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Aim: The aim of the present study was to explore the associations between the economic, political, sociocultural and physical environments in kindergartens, along with the frequency and variety of vegetables served, and the amount of vegetables eaten. Method: The BRA Study collected data through two paper-based questionnaires answered by the kindergarten leader and pedagogical leader of each selected kindergarten, and a five-day vegetable diary from kindergartens (n = 73) in Vestfold and Buskerud Counties, Norway. The questionnaires assessed environmental factors, and the frequency and variety of vegetables served. The non-parametric Mann–Whitney U and Kruskal–Wallis tests were used to explore the associations between factors in the kindergarten environments and vegetables served and eaten. Results: Kindergartens that included expenditures for food and beverages in the parental fees served a larger variety of vegetables (p = 0.046). A higher frequency of served vegetables (p = 0.014) and a larger amount (p = 0.027) of vegetables eaten were found in kindergartens where parents paid a monthly fee of 251 NOK or more. Similarly, the amount of vegetables eaten was higher (p = 0.017) in kindergartens where the employees paid a monthly fee to eat at work. Furthermore, a larger amount (p = 0.046) of vegetables was eaten in kindergartens that had written guidelines for food and beverages that were offered. Conclusions: This study indicates that the economic environment in a kindergarten seems to be positively associated with the vegetables served and eaten there. This is of high relevance for public health policy as vegetable consumption is an important factor in reducing the risk of non-communicable diseases. [ABSTRACT FROM AUTHOR]

Aims: One of the goals of the Norwegian Public Health Act is to reduce health inequities. The act mandates the implementation of policies and measures with municipalities and county municipalities to accomplish this goal. The article explores the prerequisites for municipal capacity to reduce health inequities and how the capacity is built and sustained. Methods: The paper is a literature study of articles and reports using data from two surveys on the implementation of public health policies sent to all Norwegian municipalities: the first, a few months before the implementation of the Public Health Act in 2012; the second in 2014. Results: Six dimensions are included in the capacity concept. Leadership and governance refers to the regulating tool of laws that frame the local implementation of public health policies. Municipalities implement inter-sectoral working groups and public health coordinators to coordinate their public health policies and measures. Financing of public health is fragmented. Possibilities for municipalities to enter into partnerships with county municipalities are not equally distributed. Owing to the organisational structures, municipalities largely define public health as health policy. Workforce and competence refers to the employment of public health coordinators, and knowledge development refers to the mandated production of health overviews in municipalities. Conclusions: The capacity to reduce health inequities varies among municipalities. However, if municipalities build on the prerequisites they control, establishing inter-sectoral working groups and employing public health coordinators in authoritative positions, national governance instruments and regional resources may sustain their capacity. [ABSTRACT FROM AUTHOR]

Aims: The aim of the present paper is to present and validate a Knowledge-Intensive Work Environment Survey Target (KIWEST), a questionnaire developed for assessing the psychosocial factors among people in knowledge-intensive work environments. Methods: The construct validity and reliability of the measurement model where tested on a representative sample of 3066 academic and administrative staff working at one of the largest universities in Norway. Results: Confirmatory factor analysis provided initial support for the convergent validity and internal consistency of the 30 construct KIWEST measurement model. However, discriminant validity tests indicated that some of the constructs might overlap to some degree. Conclusion: Overall, the KIWEST measure showed promising psychometric properties as a psychosocial work environment measure. [ABSTRACT FROM AUTHOR]

Aims: The aim of the 'Pathways to Independence' study was to gain knowledge of how to facilitate a healthy development for unaccompanied refugee minors (URMs) after settling in Norwegian municipalities. Methods: The project is located in the URM child welfare services (URM CWS) of the Bergen municipality. We invited 101 URMs older than 15 years connected to the URM CWS to participate in a comprehensive survey. Of the invited, 81 consented to participate. The survey included questions on the user's experiences and satisfaction with the URM CWS, and questions related to schooling, social support and activities after settlement. We also included standardized and validated questionnaires on potential traumatic events, mental and somatic health, protective factors and quality of life. These questionnaires have previously been used in two Norwegian epidemiological studies, the 'Youth@Hordaland' and 'Young in Foster care', facilitating comparison of the results with other youth populations in Norway. Conclusion: Results from the project will be valuable in the process of reaching knowledge-based recommendations for successful settlement of URMs. [ABSTRACT FROM AUTHOR]

