| 1. |
- Andersson, Filip, et al.
(author)
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Prevalence of cannabis use among young adults in Sweden comparing randomized response technique with a traditional survey
- 2023
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In: Addiction. - 0965-2140 .- 1360-0443. ; 118:9, s. 1801-1810
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Journal article (peer-reviewed)abstract
- Background and Aims: The prevalence of cannabis use based on self-reports is likely to be underestimated in population surveys, especially in contexts where its use is a criminal offence. Indirect survey methods ask sensitive questions ensuring that answers cannot be identified with an individual respondent, therefore potentially resulting in more reliable estimates. We aimed to measure whether the indirect survey method ‘randomized response technique’ (RRT) increased response rate and/or increased disclosure of cannabis use among young adults compared with a traditional survey.Design: We conducted two parallel nation-wide surveys during the spring and the summer of 2021. The first survey was a traditional questionnaire-based one (focusing on substance use and gambling). The second survey applied an indirect survey method known as ‘the cross-wise model’ to questions related to cannabis use. The two surveys employed identical procedures (e.g. invitations, reminders and wording of the questions)Setting and Participants: The participants were young adults (aged 18–29 years) living in Sweden. The traditional survey had 1200 respondents (56.9% women) and the indirect survey had 2951 respondents (53.6% women).Measurements: In both surveys, cannabis use was assessed according to three time-frames: life-time use; use during the past year; and use during the past 30 days.Findings: The estimated prevalence of cannabis use was two- to threefold higher on all measures when estimated using the indirect survey method compared with the traditional survey: use during life-time (43.2 versus 27.3%); during the past year (19.2 versus 10.4%); and during the past 30 days (13.2 versus 3.7%). The discrepancy was larger among males and individuals with an education shorter than 10 years, who were unemployed, and who were born in non-European countries.Conclusions: Indirect survey methods may provide more accurate estimates than traditional surveys on prevalence of self-reported cannabis use.
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| 2. |
- Araghi, Marzieh, et al.
(author)
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No association between moist oral snuff (snus) use and oral cancer : pooled analysis of nine prospective observational studies
- 2021
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In: Scandinavian Journal of Public Health. - : Sage Publications. - 1403-4948 .- 1651-1905. ; 49:8, s. 833-840
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Journal article (peer-reviewed)abstract
- Aims: Worldwide, smokeless-tobacco use is a major risk factor for oral cancer. Evidence regarding the particular association between Swedish snus use and oral cancer is, however, less clear. We used pooled individual data from the Swedish Collaboration on Health Effects of Snus Use to assess the association between snus use and oral cancer.Methods: A total of 418,369 male participants from nine cohort studies were followed up for oral cancer incidence through linkage to health registers. We used shared frailty models with random effects at the study level, to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) adjusted for confounding factors.Results: During 9,201,647 person-years of observation, 628 men developed oral cancer. Compared to never-snus use, ever-snus use was not associated with oral cancer (adjusted HR 0.90, 95% CI: 0.74, 1.09). There were no clear trends in risk with duration or intensity of snus use, although lower intensity use (<= 4 cans/week) was associated with a reduced risk (HR 0.65, 95% CI: 0.45, 0.94). Snus use was not associated with oral cancer among never smokers (HR 0.87, 95% CI: 0.57, 1.32).Conclusions: Swedish snus use does not appear to be implicated in the development of oral cancer in men.
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| 3. |
- Araghi, Marzieh, et al.
(author)
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Smokeless tobacco (snus) use and colorectal cancer incidence and survival : Results from nine pooled cohorts
- 2017
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In: Scandinavian Journal of Public Health. - : SAGE Publications. - 1403-4948 .- 1651-1905. ; 45:8, s. 741-748
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Journal article (peer-reviewed)abstract
- AIMS: Although smoking is considered to be an established risk factor for colorectal cancer, the current evidence on the association between smokeless tobacco and colorectal cancer is scant and inconclusive. We used pooled individual data from the Swedish Collaboration on Health Effects of Snus Use to assess this association.METHODS: A total of 417,872 male participants from nine cohort studies across Sweden were followed up for incidence of colorectal cancer and death. Outcomes were ascertained through linkage to health registers. We used shared frailty models with random effects at the study level to estimate hazard ratios (HRs) and 95% confidence intervals (CIs).RESULTS: During 7,135,504 person-years of observation, 4170 men developed colorectal cancer. There was no clear association between snus use and colorectal cancer overall. Exclusive current snus users, however, had an increased risk of rectal cancer (HR 1.40: 95% CI 1.09, 1.79). There were no statistically significant associations between snus use and either all-cause or colorectal cancer-specific mortality after colorectal cancer diagnosis.CONCLUSIONS: Our findings, from a large sample, do not support any strong relationships between snus use and colorectal cancer risk and survival among men. However, the observed increased risk of rectal cancer is noteworthy, and in merit of further attention.
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| 4. |
- Araghi, Marzieh, et al.
(author)
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Use of moist oral snuff (snus) and pancreatic cancer : Pooled analysis of nine prospective observational studies
- 2017
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In: International Journal of Cancer. - : Wiley. - 0020-7136 .- 1097-0215. ; 141:4, s. 687-693
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Journal article (peer-reviewed)abstract
- While smoking is a well-established risk factor for pancreatic cancer, the effect of smokeless tobacco is less well understood. We used pooled individual data from the Swedish Collaboration on Health Effects of Snus Use to assess the association between Swedish snus use and the risk of pancreatic cancer. A total of 424,152 male participants from nine cohort studies were followed up for risk of pancreatic cancer through linkage to health registers. We used shared frailty models with random effects at the study level, to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) adjusted for confounding factors. During 9,276,054 person-years of observation, 1,447 men developed pancreatic cancer. Compared to never-snus use, current snus use was not associated with risk of pancreatic cancer (HR 0.96, 95% CI 0.83-1.11) after adjustment for smoking. Swedish snus use does not appear to be implicated in the development of pancreatic cancer in men. Tobacco smoke constituents other than nicotine or its metabolites may account for the relationship between smoking and pancreatic cancer. What's new? While smoking is a well-established risk factor for pancreatic cancer, the effect of smokeless tobacco is less well understood. Smokeless tobacco like snus yields lower exposure to tobacco carcinogens compared with smoking, because it does not undergo combustion, but delivers an equivalent dose of nicotine. Using pooled individual data from the Swedish Collaboration on Health Effects of Snus Use, here the authors show that Swedish snus use does not appear to be implicated in the development of pancreatic cancer in men. Tobacco smoke constituents other than nicotine or its metabolites may account for the relationship between smoking and pancreatic cancer.
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| 5. |
- Arefalk, Gabriel, et al.
