| 1. |
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| 2. |
- Carlerby, Heidi, 1967-
(author)
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Health and Social Determinants Among Boys and Girls in Sweden : Focusing on Parental Background
- 2012
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Doctoral thesis (other academic/artistic)abstract
- The majority of Swedish boys and girls have good psychosomatic health. Despite that the risk of mental health problems such as nervousness, feeling low and sleeping difficulties has increased steadily in recent decades. Moreover, previous surveys on health and well-being indicate that boys and girls of foreign extraction in Sweden are at increased risk of ill health compared to boys and girls of Swedish background. The main aim of this thesis was to analyse health and social determinants among boys and girls of foreign extraction in Sweden. The factors explored in papers I–IV include parental background, family affluence and gender and their associations with subjective health complaints, psychosomatic problems or health risk behaviours. Other included risk factors for ill health were involvement in bullying, low participation and discrimination at school. This thesis takes an intersectional perspective, with ambitions to be able to emphasize the interplay between different power relations (i.e. gender, social class and parental background). Two sets of cross-sectional data were used. Three papers were based on the Swedish part of the World Health Organization’s Health Behaviour in School-Aged Children. The sample consisted of 11,972 children (boys n = 6054; girls n = 5918) in grades five, seven and nine from the measurement years 1997/98, 2001/02 and 2005/06. The response rate varied between 85 and 90%. About one fifth of the included children were of foreign extraction. For the fourth paper regional data from Northern Sweden were used. Boys (n = 729) and girls (n = 798) in grades six to nine answered a questionnaire in 2011 and the response rate was 80%. About 14% of the included children were of foreign extraction. Statistical methods used were chi-square test, correlation analyses, logistic regression analyses, cluster analyses and test of mediating factor. The results showed that girls of foreign background were at increased risk of subjective health complaints (SHC) and boys of mixed background were at increased risk of psychosomatic problems (PSP). Increased risk of allocation to the cluster profile of multiple risk behaviour was shown in boys and girls of mixed background, in girls of foreign background and in girls of low family affluence. Increased risk of allocation to the cluster profile of inadequate tooth brushing was shown in boys and girls of foreign background and in girls of low family affluence. General risk factors for increased risk of ill health for boys and girls in Sweden were: any form of bullying involvement, low family affluence, low participation and discrimination at school, of which the latter also was a mediating factor for ill health. Living with a single parent was a risk factor for ill health among girls. The results can function as a basis for developing health promotion programmes at schools that focus on social consequences of foreign extraction, family affluence, participation as well as health risk behaviours and gender.
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| 3. |
- Carlerby, Heidi, 1967-, et al.
(author)
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How Bullying Involvement is Associated with the Distribution of Parental Background and With Subjective Health Complaints Among Swedish Boys and Girls
- 2013
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In: Social Indicators Research. - : Springer Science and Business Media LLC. - 0303-8300 .- 1573-0921. ; 111:3, s. 775-783
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Journal article (peer-reviewed)abstract
- This study aimed to analyze how bullying involvement is associated with the distribution of parental background and with subjective health complaints (SHC) among Swedish boys and girls. Data were collected from the World Health Organization, Health Behavior in School-aged Children (WHO/HBSC) survey, measurement years 1997/1998, 2001/2002 and 2005/2006. A total of 11,972 boys (50.6 %) and girls (49.4 %) in grades five, seven and nine participated in the study. The adolescents were categorized in subgroups according to parental background: Swedish (80.1 %), mixed (10.5 %) and foreign(9.7 %). Multivariate logistic regressions were used to estimate remaining risk of SHC in the categories of bullying involvement. The frequencies of bullying involvement once or more were: none involved (74.8 %), victims (10.6 %), bullies (10.3 %) and bully/victims (4.4 %). Six out of ten involved in bullying were boys. Boys of foreign background were more involved as bullies compared to boys of mixed or Swedish background. Girls of foreign background were more involved in all three categories of bullying than girls of mixed or Swedish background. Increased risk of SHC was estimated among all adolescents involved in bullying, with highest OR in the category of bully/victims, OR 3.95 (CI 3.13–4.97) for the boys and OR 4.51 (CI 4.51–6.40) for the girls. The multivariate models were stable even after adjustment for socio-demographics. There are some associations between bullying involvement and parental background. Regardless of parental background, family affluence, family structure and gender, all adolescents involved in bullying are at increased risk of SHC.
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| 4. |
- Carlerby, Heidi, 1967-, et al.