Aims: The major causes of social inequalities in health are found outside of healthcare. However, healthcare can also play a role in maintaining, reducing, or reinforcing inequality. We present and discuss results from a panel study of doctors' views on whether and how socioeconomic factors should play a role in clinical decision making. Methods: The panel comprised a representative sample of Norwegian doctors, established in 1994. For the current study, the doctors received postal questionnaires in 2008, 2012 and 2016. Data were analysed using descriptive statistics, correlation analysis, factor analysis and mixed models for repeated measurements. Results: The sample sizes were 1072 (65%), 1279 (71%) and 1605 (73%), respectively. The doctors were increasingly positive towards considering socioeconomic factors, and reported giving more time and advice and asking for less pay to compensate for unfavorable socioeconomic factors. General practitioners were more likely to consider socioeconomic factors and changed their practice accordingly compared to other clinicians. The percentage of doctors who agreed that different amounts of resources should be used to obtain similar health effects was high and increased over time. Conclusions: Increasingly more doctors are willing to consider patients' socioeconomic factors in clinical care. This could be contrary to professional ethics, in which only medical need should count. However, it depends on how 'need' is interpreted. As treatment outcomes partly depend on non–medical factors, socioeconomic factors should be considered because they influence patients' ability to benefit from medical care. Equality requires mitigating factors with negative impacts on health outcomes. [ABSTRACT FROM AUTHOR]

Aims: This study aims to estimate the prevalence of intimate partner violence (IPV) and its association with psychological distress and symptoms of post-traumatic stress (PTS) among Sami and non-Sami and to explore whether the association between IPV and mental health is modified by exposure to childhood violence (CV). These issues are scarcely studied among the Sami. Methods: This study was based on the cross-sectional SAMINOR 2 Questionnaire Survey, a part of the Population-based Study on Health and Living Conditions in Regions with Sami and Norwegian Populations (SAMINOR). Chi-square tests and two-sample t -tests were used to test differences between groups. Multiple linear regression analysis was applied to explore the association between IPV/CV and continuous scores of psychological distress and symptoms of post-traumatic stress. Results: Experiences of IPV (emotional, physical, and/or sexual) were reported by 12.8% of women and 2.0% of men. A significantly higher proportion of Sami women reported exposure to emotional (12.4 v. 9.5%, p = 0.003), physical (11.6 v. 6.9%, p < 0.001), and any IPV (17.2 v. 11.8%, p < 0.001) compared to non-Sami women. There were no ethnic differences in sexual IPV among women (2%). Exposure to IPV was associated with a higher score of psychological distress and PTS and was highest among those exposed to both IPV and CV. Conclusions: Sami women reported the highest prevalence of IPV. The association between IPV/CV and mental health problems did not differ by ethnicity or gender. The most severe mental health problems were observed for those who were exposed to both IPV and CV. [ABSTRACT FROM AUTHOR]

Aims: The Tromsø Study is an ongoing population-based health study in Tromsø, Norway, initiated in 1974. The purpose of the seventh survey (Tromsø7) 2015–2016 was to advance the population risk factor surveillance and to collect new types of data. We present the study design, data collection, attendance, and prevalence of risk factors and disease. Methods: All inhabitants in Tromsø municipality, Norway, aged 40 years and older (N =32,591) were invited to a health screening including extensive questionnaires, face-to-face interviews, biological sampling (blood, urine, saliva, nasal/throat swabs, faeces), measurements (anthropometry, blood pressure, pulse, pulse oximetry) and clinical examinations (pain sensitivity, echocardiography, cognitive, physical, and lung function, accelerometer measurements, eye examinations, carotid ultrasound, electrocardiography, dual-energy X-ray absorptiometry, and heart, lung and carotid auscultation). New research areas in this round were dental and oral health examinations, collection of faecal samples for studies of normal bacterial flora and antibiotic resistance, and 24-hour urine samples for examination of sodium and iodine intakes. Results: Attendance was 65% (N =21,083), and was higher in women, age group 50–79 years, previous attenders, and Norwegian-born individuals. Cardiovascular risk factor levels and prevalence of chronic obstructive lung disease decreased since the last survey, while the prevalence of obesity and diabetes increased. Conclusions: Attendance was stable from the sixth survey. Interaction with participants might be key to maintain participation. Favourable trends in risk factors continue, except for a continued increase in obesity. Both new data collection technology and traditional physical examinations will be crucial for the impact of future population studies. [ABSTRACT FROM AUTHOR]

