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Background: Studies of time trends in Nordic adolescents' mental health have often relied on analyses of adolescents' psychosomatic symptoms. In this study, we examine adolescents' self-reports on mental health in the context of the dual factor model, which encompasses both overt manifestations of mental health symptoms and subjective perception of one's health status. Method: The objective of this study was to employ a person-oriented approach utilizing cluster analysis to discern time trends in mental health profiles of Nordic adolescents, using their psychosomatic complaints and their perception of their overall health as cluster variables. The resulting health profiles were then subjected to a comparative analysis with regard to different measures of psychological and social adjustment. The mental health profiles were based on data from the Health Behaviour in School-aged Children (HBSC) survey, which was conducted among almost 50000 15-year-olds in five Nordic countries (Denmark, Finland, Iceland, Norway, and Sweden) between 2002 and 2022. Results: Mental health profiles exhibiting comparable content were observed in all Nordic countries, including profiles indicating adequate health, perceived good health, perceived poor health, high psychosomatic complaints, and dual health problems (defined as both high psychosomatic complaints and perceived poor health). These health profiles showed similar trends over time in the Nordic countries. Significant gender differences were observed. In 2002, adequate health was the dominant profile for both sexes. After 20 years, however, the high psychosomatic profile became the most common profile among girls. Among the three risk profiles, namely perceived poor health, high psychosomatic complaints and dual health problems, adolescents in the dual problems profile had the most psychological and social adjustment problems. Conclusions: The comparatively lower incidence of adjustment problems among adolescents in the high psychosomatic profile relative to the dual mental health group challenges the prevailing view that there has been a sharp increase in mental health problems among Nordic adolescents. This view was largely based on the observed rise in psychosomatic symptoms. Indeed, there was a doubling in the proportion of adolescents in the high psychosomatic complaints profile between 2002 and 2022. This increase was considerably more pronounced than that observed for the dual health problems profile which exhibited most problems. [ABSTRACT FROM AUTHOR]

Background: The role of eating habits in adolescent mental health has become a growing area of interest for researchers and health professionals. Recent studies suggest that healthy eating habits may play a role in the development and management of mental health. However, existing literature is largely based on clinical populations, and comparisons are challenged by sociocultural differences and methodological issues. The aim of the present study was to use nationally representative data based on standardized procedures, to explore associations between adolescents eating habits and mental health, considering the importance of age, gender, socioeconomic factors, and country. Methods: The study was based on data from Nordic adolescents (age 11, 13 and 15 years) who participated in the 2017/2018 Health Behavior in School-aged Children (HBSC) study (n = 22384). General linear modelling and multigroup regression analysis were used to examine the relationship between food habits (intake of fruit, vegetables, sweets, soft drinks), meal habits (intake of breakfast and having family meals together), and mental health (life satisfaction and subjective health complaints). The analyses were weighted and adjusted for age, gender, socio-economic status, and country. Results: Overall, healthier eating habits were associated with better mental health. The strongest associations were found between meal habits (breakfast consumption and having family meals together) and mental health. Gender and country differences were seen, with weaker associations found among Danish boys. Conclusion: Eating habits should be considered when promoting mental health in the adolescent population. While gender differences and cross-country variations exist, even minor enhancements in eating behaviors could yield meaningful benefits. [ABSTRACT FROM AUTHOR]

Background: Studies of time trends in Nordic adolescents' mental health have often relied on analyses of adolescents' psychosomatic symptoms. In this study, we examine adolescents' self-reports on mental health in the context of the dual factor model, which encompasses both overt manifestations of mental health symptoms and subjective perception of one's health status. Method: The objective of this study was to employ a person-oriented approach utilizing cluster analysis to discern time trends in mental health profiles of Nordic adolescents, using their psychosomatic complaints and their perception of their overall health as cluster variables. The resulting health profiles were then subjected to a comparative analysis with regard to different measures of psychological and social adjustment. The mental health profiles were based on data from the Health Behaviour in School-aged Children (HBSC) survey, which was conducted among almost 50000 15-year-olds in five Nordic countries (Denmark, Finland, Iceland, Norway, and Sweden) between 2002 and 2022. Results: Mental health profiles exhibiting comparable content were observed in all Nordic countries, including profiles indicating adequate health, perceived good health, perceived poor health, high psychosomatic complaints, and dual health problems (defined as both high psychosomatic complaints and perceived poor health). These health profiles showed similar trends over time in the Nordic countries. Significant gender differences were observed. In 2002, adequate health was the dominant profile for both sexes. After 20 years, however, the high psychosomatic profile became the most common profile among girls. Among the three risk profiles, namely perceived poor health, high psychosomatic complaints and dual health problems, adolescents in the dual problems profile had the most psychological and social adjustment problems. Conclusions: The comparatively lower incidence of adjustment problems among adolescents in the high psychosomatic profile relative to the dual mental health group challenges the prevailing view that there has been a sharp increase in mental health problems among Nordic adolescents. This view was largely based on the observed rise in psychosomatic symptoms. Indeed, there was a doubling in the proportion of adolescents in the high psychosomatic complaints profile between 2002 and 2022. This increase was considerably more pronounced than that observed for the dual health problems profile which exhibited most problems. [ABSTRACT FROM AUTHOR]

Objectives: This repeated cross-sectional study aimed to (a) report trends in adolescents' perceived family, friend, classmate, and teacher support, (b) estimate the extent to which each source of support related to life satisfaction across space and time, and (c) ascertain whether sociodemographic factors moderated the relationship in question. Methods: We relied on data pertaining to the 2013/14, 2017/18, and 2021/22 waves of the Health Behaviour in School-aged Children study. The examined sample covered 44 countries and regions (n = 716,083; MAGE = 13.6; SDAGE = 1.64; 50.7% female). Results: The level of all sources of perceived social support slightly decreased over the examined period (all ω² < .01). Family support involved the largest association with life satisfaction (ß = 0.16); friend support, the lowest one (ß = 0.03). These associations varied only tenuously across space and time. Sociodemographic factors moderated the link between perceived social support and life satisfaction to a negligible-toweak extent. Conclusion: Levels of perceived social support and their associations with life satisfaction subtly changed. Future research may attempt to pinpoint the macrosocial levers of these temporal dynamics. [ABSTRACT FROM AUTHOR]

Background: Variable-oriented analyses of time trends in the ease of communicating with mothers and fathers in the Swedish HBSC (Health and Behavior in School-aged Children) dataset show that communication problems with fathers, but not with mothers, positively predict mental health problems among adolescents. This similarity across years is likely to lead to high structural stability in person-oriented analyses across survey years, providing opportunities to uncover typical communication patterns in a robust way. A person-oriented method, cluster analysis, was used in this study to clarify these variable-oriented findings on the prediction of mental health problems. Methods: The Swedish HBSC dataset of 15-year-olds for 2002, 2006, 2010, 2014, and 2018, with a total of 9255 participants, was used for variable- and person-oriented analyses. Results: Person-oriented analyses of ease of communication with the mother and ease of communication with the father show that poor communication with both parents is associated with the worst mental health problems. They also show that when there is poor communication with mothers, in most cases, adolescents also have poor communication with fathers. The variable-oriented analyses do not show that mental health problems are highest when adolescents find it difficult to communicate with both parents. Conclusions: Person-oriented analyses offer the possibility of drawing more specific conclusions about family conditions that affect adolescents' mental health. More generally, person-oriented analyses are likely to clarify the results of variable-oriented analyses in many other areas also. [ABSTRACT FROM AUTHOR]