(author)
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Smokeless Tobacco (Snus) and Risk of Heart Failure of Ischemic and Non-Ischemic Origin: a Pooled Analysis of Eight Prospective Cohort Studies
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Other publication (other academic/artistic)abstract
- BackgroundSnus, a Swedish type of smokeless tobacco, has potent acute hemodynamic effects, which could provoke stress on the cardiovascular system, including the myocardium. Snus has, however, not been linked to risk of ischemic heart disease. Therefore, we hypothesized that snus use increases the risk for heart failure of non-ischemic origin.MethodsWe conducted a pooled analysis of eight Swedish prospective cohort studies involving individual participant data from 350,711 men. Shared frailty models with random effects at the cohort level, were used to estimate hazard ratios (HRs) with 95 % confidence intervals (CIs) of heart failure in relation to snus use. We investigated dose-response associations, and association with ischemic and non-ischemic heart failure in separate. For positive control purposes, we also investigated associations between smoking and risk of heart failure.ResultsDuring a median follow-up time of 16 years, 5,404 men were hospitalized for heart failure. In models adjusting for age, smoking, previous myocardial infarction and educational level, current snus use was associated with a higher risk of heart failure (HR 1.27, 95 % CI 1.07-1.50), relative to non-current snus use. A dose-response pattern was observed, with higher risk with more snus cans used per week. We observed an association of snus use with non-ischemic heart failure, HR 1.34 (95 % CI 1.11-1.63), but not with ischemic heart failure, HR 1.01 (95 % CI 0.72-1.42). Smoking was more strongly associated with heart failure, particularly of ischemic origin, than snus use.ConclusionsSnus use was associated with a modestly increased risk for heart failure of non-ischemic origin in a dose-response manner. This finding has public health implications for the risk assessment of snus use, and potentially other modes of smokeless use of nicotine.
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| 6. |
- Beeres, Dorien Tecla, et al.
(author)
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Child–adult contract for prevention of tobacco use : "as-treated" analysis of a cluster randomized controlled trial (the TOPAS study) at 3-year follow-up
- 2024
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In: Prevention Science. - : Springer Nature. - 1389-4986 .- 1573-6695. ; 25, s. 175-192
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Journal article (peer-reviewed)abstract
- To estimate the effect of a 3-year commitment to remain tobacco free on tobacco uptake among high school students in Sweden. The commitment is developed in the form of a contract between a child and a significant adult, constituting the core component of Tobacco-free Duo (T-Duo), a Swedish school-based tobacco prevention program. Secondary analysis of data from a cluster randomized controlled trial. Participants were 586 students in high schools assigned to the intervention arm of T-Duo. At inception, participants attended grade 7 (i.e., age 12–13). Only students who were tobacco naïve at baseline for the respective outcome and participated in all follow-ups were included. The exposure was defined as signing a 3-year contract with a significant adult, categorized as “stable contract” (3 years contract with the same contract partner), “unstable” (signed a contract sometime during follow-up but this was not sustained over time and/or with the same partner), and “no contract” at all during the intervention period. The primary outcome was having never tried cigarette smoking at the end of grade 9. Exposure and outcomes were self-reported in yearly questionnaires. Of 586 students, 321 (55%) held a stable contract, 204 (35%) an unstable contract, and 61 (10%) did not sign a contract at all. At the end of grade 9 (age 15–16), the relative risk (RR) to remain cigarette free was 1.11 (95% CI 1.00–1.22) (Number Needed to Treat = 10) among students in any type of contract compared to students that did not write a contract at all. The RRs for remaining tobacco free (secondary outcomes) ranged from 1.07 (0.98–1.16) for regular snus use to 1.16 (1.00–1.35) for any type of tobacco use. A commitment to remain tobacco free through a child–adult contract seems to exert a preventive effect on the uptake of tobacco use among Swedish adolescents over 3 school years. The current findings apply to a selected sample of both schools and students.Registration: Current Controlled Trials ISRCTN52858080 Date: January 4, 2019, retrospectively registered.
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| 7. |
- Byhamre, Marja Lisa, et al.
(author)
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Swedish snus use is associated with mortality : a pooled analysis of eight prospective studies
- 2020
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In: International Journal of Epidemiology. - : Oxford University Press. - 0300-5771 .- 1464-3685. ; 49:6, s. 2041-2050
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Journal article (peer-reviewed)abstract
- BACKGROUND: The health consequences of the use of Swedish snus, including its relationship with mortality, have not been fully established. We investigated the relationship between snus use and all-cause and cause-specific mortality (death due to cardiovascular diseases, cancer diseases and all other reasons, respectively) in a nationwide collaborative pooling project.METHODS: We followed 169 103 never-smoking men from eight Swedish cohort studies, recruited in 1978-2010. Shared frailty models with random effects at the study level were used in order to estimate adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) of mortality associated with snus use.RESULTS: Exclusive current snus users had an increased risk of all-cause mortality (aHR 1.28, 95% CI 1.20-1.35), cardiovascular mortality (aHR 1.27, 95% CI 1.15-1.41) and other cause mortality (aHR 1.37, 95% CI 1.24-1.52) compared with never-users of tobacco. The risk of cancer mortality was also increased (aHR 1.12, 95% CI 1.00-1.26). These mortality risks increased with duration of snus use, but not with weekly amount.CONCLUSIONS: Snus use among men is associated with increased all-cause mortality, cardiovascular mortality, with death from other causes and possibly with increased cancer mortality.
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| 8. |
- Dimitrova, Radosveta, et al.
(author)
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Pedagogical and Social Climate in School Questionnaire : Factorial Validity and Reliability of the Teacher Version
- 2016
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In: Journal of Psychoeducational Assessment. - : SAGE Publications. - 0734-2829 .- 1557-5144. ; 34:3, s. 282-288
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Journal article (peer-reviewed)abstract
- This study evaluated the factorial structure of the Pedagogical and Social Climate in School (PESOC) questionnaire among 307 teachers in Bulgaria. The teacher edition of PESOC consists of 11 scales (i.e., Expectations for Students, Unity Among Teachers, Approach to Students, Basic Assumptions About Students’ Ability to Learn, School–Home Relations, Teacher Cooperation, Teachers’ Professional Development, Teaching Activities, Student Valuation, Principal’s Pedagogical Leadership, and School Management). A confirmatory factor analysis conducted with structural equation modeling supported a bi-dimensional factor model (Students and Teachers; School Leadership and Management). School climate indicators were also significantly and positively correlated. PESOC is an asset to the literature on assessment of school climate with evidence for factorial validity and reliability in an underresearched international context.
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| 9. |
- Eichas, Kyle, et al.
(author)
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Measuring Dimensions of Family Interaction in Adolescence : A Multitrait–Multimethod Analysis
- 2020
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In: European Journal of Psychological Assessment. - : Hogrefe Publishing Group. - 1015-5759 .- 2151-2426. ; 36:5, s. 901-906
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Journal article (peer-reviewed)abstract
- The aim of this study was to evaluate the convergent and discriminant validity of adolescent and parent ratings of family interaction. Adolescent and parent ratings of democratic parenting, parental warmth, and adolescent free disclosure were measured using a multitrait–multimethod confirmatory factor analytic approach. Participants included 3,959 Swedish youth in seventh grade (average age 13 years), with follow-up measurements in eighth and ninth grades. At each grade, findings provided support for trait discriminant validity and discriminant validity of methods. However, findings failed to provide support for convergent validity. Overall, the present findings suggest that measurement of family interactions should include the perspectives of both parents and adolescents because their perceptions of family interactions may represent different family interaction constructs.
