| 1. |
- Granstrom, Fredrik, et al.
(författare)
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Economic stress and condescending treatment in childhood and adult self-rated health : results from a population study in Sweden
- 2017
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Ingår i: BMC Public Health. - : BioMed Central. - 1471-2458. ; 17
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Tidskriftsartikel (refereegranskat)abstract
- Background: Even today, 12% of the children in Sweden live in poverty and many children are exposed to adverse experiences, such as being bullied, which may have long-term consequences on public health. This study examined the associations between economic stress and condescending treatment in childhood and self-rated health (SRH) in adulthood. Methods: The study is based on 26,706 persons who responded to a postal survey questionnaire sent to a random sample of men and women aged 25-84 years in 2012 (response rate 53%). The associations between childhood circumstances and adult SRH were analysed by logistic regression, adjusting for sex, age, economic stress in adulthood, condescending treatment in adulthood, socioeconomic status and several other known material, behavioural and psychosocial risk factors. Results: In total, 39% of both men and women reported economic stress in their family during childhood. 36% of the men and 41% of the women indicated that they had been treated in a condescending manner, e.g. in school or at home, during childhood. Both economic stress in childhood and condescending treatment in childhood were strongly associated with adult SRH. The associations attenuated, but were still statistically significant after adjustment for adulthood circumstances and other risk factors. Conclusion: Economic stress in childhood and condescending treatment in childhood were associated with SRH in adulthood, both independently and through adulthood circumstances. The results underline the importance of taking into account both material and psychosocial circumstances over the whole life course when developing public health measures.
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| 2. |
- Granström, Fredrik, et al.
(författare)
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Distinguishing independent and shared effects of material/structural conditions and psychosocial resources on educational inequalities in self-rated health : results from structural equation modelling
- 2021
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Ingår i: Public Health. - : Elsevier. - 0033-3506 .- 1476-5616. ; 196, s. 10-17
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: The aim of this study was to distinguish independent and shared effects of material/structural factors and psychosocial resources in explaining educational inequalities in self-rated health (SRH) by using structural equation modelling. Study design: Cross-sectional survey. Methods: Data were derived from a questionnaire sent to a random sample of the population in five counties in Sweden in 2008. The study population (aged 25–75 years) included 15,099 men and 17,883 women. Exploratory structural equation modelling was used to analyse the pathways from educational level to SRH. Results: The pathway including both material/structural factors (e.g. financial buffer and unemployment) and psychosocial resources (e.g. sense of coherence and social participation) explained about 40% of educational differences in SRH for both men and women. The pathways including only the independent effects of psychosocial resources (14% in men and 20% in women) or material/structural factors (9% and 18%, respectively) explained substantial but smaller proportions of the differences. Conclusions: The major pathway explaining educational inequalities in SRH included both material/structural factors and psychosocial resources. Therefore, to reduce educational inequalities in SRH, interventions need to address both material/structural conditions and psychosocial resources across educational groups.
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| 3. |
- Granström, Fredrik, et al.
(författare)
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Exploring trends in and determinants of educational inequalities in self-rated health
- 2015
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Ingår i: Scandinavian Journal of Public Health. - : SAGE PUBLICATIONS LTD. - 1403-4948 .- 1651-1905. ; 43:7, s. 677-686
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Tidskriftsartikel (refereegranskat)abstract
- Aims: Educational inequalities in self-rated health (SRH) in European welfare countries are documented, but recent trends in these inequalities are less well understood. We examined educational inequalities in SRH in different age groups, and the contribution of selected material, behavioural and psychosocial determinants from 2000 to 2008. Methods: Data were derived from cross-sectional surveys conducted in 2000, 2004 and 2008 including 37,478, 34,876 and 32,982 respondents, respectively, aged 25-75 in mid-Sweden. Inequalities were analysed by age-standardized and age-stratified rate ratios of poor SRH and age-standardized prevalence of determinants, and contribution of determinants by age-adjusted logistic regression. Results: Relative educational inequalities in SRH increased among women from 2000 (rate ratio (RR) 1.70, 95% CI 1.55-1.85) to 2008 (RR 2.07, 95% CI 1.90-2.26), but were unchanged among men (RR 1.91-2.01). The increase among women was mainly due to growing inequalities in the age group 25-34 years. In 2008, significant age differences emerged with larger inequalities in the youngest compared with the oldest age group in both genders. All determinants were more prevalent in low educational groups; the most prominent were lack of a financial buffer, smoking and low optimism. Educational differences were unchanged over the years for most determinants. In all three surveys, examined determinants together explained a substantial part of the educational inequalities in SRH. Conclusions: Increased relative educational health inequalities among women, and persisting inequalities among men, were paralleled by unchanged, large differences in material/structural, behavioural and psychosocial factors. Interventions to reduce these inequalities need to focus on early mid-life.