Summary: The United Nations Convention on the Rights of the Child emphasizes the importance of allowing children and adolescents to influence decisions that are important to them following their age and maturity. This paper explores the principles, practices, and implications around using parental versus child/adolescent consent when participating in social science research and policy development. Experiences from two studies are presented: The Confronting Obesity: Co‐creating policy with youth (CO‐CREATE) and the Health Behaviour in School‐aged Children (HBSC) study, a World Health Organization (WHO) Collaborative Cross‐National study. Although parental consent may be an important gatekeeper for protecting children and adolescents from potentially harmful research participation, it may also be considered an obstacle to the empowerment of children and adolescents in case they want to share their views and experiences directly. This paper argues that evaluation of possible harm should be left to ethics committees and that, if no harm related to the research participation processes is identified and the project has a clear perspective on collaborating with the target group, adolescents from the age of 12 years should be granted the legal capacity to give consent to participate in the research project. Collaboration with adolescents in the development of the research project is encouraged. [ABSTRACT FROM AUTHOR]

Background: Studies that have examined time trends in adolescents' mental health have frequently been based on analyses of adolescents' psychosomatic symptoms. Adolescents' reports of psychosomatic complaints need to be seen in the light of their overall evaluations of their health. The objectives of this study were to apply a person-centred approach to identifying adolescents' mental-health profiles based on evaluations of their overall health and psychosomatic complaints. The relationships between these mental-health profiles and indicators of positive mental health and psychological and social-adjustment problems are examined. Methods: A dual-factor approach was used for nationally representative adolescent samples and examined adolescents' self-rated psychosomatic complaints and perceived overall health simultaneously. Cluster analyses of data from the Swedish Health Behaviour in School-aged Children (HBSC) 2017/18 survey, including 3222 children aged 11, 13 and 15, were used to identify mental-health profiles. Results: Four mental-health profiles were identified by cluster analyses in all age groups. The profiles showed good construct validity in relation to mental well-being, life satisfaction and self-esteem. The poorest psychological adjustment was found among the adolescents with high levels of psychosomatic symptoms together with low levels of perceived overall health. Adolescents with high levels of psychosomatic symptoms only or with low levels of overall health only showed considerably better psychological adjustment. Conclusions: Cluster analyses identified distinct, valid and consistent mental-health profiles based on differing levels of perceived health and psychosomatic complaints. The dual-factor model in population health research may increase our potential to understand the mental health of adolescents better. [ABSTRACT FROM AUTHOR]

Background and Objectives: Despite the importance of life satisfaction for health and well-being, there is a paucity of cross-national comparative studies in life satisfaction related to the family environment. The present research examined the pathways of life satisfaction association with perceived family support and other family environment variables among adolescents aged from 11 to 15 years in 45 countries. Materials and Methods: Samples from the Health Behaviour in School-aged Children (HBSC) survey in 2017/2018 were analysed (n = 188,619). Path analysis was applied to evaluate the associations among the study variables. Results: A positive association between the life satisfaction score and high family support was identified in all 45 countries (standardized regression weight ranged from 0.067 to 0.420, p < 0.05). In majority of countries, living with both parents and higher levels of family affluence had a positive effect on adolescent life satisfaction both directly and indirectly through family support. In the described path model, the proportion of life satisfaction score variance that was accounted for by family support, family structure, family affluence, gender and age was up to 25.3%. The path models made it possible to group the participating countries into two clusters. In the first cluster (10 countries) the Eastern and Southern European countries dominated, while the second cluster (35 countries) united the countries of Western and Central Europe. Conclusions: There is evidence that countries with high level of adolescent life satisfaction differ in the high rate of intact family structure and the strong relation between family support and perceived life satisfaction. [ABSTRACT FROM AUTHOR]

This study aimed to investigate how family structure varies and identify its time trends in European and North American countries using data from seven surveys conducted between 1994 and 2018 according to the Health Behaviour in School-aged Children (HBSC) study. The current family structure in 44 countries was described and time trend analysis of 28 countries was performed. Adolescents were asked whom they lived with in their home to describe family structures. Family structures showed distinct patterns and dynamics between countries. In 2018, in all countries, 73% of adolescents lived with both their mother and father; 14% and 5% of adolescents lived in a single-parent family and stepfamily, respectively; and around 9% of adolescents lived in another family type. In the period 1994–2018, the proportion of young people living in intact families decreased from 79.6% to 70.0%, on average about 10 percentage points. There were no significant changes in the prevalence of single-parent families and stepfamilies, but a significant increase in the number of adolescents living without either parent was revealed. The findings have implications for cross-national adjustment of adolescent health, well-being, and behaviours, and for critical analysis of socioeconomic family resources. [ABSTRACT FROM AUTHOR]

Although previous research established a positive association between perceived social support and adolescent life satisfaction, little is known about the relative importance of different sources of support for adolescent life satisfaction and cross-country variations in this respect. Using large-scale representative samples from the 2017/18 Health Behaviour in School-aged Children (HBSC) study, this study examined to what extent the association between social support and life satisfaction in early adolescence varied across different social sources and countries. Also, it examined whether cross-country variations are explained by national-level generalized trust, a sociocultural factor that shapes adolescent socialization. National-level data were linked to data from 183,918 early adolescents (Mage = 13.56, SD = 1.63, 52% girls) from 42 European and North American countries/regions obtained from HBSC. Multilevel regression analyses yielded a positive association between support from different sources and life satisfaction. The strongest associations were found for support from families, followed by teachers and classmates, and weakest for support from friends. Associations varied across different countries/regions. National-level trust amplified the association between perceived classmate support and adolescent life satisfaction. The revealed cross-country differences open avenues for future cross-cultural research on explanations for cross-cultural differences in the association between social support from different sources and life satisfaction in early adolescence. [ABSTRACT FROM AUTHOR]