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| 10. |
- Ferrer-Wreder, Laura, et al.
(author)
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Ways to Measure Family-Related Factors in Swedish Families using Child and Parent Reports
- 2018
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Conference paper (other academic/artistic)abstract
- Many Swedish parents report that they tend to employ moderate control as well as frequent use of democratic parenting practices (Trost, 2012). This approach to parenting combined with policy and institutional supports for child and family welfare make the Swedish parenting context in some ways unique and in need of further investigation (e.g., Trost, El-Khouri, & Sundell, 2015). From a measurement perspective, when parents and children in the same family report on the same construct, one is faced with several questions such as are the child and parent reports reflective of the same construct? If yes, then child and parent reports can be modelled or conceptualized as indicators of the same construct. Another possibility is that adolescents’ and parents’ perceptions of a given construct are fundamentally different from one another. A number of options exist in terms of how to conceptualize measurement when parents and children report on the same construct (Bank, Dishion, Skinner, & Patterson, 1990).The results presented in this poster are from a longitudinal study of school climate and mental health (study name and citation blinded for peer review). The sample consists of a cohort of Swedish 7th graders (N=3,932, aged 13-14 years old, 51.8% =female, from 101 schools in eight Swedish regions). At grade 7, using structural equation modelling (SEM), different measurement models of family-related factors were tested, namely democratic parenting (Wray-Lake & Flanagan, 2012), parental warmth (Trost, et al, 2007; Tilton-Weaver et al., 2010), and child-parent communication (Kerr & Statin, 2000). Adolescents in the cohort and one of their parents reported on these constructs at grades 7, 8, and 9. The results presented here are for grade 7. Analyses were conducted with Mplus 7.4 (using Mplus’s robust maximum likelihood estimator, TYPE = COMPLEX in Mplus, to account for the nested nature of responses by school building, and FIML estimation for missing data). Three SEM models were tested, including (1) a three-factor model in which parallel child and parent reports were indicators of the same family factors, (2) a six-factor model in which parallel child and parent reports were indicators of separate family factors, and (3) a multi-trait multi-method model with three family factors and two method factors (parent and child report; Model 3). Two models showed good fit to the data: the six-factor model, χ2(89) = 164.873; CFI = .997; RMSEA = .015 [.011, .018], and the multi-trait multi-method model, χ2(84) = 533.735; CFI = .982. RMSEA = .037 [.034, .040]. While both models evidenced good fit, the six-factor model provided the more parsimonious solution. This result indicates that adolescents and parents in this sample may be viewing the family-related factors in different ways. In the poster, other analyses will be reported on the utility of the models identified in grade 7 at the other study time points, such as at grades 8 and 9. Study findings will also be discussed in terms of culture and parenting.
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| 11. |
- Galanti, M. Rosaria, et al.
(author)
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Diet and the risk of papillary and follicular thyroid carcinoma : A population-based case-control study in Sweden and Norway
- 1997
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In: Cancer Causes and Control. - 0957-5243 .- 1573-7225. ; 8:2, s. 205-214
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Journal article (peer-reviewed)abstract
- A population-based case-control study was conducted in two regions of Sweden and Norway to investigate the association between dietary habits and the risk of thyroid cancer. The consumption of selected foods was reported in a self-completed food-frequency questionnaire by 246 cases with histologically confirmed papillary (n = 209) and follicular (n = 37) thyroid carcinoma, and 440 age- and gender-matched controls. Odds ratios (OR) and their 95 percent confidence interval (CI) were calculated as estimates of the relative risk using conditional logistic regression. High consumption of butter (OR = 1.6, CI = 1.1-2.5) and cheese (OR = 1.5, CI = 1.0-2.4) was associated with increased risks. Residence in areas of endemic goiter in Sweden was associated with an elevated risk, especially among women (OR = 2.5, CI = 1.3-4.9). High consumption of cruciferous vegetables was associated with increased risk only in persons who ever lived in such areas. A decreased risk was associated with consumption of iodized salt in northern Norway, and with use of iodized salt during adolescence among women (OR = 0.6, CI = 0.6-1.0). The results of this study suggest a role of diet and environment in the risk of thyroid cancer.
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| 12. |
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| 13. |
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| 14. |
- Galanti, Maria Rosaria, et al.
(author)
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School environment and mental health in early adolescence - a longitudinal study in Sweden (KUPOL)
- 2016
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In: BMC Psychiatry. - : Springer Science and Business Media LLC. - 1471-244X. ; 16
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Journal article (peer-reviewed)abstract
- Background: Longitudinal studies indicate strong associations between school proficiency and indicators of mental health throughout adulthood, but the mechanisms of such associations are not fully elucidated. The Kupol study is a prospective cohort study in Sweden set up in order to: (i) describe the association of school pedagogic and social environment and its specific dimensions with the risk of mental ill-health and psychiatric disorders in adolescence; (ii) evaluate the direct effects of school pedagogic and social environment on mental health and the effects mediated by the individual's academic achievements; and (iii) assess if school pedagogic and social environment are associated with mental ill-health through epigenetic mechanisms, in particular those involving genes regulating the response to stress.Methods: The Kupol cohort at baseline consists of 3959 children attending the 7th grade of compulsory school (13-14 years old) in 8 regions of central Sweden in the school years 2013-2014 or 2014-2015. Three follow-up surveys in subsequent years are planned. Teachers' and students' perceptions of the culture, climate and ethos of their schools, and students' mental ill-health are assessed at the whole school level by annual questionnaire surveys. In order to conduct epigenetic analyses saliva specimens are collected from a nested sample of students at inception and two years later. Further, class-, family-and child-level information is collected at baseline and during each year of follow-up. Self-reported information is being complemented with register data via record-linkages to national and regional health and administrative registers.Discussion: The topic being investigated is new, and the sample constitutes the largest adolescent cohort in Sweden involved in an ad hoc study. Epigenetic analyses centered on environmental cues to stress response are a thoroughly new approach. Finally a notable feature is the multi-informant and multi-method data collection, with surveys at the school, class, family, and student level. Collaboration and data access: interested investigators should contact the coordinating centre. Additional information is available on the study's website, http://kupolstudien.se/.
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| 15. |
- Galanti, Maria Rosaria, et al.
(author)
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Smoking and environmental iodine as risk factors for thyroiditis among parous women
- 2007
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In: European Journal of Epidemiology. - : Springer Science and Business Media LLC. - 0393-2990 .- 1573-7284. ; 22:7, s. 467-472
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Journal article (peer-reviewed)abstract
- Objective To elucidate whether exposure to some environmental factors, i.e. cigarette smoking and iodine deficiency influence the risk of thyroiditis. Methods We identified a cohort of 874, 507 parous women with self-reported information on smoking during pregnancy registered in the Swedish Medical Birth Registry from September 1983 through December 1997. Hospital diagnoses of thyroiditis (n = 286) and hypothyroidism (n = 690) following entry into the cohort were identified by record-linkage with the national Inpatient Registry. The hazard ratio (HR) of smokers compared to non-smokers and the corresponding 95% confidence limits (CL) were estimated by Cox regression. Results Smoking was inversely associated with risk of overt thyroiditis (adjusted HR = 0.72; CL = 0.54-0.95), even when diagnoses of primary hypothyroidism were included. However, a diagnosis of thyroiditis within 6 months from a childbirth was positively associated with smoking (adjusted HR = 1.88; CL = 0.94-3.76). Being born in areas of endemic goiter was not associated to hospital admission for thyroiditis. Thyroiditis patients who were smokers had more often than non-smokers a co-morbidity with other autoimmune disorders. Conclusions Smoking may increase the risk of thyroiditis occurring in the post-partum period and influence the clinical expression of other thyroiditis, especially when occurring as part of a polymorphic autoimmune disease.