Background: The COVID-19 pandemic has led to major social and economic changes that could impact public mental health. The main aim of the current study was to investigate mental health in Norway during the COVID-19 outbreak (since the first confirmed case on 26 February 2020). Methods: The results are from the first wave of the data collection (1 April–2 June 2020), which took place during the outbreak along with its initial restrictions. A total of 19,372 (11,883 students) people participated in a cross-sectional web-based survey. Results: A total of 21.8% scored above the cut-off for depression and 23.7% for anxiety. Severity of symptoms was associated with the accumulation of risk factors, such as possible/confirmed infection for oneself or one's family, female/other sex, students, having mental health problems, increased use of tobacco, increased use of alcohol, less exercise, losing one's job, suffering economic impact and lower education. Conclusions: COVID-19 could have a negative association with public mental health, especially for certain risk groups. Future data-collection waves will provide further insight into the development of symptoms following the pandemic. [ABSTRACT FROM AUTHOR]

Aims: To develop a questionnaire to examine attitudes among employees and managers to include people with various health problems into their work group, and to test the questionnaire in one relevant population within the labour market. Methods: A questionnaire was developed through a process involving discussions in a scientific forum and pilot testing with group discussions. The final questionnaire, which was tested in a survey study of managers and employees in 33 Norwegian kindergartens (N =485), contained 10 short case stories followed by questions concerning workplace inclusion. The case stories described individuals with musculoskeletal and mental disorders, as well as individuals with potentially stigmatising behavioural history and lifestyle, and control cases. Risk ratios with 95% confidence intervals (CIs) were used to compare the case stories. Cases with high risk ratios had an increased risk of not being included compared to a control case. Results: Attitudes for workplace inclusion varied between the different case stories. Cases portraying mental illness had the highest risk ratios, indicating that employees and managers are less likely to include people with mental illness than people with musculoskeletal illness. Furthermore, unspecific or chronic illness had higher risk ratios than specific and acute illness. The most important barriers also varied between case stories. Conclusions: The workplace inclusion questionnaire fulfills the need for a quantitative measure of attitudes to include individuals with various health problems into the workplace. Comparison of risk ratios showed clear differences between case stories, indicating that the workplace inclusion questionnaire is a valuable tool to measure the variance in workplace inclusion. [ABSTRACT FROM AUTHOR]

Aims: We investigated the effect of a school-based physical-activity intervention on children's health-related quality of life (HRQoL) and the potential influence of moderate to vigorous physical activity (MVPA). Methods: A randomised, controlled trial (Active School) involving fifth-grade children was conducted during the 2014/15 school year. The sample included 435 children (10–11 years old) at five intervention schools and four control schools. The weekly interventions concerned two 45 min of physically active lessons, five 10 min of physically active breaks and five 10 min of physically active homework. The children's HRQoL was measured using KIDSCREEN-27 and a self-report questionnaire, while physical activity was measured using accelerometers. Results: The results of multilevel analysis showed a significant effect on psychological wellbeing (p = 0.005), social support and peers (p = 0.005) and school environment (p = 0.013). No gender differences were observed. Children's MVPA did not influence their KIDSCREEN-27 score. Conclusions: The school-based physical-activity intervention (Active School) shows positive effects on children's self-reported psychological wellbeing, social support and peers, and school environment. [ABSTRACT FROM AUTHOR]

Background: Female educational advantage is evident from elementary school and throughout the education system. Understanding the gender differences that precede school entry might provide important insight as to why girls outperform boys later in their educational careers. Aims: The aim of this study was to explore gender differences in early literacy and numeracy skills, as well as a range of neurodevelopmental and behavioral domains between the age of five and six years. Methods: We used questionnaire data from preschool teachers in the Norwegian Mother, Father and Child Cohort Study reported for 7467 children attending the final year in preschool, to explore gender differences and age patterns by fitting flexible regression models predicting pre-academic, behavioral and neurodevelopmental outcomes. Results: We found gender differences favoring girls for all outcomes except internalizing behavior. For neurodevelopment and behavior, differences in adjusted standardized scores ranged from 46% of a standard deviation (95% confidence interval (CI) 0.41, 0.50) in overall school readiness to 31% of a standard deviation difference in externalizing behavior problems (CI 0.21, 0.41). We found gender differences for all literacy skills in favor of girls. The gender gap in naming and adding numbers was small, but in favor of girls. Increasing age was associated with improved pre-academic skills and school readiness, as well as reduction of attention problems and language difficulties, the latter especially for boys. Conclusions: We conclude that gender differences favoring girls exist prior to school entry for a broad range of pre-academic, behavioral and neurodevelopmental skills relevant to school functioning. [ABSTRACT FROM AUTHOR]