Background: The context is highly relevant to the implementation of new health-related programs and is an implicit or explicit part of the major implementation models in the literature. The Resilience Curriculum (RESCUR) program was developed to foster the psychosocial development of children in early and primary education. RESCUR seeks specifically to decrease children's vulnerability. It aims to promote the emotional and social learning of children who may be at risk of leaving school pre-maturely, social exclusion and mental-health problems. The program is taught using a teachers' manual to support consistency of delivery, a parents' guide, and a resource package. This study aimed to examine the scaling-out of RESCUR to social services, and specifically to test if implementation differs between the school and social services sectors. Methods: RESCUR was implemented in schools and social services in Sweden 2017–2019. Data were collected via group leaders' self-reports and observation protocols for 3 months after implementation started. There were 34 self-reports from schools, and 12 from the social services sector; 30 observation protocols were collected from schools, and 10 from social services. We examined whether there were differences in implementation outcomes (in, for example, dosage, duration, fidelity, adaptation, quality of delivery) between the two delivery systems. Descriptive statistics were prepared and non-parametric tests of significance conducted to compare implementation-related factors across the two settings. Results: Analyses of both the observation protocols and group leaders' self-reports revealed that RESCUR was well-implemented in both schools and social services. The results showed a few significant differences in the outcomes of implementation between the sectors. First, regarding observations, school staff more often adapted the pace of RESCUR lessons to ensure that the children could understand than did social services staff (p < 0.01). Second, social services staff demonstrated greater interest in students and sensitivity to the needs of individual students than did school staff (p = 0.02). Regarding self-reports, social services staff reported having delivered more (p = 0.4) and longer (p < 0.01) lessons than did school staff. Second, school staff reported greater fidelity to (p = 0.02) and less adaptation of (p < 0.01) the intervention than did social services staff. Both observations and self-reports, however, indicated a high fidelity of implementation. Conclusions: Overall, the findings suggest that the resilience program, designed for delivery in schools, can be scaled-out to social services with its implementation outcomes retained. Further research is needed to test the effectiveness of the program regarding child health-related outcomes. Clinical Trial Registration: National Institute of Health, ClinicalTrials.gov, identifier: NCT03655418. Registered August 31, 2018. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Background: Improving 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.Methods: Qualitative 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.Results: From 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.Conclusions: The 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. [ABSTRACT FROM AUTHOR]

Many countries have adopted abstinence guidelines for pregnant women, due to uncertainty around the risk of harm caused by small amounts of alcohol. There is a lack of research exploring frontline midwives' attitudes towards alcohol use during pregnancy and comparisons of practices in different countries. Sixteen semi-structured interviews were conducted with midwives working in Liverpool, England (n = 7) and Örebro County, Sweden (n = 9). Data were analysed inductively, using thematic analysis with thematic networks. The findings show that all midwives believed pregnant women should be advised not to consume any alcohol during pregnancy and there is a need to tailor their approach to the individual. A key concern among midwives in both countries was how to advise about alcohol exposure that occurs before the pregnancy is known to the woman. English midwives discussed the uncertainty around the risk of consuming small amounts of alcohol, whereas Swedish midwives believed any amount of alcohol was associated with risk. Discussing alcohol was viewed as part of the health professional's role, but routine questions for all women were perceived to aid discussions about alcohol. Future research should further explore the impact of wider social and political environment on midwives' attitudes around risks with prenatal alcohol use. [ABSTRACT FROM AUTHOR]

Background: Qualitative studies have aimed to understand why some women continue to drink during pregnancy; however, there is a lack of comparative cross-cultural research. We aimed to explore perceptions and practices of alcohol use during pregnancy in England and Sweden. Methods: Semi-structured interviews were conducted with 21 parents in Merseyside, England and 22 parents in O¨ rebro County, Sweden. Interviews were audio recorded, transcribed verbatim and translated. Data were analyzed using thematic analysis. Results: The majority of women in both countries abstained from alcohol when they found out they were pregnant, despite alcohol being part of many social contexts before pregnancy. Nine of the seventeen English women drank at some point during pregnancy, typically on special occasions. Most parents felt women should modify their alcohol intake when they become mothers, though several English parents argued that responsible motherhood did not necessarily equate to abstinence. Swedish parents held strong opinions against drinking during pregnancy and argued that any amount of alcohol could harm the foetus. English parents' opinions were divided; some were skeptical of whether low to moderate drinking was associated with risks. Conclusions: Practices and attitudes towards alcohol use during pregnancy and views on foetal rights and responsibilities of pregnant women differed in England and Sweden. Shared social norms around drinking may be shaped within the policy context of pregnancy drinking guidelines, determining whether women consume alcohol or not. [ABSTRACT FROM AUTHOR]

Aims: The aim of this paper is to advocate for the importance of meaningful leisure time for young people from a health-promotion perspective using experiences from two youth centres in multicultural neighbourhoods in Sweden. Methods: In this practice-based study, data were collected between 2012 and 2014 at two youth centres in multicultural, socially deprived suburbs in Sweden using surveys with 12- to 16-year-old adolescents (n = 207), seven individual interviews with staff and three cooperation partners in the neighbourhoods, and six group interviews with adolescents (50% girls). Quantitative, qualitative and mixed methods were used for analysis. Results: As part of the youth centres’ strategies, they are open and inclusive, foster supportive relationships, emphasise youth empowerment, and integrate family, school and community in their work. The youth centres are health-promoting settings with regard to four of the action areas in the Ottawa Charter: build healthy public policy, create supportive environments, strengthen community actions and develop personal skills. Conclusions:There is a need for a variety and a combination of various structured and unstructured leisure-time activities because young people’s background and life situation plays a role for their participation in leisure-time activities. We conclude that youth centres are well placed to be or to become health-promoting settings if the activities takes place in a structured environment. [ABSTRACT FROM AUTHOR]

Background: The aim of the study was to address the lack of evaluations of school-based substance use prevention programs and to conduct a quasi-experimental evaluation of the alcohol use part of the Triad intervention.Methods: Eleven Swedish intervention schools (285 pupils) and three control schools (159 pupils) participated in the evaluation. Baseline measurements were conducted in 2011 before the alcohol part in the prevention program was implemented in the intervention schools (school year 6, ages 12-13). We estimated an Intention-To-Treat (ITT) Difference-in-Difference (DD) model to analyze the effectiveness of the intervention on subsequent alcohol use measured in grades 7, 8 and 9.Results: The main results show no effect on the likelihood of drinking alcohol or drinking to intoxication.Conclusions: The lack of positive effects highlights the need for policy-makers and public health officials need to carefully consider and evaluate prevention programs in order to ensure that they are worthwhile from school, health, and societal perspectives. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to explore the motives of young people in multicultural suburbs for participating in youth-centre activities. Design and setting: The study employed practice-based research with a focus on collaboration and methodological diversity. Data on motives for participation were collected in spring 2013 at two non-governmental organisation (NGO)-run youth centres located in the suburbs of two cities in Sweden using surveys and focus-group interviews. Method: The study used mixed methods, with qualitative data being used to help explain initial quantitative findings. Statistical analysis was conducted using measures of competence and social motives. Qualitative analysis used both deductive and inductive content analysis. Results: Study findings suggest that motives concerning competence development and socialising are insufficient to account for why young people in multicultural, socially disadvantaged suburbs participate in youth-centre activities. The study highlights the importance of additional motives influencing participation in leisure-time activities. The additional motives of ‘fun/undemanding’ and ‘support’ were found to be important to most young people in this study. Conclusion: Study findings suggest that motives for participation in youth-centre activities have to do with characteristics of the participants, of the neighbourhood in which the centre is located and the specific type of unstructured leisure-time activity. Future motive measurement scales should include items concerning socioeconomic status, activities provided and young people’s degree of influence over the activities in which they participate. [ABSTRACT FROM AUTHOR]