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| 4. |
- Granström, Fredrik
(författare)
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Inequalities in Health : the Importance of Material/Structural Factors and Psychosocial Resources
- 2021
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Socioeconomic inequalities in health are well-documented in most countries. Health differences have been shown to follow a gradient, where health status in average is somewhat poorer for every lower level in the social hierarchy. Notably, the welfare state Sweden is no exception. Considerable socioeconomic inequalities in health are found, and the magnitude of e.g. educational inequalities in health has even increased over recent decades. Important contributors, or “health determinants” of observed health inequalities, include material/structural factors, behavioral factors and psychosocial factors. The inequalities arise from uneven distributions of these health determinants accumulated over the life course. Whereas earlier research has focused on independent effects of different determinants, recent research has showed that health determinants interact in complex ways when contributing to health inequalities. However, the relative importance of the independent contributions of specific types of health determinants and of the shared contributions have not been assessed. The overall aim of this thesis was to examine possible explanations of inequalities in self-reported health among groups with different educational levels in a Swedish population, in particular how material/structural factors and psychosocial resources contribute to these inequalities. This thesis is based on four population-based studies. Studies I and IV used data from the Life & health study, based on crosssectional survey questionnaires, conducted in 2000, 2004 and 2008 in five counties in the central part of Sweden. Around 35,000 respondents were included each year with response rates varying from 60% to 67%. Studies II and III used data from a sub-sample of the Swedish national public health survey (HLV) from 2012, another cross-sectional survey questionnaire. The sub-sample was carried out in four counties in the central part of Sweden. The total number of respondents in the sub-sample was 26,706, with a response rate of 53%. Outcome variables were, in studies I, II and IV, self-rated health (SRH) and, in study III, psychological distress. The magnitudes of health inequalities were examined using rate ratios and rate differences. The associations between health determinants and health out-comes were examined using logistic regression, and the analysis of independent versus shared contributions of health determinants to health inequalities was conducted using structural equation modeling (SEM). Study I showed that relative educational inequalities in SRH were two-fold among men, unchanged from 2000 to 2008, while the inequalities initially were smaller among women but increased over time, from 1.7 to 2.1. This increase was mainly due to growing inequalities in the age group 25–34 years. The distributions of all observed health determinants were more unfavorable in low education groups; most prominent for lack of a financial buffer, smoking and low optimism. These educational differences were, for most health determinants, unchanged over time. Study II examined the association of adult SRH with adverse material conditions (eco-nomic stress in the family) in childhood as well as adverse psychosocial conditions (condescending treatment) in childhood. Both economic stress and condescending treatment in childhood were strongly associated with poorer adult SRH. These associations were attenuated, but still statistically significant after adjustment for economic stress and condescending treatment in adulthood and other risk factors. Study III showed, after adjustment for age, economic difficulties, employment status and social support, a moderate association between educational level and psychological dis-tress, where low and medium educational levels were related to a lower risk of psychological distress. However, current economic difficulties showed a strong, and positive, association with psychological distress. Study IV showed that the shared pathways, including both material/structural fac-tors (e.g. financial buffer and unemployment) and psychosocial resources (e.g. optimism and social participation), explained about 40% of educational inequalities in SRH for both men and women aged 25–74 years. The pathways including only the independent effects of psychosocial resources (14% in men and 20% in women) or material/structural factors (9% and 18%, respectively) explained substantial but smaller proportions of the inequalities. In conclusion, in an adult population in the central part of Sweden, prevalence of poor SRH was, among men, twice as high in the low education group compared to the high education group during the first decade of the new millennium. Among women, educational inequalities were initially smaller, but increased over time to the same level as among men. However, when using self-reported psychological distress as health outcome, no corresponding educational inequalities were found. Instead, economic difficulties were an important determinant of psychological distress. SRH in adulthood was significantly associated with economic stress and condescending treatment during childhood, also when the same conditions in adulthood were taken into account. Material/structural factors and psychosocial resources explained more than half of the educational inequalities in SRH, and the majority of this contribution was in the form of a shared effect of material/structural factors and psychosocial resources. A shared effect means that a material/structural factor and a psychosocial resource are strongly associated, and that the combination of the two has an effect on the educational inequalities in SRH. Therefore, to reduce educational inequalities in SRH, interventions need to address both material/structural conditions and psychosocial resources. This needs to be done across educational groups, using a life course perspective, but with more intensive interventions in lower education groups.