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| 16. |
- Galanti, Maria Rosaria, et al.
(author)
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Tobacco-Free Duo Adult-Child Contract for Prevention of Tobacco Use Among Adolescents and Parents : Protocol for a Mixed-Design Evaluation
- 2020
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In: JMIR Research Protocols. - : JMIR Publications Inc.. - 1929-0748. ; 9:10
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Journal article (peer-reviewed)abstract
- BACKGROUND: Universal tobacco-prevention programs targeting youths usually involve significant adults, who are assumed to be important social influences. Commitment not to use tobacco, or to quit use, as a formal contract between an adolescent and a significant adult is a preventive model that has not been widely practiced or explored and has been formally evaluated even less. In this paper, we present the rationale and protocol for the evaluation of the Swedish Tobacco-free Duo program, a multicomponent school-based program the core of which rests on a formal agreement between an adolescent and an adult. The adolescent's commitment mainly concerns avoiding the onset of any tobacco use while the adult commits to support the adolescent in staying tobacco free, being a role model by not using tobacco themselves.OBJECTIVE: To assess (1) whether Tobacco-free Duo is superior to an education-only program in preventing smoking onset among adolescents and promoting cessation among their parents, (2) whether exposure to core components (adult-child agreement) entails more positive effects than exposure to other components, (3) the impact of the program on whole school tobacco use, (4) potential negative side effects, and (5) school-level factors related to fidelity of the program's implementation.METHODS: A mixed-design approach was developed. First, a cluster randomized controlled trial was designed with schools randomly assigned to either the comprehensive multicomponent program or its educational component only. Primary outcome at the adolescent level was identified as not having tried tobacco during the 3-year junior high school compulsory grades (12-15 years of age). An intention-to-treat cohort-wise approach and an as-treated approach complemented with a whole school repeated cross-sectional approach was devised as analytical methods of the trial data. Second, an observational study was added in order to compare smoking incidence in the schools participating in the experiment with that of a convenience sample of schools that were not part of the experimental study. Diverse secondary outcomes at both adolescent and adult levels were also included.RESULTS: The study was approved by the Umeå Regional Ethics Review Board (registration number 2017/255-31) in 2017. Recruitment of schools started in fall 2017 and continued until June 2018. In total, 43 schools were recruited to the experimental study, and 16 schools were recruited to the observational study. Data collection started in the fall 2018, is ongoing, and is planned to be finished in spring 2021.CONCLUSIONS: Methodological, ethical, and practical implications of the evaluation protocol were discussed, especially the advantage of combining several sources of data, to triangulate the study questions. The results of these studies will help revise the agenda of this program as well as those of similar programs.TRIAL REGISTRATION: International Standard Randomized Controlled Trial Number (ISRCTN) 52858080; https://doi.org/10.1186/ISRCTN52858080.INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/21100.
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| 17. |
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| 18. |
- Gebreslassie, Mihretab, et al.
(author)
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Should Nicotine Replacement Therapy be Provided Free of Charge? : A Cost-Utility Analysis in Sweden
- 2023
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In: Nicotine & tobacco research. - : Oxford University Press. - 1462-2203 .- 1469-994X. ; 25:11, s. 1762-1769
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Journal article (peer-reviewed)abstract
- Introduction Treatment with nicotine replacement therapy (NRT) during an attempt to quit smoking increases the likelihood of success by about 55%. However, out-of-pocket payment for NRT can hinder its use. Aims and Methods This study aims therefore to assess the cost-effectiveness of subsidizing NRT in Sweden. A homogeneous cohort-based Markov model was used to assess the lifetime costs and effects of subsidized NRT from a payer and societal perspective. Data to populate the model were retrieved from the literature, and selected parameters were varied in deterministic and probabilistic sensitivity analyses to assess robustness of model outputs. Costs are presented in USD, year 2021. Results A 12-week treatment with NRT was estimated to cost USD 632 (474-790) per person. From a societal perspective, subsidized NRT was a cost-saving alternative in 98.5% of the simulations. NRT is cost-saving across all ages, but the health and economic gains are somewhat larger among younger smokers from a societal perspective. When a payer perspective was used, the incremental cost-effectiveness ratio was estimated at 14 480 (11 721-18 515) USD per QALY which was cost-effective at a willingness to pay of 50 000 USD per QALY in 100 % of the simulations. Results were robust with realistic changes in the inputs during scenario and sensitivity analyses. Conclusions Subsidizing NRT is potentially a cost-saving smoking cessation strategy from a societal perspective and cost-effective from a payer perspective. Implications This study found that subsidizing NRT is potentially a cost-saving smoking cessation policy alternative compared to current practice from a societal perspective. From a healthcare payer perspective, subsidizing NRT is estimated to cost USD 14 480 to gain an extra QALY. NRT is cost-saving across all ages, but the health and economic gains are somewhat larger among younger smokers from a societal perspective. Moreover, subsidizing NRT removes the financial barriers that are mostly faced by socioeconomically disadvantaged smokers which might reduce health inequalities. Thus, future economic evaluations should further investigate the health inequality impacts with methods that are more suitable for this.
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| 19. |
- Giannotta, Fabrizia, 1978-, et al.
(author)
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Short-Term Mediating Factors of a School-Based Intervention to Prevent Youth Substance Use in Europe
- 2014
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In: Journal of Adolescent Health. - New York : Elsevier. - 1054-139X .- 1879-1972. ; 54:5, s. 565-573
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Journal article (peer-reviewed)abstract
- Purpose: To investigate factors mediating the effects of a European school-based intervention (Unplugged) based on a social influence approach to youths' substance use.Methods: Schools in seven European countries (n = 143, including 7,079 pupils) were randomly assigned to an experimental condition (Unplugged curriculum) or a control condition (usual health education). Data were collected before (pretest) and 3 months after the end of the program (posttest). Multilevel multiple mediation models were applied to the study of effect mediation separately for tobacco, alcohol, and cannabis use. Analyses were conducted on the whole sample, and separately on baseline users and nonusers of each substance.Results: Compared with the control group, participants in the program endorsed less positive attitudes toward drugs; positive beliefs about cigarettes, alcohol, and cannabis; and the normative perception of peers using tobacco and cannabis. They also increased in knowledge about all substances and refusal skills toward tobacco. Decreased positive attitudes toward drugs, increase in refusal skills, and reappraisal of norms about peer using tobacco and cannabis appeared to mediate the effects of the program on the use of substances. However, mediating effects were generally weak and some of them were only marginally significant.Conclusions: This study lends some support to the notion that school-based programs based on a social influence model may prevent juvenile substance use through the modification of attitudes, refusal skills, and normative perceptions. (C) 2014 Society for Adolescent Health and Medicine. All rights reserved.