Aims: This article reports on the development and reliability of two questionnaires that measure adherence to the Norwegian National Guideline on Food and Meals in School among primary schools and after-school services. Methods: Questionnaires for school principals and after-school leaders were developed systematically, using the following steps: (a) selection of scope, questions and adherence values; (b) face validity testing through expert review of initial drafts; (c) content validity testing through 19 cognitive interviews; (d) assessment of test–retest reliability in samples of principals (n = 54) and after-school leaders (n = 47); and (e) development of adherence indices. Results: The cognitive interviews led to substantial revisions of the draft questionnaires, increasing content validity through improved relevance and clarity. Test–retest assessment showed that Cohen's κ ranged from −0.03 to 1.0 for principals and from −0.05 to 0.98 for after-school leaders, with 64 and 53% of values rated as 'substantial' or better. Percentage agreement averaged 85% among principals and 82% among after-school leaders. Intraclass correlation for the adherence index scores was 0.84 for principals and 0.91 for after-school leaders. Guideline adherence had a wide range in our samples, with an average of 71% for schools and 76% for after-school services. Conclusion: The questionnaires for measuring adherence to the national school meal guideline among primary schools and after-school services are sufficiently reliable for future use in public health evaluation and research. [ABSTRACT FROM AUTHOR]

Aims: This ongoing study is investigating the implementation and long-term impact of Healthy Life Centres (HLCs), a primary-care service intervention for behaviour change in Norway. The primary aim is to study changes in objectively measured physical activity (PA) levels following a HLC intervention in the short (three months) and long term (15 months). Furthermore, the study is evaluating determinants concerning implementation and adaption of the HLC intervention that influence reach and impact on participants outcomes. Methods : This prospective observational study includes 32 HLCs from four different geographical regions in Norway. Subjects aged ⩾18 years were invited to participate. The study has a pre–post design with a 15-month follow-up. The HLC intervention is a three-month individualised program, containing personal consultations and group-based behaviour-specific courses on PA, diet and smoking cessation. Data collection consists of registration of objectively measured PA level, physical examinations, interviews and questionnaires. In addition, HLC organisation, offers, professions and resources are being examined. The Reach, Efficacy/Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) framework is being applied to study the external validation of the HLC intervention. The study enrolled 1020 participants who gave their written informed consent. Post-tests and follow-up data collection is still ongoing and will continue until August 2019. Conclusions : By exploring the HLC intervention in a real-world setting and addressing the elements of RE-AIM, this study will contribute to an improved understanding and development of effective primary-care behaviour interventions such as the HLC model. The strengths of the study are the large sample size and the many HLCs and regions included. [ABSTRACT FROM AUTHOR]

Aims: Illegal substance use at music festivals is less documented than it is in nightlife and electronic dance music settings. This study investigated such use through questionnaires, breathalysers and oral fluid drug testing. We also examined the associations between testing positive for illegal substances and demographics, self-reported substance use and measured blood alcohol concentration levels. Methods : A cross-sectional study of 1,309 festival attendees from six Norwegian music festivals taking place between July and August 2016. Logistic regression models estimated the likelihood of a positive oral fluid drug test. Covariates were male, age, education, employment, smoking status, early age for alcohol intoxication, alcohol intoxication ⩾2 times a week, past-month and past-year illegal substance use, blood alcohol concentration levels and festivals. Results : Overall, 12% reported illegal substance use in the past 30 days and 11% tested positive for illegal substances. Cannabis (6%), cocaine (3%) and MDMA/ecstasy (2%) were most commonly detected. One-third had a blood alcohol concentration ⩾0.10%. Of those with a positive test result (n =146), 95% had detectable alcohol levels and 41% had a blood alcohol concentration above 0.10%. Those studying or working part-time were less likely to test positive compared to those who were not employed. Furthermore, those reporting daily smoking and past-year cannabis or MDMA/ecstasy use were more likely to test positive, compared to those not reporting such use. Conclusions : Illegal substance use was less prevalent than in previous nightlife and electronic dance music studies. Almost all those testing positive for illegal substances had detectable alcohol levels and 41% had a blood alcohol concentration greater than 0.10%, possibly indicating combined use. [ABSTRACT FROM AUTHOR]