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| 5. |
- Hasselgren, Mikael, 1964-, et al.
(författare)
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Socioeconomic status, lifestyle factors and asthma prevalence : Results from a population-based study in Sweden
- 2021
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Ingår i: European Respiratory Journal. - : European Respiratory Society. - 0903-1936 .- 1399-3003. ; 58:Suppl. 65
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Conclusion: In this population-based study, self-reported diagnosed asthma was independently associated with economic difficulties but not with educational level. Lifestyle factors did not explain the association between economic difficulties and asthma prevalence.These findings apply to both men and women as well as younger and older age groups.Introduction: Previous studies have reported inconsistent findings about socioeconomic differences in asthma prevalence among adults. The aim of this study was to examine differences in the prevalence of self-reported diagnosed asthma by socioeconomic status and the contribution of lifestyle factors to these differences.Methods: The study was based on 28,531 persons aged 18 years or older who answered a survey questionnaire sent to a random population sample in Mid-Sweden in 2017. The overall response rate was 44%. Socioeconomic status was measured with educational level and economic difficulties, and lifestyle factors with physical activity, smoking, snuff use, risk-drinking of alcohol and obesity. The associations were analysed using multivariate logistic regression.Results: The overall asthma prevalence was 9% among women and 7% in men. Asthma was most prevalent in the youngest age group 18-29 years.Educational level was not independently associated with asthma.Statistically significant odds ratios for the prevalence of asthma were observed for economic difficulties 1.5 (95% CI: 1.3-1.7), physical inactivity 1.2 (95% CI: 1.1- 1.3) and obesity 1.6 (95% CI: 1.4-1.8).Persons born outside the Nordic countries had lower prevalence of asthma than persons born in Sweden.Smoking was not associated with asthma.
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| 6. |
- Hellstrand, Mats, et al.
(författare)
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A health dialogue intervention reduces cardiovascular risk factor levels : a population based randomised controlled trial in Swedish primary care setting with 1-year follow-up
- 2017
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Ingår i: BMC Public Health. - : BIOMED CENTRAL LTD. - 1471-2458. ; 17
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Tidskriftsartikel (refereegranskat)abstract
- Background: The total number of cardiovascular (CVD) deaths accounted for almost a third of all deaths globally in 2013. Population based randomised controlled trials, managed within primary care, on CVD risk factor interventions are scarce. The aim of the study was to evaluate the effects of a health dialogue intervention in a primary care setting offered to a population at the age of 55 years, focusing on CVD risk factors. Methods: The study was performed in five primary health care centres in the county of Vastmanland, Sweden between April 2011 and December 2012. Men and women were randomly assigned to intervention (n = 440) and control groups (n = 440). At baseline, both groups filled in a health questionnaire and serum cholesterol, fasting plasma glucose, glycated haemoglobin (HbA1c), weight, height, waist (WC) and hip circumference, waist hip ratio (WHR) and systolic/diastolic blood pressure were measured. Intervention group attended a health dialogue, supported by a visualised health profile, with a possibility for further activities. Participation rates at baseline were 53% and 52% respectively. A 1-year follow-up was carried out. Results: The intervention group (n = 165) showed reductions compared to the control group (n = 177) concerning body mass index (BMI) (0.3 kg/m(2), p = .031), WC (2.1 cm, p <= .001) and WHR (. 002, p <= .001) at the 1-year follow-up. No differences between the intervention and control groups were found in other variables. Intervention group, compared to baseline, had reduced weight, BMI, WC, WHR, HbA1c, and diet, while the men in the control group had reduced their alcohol consumption. Conclusions: A health dialogue intervention at the age of 55 years, conducted in ordinary primary care, showed a moderate effect on CVD risk factor levels, in terms of BMI, WC and WHR.
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| 7. |
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| 8. |
- Lindstrom, Jim, et al.