Objectives: Social Autopsy (SA) is an innovative strategy where a trained facilitator leads community groups through a structured, standardised analysis of the physical, environmental, cultural and social factors contributing to a serious, non-fatal health event or death. The discussion stimulated by the formal process of SA determines the causes and suggests preventative measures that are appropriate and achievable in the community. Here we explored individual experiences of SA, including acceptance and participant learning, and its effect on rural communities in Bangladesh. The present study had explored the experiences gained while undertaking SA of maternal and neonatal deaths and stillbirths in rural Bangladesh. Design: Qualitative assessment of documents, observations, focus group discussions, group discussions and in-depth interviews by content and thematic analyses. Results: Each community's maternal and neonatal death was a unique, sad story. SA undertaken by government field-level health workers were well accepted by rural communities. SA had the capability to explore the social reasons behind the medical cause of the death without apportioning blame to any individual or group. SA was a useful instrument to raise awareness and encourage community responses to errors within the society that contributed to the death. People participating in SA showed commitment to future preventative measures and devised their own solutions for the future prevention of maternal and neonatal deaths. Conclusions: SA highlights societal errors and promotes discussion around maternal or newborn death. SA is an effective means to deliver important preventative messages and to sensitise the community to death issues. Importantly, the community itself is enabled to devise future strategies to avert future maternal and neonatal deaths in Bangladesh. [ABSTRACT FROM AUTHOR]

Introduction: Maternal and neonatal death review (MNDR) introduced in Bangladesh and initially piloted in a district during 2010. MNDR is able to capture each of the maternal, neonatal deaths and stillbirths from the community and government facilities (hospitals). This study aimed to estimate the cost required to implement MNDR in a district of Bangladesh during 2010-2012. Materials and methods: MNDR was implemented in Thakurgaon district in 2010 and later gradually extended until 2015. MNDR implementation framework, guidelines, tools and manual were developed at the national level with national level stakeholders including government health and family planning staff at different cadre for piloting at Thakurgaon. Programme implementation costs were calculated by year of costing and costing as per component of MNDR in 2013. The purchasing power parity conversion rate was 1 $INT = 24.46 BDT, as of 31st Dec 2012. Results: Overall programme implementation costs required to run MNDR were 109,02,754 BDT (445,738 $INT $INT) in the first year (2010). In the following years cost reduced to 8,208,995 BDT (335,609 $INT, during 2011) and 6,622,166 BDT (270,735 $INT, during 2012). The average cost per activity required was 3070 BDT in 2010, 1887 BDT and 2207 BDT required in 2011 and 2012 respectively. Each death notification cost 4.09 $INT, verbal autopsy cost 8.18 $INT, and social autopsy cost 16.35 $INT. Facility death notification cost 2.04 $INT and facility death review meetings cost 20.44 $INT. One death saved by MNDR costs 53,654 BDT (2193 $INT). Conclusions: Programmatic implementation cost of conducting MPDR give an idea on how much cost will be required to run a death review system for a low income country settings using government health system. [ABSTRACT FROM AUTHOR]

Background: In 2013, around 40 % of the schools in Sweden had structured programs to prevent tobacco and alcohol debut in compulsory school. There has unfortunately been a lack of scientific evidence to support most of the prevention methods focusing on primary prevention in schools in Sweden. The aim and purpose of the present study is to evaluate the effectiveness of the Non-Governmental Organization SMART contract-signing strategy in reducing the growth of youth substance use and other problem behaviors amongst Swedish adolescents.Methods: Students from five schools in a medium-sized Swedish municipality were surveyed in three waves from 7(th) to 9(th) grade of compulsory school. We used General Linear Model (GLM) repeated-measures ANOVA to test if the outcome measures smoking, use of snus and alcohol, drunkenness, delinquency, and bullying significantly changed different amounts over time in groups that had participated in the SMART program for long time, a short time, sporadically- or not at all. Groups were compared on demographic background variables, and outcome measures were assessed on all measurement occasions by a one-way ANOVA. The magnitude of group differences at the end of the study was estimated according to Cohen's d.Results: Number of years with a contract has an effect on the levels of self-reported youth problems in 9(th) grade. We found small to medium-sized differences in measured outcomes between students who participated in the program for the longest period of time, 5 years, and who participated for the shortest time, 0-2 years.Conclusion: Findings suggests that the SMART program has preventive effects on adolescent substance use. [ABSTRACT FROM AUTHOR]

Background: Mental health problems among young women aged 16-24 have increased significantly in recent decades, and interventions are called for. Mentoring is a well-established preventative/promotive intervention for developing adolescents, but we have yet to fully understand how the relationship between the mentor and the protégé forms, develops, and closes. In this study, we focused on a female mentoring program implemented by a Swedish non-governmental organization, The Girls Zone. First, we examined the psychological and social characteristics of the young women who chose to take part in the program as protégés. Second, we investigated adolescent female protégés' own experiences of the relationship process based on a relational-cultural theory perspective.Methods: The mixed-method study included 52 questionnaires and five semi-structured interviews with young women aged 15-26 who had contacted The Girls Zone between 2010 and 2012 in order to find a mentor. Their experience of the mentoring relationships varied in duration. Data were analysed statistically and with inductive qualitative content analysis.Results: The group of protégés was heterogeneous in that some had poor mental health and some had good mental health. On the other hand, the group was homogenous in that all its members had shown pro-active self-care by actively seeking out the program due to experiences of loneliness and a need to meet and talk with a person who could listen to them. The relationships were initially characterized by feelings of nervousness and ambivalence. However, after some time, these developed into authentic, undemanding, non-hierarchical relationships on the protégés' terms. The closure of relationships aroused feelings of both abandonment and developing strength.Conclusions: Mentorships that are in line with perspectives of the relational-cultural theory meet the relationship needs expressed by the female protégés. Mentor training should focus on promoting skills such as active listening and respect for the protégé based on an engaged, empathic, and authentic approach in a non-hierarchical relationship. These insights have the potential to inform interventions in several arenas where young women create authentic relationships with older persons, such as in school, in traditional health care contexts, and in youth recreation centres. [ABSTRACT FROM AUTHOR]

Parents and family are very important for a young person's health and development, but knowledge is scarce on how young people perceive them. The aim of this study is to give voice to adolescent girls' and boys' perceptions of how parents and families should be. Nineteen adolescents were interviewed. A descriptive design and a qualitative content approach were used to analyse the interview material. To make the approach participatory, young students were involved as partners. They did some pilot interviews, and their conclusions were used during the planning of the study. The results show that adolescents regard their parents and family as very important to them. Everybody in the family has shared responsibility for it, and it is important to spend time together, i.e., ‘to do family’. Moreover, parents have special obligations; in particular, they have a duty to ensure a good future for their children. [ABSTRACT FROM PUBLISHER]

Objectives: To explore the experiences, acceptance, and effects of conducting facility death review (FDR) of maternal and neonatal deaths and stillbirths at or below the district level in Bangladesh. Methods: This was a qualitative study with healthcare providers involved in FDRs. Two districts were studied: Thakurgaon district (a pilot district) and Jamalpur district (randomly selected from three follow-on study districts). Data were collected between January and November 2011. Data were collected from focus group discussions, in-depth interviews, and document review. Hospital administrators, obstetrics and gynecology consultants, and pediatric consultants and nurses employed in the same departments of the respective facilities participated in the study. Content and thematic analyses were performed. Results: FDR for maternal and neonatal deaths and stillbirths can be performed in upazila health complexes at sub-district and district hospital levels. Senior staff nurses took responsibility for notifying each death and conducting death reviews with the support of doctors. Doctors reviewed the FDRs to assign causes of death. Review meetings with doctors, nurses, and health managers at the upazila and district levels supported the preparation of remedial action plans based on FDR findings, and interventions were planned accordingly. There were excellent examples of improved quality of care at facilities as a result of FDR. FDR also identified gaps and challenges to overcome in the near future to improve maternal and newborn health. Discussion: FDR of maternal and neonatal deaths is feasible in district and upazila health facilities. FDR not only identifies the medical causes of a maternal or neonatal death but also explores remediable gaps and challenges in the facility. FDR creates an enabled environment in the facility to explore medical causes of deaths, including the gaps and challenges that influence mortality. FDRs mobilize health managers at upazila and district levels to forward plan and improve healthcare delivery. [ABSTRACT FROM AUTHOR]