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| 20. |
- Hansson, Jenny, et al.
(author)
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Use of snus and acute myocardial infarction: pooled analysis of eight prospective observational studies
- 2012
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In: European Journal of Epidemiology. - : Springer Science and Business Media LLC. - 1573-7284 .- 0393-2990. ; 27:10, s. 771-779
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Journal article (peer-reviewed)abstract
- The use of snus (also referred to as Scandinavian or Swedish moist smokeless tobacco), which is common in Sweden and increasing elsewhere, is receiving increasing attention since considered a tobacco smoke "potential reduction exposure product". Snus delivers a high dose of nicotine with possible hemodynamic effects, but its impact on cardiovascular morbidity and mortality is uncertain. The aim of this study was to investigate whether snus use is associated with risk of and survival after acute myocardial infarction (AMI). Data from eight prospective cohort studies set in Sweden was pooled and reanalysed. The relative risk of first time AMI and 28-day case-fatality was calculated for 130,361 men who never smoked. During 2,262,333 person-years of follow-up, 3,390 incident events of AMI were identified. Current snus use was not associated with risk of AMI (pooled multivariable hazard ratio 1.04, 95 % confidence interval 0.93 to 1.17). The short-term case fatality rate appeared increased in snus users (odds ratio 1.28, 95 % confidence interval 0.99 to 1.68). This study does not support any association between use of snus and development of AMI. Hence, toxic components other than nicotine appear implicated in the pathophysiology of smoking related ischemic heart disease. Case fatality after AMI is seemingly increased among snus users, but this relationship may be due to confounding by socioeconomic or life style factors.
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| 21. |
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| 22. |
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| 23. |
- Hergens, Maria-Pia, et al.
(author)
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Use of Scandinavian Moist Smokeless Tobacco (Snus) and the Risk of Atrial Fibrillation
- 2014
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In: Epidemiology. - 1044-3983 .- 1531-5487. ; 25:6, s. 872-876
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Journal article (peer-reviewed)abstract
- BACKGROUND: Snus is a smokeless tobacco product, widely used among Swedish men and increasingly so elsewhere. There is debate as to whether snus is an acceptable "harm-reduction" tobacco product. Since snus use delivers a dose of nicotine equivalent to cigarettes, and has been implicated in cardiac arrhythmia because of associations with sudden cardiovascular death, a relation with atrial fibrillation is plausible and important to investigate.METHODS:: To assess the relation between use of snus and risk of atrial fibrillation, we carried out a pooled analysis of 7 prospective Swedish cohort studies. In total, 274,882 men, recruited between 1978 and 2004, were followed via the National Patient Register for atrial fibrillation. Primary analyses were restricted to 127,907 never-smokers. Relative risks were estimated using Cox proportional hazard regression.RESULTS:: The prevalence of snus use was 25% among never-smokers. During follow-up, 3,069 cases of atrial fibrillation were identified. The pooled relative risk of atrial fibrillation was 1.07 (95% confidence interval = 0.97-1.19) in current snus users, compared with nonusers.CONCLUSION:: Findings from this large national pooling project indicate that snus use is unlikely to confer any important increase in risk of atrial fibrillation.
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| 24. |
- Hultin, Hanna, et al.
(author)
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Pedagogical and Social School Climate : Psychometric Evaluation and Validation of the Student Edition of PESOC
- 2019
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In: Scandinavian Journal of Educational Research. - : Routledge. - 0031-3831 .- 1470-1170. ; 63:4, s. 534-550
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Journal article (peer-reviewed)abstract
- Previous studies indicate that school climate is important for student health and academic achievement. This study concerns the validity and reliability of the student edition a Swedish instrument for measuring pedagogical and social school climate (PESOC). Data were collected from 5,745 students at 97 Swedish secondary schools. Multilevel confirmatory factor analyses were conducted, and multilevel composite reliability estimates, as well as correlations with school-level achievement indicators, were calculated. The results supported an 8-factor structure at the student level and 1 general factor at the school level. Factor loadings and composite reliability estimates were acceptable at both levels. The school-level factor was moderately and positively correlated with school-level academic achievement. The student PESOC is a promising instrument for studying school climate.
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| 25. |
- Hultin, Hanna, et al.
(author)
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The Importance of Pedagogical and Social School Climate to Bullying : A Cross‐Sectional Multilevel Study of 94 Swedish Schools
- 2021
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In: Journal of School Health. - : Wiley. - 0022-4391 .- 1746-1561. ; 91:2, s. 111-124
-
Journal article (peer-reviewed)abstract
- BACKGROUND: Bullying is a public health issue with long‐term effects for victims. This study investigated if there was an association between pedagogical and social school climate and student‐reported bullying victimization, which dimensions of pedagogical and social school climate were associated with bullying, and if these associations were modified by individual‐level social factors.METHODS: The study had a cross‐sectional multilevel design with individual‐level data on bullying from 3311 students nested in 94 schools over 3 consecutive school years. School climate was measured with student and teacher questionnaires, aggregated at the school level. The association between school climate and bullying victimization was estimated with multilevel mixed‐model logistic regression.RESULTS: In schools with the most favorable school climate, fewer students reported being bullied. This was especially evident when school climate was measured with the student instrument. Students in schools with favorable climate had an adjusted odds ratio of bullying of 0.74 (95% CI: 0.55‐1.00) compared to students in schools with the worst climate. Results from the teacher instrument were in the same direction, but less consistent.CONCLUSIONS: Improvement in school climate has the potential to affect students both academically, and socially, as well as decrease the prevalence of bullying.
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| 26. |
- Karlberg, Martin, 1969-, et al.
(author)
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The Importance of School Pedagogical and Social Climate to Students’ Unauthorized Absenteeism – a Multilevel Study of 101 Swedish Schools
- 2022
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In: Scandinavian Journal of Educational Research. - : Taylor & Francis Group. - 0031-3831 .- 1470-1170. ; 66:1, s. 88-104
-
Journal article (peer-reviewed)abstract
- While individual and family factors behind students’ school absenteeism are well-researched, fewer studies have addressed school climate factors. This study investigated the association between school climate in Swedish schools and students’ absenteeism. A multi-informant survey of school climate was conducted in 101 schools and analysed in relation to the history of absenteeism of 2770 students attending those schools in the 7th grade at inception, with follow-up until completion of the compulsory school (9th grade). Data on absenteeism was extracted from schools’ registers. Student (but not teacher) positive ratings of school climate were associated with lower absenteeism between the age of 13 and the age of 16. The associations between student rated school climate and absenteeism appeared stronger among students with highly educated parents.
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| 27. |
- Lindstrand, Sofia, et al.