(författare)
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Alcohol consumption and self-rated health among older people : population-based study in Sweden
- 2020
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Ingår i: Journal of Public Health. - : Oxford University Press. - 1741-3842 .- 1741-3850. ; 42:4, s. 756-765
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Tidskriftsartikel (refereegranskat)abstract
- Objective To analyse alcohol consumption and its association with self-rated health among a representative sample of older people in mid-Sweden. Background Over the past decades, alcohol consumption has increased in the older population in Sweden, but few studies have investigated the association between alcohol consumption and self-rated health in this group. The aim was therefore to investigate alcohol consumption and self-rated health among older Swedes. Methods The study is based on a cross-sectional study of 11,716 men and women, 65 years and over, answering a survey questionnaire sent to a random population sample in mid-Sweden in 2012. We assessed alcohol consumption with AUDIT-C and its association with self-rated health using logistic regression analysis, adjusting for age, economic situation, educational level, BMI, physical activity, social support and medication use. Results Men (83%) were more prone to drink alcohol compared to women (71%). The prevalence of risk drinking was about 2% for both genders. Alcohol consumption declined with age. Moderate consumption of alcohol was associated with lower probability of poor self-rated health compared to non-drinking with an adjusted odds ratio 0.64 (95% confidence interval: 0.54-0.76) for men and 0.68 (0.59-0.79) for women. Conclusion Since the study was cross-sectional the direction of the association could not be determined, and the results should not be interpreted as an argument for promoting alcohol consumption among older people.
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| 9. |
- Molarius, Anu, et al.
(författare)
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Can financial insecurity and condescending treatment explain the higher prevalence of poor self-rated health in women than in men? : A population-based cross-sectional study in Sweden
- 2012
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Ingår i: International Journal for Equity in Health. - London : BioMed Central. - 1475-9276. ; 22, s. 37-37
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: Women have in general poorer self-rated health than men. Both material and psychosocial conditions have been found to be associated with self-rated health. We investigated whether two such factors, financial insecurity and condescending treatment, could explain the difference in self-rated health between women and men. Methods: The association between the two factors and self-rated health was investigated in a population-based sample of 35,018 respondents. The data were obtained using a postal survey questionnaire sent to a random sample of men and women aged 18-75 years in 2008. The area covers 55 municipalities in central Sweden and the overall response rate was 59%. Multinomial odds ratios for poor self-rated health were calculated adjusting for age, educational level and longstanding illness and in the final model also for financial insecurity and condescending treatment. Results: The prevalence of poor self-rated health was 7.4% among women and 6.0% among men. Women reported more often financial insecurity and condescending treatment than men did. The odds ratio for poor self-rated health in relation to good self-rated health was 1.29 (95% CI: 1.17-1.42) for women compared to men when adjusted for age, educational level and longstanding illness. The association became, however, statistically non-significant when adjusted for financial insecurity and condescending treatment. Conclusion: The present findings suggest that women would have as good self-rated health as men if they had similar financial security as men and were not treated in a condescending manner to a larger extent than men. Longitudinal studies are, however, required to confirm this conclusion.
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| 10. |
- Molarius, Anu, et al.
(författare)
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Desire to lose weight and need of weight loss support in the adult population-Results from a cross-sectional study in Sweden
- 2020
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Ingår i: Obesity Science & Practice. - : Wiley-Blackwell. - 2055-2238. ; 6:4, s. 373-381
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Tidskriftsartikel (refereegranskat)abstract
- Objective Evidence-based methods to lose weight are important in tackling increasing obesity trends in adult populations. More knowledge about persons who want to lose weight and do not/do need weight loss support is necessary to design effective preventive practices. Thus, the aim of the study was to investigate the prevalence of desire to lose weight in the general population and the prevalence of health problems and health-related factors in persons with overweight or obesity who want to lose weight and believe that they do not/do need weight loss support. Methods The study included 14 126 persons aged 30 to 69 years who responded to a questionnaire sent to a random sample. Persons with overweight or obesity (BMI >= 25 kg/m(2)) were divided into three groups: those who do not want to lose weight (n = 1236), those who want to lose weight but do not believe they need support (n = 5484), and those who want to lose weight and believe they need weight loss support (n = 1462). Results In total, 69% of the women and 59% of the men reported that they wanted to lose weight. The prevalence of hypertension, musculoskeletal pain, poor self-rated health, anxiety/worry, and depression was highest among persons with overweight or obesity who wanted to lose weight and believed they need weight loss support. They were also more physically inactive and reported less social support. Conclusions To want to lose weight is very common among adults. People with overweight or obesity who want to lose weight and believe they need weight loss support have higher frequency of various health problems, including mental health problems, and less social support.
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