Background: Bangladesh has achieved remarkable progress in healthcare with a steady decline in maternal and under-5 child mortality rates in efforts to achieve Millennium Development Goals 4 and 5. However, the mortality rates are still very high compared with high-income countries. The quality of healthcare needs improve to reduce mortality rates further. It is essential to investigate the current quality of healthcare before implementing any interventions. The study was conducted to explore the perception of healthcare providers about the quality of maternal and neonatal health (MNH) care. The study also investigated patient satisfaction with the MNH care received from district and sub-district hospitals. Methodology: Both qualitative and quantitative methods were used in the study. Two district and 12 sub-district hospitals in Thakurgaon and Jamalpur in Bangladesh were the study settings. Fourteen group discussions and 56 in-depth interviews were conducted among the healthcare providers. Client exit interviews were conducted with 112 patients and their attendants from maternity, labor, and neonatal wards before being discharged from the hospitals. Eight physicians and four anthropologists collected data between November and December 2011 using pretested guidelines. Results: The hospital staff identified several key factors that affected the quality of patient care: shortage of staff and logistics; lack of laboratory support; under use of patient-management protocols; a lack of training; and insufficient supervision. Doctors were unable to provide optimal care because of the high volume of patients. The exit interviews revealed that 85 % of respondents were satisfied with the hospital services received. Seven out of 14 respondents were satisfied with the cleanliness of the hospital facilities. More than half of the respondents were satisfied with the drugs they received. In half of the facilities, patients did not get an opportunity to ask the healthcare providers questions about their health conditions and treatments. Conclusion: The quality of healthcare is poor in district and sub-district hospitals in Bangladesh because of the lack of healthcare personnel and logistic support. An integrated quality improvement approach is needed to improve MNH care service in district and sub-district hospitals in Bangladesh. [ABSTRACT FROM AUTHOR]

Background: Bangladesh has achieved remarkable progress in healthcare with a steady decline in maternal and under-5 child mortality rates in efforts to achieve Millennium Development Goals 4 and 5. However, the mortality rates are still very high compared with high-income countries. The quality of healthcare needs improve to reduce mortality rates further. It is essential to investigate the current quality of healthcare before implementing any interventions. The study was conducted to explore the perception of healthcare providers about the quality of maternal and neonatal health (MNH) care. The study also investigated patient satisfaction with the MNH care received from district and sub-district hospitals. Methodology: Both qualitative and quantitative methods were used in the study. Two district and 12 sub-district hospitals in Thakurgaon and Jamalpur in Bangladesh were the study settings. Fourteen group discussions and 56 in-depth interviews were conducted among the healthcare providers. Client exit interviews were conducted with 112 patients and their attendants from maternity, labor, and neonatal wards before being discharged from the hospitals. Eight physicians and four anthropologists collected data between November and December 2011 using pretested guidelines. Results: The hospital staff identified several key factors that affected the quality of patient care: shortage of staff and logistics; lack of laboratory support; under use of patient-management protocols; a lack of training; and insufficient supervision. Doctors were unable to provide optimal care because of the high volume of patients. The exit interviews revealed that 85 % of respondents were satisfied with the hospital services received. Seven out of 14 respondents were satisfied with the cleanliness of the hospital facilities. More than half of the respondents were satisfied with the drugs they received. In half of the facilities, patients did not get an opportunity to ask the healthcare providers questions about their health conditions and treatments. Conclusion: The quality of healthcare is poor in district and sub-district hospitals in Bangladesh because of the lack of healthcare personnel and logistic support. An integrated quality improvement approach is needed to improve MNH care service in district and sub-district hospitals in Bangladesh. [ABSTRACT FROM AUTHOR]

Health is not equally distributed and various neighbourhoods differ from each other in terms of people's health and other social and economic variables. Numerous efforts are undertaken to develop healthier and more sustainable neighbourhoods, and a key concern in the process is citizen participation. Due to the challenge of conducting research in poor neighbourhood's complementary research approaches with a more practice-based and democratic knowledge development are needed. Community-based participatory research (CBPR) is a partnership approach that aims to conduct collaborative knowledge production and to use the research findings for public health interventions. This paper sets out to describe and analyse a community-academic partnership and a CBPR process within a poor neighbourhood in Sweden. Two years of fieldwork were conducted at 26 meetings comprising 84 h in a CBPR group including a researcher, and lay and professional stakeholders. Participatory observation and detailed meeting process-notes were used when doing a qualitative thematic analysis. Eight different developmental phases was identified in the implementation of a CBPR process and four key lessons were found to be important. These were that a community-academic partnership should (1) accept different levels of participation in different phases; (2) openly discuss mutual expectations and individual prerequisites; (3) unmask power and authority; and (4) allow the work to take the time it needs. The design, process, and result of the CBPR project are relevant for local community-academic partnerships using a CBPR approach with the goal of increasing participation as a means of improving people's health and well-being in poor neighbourhoods. [ABSTRACT FROM AUTHOR]

Background: The development of knowledge for health promotion requires an effective mechanism for collaboration between academics, practitioners, and policymakers. The challenge is better to understand the dynamic and ever-changing context of the researcher–practitioner–policymaker–community relationship. Aims: The aims were to explore the factors that foster Academic Practice Policy (APP) partnerships, and to systematically and transparently to review three cases. Methods: Three partnerships were included: Power and Commitment–Alcohol and Drug Prevention by Non-Governmental Organizations in Sweden; Healthy City–Social Inclusion, Urban Governance, and Sustainable Welfare Development; and Empowering Families with Teenagers–Ideals and Reality in Karlskoga and Degerfors. The analysis includes searching for evidence for three hypotheses concerning contextual factors in multi-stakeholder collaboration, and the cumulative effects of partnership synergy. Results: APP partnerships emerge during different phases of research and development. Contextual factors are important; researchers need to be trusted by practitioners and politicians. During planning, it is important to involve the relevant partners. During the implementation phase, time is important. During data collection and capacity building, it is important to have shared objectives for and dialogues about research. Finally, dissemination needs to be integrated into any partnership. The links between process and outcomes in participatory research (PR) can be described by the theory of partnership synergy, which includes consideration of how PR can ensure culturally and logistically appropriate research, enhance recruitment capacity, and generate professional capacity and competence in stakeholder groups. Moreover, there are PR synergies over time. Conclusions: The fundamentals of a genuine partnership are communication, collaboration, shared visions, and willingness of all stakeholders to learn from one another. [ABSTRACT FROM PUBLISHER]