(author)
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How discrimination and participation are associated with psychosomatic problems among boys and girls in northern Sweden
- 2012
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In: Health. - : Scientific Research Publishing, Inc.. - 1949-5005 .- 1949-4998. ; 4:10, s. 866-872
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Journal article (peer-reviewed)abstract
- Background: Negative impact on health from school disturbance due to asymmetric power relations such as discrimination and offensive treatment are frequent problems among students. This study sought to analyze associations between occurrence of discrimination at school, participation and psychosomatic problems. Methods: Pupils in grades 6–9 in ten schools in a northern Swedish municipality participated in the study. The frequency of discrimination at school was measured by six items: sex; culture or ethnicity; disability; religion beliefs; sexual preferences; and any other form of discrimination. The Social and Civic Objectives Scale (SCOS) was used for an estimation of the level of participation. The pupils’ health was measured by the PsychoSomatic Problem (PSP) scale. Multivariate logistic regression models were used for estimation of increased risk of PSP. The formula Z=d/s (d)was used to test mediation. Results: Two thirds of the boys and three fourths of the girls reported occurrences of discrimination at schools (p = 0.001). Discrimination was a mediating factor between participation and PSP among boys and girls as the mediating formula Z=d/s (d) was > + 2 SD, –2.59 for boys and –39.27 for girls. Independent of each other, low participation and discrimination were associated with increased risk of PSP. Conclusion: Discrimination was a mediating factor between participation and PSP. The mediating effectwas stronger in girls than in boys. There is a need for school health promotion programsfocusing on participation in terms of democratic processes, communication and cooperation in the classroom.
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| 5. |
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| 6. |
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| 7. |
- Carlerby, Heidi, 1967-, et al.
(author)
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Risk behaviour, parental background, and wealth: a cluster analysis among Swedish boys and girls in the HBSC study
- 2012
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In: Scandinavian Journal of Public Health. - : SAGE Publications. - 1403-4948 .- 1651-1905. ; 40:4, s. 368-376
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Journal article (peer-reviewed)abstract
- Aim: To analyse how health risk behaviours (HRB) are clustered and associated with parental background and family wealth among Swedish boys and girls.Methods: Data were collected from Health Behaviour in School-aged Children (HBSC),a global cross-sectional survey for 1997/98, 2001/02, and 2005/06. A total of 11,972 boys and girls in grades 5, 7, and 9 participated in the study. The pupils were categorised in subgroups according to parental background: Swedish (80.0%), mixed (10.6%), and foreign (9.4%). Cluster analyses were used to identify HRB profiles. Multinomial logistic regression analysis was used to estimate associations between cluster allocation, parental background, and family affluence.Results: In total 11,232 pupils were identified and allocated to five cluster profiles, half of them in the cluster profile of low-risk behaviour. The most disadvantaged cluster was multiple HRB, which was characterised by high prevalence of smoking, drunkenness, low physical activity, and high soft-drink consumption. The cluster profile of multiple HRB was associated with both mixed background and foreign background in girls and with mixed background in boys.. The cluster profile of inadequate tooth brushing was associated with foreign background in both boys and girls. The cluster profiles of multiple HRB and inadequate tooth brushing were associated with low family affluence in girls.Conclusions: The cluster profiles of multiple HRB and inadequate tooth brushing were associated with parental foreign extraction in boys and girls and with low family affluence in girls. Prevention programmes based on identified clusters of HRB, including consideration of impact of socio-demographic indicators, are needed.
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| 8. |
- Forsberg, Hanna, et al.
(author)
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Positive self-reported health might be an important determinant of student's experiences of high school in northern Sweden
- 2019
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In: International Journal of Circumpolar Health. - : Taylor & Francis. - 1239-9736 .- 2242-3982. ; 78:1
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Journal article (peer-reviewed)abstract
- There is a need for more knowledge about positive health determinants in the school setting. The overall aim of this study was to analyse if positive self-reported health is associated with experiences of school among high-school students. Data originated from the health dialogue questionnaire answered by students in grade 1 of high school. A total of 5035 students participated from the academic years 2013 to 2016. Logistic regression with positive odds ratio (POR) was used to analyse associations between positive self-reported health and school experiences. There was an association between positive self-reported health and school experiences among students. Positive mental health was the strongest predictor for positive school experiences. To frequently participate in Physical Education, have a positive body image and satisfactory sleep nearly doubled the students' odds for positive school experiences. The results also revealed gender differences; boys more often reported positive experiences of school and positive health than girls. Positive self-reported health is associated with positive experiences of school, particularly mental health. Moreover, these findings have significant implications for how students experience school and demonstrate the importance of including health-promoting interventions in systemic school improvement, meeting both girls' and boys' needs.
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| 9. |
- Mosleh, Marwan, et al.
(author)
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Barriers to managing and delivery of care to war-injured survivors or patients with non-communicable disease : a qualitative study of Palestinian patients' and policy-makers' perspectives
- 2020
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In: BMC Health Services Research. - : Springer Science and Business Media LLC. - 1472-6963. ; 20:1
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Journal article (peer-reviewed)abstract
- BackgroundImproving access to optimal quality of care is a core priority and ambitious health policy goal in spite of impediments, threats and challenges in Palestine. Understanding the factors that may impede quality of care is essential in developing an effective healthcare intervention for patient with non-communicable disease (NCD) or war-injured survivors.MethodsQualitative interviews were performed using a purposive sampling strategy of 18 political-key informants, 10 patients with NCD and 7 war-injured survivors from different health facilities in Gaza Strip. A semi-structured interview guide was developed for data collection. The interviews were audio recorded and transcribed verbatim. Important field notes of the individual interviews were also reported. Thematic-driven analytic approach was used to identify key themes and patterns.ResultsFrom the policy maker’s perspective, the following important barriers to accessing optimal healthcare for patients with NCD or war-injured survivors’ treatment were identified; 1) organizational/structural 2) availability 3) communication 4) personnel/lack of staff 5) financial and political barriers. Patient with NCD or war-injury had similar experiences of barriers as the policy makers. In addition, they also identified socioeconomic, physical and psychological barriers for accessing optimal healthcare and treatment.ConclusionsThe main perceived barriers explored through this study will be very interesting and useful if they are considered seriously and handled carefully, in order to ensure efficient, productive, cost-effective intervention and delivery of a high-standard quality of care and better disease management.
