| 1. |
- Berg, Noora
(författare)
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Accumulation of disadvantage from adolescence to midlife : A 26-year follow-up study of 16-year old adolescents
- 2017
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- There is a wide range of evidence that childhood conditions are associated with adult wellbeing and disadvantage. However, in many cases, there is still a lack of knowledge on how and why these associations are formed. The life-course perspective examines these longitudinal mechanisms linking wellbeing and disadvantage in different life phases and tries to understand the continuities and discontinuities of individual lives. Information on these longitudinal associations is needed in order to be able to affect adverse life paths. For several decades, it has been suggested that disadvantage is a multidimensional concept that encompasses several dimensions of life such as health, social relations, socioeconomic factors and risky behaviour. Different forms of disadvantage are known to correlate, but less is known about how these disadvantages are interlocked in time. Accumulation of disadvantage refers to these processes, where previous disadvantages affect subsequent disadvantage. Mortality can be seen as an extreme end point of accumulation of disadvantage. The multidimensional approach to disadvantage is still underutilized in research in many ways. Often the focus has been in socioeconomic and health related forms of disadvantage or in risky behaviour, but rarely studies have taken several different dimensions of life into account simultaneously. The general aim of this study was to examine accumulation of disadvantage from adolescence to midlife in a life-course perspective. This study approaches the concept of disadvantage from a multidimensional perspective covering life dimensions of health, social relations, socioeconomic factors and risky behaviour. This study is a part of wider follow-up study Stress, Development and Mental Health –Study (TAM-project), which is carried out at the National Institute for Health and Welfare (THL). The study has prospectively followed up a Finnish urban age cohort at the ages of 16, 22, 32 and 42. The original study population included all Finnish speaking ninth-grade pupils attending secondary schools in the spring of 1983 in Tampere, Finland. In the first phase of the study, 2194 pupils (96.7%) aged 16 years completed a self-administered questionnaire during school hours. In three later phases the study cohort was followed up using postal questionnaires when the subjects were 22 (n=1656, 75.5%), 32 (n=1471, 67.0%) and 42 (n=1334, 60.7%) years old. This study examined multidimensional disadvantage using life-course models of clustered disadvantage, chain of risk and accumulation and found support for all of them. According to the results of this study, several individual and clustered forms of disadvantage in adolescence were associated with mortality before midlife. Lack of educational plans or uncertainty of them at age 16 was the strongest single predictor of mortality. Multiple simultaneous forms of disadvantage related to social relations, risky behaviour and own and parental socioeconomic factors were associated with mortality. This was the case also when disadvantage extended to many dimensions of disadvantage simultaneously. We found that poor family relationships in adolescence played a role in chains of disadvantages lasting all the way to midlife. The pathways from poor family relationships to economic adversity in midlife were shaped by low education and poor mental health in 5 early adulthood in women. In men this association was found to be shaped by early adult education, but it was explained by poor school performance already at age 16, indicating that those men with poor family relationships are already in adolescence on a disadvantage trajectory that will continue into adulthood regardless of whether they have problems in family relationships. The pathways to poor mental health in midlife were shaped mainly by mental health in early adulthood and in women also by heavy drinking. In the final life-course model we focused on accumulation of heavy drinking and examined it by using trajectory models. The results indicate that women of the steady high alcohol trajectory from adolescence to midlife had an increased risk of experiencing almost all measured disadvantages at age 42 (health, social relations, socioeconomic factors). In men, those who increased their drinking or drank steadily heavily had an increased risk for experiencing health and economic disadvantage in midlife. Frequent heavy drinking in adolescence did not leave 'a scar' that would associate with midlife disadvantage, if the drinking was reduced after adolescence. Childhood and adolescent disadvantages have long-term effects on wellbeing/disadvantage all the way to midlife, but they do not inexorably determine people's lives, also conditions in other life phases shape the life course. This provides many possibilities for preventive actions that should be targeted, not only to early years of life, but to later life phases as well. Our results highlight the importance of targeting interventions to improving the family relationships, supporting the educational career of the disadvantaged and preventing detrimental alcohol use
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| 2. |
- Berg, Noora, et al.