(author)
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Compositional characteristics of neighbourhoods and of schools as correlates of youths mental health: A cross-sectional study among Swedish adolescents
- 2022
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In: Scandinavian Journal of Public Health. - : SAGE PUBLICATIONS LTD. - 1403-4948 .- 1651-1905. ; 50:8, s. 1081-1088
-
Journal article (peer-reviewed)abstract
- Aims: The study aimed to analyse the association between neighbourhood- and school-level socio-demographic factors and self-reported mental health among adolescents. Methods: The study population consisted of 3959 adolescents in southern and central Sweden (the KUPOL study), surveyed in the seventh grade (13 years old) and again in the ninth grade (15 years old). Cross-sectional associations were studied between socio-demographic indicators at neighbourhood level (proportion of adults with high education, without employment, of foreign-born residents) and at school level (proportion of students with at least one parent with high education, of students with a foreign background, mean qualification points in ninth grade) and mental health problems. These were assessed through the Strengths and Difficulties Questionnaire (SDQ). We derived odds ratios (OR) and corresponding 95% confidence intervals (CI) of scale scores above the threshold using multilevel logistic regression models. Results: After adjustment for individual- and family-level socio-demographic factors, there was an indication of higher OR of mental health problems with increasing proportions of foreign-born and residents without employment, especially among girls and in public schools. Stronger associations in the expected direction were found with the internalising subscale. Socio-demographic factors at the school level were not associated with adolescents mental health, except in private schools, where increasing proportions of students with highly educated parents were significantly associated with SDQ scores under the threshold (OR=0.91; 95% CI 0.85-0.97). Conclusions: The results indicate that equal living conditions may represent important cues to improve the mental health of adolescents. Longitudinal studies are needed to determine any causality.
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| 28. |
- Nilsson, Maria, 1957-, et al.
(author)
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Topas - tobakspreventivt arbete i skolan. Slutrapport : en utvärdering av det ANDT-förebyggande programmet Tobaksfri duo
- 2022
-
Reports (other academic/artistic)abstract
- I Sverige har tobaksförebyggande program med ungdomar som målgrupp under många år initierats, utvecklats och drivits av kommuner, regioner, och den ideella sektorn. Antalet vetenskapliga studier om tobaksförebyggande arbete i landet som publicerats i vetenskapliga tidskrifter är mycket få och har främst genomförts med en kvasiexperimentell design. Tobaksfri duo (T-Duo) har spridits i landet och önskemål har uttryckts om en utvärdering med metodik som ger högre evidensgrad jämfört med de studier som genomförts tidigare. Genom Topasprojektet har en sådan utvärdering av användningen av programmets kärnkomponenter möjliggjorts. Studien har genomförts av Umeå universitet och Karolinska Institutet på uppdrag av Folkhälsomyndigheten. Den hade en blandad design: 1) en klusterrandomiserad kontrollerad studie (CRCT) där skolor tilldelades programmet T-Duos sex kärnkomponenter eller en minimal komponent i form av Strukturerad undervisning, 2) en observationsstudie där programskolor jämfördes med skolor i en extern referensgrupp samt 3) en hälsoekonomisk utvärdering av programmets kostnadseffekt.Studiens övergripande syfte var att utvärdera effekterna och kostnaderna av programmet T-Duos sex kärnkomponenter genom att besvara följande specifika frågeställningar:Påverkas ungas tobaksdebut och tobaksanvändning av programmet? - d.v.s. är den förebyggande effekten större om man arbetar med programmet jämfört med en minimal komponent, alternativt ordinarie ANDT-undervisning i skolan?Påverkar deltagande i programmet vårdnadshavares tobaksbruk?Har graden av implementering av programmet betydelse för effekten?Är effekterna sådana att programkostnaderna är motiverade?Resultaten från studien visar att det fullständiga programmet T-Duo förknippas med en måttlig förebyggande effekt på högstadieelevers tobaksdebut (cirka 8 % större sannolikhet att förbli rökfria efter tre år), jämfört med om man enbart bedrev undervisning om tobak enligt programmet som ingick i Topas kontrollgrupp Undervisningsskolor (U-skolor). Resultaten kan dock ha påverkats av vissa systematiska fel, dels bortfall, dels beroende på självrapportering.Kontraktet som skrevs mellan ett barn och en vuxen 18 år eller äldre som barnet själv valde som vuxenpartner i T-Duo visade sig vara en effektiv komponent om kontraktet kunde upprätthållas under samtliga år. Komponenten innehåller tre delar kopplat till kontraktet, i) dels en möjlighet till stöd från en vuxen som barnet själv valt, att barnet ii) vid kontraktsskrivning gör ett åtagande inför andra om att man inte ska använda tobak under de kommande tre åren och slutligen iii) möjligheten för barnet att delta i utlottning av mindre priser och till rabatter (på till exempel skolfiket).Resultaten indikerade också att T-Duo kan påverka tobaksbruk på gruppnivå, det vill säga på skolnivå, på ett positivt sätt över tid. Med andra ord att alla elever på en skola som jobbade med T-Duo påverkades av programmet och inte bara de som deltog.Vad gällde vårdnadshavare (VH) i T-skolor sågs en möjlig effekt avseende tobaksstopp, det vill säga att de få deltagare som använde tobak i början av studien och som var kvar i slutet slutade använda tobak i större utsträckning än föräldrar i skolor lottade till enbart undervisningskomponenten. Dock måste resultaten tolkas med stor försiktighet på grund av det låga antalet VH som svarade på enkäten. Av denna anledning är det inte möjligt att säga om VH som tecknade kontrakt med sina barn hade större sannolikhet att förbli tobaksfria eller inte, eftersom andelen tobaksbrukare i gruppen som tecknade kontraktet med sina barn redan från början var mycket låg och betydligt lägre än bland resterande VH.Mycket få skolor hade implementerat programmet T-Duo helt enligt manualen för studien. Implementeringen var oftast måttlig, dvs att man hade genomfört mer än två kärnkomponenter enligt manualen, dock inte alla. Graden av implementering påverkade dock inte resultaten.I beräkningen av kostnadseffektivitet relaterades skillnaden i kostnader mellan T-skolor och U-skolor till den beräknade effekten i termer av hur många fler barn som förblev rökfria på grund av programmet. Det treåriga programmet kostade 785 kr per exponerat barn på T-skolorna och endast strukturerad undervisning kostade 491 kr per barn på U-skolorna. T-Duo kostade därmed 294 kr mer per barn jämfört med endast Strukturerad undervisning och kostnadseffektiviteten uppskattades till 5 066 kr för varje ytterligare barn som var rökfri i slutet på årskurs nio. Om effekten kvarstår fram till vuxen ålder representerar T-duo en mycket bra användning av resurserna i förhållande till framtida konsekvenser på hälsan som vuxen. Osäkerheten rörande programeffekten och om effekten kommer att bestå är avgörande för denna slutsats.
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| 29. |
- Pelters, Pelle, Ph.D. 1972-, et al.
