. Similar results were found for all subcategories of psychotropic medication. In summary, these findings suggested that the mental health difference between cohabiting and married individuals, but not the difference between cohabiting individuals and those living alone, was largely due to selection.

  • 20.
    Vågerö, Denny
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Aronsson, Vanda
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Modin, Bitte
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Why is parental lifespan linked to children’s chances of reaching a high age? A transgenerational hypothesis2018In: SSM - Population Health, ISSN 2352-8273, Vol. 4, p. 45-54Article in journal (Refereed)
    Abstract [en]

    Purpose

    Transgenerational determinants of longevity are poorly understood. We used data from four linked generations (G0, G1, G2 and G3) of the Uppsala Birth Cohort Multigeneration Study to address this issue.

    Methods

    Mortality in G1 (N = 9565) was followed from 1961–2015 and analysed in relation to tertiles of their parents’ (G0) age-at-death using Cox regression. Parental social class and marital status were adjusted for in the analyses, as was G1’s birth order and adult social class. For an almost entirely deceased segment of G1 (n = 1149), born 1915–1917, we compared exact age-at-death with G0 parents’ age-at-death. Finally, we explored ‘resilience’ as a potentially important mechanism for intergenerational transmission of longevity, using conscript information from psychological interviews of G2 and G3 men.

    Results

    G0 men’s and women’s ages-at-death were independently associated with G1 midlife and old age mortality. This association was robust and minimally reduced when G0 and G1 social class were adjusted for. We observed an increased lifespan in all social groups. Median difference in age-at-death for sons compared to fathers was + 3.9 years, and + 6.9 years for daughters compared to mothers.

    Parents’ and maternal grandmother’s longevity were associated with resilience in subsequent generations. Resilience scores of G2 men were also associated with those of their G3 sons and with their own mortality in midlife.

    Conclusions

    The chance of reaching a high age is transmitted from parents to children in a modest, but robust way. Longevity inheritance is paralleled by the inheritance of individual resilience. Individual resilience, we propose, develops in the first part of life as a response to adversity and early experience in general. This gives rise to a transgenerational pathway, distinct from social class trajectories. A theory of longevity inheritance should bring together previous thinking around general susceptibility, frailty and resilience with new insights from epigenetics and social epidemiology.

  • 21.
    Wells, Laura
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Östberg, Viveca
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Parental education differentially predicts young adults' frequency and quantity of alcohol use in a longitudinal Swedish sample2018In: SSM - Population Health, ISSN 2352-8273, Vol. 6, p. 91-97Article in journal (Refereed)
    Abstract [en]

    Background

    Alcohol consumption contributes to health inequalities, but few studies have examined how socially differentiated alcohol use develops across the life course. In this study, we examine how one aspect of childhood socioeconomic position (parental education) relates to two often-conflated young adult drinking patterns: drinking frequency and quantity per occasion. Using a life course perspective, we also explore whether parental drinking patterns or young adults’ own educational attainment might account for such associations.

    Methods

    This study used longitudinal data from the nationally representative Swedish Level of Living Surveys (LNU). Young adults’ (aged 20–28, n = 803) drinking patterns and educational attainment were determined through the LNU 2010 and official registers. A decade earlier, parents self-reported their education and drinking patterns in the LNU 2000 and Partner-LNU 2000.

    Results

    Logistic regression models showed that high parental education predicted young adult frequent drinking, while low parental education predicted young adult high quantity drinking. Drinking patterns were associated inter-generationally, but parental alcohol use did not account for differences in young adult drinking patterns by parental education. Young adults’ own education similarly predicted their drinking patterns but did not account for differences in drinking frequency by parental education. Differences in drinking quantity by parental education were no longer significant when young adults’ own education was included in the final model.

    Conclusions

    Findings suggest that parental education constitutes an early-life structural position that confers differential risk for young adult drinking patterns. Young adults whose parents had low education were less likely to drink frequently but were more likely to drink heavily per occasion, a drinking pattern that may place more disadvantaged young adults at a greater health risk.

  • 22.
    Östergren, Olof
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Educational inequalities in mortality are larger at low levels of income: A register-based study on premature mortality among 2.3 million Swedes, 2006–20092018In: SSM - Population Health, ISSN 2352-8273, Vol. 5, p. 122-128Article in journal (Refereed)
    Abstract [en]

    Education develops skills that help individuals use available material resources more efficiently. When material resources are scarce, each decision becomes comparatively more important. Education may also protect from health-related income decline, since the highly educated tend to work in occupations with lower physical demands. Educational inequalities in health may, therefore, be more pronounced at lower levels of income. The aim of this study is to assess whether the shape of the income gradient in premature mortality depends on the level of education.

    Total population data on education, income and mortality was obtained by linking several Swedish registers. Income was defined as five-year average disposable household income for ages 35–64 and mortality follow-up covered the period 2006–2009. The final population comprised 2.3 million individuals, 6.2 million person-years and 14,362 deaths. Income was modeled using splines in order to allow variation in the functional form of the association across educational categories. Poisson regression with robust standard errors was used.

    The curvilinear shape of the association between income and mortality was more pronounced among those with a low education. Both absolute and relative educational inequalities in premature mortality tended to be larger at low levels of income. The greatest income differences in mortality were observed for those with a low education and the smallest for the highly educated.

    Education and income interact as predictors of mortality. Education is a more important factor for health when access to material resources is limited.

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