Aims: Patients' attitude towards treatment and health (ATH) is crucial for compliance at all stages of treatment. This study examined the psychometric properties of the developed PRACTA Attitude Towards Treatment and Health questionnaire, designed to measure ATH as perceived by seniors (PRACTA-ATH) and doctors (PRACTA-ATH-D) in primary health care. Methods: The data were collected in two waves of the Polish–Norwegian PRACTA project. Exploratory factor analyses (EFAs) were conducted on wave 1 data from senior patients (n = 3392) and their general practitioners (n = 491). Confirmatory factor analyses (CFAs) were conducted on wave 2 data. This was a new sample of senior patients (n = 2765) and a follow-up sample of doctors (n = 393). Results: The EFAs showed that the 16-item four-factor solution is the best solution reflecting the structure of both seniors and doctors' ATH questionnaires. The CFAs conducted to establish the best unified model for PRACTA-ATH and PRACTA-ATH-D indicated three comparatively good solutions: the 16-item four-factor solution, the 12-item four-factor solution and the 12-item five-factor solution. Conclusions: The questionnaire is found appropriate for use among patients and doctors, and can be used as a good tool to monitor older patients' ATH and concordance between doctors and patients' perspectives. [ABSTRACT FROM AUTHOR]

Aims: The primary aim of the present study was to evaluate the association between parents’ level of education, measurements of physical attributes, and quality of life in a general sample of primary school children. Methods: The children’s and the parents’ versions of the Inventory of Life Quality in Children and Adolescents (ILC) were used to measure health-related quality of life (QOL) in 2140 school children (response rate 93%) and 1639 parents (response rate 71%) recruited from nine primary schools in Norway. A set of physical characteristics were also measured in the children: body mass index (BMI), waist circumference, average daily minutes of physical activity, aerobic fitness, and handgrip strength. Results: The regression analysis showed stronger relationships between the covariates and QOL for the parents’ assessments than for the children’s. Parents’ level of education was significantly related to children’s QOL, with the strongest association for parental QOL assessment. Among the physical variables, aerobic fitness (B = 0.01, p > .001 in both samples), and handgrip strength in the parents’ sample (B = 0.21, p < .05) were significantly related to the children’s QOL. Conclusions: The present study replicated the well-known finding that parents’ sociodemographic status is important for children’s QOL. Our new contribution is to show that the physiological variables aerobic fitness and muscular strength also contributed significantly to explain variance in QOL. This opens up interesting perspectives on how to improve QOL among children through more emphasis on physical activity and physical fitness in schools. [ABSTRACT FROM AUTHOR]

Aims: The aim of this study was to explore the relationships between measured body size (body mass index (BMI)), perceived body size, weight change wishes and self-perceived health in young adults. Methods: The participants were recruited from a school-based population study in Norway, the Tromsø Study: Fit Futures 2, carried out in 2012–2013. A total of 629 young women and men (aged 18–23 years) reported on the main variables. The data were collected through weight and height measurements and questionnaires. The analyses were performed with descriptive statistics, the χ2 test and Student’s t-test. Results: A total of 20% of the women and 28% of the men were overweight or obese. There were considerable discrepancies between the measured BMI and perceived body size in both sexes. A substantial number of participants wanted to change their weight. Among the 174 women who reported that they were trying to lose weight, as many as 57 (32.8%) had a low normal weight (BMI 18.5–21.9 kg/m2). Correspondingly, among the 66 men who reported that they wanted to gain weight, as many as 19 (28.8%) had a high normal weight (BMI 22–24.9 kg/m2). We found no relation between body size perceptions, weight change wishes and self-perceived health. Conclusions: Discrepancies between measured and perceived body size and weight change wishes are common findings in young adults. The lack of relation with self-perceived health found in our study is surprising and not easy to interpret. To gain more knowledge about these matters, further research, including both qualitative and quantitative studies, is needed. [ABSTRACT FROM AUTHOR]

Aims: Self-reported information from questionnaires is frequently used in clinical epidemiological studies, but few provide information on the reproducibility of instruments applied in secondary coronary prevention studies. This study aims to assess the test–retest reproducibility of the questionnaire applied in the cross-sectional NORwegian CORonary (NOR-COR) Prevention Study. Methods: In the NOR-COR study 1127 coronary heart disease (CHD) patients completed a self-report questionnaire consisting of 249 questions, of which there are both validated instruments and de novo questions. Test–retest reliability of the instrument was estimated after four weeks in 99 consecutive coronary patients. Intraclass Correlation Coefficient (ICC) and Kappa (κ) were calculated. Results: The mean interval between test and retest was 33 (±6.4) days. Reproducibility values for questions in the first part of the questionnaire did not differ from those in the latter. A good to very good reproducibility was found for lifestyle factors (smoking: κ = 1.0; exercise: ICC = 0.90), medical factors (drug adherence: ICC = 0.74; sleep apnoea: ICC = 0.87), and psychosocial factors (anxiety and depression: ICC = 0.95; quality of life 12-Item Short-Form Health Survey (SF12): ICC = 0.89), as well as for the majority of de-novo-created variables covering the patient’s perceptions, motivation, needs, and preferences. Conclusions: The present questionnaire demonstrates a highly acceptable reproducibility for all key items and instruments. It thus emerges as a valuable tool for evaluating patient factors associated with coronary risk factor control in CHD patients. [ABSTRACT FROM AUTHOR]