(author)
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“It's nice to just be” : A qualitative study on the meaning-imbued reality of waterpipe smoking among young adults in Sweden
- 2023
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In: Nordic Studies on Alcohol and Drugs. - 1455-0725 .- 1458-6126. ; 40:5, s. 482-501
-
Journal article (peer-reviewed)abstract
- Background and aims: Waterpipe smoking is regarded as a burgeoning public health problem due to its popularity among young adults. This study aims to understand the meaning-imbued reality of waterpipe smoking for young adults in Sweden. Method: Data from 18 individual interviews with ethnically diverse Swedish young adults were analysed using inductive latent-level qualitative content analysis. Results: The youth's experience of waterpipe smoking shows different dimensions (time, space, fun, community) that construct the practice of waterpipe smoking as a closed bubble characterised by harmlessness, cosiness and freedom to develop an adult self in the waterpipe group. The bubble provides a breathing space and timeout in everyday life, fuelled by an understanding of the hookah as hazard-free and liberating. A variety of control mechanisms are used to defend the bubble's constructed harmlessness, proving responsibility by applying practice-, communication- and Othering-oriented means. Conclusion: The study enhances the understanding of waterpipe smoking by highlighting its community- and self-forming meaning in a combined focus on ritualistic and symbolic qualities. For young adults, waterpipe smoking combines potentially beneficial and detrimental impacts on health. This complex situation requires a dialogical – rather than a traditional – approach to prevention that negotiates the risk landscape faced by young adults.
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| 30. |
- Raffetti, Elena, et al.
(author)
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Cortisol Concentration as Predictor of Tobacco Initiation in Adolescents: Results From a Population-Based Swedish Cohort
- 2021
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In: Journal of Adolescent Health. - : Elsevier BV. - 1054-139X. ; 68:4, s. 758-764
-
Journal article (peer-reviewed)abstract
- Purpose Stress potentiates the smoking reward, decreases the ability to resist smoking, and increases the risk of smoking relapse in adulthood. This study aimed to clarify if salivary cortisol, as an indicator of stress, may be prospectively associated with the onset and phenotype of tobacco use in adolescents. Methods This study was based on a cohort of Swedish adolescents, among whom saliva specimens were collected from a nested sample. We included adolescents with salivary cortisol measurements and without a history of tobacco use (n = 381, aged 13–14 years). Quartiles of morning and afternoon cortisol concentration and cortisol area under the curve were considered as predictors. We categorized tobacco use according to the product mainly used: cigarette smoking, snus use, or either type of tobacco. For each product use, two outcomes were considered: initiation and duration of use. Poisson regression models were used to calculate rate ratios. Results A quartile increase in morning cortisol levels and cortisol area under the curve was consistently associated with a 1.2- to 1.4-fold increased risk of initiation of cigarette smoking snus use, or any tobacco use. Similar results were obtained examining the dose–response relationship and using the duration of use as outcome. No associations were apparent between afternoon cortisol concentration and any of the outcomes. All associations were similar between sexes. Conclusions Morning cortisol concentration, an indicator of hypothalamic–pituitary–adrenal axis activation, is prospectively associated with tobacco use in adolescents. Whether this activation indicates the cumulative effect of stressors during the life course remains to be elucidated.
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| 31. |
- Raffetti, Elena, et al.
(author)
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Country differences in the cross-sectional associations between smoking and depressive symptoms in adolescence
- 2022
-
In: European Journal of Public Health. - : Oxford University Press (OUP). - 1101-1262 .- 1464-360X. ; 32:6, s. 913-918
-
Journal article (peer-reviewed)abstract
- Background: The aim of the present study was to compare the cross-sectional association between smoking and depressive symptoms among adolescents between Sweden and Italy, two countries historically characterized by different norms about tobacco use and different tobacco control efforts. Methods: A cross-sectional study including 3283 adolescents 15–16 years of age participating in the Swedish KUPOL study and 1947 same-age adolescents from the Italian BE-TEEN study. Current smoking was defined as any smoking in the past 30 days. Depressive symptoms were assessed using the Centre for Epidemiological Studies Depression Scale for Children (CES-DC) and the internalizing score of the Strengths and Difficulties Questionnaire (SDQ). Country differences were explored in stratified and interaction analyses. Results: Current smoking was associated with a 2- to 3-fold increased odds of depressive symptoms among Swedish adolescents using both CES-DC and SDQ internalizing scale. Among Italian adolescents, slightly lower increased odds of 1.5–2.5 for depressive symptoms with smoking were found using the CES-DC but not the SDQ scale. Both multiplicative and additive interactions for country were significant. The association between smoking and depressive symptoms was weaker among Italian compared with Swedish adolescents for both scores. Conclusions: Countries with different tobacco norms and control show different associations between smoking and depressive symptoms in adolescence, probably due to different psychosocial profiles of smokers. These findings need to be considered when planning tobacco prevention programmes, e.g. by focusing on early detection of mental health distress among adolescents in settings with declining smoking prevalence and restrictive tobacco control environments.
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| 32. |
- Raffetti, Elena, et al.
(author)
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DNA methylation of the glucocorticoid receptor gene predicts substance use in adolescence: longitudinal data from over 1000 young individuals.
- 2021
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In: Translational psychiatry. - : Springer Science and Business Media LLC. - 2158-3188. ; 11:1
-
Journal article (peer-reviewed)abstract
- Early life stress has been linked to increased methylation of the Nuclear Receptor Subfamily 3 Group C Member 1 (NR3C1) gene, which codes for the glucocorticoid receptor. Moreover, early life stress has been associated with substance use initiation at a younger age, a risk factor for developing substance use disorders. However, no studies to date have investigated whether NR3C1 methylation can predict substance use in young individuals. This study included adolescents 13-14 years of age that reported no history of substance use at baseline, (N=1041; males=46%). Participants contributed saliva DNA samples and were followed in middle adolescence as part of KUPOL, a prospective cohort study of 7th-grade students in Sweden. Outcome variables were self-reports of (i) recent use, (ii) lifetime use, and (iii) use duration of (a) alcohol, (b) tobacco products, (c) cannabis, or (d) any substance. Outcomes were measured annually for three consecutive years. The predictor variable was DNA methylation at the exon 1F locus of NR3C1. Risk and rate ratios were calculated as measures of association, with or without adjustment for internalizing symptoms and parental psychiatric disorders. For a subset of individuals (N=320), there were also morning and afternoon salivary cortisol measurements available that were analyzed in relation to NR3C1 methylation levels. Baseline NR3C1 hypermethylation associated with future self-reports of recent use and use duration of any substance, before and after adjustment for potential confounders. The overall estimates were attenuated when considering lifetime use. Sex-stratified analyses revealed the strongest association for cigarette use in males. Cortisol analyses revealed associations between NR3C1 methylation and morning cortisol levels. Findings from this study suggest that saliva NR3C1 hypermethylation can predict substance use in middle adolescence. Additional longitudinal studies are warranted to confirm these findings.
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| 33. |
- Sparén, Pär, et al.