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| 10. |
- Mosleh, Marwan, PhD researcher, 1975-
(author)
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Non-communicable diseases and war injuries in Palestine : burden, incidence and management in the health system
- 2020
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Doctoral thesis (other academic/artistic)abstract
- Background: The epidemics of non-communicable diseases (NCDs) and war-related injuries are a significant health concerns, and are rapidly emerging as major causes of mortality and disability globally, particularly in low and middle-income countries (LMICs) such as Palestine. Health research on the epidemiology and management of NCDs and war injuries is scarce and largely neglected. Therefore, this research responds to epidemiologic and public health concerns due to the increasing incidences of NCDs and war-injuries. The objective of this thesis was to describe, characterize and analyze the burden, incidence and management of NCDs and war-related injuries in the Palestinian health system (PHS).Methods: A combination of methods was employed in the research, including quantitative (study I and II), and qualitative approaches (study III and IV) in order to achieve the study aims and to gain a better understanding of NCDs and war injuries related issues in the PHS. For study I, the Disability-Adjusted Life Years (DALYs) framework was employed using available registry data of NCDs from 2010 to quantify the burden of NCDs, whereas, for study II a registry injuries data of the 2014 Gaza war was used to analyze the incidence and patterns of war injuries in the PHS. For study III, a qualitative focus group strategy was used to explore healthcare providers’ perspectives on NCDs and war injuries management and for study IV, a qualitative interview strategy was applied, using study topic guides to explore patients and policy makers’ perspectives of barriers to managing and delivering of care to war injured survivors or patients with NCDs. The participants were purposely selected and invited to be involved in the focus group discussions and interviews. The qualitative data were transcribed verbatim and analyzed using manifest content and thematic analysis in study III and IV respectively.Results: The research concludes that the total burden of reported NCDs was estimated at 57/1000 and 60/1000 DALYs in the Gaza Strip and the West Bank in 2010 respectively, with each DALY being thought of as one lost year of optimal healthy life. Heart diseases were found to be the leading causes of NCDs related burden among the population (study I). Study II showed that males experienced more war injury than females with a male: female ratio of 3.1:1. Almost half of victims were of age 20-39, followed by children and individuals younger than 20 years (31.4%). The overall incidence of war injuries was 6.4/1000 of the population, but it varied among regions. Explosion or blast injuries were the major causes of war-related injuries (72.9%) in the Gaza Strip. The largest percentage of injuries were reported to be in the upper body (study II). In study III, the qualitative analysis resulted in four main themes, resulting from the accounts of the key healthcare providers. The informants frequently expressed feeling that despite some positive aspects in the health system, there were, however, fundamental changes and significant improvements are necessary to make care work better than they do now. Some expressed serious concerns about the healthcare system, suggesting that it needs complete rebuilding in order to make it work better. In study IV, important barriers were explored by patients and key-policy makers, relating to managing and delivery care to war injured survivors or patients with NCDs, including organizational/structural, availability, communication, personal/shortage of staff, and financial and political barriers. Patients had similar experiences of barriers to those of the policy makers. In addition, patients experienced socioeconomic, physical, and psychological barriers.Conclusion: The epidemic of NCDs, especially heart disease, and the high influx of war-associated injuries, impose a substantial and heavy burden on the PHS. The health system has many deficiencies and public hospitals do not work as they should, because of many challenges and the burden of diseases in the health system. Given this evidence, immediate actions and effective interventions should be initiated to tackle the burden of NCDs and war injuries in Palestine. A clear cost-effective health policy with a focus on preventive measures should be implemented. Further research using recent data on large scale populations are important to provide further insights on the magnitude and trend of NCDs and war injuries in this problematic context. Using research evidence to develop health policy-making is vital.
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| 11. |
- Mosleh, Marwan, PhD researcher, 1975-, et al.