(författare)
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Pathways from poor family relationships in adolescence to economic adversity in mid-adulthood
- 2017
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Ingår i: Advances in Life Course Research. - : Elsevier. - 1040-2608. ; 32, s. 65-78
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Tidskriftsartikel (refereegranskat)abstract
- Previous studies have found that troubled childhood family conditions have long-term detrimental effects on a person’s economic situation in adulthood. However, the mechanisms behind these effects are unclear. The aim of this study was to examine the associations between poor adolescent family relationships and the economic adversity in mid-adulthood and whether different adversities in early adulthood mediate this association.Participants of a Finnish cohort study at 16 years in 1983 were followed up when aged 22, 32 and 42 (N = 1334). Family relationships were measured according to adolescents’ perceived lack of emotional parental support (e.g. My mother is close to me (reversed)), lack of parental support in the individuation process and poor atmosphere at home. We analysed the direct effects of poor family relationships at age 16 on the economic adversity at age 42 and also indirect effects via various adversities at ages 22 and 32. The examined adversities were poor somatic and mental health, lack of an intimate relationship, low education and heavy drinking.Poor adolescent family relationships were associated with economic adversity in mid-adulthood. For women, poor relationships were associated with their economic adversity (42y) through poor mental health and low education in early adulthood. For men, the effect was transmitted via low education, although this was not the case after adjusting for school achievement in adolescence.The quality of family relationships in adolescence is associated with an individual’s economic situation well into mid-adulthood in women. Moreover, this association was not explained by family structure and parental SEP in adolescence. Early promotion of parent-child interaction, as well as health and education of individuals from troubled family conditions, might reduce economic inequality in adulthood.
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| 3. |
- Berg, Noora, et al.
(författare)
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Pathways from problems in adolescent family relationships to midlife mental health via early adulthood disadvantages – a 26-year longitudinal study
- 2017
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Ingår i: PLOS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 12:5
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Tidskriftsartikel (refereegranskat)abstract
- Poor childhood family conditions have a long-term effect on adult mental health, but the mechanisms behind this association are unclear. Our aim was to study the pathways from problematic family relationships in adolescence to midlife psychological distress via disadvantages in early adulthood. Participants of a Finnish cohort study at the age of 16 years old in 1983 were followed up at ages 22, 32 and 42 years old (N = 1334). Problems in family relationships were measured with poor relationship with mother and father, lack of parental support in adolescent's individuation process and poor home atmosphere, and mental health was assessed using Kessler's Psychological Distress Scale (K10). We analyzed the indirect effects of adolescent family relations on mental health at age 42 years old via various disadvantages (somatic and psychological symptoms, relationship/marital status, low education/unemployment and heavy drinking) at ages 22 and 32 years old. Problematic adolescent family relationships were associated with midlife psychological distress in women (0.19; 95% CI 0.11, 0.26) and men (0.13; 95% CI 0.04, 0.21). However, after adjustment for adolescent psychological symptoms, the association was only significant for women (0.12; 95% CI 0.04, 0.20). Poor family relationships were associated with various disadvantages in early adulthood. The association from poor family relationships (16 years old) to psychological distress (42 years old) was in part mediated via psychological symptoms in women (0.03; 95% CI 0.01, 0.04) and men (0.02; 95% CI 0.00, 0.04) and in women also via heavy drinking in early adulthood (0.02; 95% CI 0.00, 0.03). Adolescent family relationships have a role in determining adult mental health. Targeted support addressing psychological well-being and hazardous drinking for adolescents with problematic family relationships might prevent disadvantages in early adulthood, and further prevent poor midlife mental health.
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| 4. |
- Modin, Bitte, et al.
(författare)
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School performance, school segregation and stress-related symptoms : comparing Helsinki and Stockholm
- 2015
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Ingår i: School Effectiveness and School Improvement. - : Informa UK Limited. - 0924-3453 .- 1744-5124. ; 26:3, s. 467-486
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Tidskriftsartikel (refereegranskat)abstract
- This study investigates cross-cultural differences in the interrelation between school performance, school segregation, and stress-related health among 9th-grade students in the greater Stockholm and Helsinki areas. Contrary to the Swedish case, it has been proposed that school performance in Finland is largely independent of the specific school attended and of socioeconomic background. Finland also stands out as a contrast to Sweden considering their better performance in the Programme for International Student Assessment (PISA) surveys. Our first 2 hypotheses explore whether there is a greater degree of school segregation in Stockholm than in Helsinki, and our second pair of hypotheses test whether Finland’s school success has come at a price in terms of increased student stress. Our results largely confirm that Stockholm schools are less “equal” and more segregated than those in Helsinki. We also find that school performance is more strongly linked to stress-related complaints among students in Helsinki than in Stockholm, especially among Finnish girls.
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| 5. |
- Theorell, Töres, et al.