Purpose: Common mental disorders are a major cause of long-term sickness absence and a reason for disability benefits, although many people with these disorders remain employed. Therefore, it is important to prevent them from taking sick leave or relying on disability benefits. Consequently, we wished to identify the factors associated with sickness presence among patients undergoing treatment. Method: Participants were recruited from patients who met for their first session at a Return to Work clinic. A total of 251 patients completed a questionnaire that included questions on background information, mental health and functioning, and psychosocial work factors. Of these, 49% were fully working, 21.9% were partially working, and 29.1% were on full sickness absence. Results: Fully working patients had fewer symptoms, functioned better, and experienced greater well-being than patients wholly on sick leave. They also experienced work as less demanding, were more appreciative, and had more employment security and autonomy. They reported symptoms, functioning, and well-being at the same level as the partially working group. However, their therapists reported that they functioned better and they themselves considered work demands somewhat less stressful. Conclusions: The results indicate that both symptoms and functional capacity, in addition to work environment, are perceived as more favorable among fully working patients, compared with those completely on sick leave. However, because of the cross-sectional design, we need more studies with prospective design to examine whether these relationships are causal, and to examine when sickness presence is beneficial for patients. [ABSTRACT FROM AUTHOR]

Background: There is a lack of knowledge on how health problems in adolescence are connected to work marginalization in adulthood. The aim of this study was to study work marginalization in young adulthood, measured by use of long-term social welfare benefits, and its associations with self-reported health complaints, total symptom burden and self-rated general health at ages 15–16. Methods: We linked data from a youth health survey conducted during 1999–2004 to data from Norwegian registries that followed each participant through February 2010. Cox regression analysis was used to compute hazard ratios (HRs) for the use of long-term social welfare benefits in young adulthood, based on health measures in 15–16 year-olds. Results: During the follow-up, 17% of the study population received some sort of long-term social welfare benefit. In the baseline survey, 95% of the adolescents reported one or more health complaints. The mean number of health complaints was 4.8. Girls reported a significantly higher mean number of complaints (5.7) than did boys (3.8) (p < 0.001). Several individual health complaints were associated with an increased use of long-term social welfare benefits. We found an increasing relative hazard of social welfare usage, depending on the number of complaints reported at baseline. Ill self-perceived general health was found to be strongly associated with the use of benefits during the follow-up: In girls, we found HRs of 1.41 (CI 1.21–1.65), 2.76 (2.29–3.31) and 2.77 (1.51–5.07) for those with good, not so good and bad health, respectively; compared to very good health. The corresponding numbers in boys were 1.41 (1.25–1.59), 1.93 (1.60–2.32) and 1.31 (0.72–2.38), respectively. Conclusions: Several health measures in adolescents were found to be associated with future work marginalization in young adulthood. The associations remained significant, even after correcting for such strong predictors as the parents’ education and family economy. Total symptom burden and self-perceived general health can add additional knowledge onto how adolescent health is related to work marginalization, in a longitudinal perspective. [ABSTRACT FROM AUTHOR]

Aims: To assess the prevalence and investigate ethnic differences of emotional, physical and sexual violence among a population of both Sami and non-Sami in Norway. Methods: Our study was based on the SAMINOR 2 study, a population-based survey on health and living conditions in multiethnic areas with both Sami and non-Sami populations in Central and Northern Norway. Our study includes a total of 11,296 participants: 2197 (19.4%) Sami respondents and 9099 (80.6 %) non-Sami respondents. Results: Almost half of the Sami female respondents and one-third of the non-Sami female respondents reported any violence (any lifetime experience of violence). Sami women were more likely to report emotional, physical and sexual violence than non-Sami women. More than one-third of the Sami men compared with less than a quarter of non-Sami men reported having experienced any violence in their life. Sami men were more likely to report emotional and physical violence than non-Sami men. However, ethnicity was not significantly different regarding sexual violence experienced among men. Violence was typically reported to have occurred in childhood. Sami participants were more likely to report having experienced violence in the past 12 months. For all types of violence, the perpetrator was typically known to the victim. Conclusions: Regardless of gender, Sami respondents were more likely to report interpersonal violence. The prevalence of any violence was substantial in both ethnic groups and for both genders; it was highest among Sami women. [ABSTRACT FROM AUTHOR]