(author)
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Long term mortality after severe starvation during the siege of Leningrad : prospective cohort study
- 2004
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In: The BMJ. - 1756-1833. ; 328:7430, s. 11-14A
-
Journal article (peer-reviewed)abstract
- Objectives To determine whether starvation during periods of increased growth after birth have long term health consequences.Design Analysis of cardiovascular risk factors and mortality in a longitudinal follow up after the 1941-4 siege of Leningrad. Mortality measured from 1975 up to the end of 1999.Setting St Petersburg, Russia (formerly Leningrad).Participants 5000 men born 1916-35 who lived in Leningrad, randomly selected to take part in health examinations in 1975-7. Of the 3905 men who participated, a third had experienced the siege.Main outcome measures Relative risk of ischaemic heart disease and mortality from stroke by siege exposure. Odds ratios and means for several cardiovascular risk factors.Results Three to six decades after the siege, in men who experienced the siege around the age of puberty blood pressure was raised (mean difference in systolic 3.3 mm Hg, in diastolic 1.3 mm Hg) as was mortality from ischaemic heart disease (relative risk 1.39, 95% confidence interval 1.07 to 1.79) and stroke (1.67, 1.15 to 2.43), including haemorrhagic stroke (1.71, 0.90 to 3.22). The effect on mortality was partly mediated via blood pressure but not by any other measured biological, behavioural, or social factor.Conclusions Starvation, or accompanying chronic stress, particularly at the onset of or during puberty, may increase vulnerability to later cardiovascular disease.
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| 34. |
- Sundin, Erica, et al.
(author)
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Are differences in population prevalence of alcohol's harm to others related to survey administration mode?
- 2018
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In: Drug and Alcohol Review. - : Wiley. - 0959-5236 .- 1465-3362. ; 37:3, s. 375-381
-
Journal article (peer-reviewed)abstract
- Introduction and Aims. This study assessed the comparability of estimates of alcohol's harm to others across different administration modes in Swedish general population surveys. Harm was categorised as harm from strangers' drinking and harm from heavy drinkers known to the respondent. Design and Methods. Three surveys were conducted in 2011/2012 (n=6841), including identical questions. One was based on self-administered postal or Web questionnaires, and two were based on computer-assisted telephone interviews of which one included a more ambitious procedure in terms of for example monetary incentives to the respondents. Pearson (2)-tests were used to compare differences in the prevalence of harm. To estimate potential effects of survey mode, the samples were pooled, and multivariate Poisson regression models with mode as explanatory variable were used, adjusting for socio-demographic and behavioural factors. Results. Respondents in the two computer-assisted telephone interviews were more likely to report harm from strangers' drinking compared with respondents in the self-administered postal or Web questionnaires. However, no significant differences were found between survey modes concerning reports of harm from known people's drinking. Discussion and Conclusions. A survey mode based on interviews seems to facilitate reports of harm from strangers' drinking. This does not apply to reports of harm from known people's drinking. Therefore, the comparability of estimates of alcohol's harm to others between survey modes depends on the type of harm being studied.
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| 35. |
- Sundin, Erica, et al.
(author)
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Country-Level Heavy Episodic Drinking and Individual-Level Experiences of Harm from Others' Drinking-Related Aggression in 19 European Countries
- 2022
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In: European Addiction Research. - : S. Karger AG. - 1022-6877 .- 1421-9891. ; 28:2, s. 134-142
-
Journal article (peer-reviewed)abstract
- Introduction: There is limited knowledge about how individual experiences of harm from others’ drinking are influenced by heavy episodic drinking (HED) at the country level. The present study aimed to assess (1) the association between the country-level prevalence of HED and the risk of experiencing harm from others’ drinking-related aggression and (2) if HED at the country level modifies the association between consumption of alcohol per capita (APC) and such harm. Methods: Outcome data from 32,576 participants from 19 European countries stem from the RARHA SEAS study. Self-reported harm from others’ drinking included having been verbally abused, harmed physically, or having serious arguments. Data on country-level drinking patterns were derived from the World Health Organization. Associations between country-level prevalence of monthly HED and experiences of aggression (at least 1 of 3 studied harms) were derived through multilevel models – adjusted for country-level age structure and by including the respondent’s own HED patterns as a mediator. Results: A 1% increase in the prevalence of monthly HED was associated with 5% higher odds (odds ratio [OR] 1.05) of experiencing others’ alcohol-related aggression among men, and 6% (OR 1.06) among women. The results suggest that the association between APC and harm was stronger in countries with high prevalences of HED, but the modifying effect could not be confirmed. Discussion/Conclusion: Harm from others’ drinking-related aggression depends not only on individual factors but is also influenced by the drinking patterns of the population. However, the country-level prevalence of HED only explains a small part of the variance of this type of harm.
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| 36. |
- Trost, Kari, et al.
(author)
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The Study of Family Context : Examining Its Role for Identity Coherence and Adolescent Adjustment for Swedish Adolescents
- 2020
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In: Journal of Early Adolescence. - : SAGE Publications. - 0272-4316 .- 1552-5449. ; 40:2, s. 165-196
-
Journal article (peer-reviewed)abstract
- The present cross-sectional study aimed to examine whether characteristics of the parent-child relationship in adolescence are important for adjustment and identity development. Participants were recruited from schools in central Sweden for a larger longitudinal study when the cohort was 13- to 14-year-olds (N = 3,667). Characteristics of the parent-child relationship, like parental warmth, democratic parenting, and child communication, and adolescent adjustment problems and identity coherence were studied. It was found that democratic parenting was positively linked to child communication but negatively associated with problematic peer relationships and behavioral problems. Parental warmth was linked to other parenting characteristics as well as identity cohesion. Democratic parenting was linked to greater school engagement and identity coherence for boys and girls. Gender differences were found. The findings support the notion that democratic and warm parenting may provide support for adolescent identity development and adjustment.
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| 37. |
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| 38. |
- Yang, Fei, et al.
(author)
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Moist smokeless tobacco (Snus) use and risk of Parkinson's disease
- 2017
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In: International Journal of Epidemiology. - : Oxford University Press (OUP). - 0300-5771 .- 1464-3685. ; 46:3, s. 872-880
-
Journal article (peer-reviewed)abstract
- BACKGROUND: Cigarette smoking is associated with a lower risk of Parkinson's disease. It is unclear what constituent of tobacco smoke may lower the risk. Use of Swedish moist smokeless tobacco (snus) can serve as a model to disentangle what constituent of tobacco smoke may lower the risk. The aim of this study was to determine whether snus use was associated with a lower risk of Parkinson's disease.METHODS: Individual participant data were collected from seven prospective cohort studies, including 348 601 men. We used survival analysis with multivariable Cox regression to estimate study-specific relative risk of Parkinson's disease due to snus use, and random-effects models to pool estimates in a meta-analysis. The primary analyses were restricted to never-smokers to eliminate the potential confounding effect of tobacco smoking.RESULTS: During a mean follow-up time of 16.1 years, 1199 incident Parkinson's disease cases were identified. Among men who never smoked, ever-snus users had about 60% lower Parkinson's disease risk compared with never-snus users [pooled hazard ratio (HR) 0.41, 95% confidence interval (CI) 0.28-0.61]. The inverse association between snus use and Parkinson's disease risk was more pronounced in current (pooled HR 0.38, 95% CI 0.23-0.63), moderate-heavy amount (pooled HR 0.41, 95% CI 0.19-0.90) and long-term snus users (pooled HR 0.44, 95% CI 0.24-0.83).CONCLUSIONS: Non-smoking men who used snus had a substantially lower risk of Parkinson's disease. Results also indicated an inverse dose-response relationship between snus use and Parkinson's disease risk. Our findings suggest that nicotine or other components of tobacco leaves may influence the development of Parkinson's disease.
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