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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]

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.

Purpose: The purpose of this paper is to present the development of a resilience curriculum in early years and primary schools to enhance social inclusion, equity and social justice amongst European communities, particularly amongst disadvantaged and vulnerable ones, through quality education. It defines educational resilience in terms of academic, social and emotional growth in the face of life challenges; discusses the conceptual framework and key principles underpinning the curriculum; and presents the six major content areas of the curriculum. Finally, it presents the preliminary findings of a pilot project on the implementation of the curriculum in more than 200 classrooms in about 80 early and primary schools in six European countries. Design/methodology/approach: The curriculum was first drafted collaboratively amongst the six partners on the basis of the existing literature in the promotion of resilience in early years and primary schools, with a particular focus to European realities. Once it was internally reviewed, it was piloted in 200 early years and primary school classrooms in six European countries, with each of the six partners implementing one theme. Data collection included teacher reflective diaries, classroom checklists, semi-structured interviews with teachers and focus groups with students. Findings: The preliminary results from the pilot evaluation of the curriculum in 199 classrooms totalling 1,935 students across six countries indicate that both the teachers and the learners overwhelmingly found the curriculum highly enjoyable, useful, relevant and easy to use. They looked forward to the possibility of having the programme on a full-time basis as part of the general curriculum in the future. The teachers reported a positive moderate change in learners' behaviour related to the theme implemented and argued that for the implementation to be effective, it needs to take place throughout the whole year. A number of modifications have been on the basis of the teachers' and learners' feedback. Originality/value: This is the first resilience curriculum for early years and primary schools in Europe. While it seeks to address the needs of vulnerable children such as Roma children, immigrant and refugee children and children with individual educational needs, it does so within an assets-based, developmental, inclusive and culturally responsive approach, thus avoiding potential labelling and stigmatising, while promoting positive development and growth. It puts the onus on the classroom teacher, in collaboration with parents and other stakeholders, in implementing the curriculum in the classroom.

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]

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. (Contains 6 tables.)

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]

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 Orebro 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 less than 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. (Contains 6 tables and 4 figures.)

The aims of this study are to analyse the concept of mental health from the perspective of adolescent girls and boys and to describe what adolescent girls and boys regard as important determinants of mental health. Interviews with 48 children, 13 and 16 years old, in Sweden were held individually or in focus groups. The adolescents perceived mental health as an emotional experience, where positive as well as negative health is part of the concept. Family is the most important determinant for young people's mental health, closely followed by friends. Neither girls nor boys believed that there were any large differences in mental health between girls and boys. Age differences seemed to be more important than gender in the perception of mental health by children. (Contains 4 tables.)

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]

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.socscimed.2005.07.008 Byline: Kristina Johnell (a), Martin Lindstrom (b), Arne Melander (b)(c), Jan Sundquist (a), Charli Eriksson (d), Juan Merlo (b) Keywords: Anxiolytic-hypnotic drugs; Multilevel analysis; Miniaturization of community; Social capital; Social participation; Trust; Sweden Abstract: The concept of social capital has gained wide interest in public health research in recent years. However, we suggest a concept that was introduced and developed by Fukuyama, named 'miniaturization of community', as an alternative to that of social capital. The concept of miniaturization of community emphasizes that a high level of social participation can be accompanied by a low level of trust, both at the individual and at the community level, which may in turn result in social disorder and lack of social cohesion. When society becomes more disordered, people may tend to feel more insecure and anxious. Use of anxiolytic-hypnotic drugs (AHDs) could under such circumstances be a coping strategy. In this study, we first wanted to investigate whether the contextual component of the miniaturization of community concept (i.e. area high social participation and low trust) is associated with individual AHD use, over and above individual characteristics. Secondly, we aimed to study whether people living in the same municipality share a similar probability of AHD use, after adjusting for individual characteristics, and if so, how large this contextual phenomenon is. We used data on 20,319 women and 17,850 men aged 18-79 years from 58 municipalities in six regions in central Sweden, who participated in the Life & Health year 2000 postal survey. We applied multilevel logistic regression analysis with individuals at the first level and areas at the second level. Our results suggest that living in an area with a high level of miniaturization of community seems to be associated with individual AHD use, beyond people's individual characteristics including their own level of social participation and trust. The concept of miniaturization of community may be an extension of the classic concept of social capital and may increase our understanding of contextual effects on health. Author Affiliation: (a) Center for Family Medicine, Karolinska Institute, Stockholm, Sweden (b) Community Medicine, Department of Clinical Sciences, Faculty of Medicine, Malmo University Hospital, Lund University, Sweden (c) The NEPI Foundation, Malmo University Hospital, Sweden (d) Department of Community Medicine and Public Health, Regional Medical Center, Arebro, Sweden

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]

Abstract Background Tobacco has long been known to be one of the most common reasons for sickness and premature deaths in the world. An important aspect of tobacco use is the youth's access to tobacco, and surveillance visits are one way to make sure how retailers are complying with age limit in the tobacco law. In Örebro County, Sweden, a project to reinforce the tobacco legislation was carried out in 2009-2010. One part of the project was surveillance visits that were done according to three different themes, called thematic surveillance. Methods This study is an evaluation of the results from thematic surveillance and has a mixed methods approach. The quantitative analyses concerns protocols from 217 surveillance visits, where questions were asked about three themes (self-monitoring programs; marketing; labeling of products and pricing). In addition, questionnaires filled out by six tobacco administrators who worked within the project were analyzed qualitatively by content analysis in order to study their perceptions and opinions of the project. Results This study shows that half of the visited retailers had self-monitoring programs. Lack of self-monitoring programs was significantly more common in smaller stores/kiosks and at restaurants. Further, the tobacco administrators who worked within the project perceived thematic surveillance as a good method for accomplishing better structure in surveillance work, but not as effective as purchase attempts (mystery shopping). Conclusions Thematic surveillance was perceived as positive and the method was also regarded to be a good way to work with surveillance. However, the method could be developed further for optimal use and better effect at the retailers. It is clear that people who work with tobacco prevention at the local level in Örebro County want to use purchase attempts as a surveillance method, and that they believe that purchase attempts is the best way to make sure if store comply with the tobacco law.

Abstract 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 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 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 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 non-participation. 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 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 Background Non-concordance with medication remains a major public health problem that imposes a considerable financial burden on the health care system, and there is still a need for studies on correlates of non-concordance. Our first aim is to analyse whether any of the individual characteristics age, educational level, financial strain, self-rated health, social participation, and trust in the health care system are associated with primary non-concordance with medication. Our second aim is to investigate whether people living in the same area have similar probability of primary non-concordance with medication, that relates to area social participation. Methods We analysed cross sectional data from 9 070 women and 6 795 men aged 18 to 79 years, living in 78 areas in central Sweden, who participated in the Life & Health year 2000 survey, with multilevel logistic regression (individuals at the first level and areas at the second level). Results Younger age, financial strain, low self-rated health, and low trust in the health care system were associated with primary non-concordance with medication. However, area social participation was not related to primary non-concordance, and the variation in primary non-concordance between the areas was small. Conclusion Our results indicate that people in central Sweden with younger age, financial difficulties, low self-rated health, and low trust in the health care system may have a higher probability of primary non-concordance with medication. However, the area of residence – as defined by administrative boundaries – seems to play a minor role for primary non-concordance.

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]

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]

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]