(author)
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Perceptions of health-care professionals about quality of care and barriers to management of war injuries in Gaza Strip : A qualitative analysis
- 2021
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In: The Lancet. - : Elsevier. - 0140-6736 .- 1474-547X. ; 398:Supplement 1, July 2021, s. S37-
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Journal article (peer-reviewed)abstract
- BACKGROUND: War-related injury is a growing clinical and public health concern in occupied Palestinian territory, especially in the Gaza Strip. However, little research has been done into the quality of care and management of war injuries in public hospitals. We explored the perceptions of health-care workers about these factors in Palestinian health-care facilities in Gaza. METHODS: This was a qualitative descriptive study. Data were obtained in four focus group discussions attended at public health facilities by 30 purposively selected health-care providers, comprising 14 head surgeons, and 16 head nurses, aged 38-55 years. A semi-structured topic guide was developed by the authors for the study based on earliest literature, and was critically reviewed by a panel of experts to ensure the trustworthiness of the qualitative guide and to minimise complexity and enhance clarity of the questions for participants. Audio recordings of discussions were transcribed verbatim, translated, and analysed with a thematic analysis approach. The study was approved by the Palestinian Health Research Council and facilitated by the Ministry of Health. FINDINGS: A consensus was expressed that, despite some positive aspects in the system, fundamental changes and essential improvements were needed to advance the care and facilitation of war injury management. Some respondents had serious concerns about the health-care system, suggesting that it needs to be comprehensively rebuilt. Unanimous views were expressed about the important barriers to effective management and quality of care: shortages of resources, medicines, and funding; underuse or absence of specific and unified clinical practice guidelines; no official commitment by the Ministry of Health to adopt updated clinical guidelines; few incentives and poor motivation, poor communications; blockade and siege; division of health systems in the country; overcrowding of patients with war injuries in hospitals with limited capacity; spreading of infection due to poor cleanliness; shortages in fuel and power supply; and low wages, which negatively affected staff motivation. Respondents also reported inadequate sharing of care and cooperation between different health-care facilities. INTERPRETATION: The perceptions about barriers to management of war injuries and the quality of care provided were similar across Palestinian health-care facilities in the Gaza strip. Our findings suggest that fundamental changes and comprehensive reform of the health-care system are needed to make the care of patients with war injuries more effective and efficient. One of the important strengths of this study is that it addressed the perspective and opinions of different key health professionals, which made it possible gain deeper and better understanding of how war injuries are managed in the Palestinian health system. In addition, the outcomes of the study were based on diverse information. However, the analysis of the qualitative data may represent challenges, and be more complicated and time consuming than a quantitative approach.
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| 12. |
- Mosleh, Marwan, et al.
(author)
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Perceptions of Non-Communicable Disease and War Injury Management in the Palestinian Health System : A Qualitative Study of Healthcare Providers Perspectives
- 2020
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In: Journal of Multidisciplinary Healthcare. - : Dove medical press. - 1178-2390. ; 13, s. 593-605
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Journal article (peer-reviewed)abstract
- Background: Palestine, like other low-income countries, is confronting an increasing epidemic of non-communicable disease (NCD) and trend of war injury. The management of health problems often presents a critical challenge to the Palestinian health system (PHS). Understanding the perceptions of healthcare providers is essential in exploring the gaps in the health system to develop an effective healthcare intervention. Unfortunately, health research on management of NCD and war injury has largely been neglected and received little attention. Therefore, the study aimed to explore the perspectives of healthcare providers regarding NCD and war injury management in the PHS in the Gaza Strip.Methods: A qualitative study approach was used, based on four focus group discussions (FGDs) involving a purposive sampling strategy of 30 healthcare providers from three main public hospitals in Gaza Strip. A semi-structured topic guide was used, and the focus group interviews data were analyzed using manifest content analysis. The study was approved by the Palestinian Health Research Council (PHRC) for ethics approval.Results: From the healthcare providers perspective, four main themes and several sub-themes have emerged from the descriptive manifest content analysis: functioning of healthcare system; system-related challenges; patients-related challenges; strategies and actions to navigating the challenges and improving care. Informants frequently discussed that despite some positive aspects in the system, fundamental changes and significant improvements are needed. Some expressed serious concerns that the healthcare system needs complete rebuilding to facilitate the management of NCD and war-related injury. They perceived important barriers to effective management of NCD and war injury such as poor hospital infrastructure and logistics, shortage of micro and sub-specialities and essential resources. Participants also expressed a dilemma and troubles in communication and interactions, especially during emergencies or crises. The informants stressed the unused of updated clinical management guidelines. There was a consensus regarding poor shared-care/task sharing, partnership, and cooperation among healthcare facilities.Conclusion: Our findings suggest that fundamental changes and significant reforms are needed in the health system to make healthcare services more effective, timely, and efficient. The study disclosed the non-use of clinical guidelines as well as suboptimal sectorial task-sharing among different stakeholders and healthcare providers. A clear and comprehensive healthcare policy considering the gaps in the system must be adopted for the improvement and development of care in the PHS.
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| 13. |
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| 14. |
- Svanholm, Sara, et al.