Aims: The aims of this review is to compile and identify key issues in international research about youth sports clubs as health-promoting settings, and then discuss the results of the review in terms of a framework for the youth sports club as a health-promoting setting. Methods: The framework guiding this review of research is the health-promoting settings approach introduced by the World Health Organization (WHO). The method used is the integrated review. Inclusion criteria were, first, that the studies concerned sports clubs for young people, not professional clubs; second, that it be a question of voluntary participation in some sort of ongoing organized athletics outside of the regular school curricula; third, that the studies consider issues about youth sports clubs in terms of health-promoting settings as described by WHO. The final sample for the review consists of 44 publications. Results: The review shows that youth sports clubs have plentiful opportunities to be or become health-promoting settings; however this is not something that happens automatically. To do so, the club needs to include an emphasis on certain important elements in its strategies and daily practices. The youth sports club needs to be a supportive and healthy environment with activities designed for and adapted to the specific age-group or stage of development of the youth. Conclusions: To become a health-promoting setting, a youth sports club needs to take a comprehensive approach to its activities, aims, and purposes. [ABSTRACT FROM PUBLISHER]

Purpose: A vehicle to reduce health inequalities and improve public health has been provided by programmes at a neighbourhood level. The purpose of this paper is to analyse the development processes in four municipalities for achieving sustainable structures in area-based development programmes during and after a formal partnership period. Design/methodology/approach: A case-study database was compiled based on the strategic and local work of four municipalities and four municipal housing companies who cooperated in the Partnership for Sustainable Welfare Development 2003-2009. The case-study database includes nine in-depth studies with interviews (n = 68), participant observations (n = 125), a survey (n = 1,160), and documents. The data are analysed using three theoretical concepts: political support, alliances, and citizen participation. Findings: Political support, alliances, and citizen participation are important building blocks in neighbourhood development work. However, when the partnership ended there was little left that could function as a sustainable structure. Political support seems to be a means to reach the target, including ensuring a consistent approach and allocation of resources. However, the support must continue also after the intervention period, when the formal partnership collaboration ends, otherwise the established structure will soon decompose. Citizen participation is another precondition for a sustainable structure able to continue despite reduced municipal support. Alliances have the best chance of forming sustainable structures when they involve both the strategic and the operational level. Originality/value: Even though many evaluations have been conducted to capture the process of interventions, little attention has been given to the challenges facing the outcomes of the intervention when it comes to making permanent the activities for reducing health inequalities. This paper is an attempt to deal with these challenges. [ABSTRACT FROM AUTHOR]

Purpose – A vehicle to reduce health inequalities and improve public health has been provided by programmes at a neighbourhood level. The purpose of this paper is to analyse the development processes in four municipalities for achieving sustainable structures in area-based development programmes during and after a formal partnership period. Design/methodology/approach – A case-study database was compiled based on the strategic and local work of four municipalities and four municipal housing companies who cooperated in the Partnership for Sustainable Welfare Development 2003-2009. The case-study database includes nine in-depth studies with interviews (n=68), participant observations (n=125), a survey (n=1,160), and documents. The data are analysed using three theoretical concepts: political support, alliances, and citizen participation. Findings – Political support, alliances, and citizen participation are important building blocks in neighbourhood development work. However, when the partnership ended there was little left that could function as a sustainable structure. Political support seems to be a means to reach the target, including ensuring a consistent approach and allocation of resources. However, the support must continue also after the intervention period, when the formal partnership collaboration ends, otherwise the established structure will soon decompose. Citizen participation is another precondition for a sustainable structure able to continue despite reduced municipal support. Alliances have the best chance of forming sustainable structures when they involve both the strategic and the operational level. Originality/value – Even though many evaluations have been conducted to capture the process of interventions, little attention has been given to the challenges facing the outcomes of the intervention when it comes to making permanent the activities for reducing health inequalities. This paper is an attempt to deal with these challenges. [ABSTRACT FROM AUTHOR]

Purpose – Alcohol stands in an ambiguous relationship to sports, and there is a common belief that participation in sports prevents alcohol consumption. Although this is not always the case, sports clubs can be important settings for health promoting alcohol policy interventions .The purpose of this paper is to explore the process of implementing alcohol policies in eight football clubs in Sweden and, in particular, how the implementation process is conveyed in the clubs' alcohol policy projects, the similarities and differences between this case study and Durlak and DuPre's implementation model and the recommendations for successful alcohol policy implementation in relation to the result. Design/methodology/approach – In total, 15 semi-structured interviews on the subject of sports' club alcohol policies were conducted with project leaders and board members from eight sports clubs. The interviews were analysed using Durlak and DuPre's model of factors affecting implementation processes. Findings – The results show that almost all the factors in Durlak and DuPre's model were comprehensively manifested in the football clubs' alcohol policy projects, although with slightly different significance and emphases. Practical implications – The results are discussed in relation to recommendations for successful alcohol policy implementation in sports clubs. Recommendations are presented in six areas: an explicit message; fit; internal policy dissemination; alcohol policy as a part of overall policy; support; and actors. Originality/value – Many sports clubs do an excellent job of implementing alcohol policies successfully and it is imperative to incorporate their "good" practices into research and provide assistance to those whose policies and practice are less developed. [ABSTRACT FROM AUTHOR]

The last decades have seen the emergence of the settings approach in Health Promotion one example is the Healthy City initiative which was launched by European division of WHO in 1990. In 2003, four Swedish municipalities accordingly signed a contract on a Partnership for Sustainable Welfare Development. One of the objectives was to promote participation, influence, and health at a neighbourhood level by focusing on one housing area in each municipality. These housing areas constitute the setting of this study. The purpose is to examine the implementation structures in the municipalities, and how variations in the implementation structure affect differences in integration of community participation. A triangulation of methods was used in building up a case study database: semi-structured key informant interviews with 29 stakeholders in the municipalities; examination of solicited and unsolicited documents; and participatory observations which included repeated visits to the neighbourhoods. The results show that the greater the visibility of community participation policy is in the implementation structure the greater is the integration of community participation in the neighbourhood renewal work. Two explanatory factors have been identified. The first is that making the community participation policy visible in the implementation structure results in more appropriate strategies for mobilizing the community in the neighbourhood renewal work. The second is that the municipal governing of the neighbourhood renewal allows more space for community participation when the policy is visible in the implementation structure. [ABSTRACT FROM AUTHOR]

Citizen participation in neighbourhood development is one way to promote public health and contribute to the well-being of individuals. However, some people participate while others do not. This study examines the individual characteristics of people who during the past 2 years have participated in a neighbourhood development process compared with potential and non-participants. Socio-demographic factors, perceptions and behaviour were analysed in a cross-sectional study. A questionnaire was answered by 1160 randomly chosen citizens over the age of 18 who lived in three Swedish cities. The most important single factor related to participation in neighbourhood development was prior experience of participation, such as attempting to influence city policies by contacting politicians, submitting a citizen proposal, etc. Furthermore, having frequent political discussions with neighbours was another behavioural factor that was found associated to people's participation in neighbourhood development. Among socio-demographic factors, only ethnicity was found significant after controlling for other factors; i.e. people born outside the Nordic countries were less likely to participate. [ABSTRACT FROM AUTHOR]