(författare)
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Obesity and loss of disease-free years owing to major non-communicable diseases : a multicohort study
- 2018
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Ingår i: The Lancet Public Health. - : Elsevier Ltd. - 2468-2667. ; 3:10, s. e490-e497
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Tidskriftsartikel (refereegranskat)abstract
- Background: Obesity increases the risk of several chronic diseases, but the extent to which the obesity-related loss of disease-free years varies by lifestyle category and across socioeconomic groups is unclear. We estimated the number of years free from major non-communicable diseases in adults who are overweight and obese, compared with those who are normal weight. Methods: We pooled individual-level data on body-mass index (BMI) and non-communicable diseases from men and women with no initial evidence of these diseases in European cohort studies from the Individual-Participant-Data Meta-Analysis in Working Populations consortium. BMI was assessed at baseline (1991–2008) and non-communicable diseases (incident type 2 diabetes, coronary heart disease, stroke, cancer, asthma, and chronic obstructive pulmonary disease) were ascertained via linkage to records from national health registries, repeated medical examinations, or self-report. Disease-free years from age 40 years to 75 years associated with underweight (BMI <18·5 kg/m2), overweight (≥25 kg/m2 to <30 kg/m2), and obesity (class I [mild] ≥30 kg/m2 to <35 kg/m2; class II–III [severe] ≥35 kg/m2) compared with normal weight (≥18·5 kg/m2 to <25 kg/m2) were estimated. Findings: Of 137 503 participants from ten studies, we excluded 6973 owing to missing data and 10 349 with prevalent disease at baseline, resulting in an analytic sample of 120 181 participants. Of 47 127 men, 211 (0·4%) were underweight, 21 468 (45·6%) normal weight, 20 738 (44·0%) overweight, 3982 (8·4%) class I obese, and 728 (1·5%) class II–III obese. The corresponding numbers among the 73 054 women were 1493 (2·0%), 44 760 (61·3%), 19 553 (26·8%), 5670 (7·8%), and 1578 (2·2%), respectively. During 1 328 873 person-years at risk (mean follow-up 11·5 years [range 6·3–18·6]), 8159 men and 8100 women developed at least one non-communicable disease. Between 40 years and 75 years, the estimated number of disease-free years was 29·3 (95% CI 28·8–29·8) in normal-weight men and 29·4 (28·7–30·0) in normal-weight women. Compared with normal weight, the loss of disease-free years in men was 1·8 (95% CI −1·3 to 4·9) for underweight, 1·1 (0·7 to 1·5) for overweight, 3·9 (2·9 to 4·9) for class I obese, and 8·5 (7·1 to 9·8) for class II–III obese. The corresponding estimates for women were 0·0 (−1·4 to 1·4) for underweight, 1·1 (0·6 to 1·5) for overweight, 2·7 (1·5 to 3·9) for class I obese, and 7·3 (6·1 to 8·6) for class II–III obese. The loss of disease-free years associated with class II–III obesity varied between 7·1 and 10·0 years in subgroups of participants of different socioeconomic level, physical activity level, and smoking habit. Interpretation: Mild obesity was associated with the loss of one in ten, and severe obesity the loss of one in four potential disease-free years during middle and later adulthood. This increasing loss of disease-free years as obesity becomes more severe occurred in both sexes, among smokers and non-smokers, the physically active and inactive, and across the socioeconomic hierarchy. Funding: NordForsk, UK Medical Research Council, US National Institute on Aging, Academy of Finland, Helsinki Institute of Life Science, and Cancer Research UK.
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| 6. |
- Virtanen, Marianna, et al.
(författare)
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Long working hours and depressive symptoms : systematic review and meta-analysis of published studies and unpublished individual participant data
- 2018
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Ingår i: Scandinavian Journal of Work, Environment and Health. - : Nordic Association of Occupational Safety and Health. - 0355-3140 .- 1795-990X. ; 44:3, s. 239-250
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Forskningsöversikt (refereegranskat)abstract
- Objectives This systematic review and meta-analysis combined published study-level data and unpublished individual-participant data with the aim of quantifying the relation between long working hours and the onset of depressive symptoms. Methods We searched PubMed and Embase for published prospective cohort studies and included available cohorts with unpublished individual-participant data. We used a random-effects meta-analysis to calculate summary estimates across studies. Results We identified ten published cohort studies and included unpublished individual-participant data from 18 studies. In the majority of cohorts, long working hours was defined as working ≥55 hours per week. In multivariable-adjusted meta-analyses of 189 729 participants from 35 countries [96 275 men, 93 454 women, follow-up ranging from 1-5 years, 21 747 new-onset cases), there was an overall association of 1.14 (95% confidence interval (CI) 1.03-1.25] between long working hours and the onset of depressive symptoms, with significant evidence of heterogeneity (I 2=45.1%, P=0.004). A moderate association between working hours and depressive symptoms was found in Asian countries (1.50, 95% CI 1.13-2.01), a weaker association in Europe (1.11, 95% CI 1.00-1.22), and no association in North America (0.97, 95% CI 0.70-1.34) or Australia (0.95, 95% CI 0.70-1.29). Differences by other characteristics were small. Conclusions This observational evidence suggests a moderate association between long working hours and onset of depressive symptoms in Asia and a small association in Europe.
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