(author)
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Civic communicators' view of and approach to health promotion for newly arrived migrants in Sweden
- 2022
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In: Frontiers In Public Health. - : Frontiers Media SA. - 2296-2565. ; 10
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Journal article (peer-reviewed)abstract
- For newly arrived migrants, integration is important in promoting health and decreasing health inequities. In a Swedish context, civic orientation is a program to promote integration and increase the chance of employment for newly arrived migrants. The aim of this project was to explore how civic communicators view and approach health promotion in their work with newly arrived migrants in the civic orientation program in Sweden. Data were collected through interviews with eight civic communicators working with newly arrived migrants in civic orientation in the north of Sweden. The interviews followed a semi-structured interview guide and were transcribed verbatim and analyzed using thematic analysis. The analysis resulted in the main theme “To dress the participants for a (healthy) life in Sweden,” with two sub-themes “Knowledge—a key to health” and “Being a guide for participants in a new context.” In their work with civic orientation for newly arrived migrants, civic communicators are involved in health promotion by preparing their participants for a life in Sweden. They work to empower their participants to be able to make informed decisions and live healthy lives by both providing information to enhance knowledge and skills. They also work to guide them through the complexity of being in a new situation and country.
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| 15. |
- Svanholm, Sara, et al.
(author)
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Collaboration in health promotion for newly arrived migrants in Sweden
- 2020
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In: PLOS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 15:5
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Journal article (peer-reviewed)abstract
- As a group, newly arrived migrants in Sweden face inequities in health compared to the general population. Successful promotion of population health requires awareness of and focus on health from several sectors of society. In light of this, the aim was to study the views of local authority officials on collaboration in health promotion activities for newly arrived migrants. Data was collected through five focus group interviews with 23 local authority officials working with the integration of newly arrived migrants in the Establishment Program in a municipality or at the Employment Services in northern Sweden. An inductive qualitative latent content analysis was performed, and the analysis showed that the participating officials considered health promotion as desirable in the Establishment Program, but it also raised complex issues within the existing organisations. The officials described unclear roles, but also possible changes to the organisation that would improve the possibility of working to promote health. The present study adds to the relatively limited knowledge of health promotion in integration activities and offers clinical relevance for policymakers through the officials’ suggestions for improvements in the Establishment Program. It also raises important questions for further research.
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| 16. |
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| 17. |
- Svanholm, Sara
(author)
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Health promotion in the integration of newly arrived migrants in northern Sweden
- 2022
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Doctoral thesis (other academic/artistic)abstract
- Background: Migrants, especially forced migrants, have an increased risk of ill health. Having a structural focus on health is crucial for battling health inequities. Actors outside the healthcare services are important to promote health, and both policy and political context are thus key to promoting the health of newly arrived migrants in Sweden. The aim of this thesis was to explore approaches to health promotion within the multi-level governance of the integration of newly arrived migrants in northern Sweden.Methods: Different methods of data collection and analysis were used in the thesis. For Study I, policies relevant to Sweden’s Establishment Program were analyzed using discourse analysis. For Studies II and III, a questionnaire on politicians’ views on their roles, responsibilities, and possibilities to promote the health of newly arrived migrants was created based on interviews with politicians. In total, 667 politicians answered the questionnaire, and both bivariate and multivariate analyses were used. For Study IV, a secondary analysis of focus group interviews was performed. The interview transcripts were analyzed using content analysis. Finally, Study V consists of interviews with civic communicators who work within the civic orientation for newly arrived migrants in Sweden. Thematic analysis was used to analyze the transcribed interviews. Results: The policy documents that described the Establishment Program in Sweden contained no explicit definition of health. The discourses of health showed a medicalized and individualized view of health, where ill health was considered a risk (Study I). Politicians more often considered health effects for the general population as a whole, rather than for newly arrived migrants specifically. Factors contributing to whether they considered health effects for newly arrived migrants included self-rated knowledge, attitude, being female, and having previous experience working in public health (Study II). Further, politicians rated societal responsibility and the possibility to promote health as higher for the population as a whole compared to newly arrived migrants specifically. The odds of rating societal responsibility and the possibility to promote health as high were associated with the factors attitude, specific knowledge of newly arrived migrants’ health status, personal interest in public health, being a municipality politician, and being female (Study III). Authority officials considered health promotion to be desirable within the Establishment Program, but the study results also raised complex issues within the existing organizations. The respondents described unclear roles but also organizational changes that could improve the possibility of working to promote health (Study IV). Finally, the civic communicators described that they viewed and approached health promotion through wanting to prepare the participants for a healthy life in Sweden. They described knowledge, but also their role as a guide for the participants, as important parts of their work (Study V). Conclusion: Within the integration of newly arrived migrants in Sweden, health promotion (and the possibility of health promotion) was invisible within the policy context. Within the political context, the focus on migrants’ health (specifically newly arrived migrants) tended to be invisible. This situation caused various uncertainties, such as a lack of definitions and assignments, for officials who worked directly with newly arrived migrants. Those who work closely with newly arrived migrants tended to have a better view of how health could be promoted through integration in Sweden.
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| 18. |
- Svanholm, Sara, et al.