Background: Recent studies have challenged the idea that illegal substances are necessarily associated with more harm than those that are legal. This study investigates perceived drug harm among students at the University of Oslo (UO) and at a smaller university located on Norway’s coast in a more conservative and religious region, called ‘Coastal University’ (CU). Methods: This study consisted of surveys (n=458) about perceived physical harm, mental health conditions, dependence, injuries and social consequences that may be associated with the use of tobacco, alcohol and cannabis. Information about substance use was also collected. Analyses of variance and multiple regression analyses were used to examine whether harm ratings differed for different drugs, whether drug type, gender and university site interacted in predicting harm ratings, and what role the participants’ own substance use played in their harm ratings. Results: UO students rated cannabis as overall less harmful than alcohol, while the opposite was true for CU students. Tobacco received the highest physical harm score. Alcohol was rated as most harmful with regard to injuries; cannabis was rated as most harmful with regard to mental health consequences. Use of the substance in question was associated with a reduced harm rating. This was particularly true for cannabis. Conclusions: Norwegian students rate the harm of substances differently from previous reports from the Norwegian general population. Most importantly, their relative ratings of cannabis harm were lower. However, the pattern was most evident among students from the urban Oslo area. [ABSTRACT FROM PUBLISHER]

Aims: Ultraviolet (UV) radiation is a major source for vitamin D production. Furthermore, UV destroys cobalamins (also called vitamin B12) in solution. However, data from humans are scarce. The aim of the present study was to clarify if UV exposure has any effect on serum cobalamins, as compared to vitamin D levels, in healthy volunteers. Methods: This single-center, open observational study was conducted in a research institute: 23 non-pregnant, non-lactating, healthy, fair-skinned female subjects had their serum cobalamin and 25-hydroxyvitamin D (25(OH)D, the marker for vitamin D status) levels measured before and after exposure to UV. Results: UV exposure increased serum 25(OH)D levels from 61.6 nmol/L to 88.5 nmol/L (44%; p < 0.001). A statistically insignificant decay in serum cobalamin levels from 300 pmol/L to 260 pmol/L (13%; p = 0.142) was observed in the volunteers after the first UV exposure; however, no additional decline of statistical significance was seen after subsequent exposures. Conclusions: Multiple exposure to UV radiation give a significant increase in 25(OH)D levels, but has no detrimental effect on cobalamin concentrations. [ABSTRACT FROM PUBLISHER]

Aims: The aim was to explore the association between weight-related attitudes and behaviours and the accuracy of body mass index (BMI) derived from self-reported weight and height. Methods: A total of 828 adolescents from the Health In Adolescents study were included. Self-reported and objective weight and height data were collected, and BMI was computed. Information about weight-related attitudes and behaviours was obtained. The association between weight-related attitudes and behaviours and the difference between BMI computed from self-reported and objective measures was assessed using generalized linear mixed model analyses. Results: BMI was under-reported by overweight girls (p<0.001) and boys (p<0.001) compared to their normal weight counterparts. Underweight girls on the other hand over-reported their BMI (p=0.002). Girls who reported trying to lose weight under-reported their BMI compared to girls who had not tried to do anything about their weight (p=0.02). Girls who perceived their weight as being too much under-reported their BMI compared to girls who thought their weight was ok, the association was however borderline significant (p=0.06); this association was also found among boys (p=0.03). Self-weighing and the reported importance of weight for how adolescents perceive themselves were not associated with the accuracy of BMI. Conclusions: Weight perception and weight control behaviour (among girls only) were related to the accuracy of self-reported BMI; no association was found with self-weighing behaviour and the perceived importance of weight for how adolescents perceive themselves. Knowledge of such factors will allow for a better interpretation and possibly adjustment/correction of results of surveys based on self-reported weight and height data. [ABSTRACT FROM PUBLISHER]

