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Abstract Background A link between low parental socioeconomic status and mental health problems in offspring is well established in previous research. The mechanisms that explain this link are largely unknown. The present study investigated whether school performance was a mediating and/or moderating factor in the path between parental socioeconomic status and the risk of hospital admission for non-fatal suicidal behaviour. Methods A national cohort of 447 929 children born during 1973-1977 was followed prospectively in the National Patient Discharge Register from the end of their ninth and final year of compulsory school until 2001. Multivariate Cox proportional hazards and linear regression analyses were performed to test whether the association between parental socioeconomic status and non-fatal suicidal behaviour was mediated or moderated by school performance. Results The results of a series of multiple regression analyses, adjusted for demographic variables, revealed that school performance was as an important mediator in the relationship between parental socioeconomic status and risk of non-fatal suicidal behaviour, accounting for 60% of the variance. The hypothesized moderation of parental socioeconomic status-non-fatal suicidal behaviour relationship by school performance was not supported. Conclusions School performance is an important mediator through which parental socioeconomic status translates into a risk for non-fatal suicidal behaviour. Prevention efforts aimed to reduce socioeconomic inequalities in non-fatal suicidal behaviour among young people will need to consider socioeconomic inequalities in school performance.

Abstract Background The evidence of an association between neighbourhood deprivation and overweight is established for different populations. However no previous studies on neighbourhood variations in obesity in pregnant women were found. In this study we aimed to determine whether obesity during early pregnancy varied by neighbourhood economic status. Methods A register based study on 94,323 primiparous pregnant women in 586 Swedish neighbourhoods during the years 19922001. Multilevel technique was used to regress obesity prevalence on socioeconomic individual-level variables and the neighbourhood economic status. Five hundred and eighty-six neighbourhoods in the three major cities of Sweden, Stockholm, Göteborg and Malmö, during 19922001, were included. The majority of neighbourhoods had a population of 4 00010 000 inhabitants. Results Seven per cent of the variation in obesity prevalence was at the neighbourhood level and the odds of being obese were almost doubled in poor areas. Conclusion Our findings supports a community approach in the prevention of obesity in general and thus also in pregnant women.

Abstract Background There is a controversy regarding the existence of a socio-economic gradient for cerebral palsy. Perinatal emergencies and preterm birth increase the risk for the offspring to develop cerebral palsy. The aim of this study was to investigate the association of socio-economic indicators with cerebral palsy (CP) and the role of perinatal health as mediator of this association. Methods Register study of a national cohort of 805,543 children born 1987–93, including 1,437 children with cerebral palsy that were identified in hospital discharge data from national registers. Socio-economic indicators of the household were taken from the Census of 1985. Logistic regression and chi-square analyses of linearity were used to test hypotheses. Results There was a linear association between the incidence of CP (excluding cases caused by registered injuries or malformations) as well as of major perinatal indicators and the socio-economic status (SES) of the household of the mother (p < 0.001). Children in households with low SES had a higher odds ratio of CP (OR 1.49 [95% C.I. 1.16–1.91]) compared with high SES after adjustment for demographic confounders. This OR decreased to 1.36 (1.05–1.71) after adjustment for perinatal indicators with preterm birth as the most important mediating variable. Conclusion This study suggests that there is a continuous socio-economic gradient for CP in Sweden. Further studies in more complete populations of children with cerebral palsy are needed to confirm this. Perinatal complications seem to mediate some of this gradient.

Abstract Background The objective of this cohort study was to examine the effect on birth weight of living in a disadvantaged neighbourhood in a Nordic welfare state. Birth weight is a health indicator known to be sensitive to political and welfare state conditions. No former studies on urban neighbourhood differences regarding mean birth weight have been carried out in a Nordic country. Methods A register based on individual data on children's birth weight and maternal risk factors was used. A neighbourhood characteristic, i.e. an aggregated measure on income was also included. Connections between individual- and neighbourhood-level determinants and the outcome were analysed using multi-level regression technique. The study covered six hundred and ninety-six neighbourhoods in the three major cities of Sweden, Stockholm, Göteborg and Malmö, during 1992–2001. The majority of neighbourhoods had a population of 4 000–10 000 inhabitants. An average of 500 births per neighbourhood were analysed in this study. Results Differences in mean birth weight in Swedish urban neighbourhoods were minor. However, gestational length, parity and maternal smoking acted as modifiers of the neighbourhood effects. Most of the observed variation in mean birth weight was explained by individual risk factors. Conclusion Welfare institutions and benefits in Sweden might buffer against negative infant outcomes due to adverse structural organisation of urban neighbourhoods.