(author)
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Local and regional politicians’ considerations of newly arrived migrants’ health in political decision-making : a public health study in northern Sweden
- 2023
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In: Journal of Public Health. - : Springer Nature. - 2198-1833 .- 1613-2238. ; 31:7, s. 1101-1111
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Journal article (peer-reviewed)abstract
- Background and aim: Early action is important for promoting newly arrived migrants’ health. Politicians are major actors in decision-making that affects health outcomes in the population. Therefore, the aim of this study was to explore local and regional politicians’ considerations of newly arrived migrants’ health in political decision-making: whether politicians reflect on or discuss the effects of decision-making specifically on newly arrived migrants’ health, whether considerations differ between municipality and regional politicians, and how knowledge and attitudes are associated with such considerations. Subject and methods: A cross-sectional quantitative study was conducted. A total of 667 municipality and regional politicians from northern Sweden responded to a questionnaire developed based on interviews with politicians. Bivariate analyses were performed using χ2 tests, the independent samples t-test, and the Wilcoxon signed-rank test. Multivariate analysis was performed using binary logistic regression. Results: Politicians considered the effects on newly arrived migrants’ health significantly less frequently than those on the total population’s health. Regional politicians discussed such effects more often than municipality politicians. Knowledge (odds ratio [OR] = 1.343), attitude (OR = 5.962), previous experience working on public health issues (OR = 1.784), and female gender (OR = 1.787) were positively associated with considering effects on newly arrived migrants’ health in decision-making. Conclusion: Politicians play important roles in health promotion, and most consider health-related effects in their decision-making. However, about a third do not consider such effects. General health-related knowledge and attitude are important factors that could be affected or changed during political assignments.
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| 19. |
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| 20. |
- Svanholm, Sara, et al.
(author)
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Politicians’ views on societal responsibility and possibility to promote newly arrived migrants’ health in Sweden
- 2023
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In: Health Promotion International. - : Oxford University Press. - 0957-4824 .- 1460-2245. ; 38:4
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Journal article (peer-reviewed)abstract
- Newly arrived migrants in Sweden risk facing ill health. Politicians at the local and regional levels are involved in many decisions regarding the social determinants of health. The aim of this study was to explore politicians’ views on different societal actors’ responsibility and possibility to promote newly arrived migrants’ health. Data were collected through online questionnaires completed by 667 politicians from municipality and regional councils in northern Sweden. Bivariate analysis was performed using the Wilcoxon signed-rank test. Multivariate analyses were performed using cluster analysis and binary logistic regression analysis. The results show that politicians generally rate societal actors’ responsibility and possibility to promote the general population’s health higher than newly arrived migrants’ health. Moreover, they consider societal actors’ responsibility to be greater than their possibility to promote health. Factors significantly contributing to politicians’ high ratings of societal responsibility and possibility are attitude (odds ratio [OR] = 2.156, 95% confidence interval [CI]: 1.306–3.558), specific knowledge of newly arrived migrants’ health status (OR = 1.528, 95% CI: 1.005–2.323), personal interest in public health (OR = 2.452, 95% CI: 1.460–4.119), being a municipality politician (OR = 1.659, 95% CI: 1.031–2.670) and being female (OR = 1.934, 95% CI: 1.333–2.806). This study shows that politicians generally rate societal responsibility and possibility to promote newly arrived migrants’ health rather high. Personal characteristics are important for politicians’ high or low ratings of responsibility and possibility, suggesting insufficient structural support for politicians in health promotion.
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| 21. |
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| 22. |
- Warne, Maria, 1957-, et al.
(author)
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Alcohol- and drug prevention among seasonal employees at a Swedish ski resort
- 2018
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In: 10th IUHPE European Conference and International Forum for Health Promotion Research.
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Conference paper (peer-reviewed)abstract
- Seasonal employees at ski resorts represent a high-risk population for the use of alcohol and drugs, as well as other negative lifestyle behaviours. These employees work and live in a context where the customers are on holiday and hence alcohol is used frequently. To our knowledge there is a gap in the literature regarding alcohol and drug consumption among seasonal employees. Particularly studies in the context of ski resorts are lacking. The overall purpose of our study was to evaluate a policy-based intervention at a ski resort area in Sweden. The intervention was led by a project leader together with managers from different tourism industries, the health sector, social service and police. Components in the intervention were e.g. policy development and implementation, education of managers and creation of a manager network. In total, 48 enterprises participated. A questionnaire, concerning alcohol and drug use and social aspects, was distributed before and after the intervention. The firs questionnaire was answered by 611 (47%) respondents and 423 (34%) respondents the follow-up questionnaire after two years. In addition, five persons in the project group was interviewed after the intervention. Based on survey data, comparisons before and after the intervention showed several positive results. The results show a significant reduction of hazardous drinking and an increased awareness of the companies’ alcohol- and drug policies among the employees. No significant effects on drug consumption were found. The project group reported better knowledge about alcohol and drugs. However, most important was the increased collaboration between managers in tourism industries. The intervention also resulted in new norm breaking ideas such as a sober end of the season instead of the traditional “drinking the bar dry” and managers taking employees out on hiking instead of going out for a beer. The conclusion is that seasonal tourism industries need to work with hazardous alcohol- and drug consumption from a “whole village perspective”. Successful health promotion work among seasonal employees, needs collaboration between private and public sector and should be related to cultural norms as well as working- and living conditions in the particular context, in this case the tourist resort.