The aim of this study is to describe adolescent children of alcoholics' (COA) perspectives on disclosure and support. COA reported assessing the trustworthiness of adults before disclosing their home situation. Before disclosure they may have raised their own level of consciousness, told a peer, told an adult stranger, or in-directly communicated with an adult. These findings are the result of interviews with 27 adolescents attending support groups for COA in Sweden. Adults, who ask questions, listen carefully and cooperate with the child/adolescent, and who are knowledgeable about families with alcohol problems, are considered as supportive and trustworthy. The adolescents reported psychological, communicative, environmental, and generational aspects of the disclosure process. [ABSTRACT FROM AUTHOR]

Background: Alcohol and drug prevention is high on the public health agenda in many countries. An increasing trend is the call for evidence-based practice. In Sweden in 2002 an innovative project portfolio including an integrated research and competence-building strategy for non-governmental organisations (NGOs) was designed by the National Board of Health and Welfare (NBHW). This research strategy case study is based on this initiative.Methods: The embedded case study includes 135 projects in 69 organisations and 14 in-depth process or effect studies. The data in the case study has been compiled using multiple methods - administrative data; interviews and questionnaires to project leaders; focus group discussions and seminars; direct and participatory observations, interviews, and documentation of implementation; consultations with the NBHW and the NGOs; and a literature review. Annual reports have been submitted each year and three bi-national conferences Reflections on preventions have been held.Results: A broad range of organisations have been included in the NBHW project portfolio. A minority of the project were run by Alcohol or drug organisations, while a majority has children or adolescents as target groups. In order to develop a trustful partnership between practitioners, national agencies and researchers a series of measures were developed and implemented: meeting with project leaders, project dialogues and consultations, competence strengthening, support to documentation, in-depth studies and national conferences. A common element was that the projects were program-driven and not research-driven interventions. The role of researchers-as-technical advisors was suitable for the fostering of a trustful partnership for research and development. The independence of the NGOs was regarded as important for the momentum in the project implementation. The research strategy also includes elements of participatory research.Conclusions: This research strategy case study shows that it is possible to integrate research into alcohol and drug prevention programs run by NGOs, and thereby contribute to a more evidence-based practice. A core element is developing a trustful partnership between the researchers and the organisations. Moreover, the funding agency must acknowledge the importance of knowledge development and allocating resources to research groups that is capable of cooperating with practitioners and NGOs. [ABSTRACT FROM AUTHOR]

Background: The present study is an evaluation of a 3-year parental program aiming to prevent underage drinking. The intervention was implemented by a non-governmental organization and targeted parents with children aged 13-16 years old and included recurrent activities during the entire period of secondary school. The program consisted of four different types of group and self-administered activities: parent meetings, family dialogues, friend meetings, and family meetings. Methods: A quasi-experimental design was used following parents and children with questionnaires during the three years of secondary school. The analytic sample consisted of 509 dyads of parents and children. Measures of parental attitudes and behaviour concerning underage drinking and adolescents' lifetime alcohol consumption and drunkenness were used. Three socio-demographic factors were included: parental education, school, and gender of the child. A Latent Growth Modelling (LGM) approach was used to examine changes in parental behaviour regarding youth drinking and in young people's drinking behaviour. To test for the pre-post test differences in parental attitudes repeated measures ANOVA were used. Results: The results showed that parents in the program maintained their restrictive attitude toward underage drinking to a higher degree than non-participating parents. Adolescents of participants were on average one year older than adolescents with non-participating parents when they made their alcohol debut. They were also less likely to have ever been drunk in school year 9. Conclusion: The results of the study suggested that Strong and Clear contributed to maintaining parents' restrictive attitude toward underage drinking during secondary school, postponing alcohol debut among the adolescents, and significantly reducing their drunkenness. [ABSTRACT FROM AUTHOR]

Background: In previous public health surveys large differences in health have been shown between citizens living in different neighbourhoods in the Örebro municipality, which has about 125000 inhabitants. The aim of this study was to investigate the determinants of health with an emphasis on the importance of neighbourhood characteristics such as the influence of neighbourhood social cohesion and social capital. The point of departure in this study was a conceptual model inspired by the work of Carpiano, where different factors related to the neighbourhood have been used to find associations to individual self-rated health.Methods: We used data from the survey 'Life & Health 2004' sent to inhabitants aged 18-84 years in Örebro municipality, Sweden. The respondents (n = 2346) answered a postal questionnaire about living conditions, housing conditions, health risk factors and individual health. The outcome variable was self-rated health. In the analysis we applied logistic regression modelling in various model steps following a conceptual model.Results: The results show that poor self-rated health was associated with social capital, such as lack of personal support and no experience of being made proud even after controlling for strong factors related to health, such as age, disability pension, ethnicity and economic stress. Also the neighbourhood factors, housing area and residential stability were associated with self-rated health. Poor self-rated health was more common among people living in areas with predominately large blocks of flats or areas outside the city centre. Moreover, people who had lived in the same area 1-5 years reported poor health more frequently than those who had lived there longer.Conclusions: The importance of the neighbourhood and social capital for individual health is confirmed in this study. The neighbourhoods could be emphasized as settings for health promotion. They can be constructed to promote social interaction which in turn supports the development of social networks, social support and social capital--all important determinants of health. [ABSTRACT FROM AUTHOR]

Aims: Parental attitudes and behaviour with regard to young people and alcohol are associated with teenagers' drinking behaviour. This study examined the association between sociodemographic factors among parents and parental attitudes and behaviour with regard to alcohol and adolescents. Methods: Postal questionnaires were sent to parents of children aged 12-16 years in six Swedish municipalities. Seven hundred and ninety-five parents were included in the study. Seven sociodemographic factors and four questions identifying parental attitudes and behaviour were examined. Logistic regression was used to compute odds ratios and confidence intervals. Results: The study showed that fathers were more likely than mothers to report that children had been drinking or tasting alcohol at home. Parents who answered the questionnaire together also stated that their children had been served alcohol at home to a larger extent than mothers. Fathers, single parents and parents with older children were more likely to have non-restrictive attitudes towards adolescents and alcohol than mothers, parents living in a household with more than one adult, and parents with younger children. Factors such as age of the parents, employment status and numbers of children in the household were not associated with either parental attitudes or behaviour. Conclusions: The sex of the responding parent was the only sociodemographic factor that was associated with both parental attitudes and behaviour. Fathers were more likely than mothers to have a non-restrictive attitude. The fathers also reported to a greater extent than mothers that children had been drinking or tasting alcohol at home. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this paper is to describe and analyse the implementation by a non-governmental organization (NGO) of an intervention with two different strategies – one employing confrontational approaches, the other cooperative ones – aiming to reduce the rate of successful purchase attempts (PAs) of medium-strength beer in Sweden. Design/methodology/approach – The Swedish Youth Temperance Movement (UNF) has been responsible for the development and implementation of the intervention, and a research team at Örebro University for the evaluation. The outcome analysis is based on 1,475 PA from 25 Swedish cities during 2003-2006. Annual reports, discussions and telephone interviews have been used to understand the intervention process. Findings – In 40 per cent of all registered PAs, beer is sold to minors. In the eight cities using a structured strategy, there is a significant decrease from 2003 to 2006 (44-27 per cent; p<0.001). The confrontation method, compared to no model, is more than four times (OR = 3.8; CI 2.0-7.0) more likely to yield a positive result. Compared to the cooperation method, it is even more likely to yield a positive result (OR = 4.7; CI 2.1-10.7). Practical implications – Working with a structured strategy gives significantly better results than working without one. The confrontation method is more successful than the cooperation method. Developing a preventive strategy takes time, cooperation perhaps requiring even more time to succeed than confrontation. The result reveals the importance of building local networks in the municipalities. Originality/value – The advocacy for Swedish alcohol policy by the young members of UNF and participatory research is a unique combination. [ABSTRACT FROM AUTHOR]