Aims: It has been shown that referral letters from GPs often are of poor quality, but research in this field is scarce, and few efforts have been made to investigate the factors that may help explain the variation in referral quality. Methods: Combining a survey among 1298 Norwegian hospital physicians (response rate: 52%) with information on the hospitals and the communities they are serving, this study investigates how they view the general quality of patient referrals received from GPs, and the extent to which insufficient information in referrals and inappropriate referrals is considered a problem for cooperation with GPs. Results: Only 15.6% of the hospital physicians perceived the quality of the referrals to be “usually good”, and both lack of information in referrals and inappropriate referrals are seen as important barriers to cooperation with GPs. Of the individual factors, former GP practice is associated with a positive view on referral quality, while regular meetings between hospital physicians and GPs seem to reduce the problems of inappropriate and incomplete referrals. Furthermore, both average number of patients on GPs’ lists and lack of free capacity in nursing and care institutions in the hospital catchment area was found to be negatively associated with perceived referral quality. Conclusions: There is a need to increase the knowledge on how contextual, institutional and professional factors affect coordination of care. The main contribution of this study lies in the attempt to address the macro and micro barriers of obtaining good referral care. [ABSTRACT FROM PUBLISHER]

Aim: The academic performance of children impacts future educational attainment which may increase socioeconomic status which again influences their health. One of several factors that might affect academic performance is the diet. The aim of this study was to investigate the cross sectional relation between diet and self-reported reading-, writing-, and mathematical difficulties in Norwegian adolescents. Methods: In total, 475 ninth- and tenth-grade students out of 625 eligible ones from four different secondary schools in three different municipalities in Vest-Agder County, Norway, participated, giving a participation rate of 77%. The students filled in a questionnaire with food frequency questions of selected healthy and unhealthy food items, questions of meal frequency and different learning difficulties. Results: Regular breakfast was significantly associated with decreased odds of both writing and reading difficulties (OR: 0.44 (0.2–0.8), p = 0.01) and mathematical difficulties (OR: 0.33 (0.2–0.6), p ≤ 0.001). In addition, having lunch, dinner and supper regularly were associated with decreased odds of mathematical difficulties. Further, a high intake of foods representing a poor diet (sugar-sweetened soft drinks, sweets, chocolate, savory snacks, pizza and hot dogs) was significantly associated with increased odds of mathematical difficulties. Conclusions: Having a less-frequent intake of unhealthy foods and not skipping meals are associated with decreased odds of self-reported learning difficulties in Norwegian adolescents in this study. The results of this study support the need for a larger study with a more representative sample. [ABSTRACT FROM PUBLISHER]

Aims: The authors sought to estimate differences in doctor-certified sickness absence during pregnancy among immigrant and native women. Methods: Population-based cohort study of pregnant women attending three Child Health Clinics in Groruddalen, Oslo, and their offspring. Questionnaire data were collected at gestational weeks 10–20 and 28. The participation rate was 74%. A multivariate Poisson regression was used to analyse differences in sickness absence in pregnancy between immigrant and native women. Results: A total of 573 women who were employed prior to their pregnancies were included, 51% were immigrants. After adjusting for age, years of education, marital status, number of children, occupation, part-time/full-time work, health status, severe pregnancy-induced emesis and language proficiency, the immigrant/native differences in number of weeks with sickness absence decreased from 2.0 to 1.2 weeks. Part-time/full-time work, health status, severe pregnancy-induced emesis and language proficiency were significant predictors of sickness absence. Conclusion: Immigrant women had higher sickness absence than native women during pregnancy. The difference in average number of weeks between native and immigrant women was partly explained by poorer health status prior to pregnancy, severe pregnancy-induced emesis and poorer proficiency in the Norwegian language among the immigrant women. [ABSTRACT FROM PUBLISHER]

Aims : The authors wished to describe non-responders and reasons for non-response and determine the magnitude and direction of non-response bias in connection with a postal questionnaire study of respiratory symptoms and disease among the elderly. Methods : An eight-page respiratory health questionnaire was mailed to subjects in a sex-age stratified random sample of the general population of Bergen, Norway, 70 years or older ( n =2,871). A reminder with repeat questionnaire was sent out to initial non-responders after three weeks. A random sample of non-responders was interviewed by telephone. Results : There were a total of 1,649 respondents (57.4%); 1,356 to the initial mailing and 293 to the reminder mailing. The response rates were highest for the age group 70-74 years (76.6%) and fell dramatically with age (27.1% in age group 95+years). Men responded (63.7%) better than women (52.0%) and this was consistent at every age level. Late and non-responders had slightly lower frequencies of respiratory symptoms but higher frequencies of current-smoker status. Conclusions : All found, differences between responders and non-responders were small and would have only minimal effects on the final prevalence estimates for respiratory symptoms and disease. In comparing the results based on initial responders to results based on all responders, associations between predictor variables and outcome variables were essentially the same, showing that a reminder had little effect on the results of the study. [ABSTRACT FROM AUTHOR]