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| 23. |
- Warne, Maria, 1957-, et al.
(author)
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Trygg i Åre – arbetsgivare mot droger : Slutrapport från genomförd forskning i projektet
- 2017
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Reports (pop. science, debate, etc.)abstract
- Under åren 2014-2016 har projektet ”Trygg i Åre - arbetsgivare mot droger” bedrivits med fokus mot att minska alkohol- och droganvändande bland säsongsanställda i kommunens företag. Projektet har drivits av kommunens drogsamordnare och en styrgrupp bestående av representanter från olika företag i regionen och Åre hälsocentral. De insatser som främst genomförts har varit: framtagande och implementering av en alkohol- och drogpolicy, fem utbildningstillfällen för arbetsgivare och chefer med personalansvar, ett utbildningstillfälle för projektets styrgrupp och kommunens personalavdelning avseende policyutveckling, kommunikationsinsatser via en utvecklad hemsida och sociala medier samt spridning av projektet genom en web-baserad värdskapsutbildning för personal hos stora arbetsgivare, krögarträffar, rekryteringsdagar etc. Projektets huvudmål har varit att minska användandet av alkohol- och droger på arbetsplatser med säsongsanställd personal i Åre kommun. Delmålen har handlat om ökad kunskapsnivå hos arbetsgivare, ökade förebyggande insatser, ökad förmåga till tidiga insatser och tydligt ställningstagande mot alkohol och droger. Projektets forskare har följt projektet interaktivt och kopplat tillbaka resultat vid ett flertal styrgruppsmöten. Projektets insatser har utvärderats via en enkät till medarbetare i företagen före och efter projektet omfattande 43 frågor om alkohol- och drogförebyggande arbete, arbetssituation, alkoholvanor, droger, hälsa och levnadsvanor. Kvalitativa analyser har bestått av intervjuer med ledare och deltagare i styrgruppen och noteringar från deltagande vid elva styrgruppsmöten. En enkätstudie med jämförelser av förhållanden i områdena Åre och Härjedalen har också genomförts. Enkäten besvarades 2014 av 611 personer (54 procent kvinnor, 46 procent män) i Åre-området, vilket utgjorde 47 procent av de som blev tillfrågade. Motsvarande siffror 2016 var att 423 personer (49 procent kvinnor, 51 procent män) besvarade enkäten med en svarsfrekvens på 34 procent. Enkäten besvarades 2016 av 125 personer i Härjedalen-området (svarsfrekvens 30 procent). Resultat från enkätstudien före projektets insatser visade att i gruppen 18-24 år fanns den högsta riskkonsumtionen av både alkohol (90 procent) och droger (6 procent). I åldersgruppen 18-24 år fanns inga signifikanta skillnader mellan könen när det gällde riskbruk av alkohol, till skillnad från droganvändning där fler män än kvinnor visade sig ha ett drogmissbruk. När det gäller det förebyggande arbetet svarade 87 procent att företaget hade en alkoholpolicy och 85 procent att det fanns en drogpolicy. Resultat av de mulitivariata regressionsanalyserna av riskkonsumtion av alkohol visade att för kvinnor var detta associerat till faktorerna: bo med kollegor/vänner, ej vara fast boende i Åre, arbeta kväll/skift. För männens del var det att vänner ofta dricker sig berusade och om de upplevde ett gott arbetsklimat som visade sig ha en signifikant association. Resultatet av de multivariata regressionsanalyserna, där riskkonsumtion av droger studerades, visade att drogriskbruk för både kvinnors och mäns del var associerat med att ha vänner som ofta dricker sig berusade. För männen var dessutom säsongsanställning associerat till ett drogriskbruk. Resultatet av intervjuer med ledare och av medarbetares öppna svar i enkäten visade att för att nå framgång i det alkohol- och drogförebyggande arbetet finns det flera utmaningar som framförallt handlar om normer och ledarskap. Tre teman utkristalliserades i analysen: reproducerande av alkoholnormer, en alkoholkontrollerande arbetsmiljö och omhändertagande ledare. Ledarna såg alkohol som en naturlig del på skidorten och medarbetarna lyfte fram problematik kring ett aktivt policyarbete parallellt med en liberal hållning till alkohol och ”partykultur”. Jämförelser av enkätresultat före och efter projektets insatser visade på flera positiva tendenser. När det gäller riskkonsumtion av alkohol, mätt med frågeformuläret AUDIT (Alcohol Use Disorders Identification Test), noterades en signifikant minskning av riskkonsumtionen: 75 procent av de säsongsanställda angav riskkonsumtion 2014 jämfört med 56 procent 2016. För riskkonsumtion av droger, mätt med frågeformuläret DUDIT (Drug Disorders Identification), var konsumtionen relativt likartad före och efter projektet. Enkätresultat om arbetsgivarnas förebyggande arbete visar att andelen medarbetare som uppger att arbetsplatsen har en alkoholpolicy respektive drogpolicy har ökat signifikant sedan 2014, signifikant fler uppger att arbetsgivaren genomför slumpmässiga nykterhetskontroller och drogtester samt en större