Background: Alcohol consumption among adolescents is a serious public health concern. Research has shown that prevention programs targeting parents can help prevent underage drinking. The problem is that parental participation in these kinds of interventions is generally low. Therefore, the aim of the present study is to examine non-participation in a parental support program aiming to prevent underage alcohol drinking. The Health Belief Model has been used as a tool for the analysis. Methods: To understand non-participation in a parental program a quasi-experimental mixed-method design was used. The participants in the study were invited to participate in a parental program targeting parents with children in school years 7-9. A questionnaire was sent home to the parents before the program started. Two follow-up surveys were also carried out. The inclusion criteria for the study were that the parents had answered the questionnaire in school year 7 and either of the questionnaires in the two subsequent school years (n = 455). Multinomial logistic regression analysis was used to examine reasons for non-participation. The final follow-up questionnaire included an opened-ended question about reasons for non-participation. A qualitative content analysis was carried out and the two largest categories were included in the third model of the multinomial logistic regression analysis. Results: Educational level was the most important socio-demographic factor for predicting nonparticipation. Parents with a lower level of education were less likely to participate than those who were more educated. Factors associated with adolescents and alcohol did not seem to be of significant importance. Instead, program-related factors predicted non-participation, e.g. parents who did not perceive any need for the intervention and who did not attend the information meeting were more likely to be non-participants. Practical issues, like time demands, also seemed to be important. Conclusion: To design a parental program that attracts parents independently of educational level seems to be an important challenge for the future as well as program marketing. This is something that must be considered when implementing prevention programs. [ABSTRACT FROM AUTHOR]

Background: Poor mental health has large social and economic consequences both for the individual and society. In Sweden, the prevalence of mental health symptoms has increased since the beginning of the 1990s. There is a need for a better understanding of the area for planning preventive activities and health care. Methods: The study is based on a postal survey questionnaire sent to a random sample of men and women aged 18-84 years in 2004. The overall response rate was 64%. The area investigated covers 55 municipalities with about one million inhabitants in central part of Sweden. The study population includes 42,448 respondents. Mental health was measured with self-reported symptoms of anxiety/depression (EQ-5D, 5th question). The association between socio-economic conditions, lifestyle factors and mental health symptoms was investigated using multivariate multinomial logistic regression models. Results: About 40% of women and 30% of men reported that they were moderately or extremely anxious or depressed. Younger subjects reported poorer mental health than older subjects, the best mental health was found at ages 65-74 years. Factors that were strongly and independently related to mental health symptoms were poor social support, experiences of being belittled, employment status (receiving a disability pension and unemployment), economic hardship, critical life events, and functional disability. A strong association was also found between how burdensome domestic work was experienced and anxiety/depression. This was true for both men and women. Educational level was not associated with mental health symptoms. Of lifestyle factors, physical inactivity, underweight and risk consumption of alcohol were independently associated with mental health symptoms. Conclusion: Our results support the notion that a ground for good mental health includes balance in social relations, in domestic work and in employment as well as in personal economy both among men and women. In addition, physical inactivity, underweight and risk consumption of alcohol are associated with mental health symptoms independent of socio-economic factors. [ABSTRACT FROM AUTHOR]

Social polarization in the urban landscape means that there are a lot of neighbourhoods with a concentration of residents suffering from high crime rates, a loss of feeling of safety, ethnic conflicts and general decay. Local and national governments respond to these challenges by adopting urban development programmes with a pronounced area-based orientation. Inspired by the global Healthy Cities Programme, some of these initiatives have an explicit public health-related focus. This article analyses the possibilities and obstacles for an initiative of this kind undertaken by four Swedish cities under the label Partnership for Sustainable Welfare Development. Sustainable development, healthy cities, neighbourhood and partnership are concepts rhetorically underpinning the policy intervention under study. After a brief, critical survey of these concepts the article presents the empirical study undertaken on the basis of interviews, official documents and participatory observation. Finally the results of this study are summarized and related to some of the literature in this field. It is found that the role of the partnership as a node for mutual learning and coordination is held in high esteem by the partnership participants. Other qualities given high priority by them are the need for comprehensive, long-term planning and residents' participation and influence. However, from a more distanced point of view it is also obvious that the approach has its limitations due to the fact that even successful interventions cannot affect the fundamental causes of urban social polarization as these causes relate to general socioeconomic cleavages in society. [ABSTRACT FROM AUTHOR]

AIMS This study examines the compliance with the taw against setting beer to under-aged persons in Sweden. It also analyses determinants of compliance and the importance of checking IDs. The paper also aims to reveal the strategies used by youths when purchasing beer. METHODS & DATA The study is the result of a close collaboration between the Swedish Youth Temperance Movement (UNF) and researchers at 0rebro University, UNF has been responsible for the purchase attempts, and the research team for the analyses. The data consists of 681 purchase attempts in seven cities in Sweden during 2003-2004. RESULTS Almost half of the purchase attempts made by under-aged persons (14-17 years old) resulted in successfully buying beer. The study reveals that the genders of the check-out clerk and the buyer are significant with regard to both selling/buying beer and asking for ID. The proportion of sales was significantly higher to girls than boys. both in total and when they were asked for ID first. CONCLUSIONS The study shows that under-aged teenagers succeed in purchasing beer in Sweden despite the present legislation. Some succeed because of the tricks they use, and some because of the check-out clerk's negligence. The procedure used in the present study -- letting under-aged persons attempt to purchase beer -- resembles the situation for ordinary teenagers trying to buy beer under normal circumstances. [ABSTRACT FROM AUTHOR]

Aims: The purpose of this study was to analyse changes in smoking habits among adolescents in three regions of Sweden following the introduction in 1997 of a law prohibiting sales of tobacco to persons under 18 years: the minimum-age law. Methods: The analysis is based on data collected among adolescents in compulsory school years 7 and 9 (about 13-14 and 15-16 years respectively), in 1996, 2000, and 2005, in three regions of Sweden. The samples comprise 43,857 students who completed a self-administered questionnaire anonymously in the classroom. The data were subjected to contingency-table analysis and logistic regression analysis. Results: The rates of smoking among students in year 9 were significantly lower in 2005 than in 1996 in two regions and unchanged in one region. This pattern held even after control for sex, parents' smoking habits, and academic orientation. In year 7 there were no changes over time (boys) or any clear pattern (girls). Conclusions: Based on outcomes from test purchases of tobacco products that were carried out in parallel to the collection of the questionnaire data, it is reasonable to hypothesize that the regional differences described may at least in part be due to differences in the availability of cigarettes. In 2005 it was significantly easier for adolescents to purchase tobacco products at retailers in the city of Malmö than at those in the counties of Värmland and Västernorrland. [ABSTRACT FROM AUTHOR]