Aims: We examined the patterns of healthcare utilisation for drug use disorders (DUDs) and charges related to narcotics among young refugees in Norway considering the role of sex, country of origin and condition of arrival (accompanied versus unaccompanied minors). Methods: Based on national registers, sex-stratified Cox regression models were used to estimate hazard ratios to assess the risk of being charged with a narcotics offence and the use of healthcare services related to DUDs. The sample consisted of 15,068 young refugees and 573,241 young Norwegians born in Norway to two Norwegian-born parents. All of the young people in the sample were born between 1983 and 1994. The follow-up period was from January 2008 to December 2015. Results: Compared with their Norwegian peers, both male and female refugees showed either a similar or lower risk of receiving healthcare for DUDs. However, male refugees showed an increased risk of being charged with a narcotic offence, except those from Afghanistan and the former Yugoslavia. Accompanied male refugees were at a higher risk of being charged, while unaccompanied male refugees showed a lower risk. Conclusions: Young male refugees generally had a higher risk of being charged for narcotic offences while showing a similar risk of receiving healthcare for DUDs compared to Norwegian-born young people. However, young men from Afghanistan and the former Yugoslavia deviated from this pattern. This may be partially explained by the length of time spent in Norway. The results add support to previous qualitative studies suggesting that punitive drug policies may disproportionately affect men from minority groups. Further research controlling for parental household-level factors is warranted. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study was to describe parental concerns about child health and behaviour and their sociodemographic predictors in 3‐year‐olds, in relation to the national guidelines of well‐baby clinics. Methods: The study included parents of 33 526 children in Stockholm who had completed a questionnaire prior to a routine visit to a well‐baby clinic at age 3 years. Multivariate regression was used to analyse predictors for concerns. Results: Child behaviour problems, defined as defiance and problem with adherence to daily routines, were the most common parental concerns (36.4%), with poor social skills and relations being second (21.8%). Regarding development, 9.6% had concerns about speech and 4.7% about motor development. Screen use (9.5%) and being underweight (6.3%) were other common parental concerns, while lifestyle concerns regarding physical activity and overweight were rare. Parents raised about twice as many concerns for first‐born children compared with younger siblings. Child behaviour and developmental concerns were more frequent in families where the mother had primary education only and attended a well‐baby clinic with a high Care Need Index. Conclusion: Parents' concerns reflected the national guidelines about child development and behaviour, but not its emphasis on a healthy lifestyle. [ABSTRACT FROM AUTHOR]

Background Parental separation has been associated with adverse child mental health outcomes in the literature. For school-aged children, joint physical custody (JPC), that is, spending equal time in both parents’ homes after a divorce, has been associated with better health and well-being than single care arrangements. Preschool children’s well-being in JPC is less studied. The aim of this study was to investigate the association of living arrangements and coparenting quality with mental health in preschool children after parental separation.Methods This cross-sectional population-based study includes 12 845 three-year-old children in Sweden. Mental health was measured by parental reports of the Strength and Difficulties Questionnaire and coparenting quality with a four-item scale. The living arrangements of the 642 children in non-intact families were categorised into JPC, living mostly with one parent and living only with one parent.Results Linear regression models, adjusted for sociodemographic confounders, showed an association between increased mental health problems and living mostly and only with one parent (B=1.18; 95% CI 0.37 to 2.00, and B=1.20; 95% CI 0.40 to 2.00, respectively), while children in intact families vs JPC did not differ significantly (B=−0.11; 95% CI −0.58 to 0.36). After adjusting the analyses for coparenting quality, differences in child mental health between the post divorce living arrangements were, however, minimal while children in intact families had more mental health problems compared with JPC (B=0.70; 95% CI 0.24 to 1.15). Factorial analysis of covariance revealed that low coparenting quality was more strongly related to mental health problems for children in intact families and JPC compared with children living mostly or only with one parent.Conclusions This study suggests that coparenting quality is a key determinant of mental health in preschool children and thus should be targeted in preventive interventions.