andel har vid eftermätningen kännedom om att arbetsgivaren erbjuder rehabilitering om alkohol- eller drogproblem uppdagas. När det gäller arbetsvillkor och hälsa kan utläsas att andelen som arbetar 40 timmar eller mer och övertid ökat något, oförändrad hälsa mätt med en positiv hälsoskala (Positive Health Scale), en liten minskning av sjuknärvaro och att drygt 80 procent av de anställda angav att de ofta/alltid upplever en meningsfull fritid både före och efter projektet. Intervjuer med deltagare i styrgruppen pekar på flera positiva resultat som en ökad samverkan mellan företagare i Åre, ett mer aktivt ställningstagande och agerande när det gäller alkohol och droger. De intervjuade styrgruppsdeltagarna nämnde även att ledare nu vågar prata om problem som uppstår kring alkohol och droger, att de fångar upp de unga tidigt men också att det finns en ökad förmåga att hitta dem som har haft problem länge. Projektledaren menar att hen lagt märke till att det är en förändring bland chefer i deras förhållningssätt till det drogförebyggande arbetet. De intervjuade menar att de utbildningar som genomförts har bidragit till en ökad kunskap inom alkohol- och drogområdet och hur de som chefer kan agera, främst bland företagare i Åre och i mindre utsträckning vid andra orter i området. Styrgruppens deltagare nämner även att framtagande och implementering av alkohol- och drogpolicyn varit en viktig del i projektet liksom förändrade rutiner vid rekryteringar inför kommande säsong och ökad förmåga att agera då alkohol- och drogproblem uppdagas, bland annat genom ökat samarbete med områdets hälsocentral. En jämförelse mellan enkätresultat för områdena Härjedalen och Åre visade på signifikant lägre riskkonsumtion av alkohol bland både kvinnor och män i Härjedalen. Däremot fanns inga signifikanta skillnader gällande riskkonsumtion av droger. När det gäller de svarandes bedömning av förekomst av alkohol- och drogpolicy och utandningstester var dessa mer förekommande i Åre-området. Säsongsanställning på en vinterturistort kan innebära särskilda utmaningar när det gäller levnads- och arbetsvillkor samt alkohol- och drogkonsumtion och därför är studier angelägna. Forskningsområdet är av betydelse eftersom kunskapen är ofullständig om alkoholrelaterade problem i arbetslivet särskilt när det gäller tillfälliga anställningar som säsongsanställning. Det finns också behov av att utveckla interventioner för att förebygga alkohol- och drogproblem i arbetslivet samt att följa sådana via kvantitativa och kvalitativa studier. Resultaten av genomförd utvärdering och forskning bör tolkas med viss försiktighet på grund av den relativt låga svarsfrekvensen i genomförda enkätstudier, att data utgörs av tvärsnitt och att det finns skillnader i åldersfördelning och boendeformer i Åre-området före och efter projektet. Med denna reservation i åtanke kan ändå följande slutsatser dras: Riskkonsumtionen av alkohol och droger ligger på en hög nivå bland studerad säsongsanställd personal jämfört med nationella urval och fortsatta förebyggande och främjande insatser är därför angelägna. Enkätresultat före och efter projektets insatser och genomförda intervjuer med ledare och deltagare i styrgruppen tyder på att projektet haft signifikanta effekter för att minska användandet av alkohol på en del företag med säsongsanställd personal i Åre-området. Genomförda utbildningar och övrig kunskapsspridning förefaller ha bidragit till ökad kunskapsnivå hos ledare i företag avseende alkohol- och drogfrågor och handlingsförmåga att förebygga dessa problem. Projektet har i mindre utsträckning nått orter utanför Åre by och därför finns behov av fortsatta insatser. Projektets utbildningar, kunskapsspridning och utveckling av policy för alkohol och droger har bidragit till ökade förebyggande insatser och ett mer tydligt ställningstagande mot alkohol och droger. Förädling av policyn och utvecklad hemsida har också bidragit med kunskap om hur arbetsgivare kan arbeta med förebyggande och främjande insatser och till strategier vid rekrytering av säsongsanställda. Andra positiva effekter i projektet är ett mer utvecklat samarbete med hälsocentral gällande alkohol- och drogfrågor samt att samarbetet mellan representanter från Åre kommun, företrädare för näringslivet och forskare upplevts positivt av berörda personer. Resultaten tyder på signifikanta skillnader mellan alkohol- och drogkonsumtion i Härjedalen jämfört med Åre området. Förklaringar bakom dessa skillnader bör analyseras inför fortsatta insatser. Projektet har i liten omfattning fokuserat på frågor kring anställningsvillkor, arbetsvillkor och hälsa. Då forskning visar på samband mellan dessa faktorer och alkohol- och drogkonsumtion bör detta beaktas i fortsatta insatser. Resultaten pekar på att sociala faktorer har stor betydelse för riskkonsumtion, framförallt gällande alkohol. Ett förebyggande arbete måste därför omfatta boendeformer, kultur och n
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