Charli Eriksson

Mental health symptoms in relation to socio-economic conditions and lifestyle factors – a population-based study in Sweden

BackgroundPoor 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.MethodsThe 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.ResultsAbout 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.ConclusionOur 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.

The youth sports club as a health-promoting setting: An integrative review of research

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

Learning and knowledge-production for public health: a review of approaches to evidence-based public health.

Public health needs to be evidence-based if it is to be done correctly, which means that learning and knowledge-production for public health must be comprehensive and include knowledge from four different domains: distribution of health, determinants or causal web, consequences, and intervention methods. Specification of development trends in cardiovascular prevention points at four generations of preventive programs; these include a clinical, a bioepidemiological, a socioepidemiological, and an environmental and policy-oriented generation. Generations differ in focus and strategy, in knowledge base--the art of making an impact--and evaluation. Comprehensive public health programs often comprise components from different generations, leading to the need for an expanded model for research and evaluation. There is an urgent need for learning and knowledge-production using both quantitative and qualitative approaches for developing the evidence base for public health action. In addition, epidemiological knowledge is necessary for making appropriate priorities.

Adolescent Girls’ and Boys’ Perceptions of Mental Health

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 peoples 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.

Individual characteristics, area social participation, and primary non-concordance with medication: a multilevel analysis

BackgroundNon-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.MethodsWe 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).ResultsYounger 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.ConclusionOur 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.

Review Article: Learning and knowledge-production for public health: a review of approaches to evidence-based public health

Public health needs to be evidence-based if it is to be done correctly, which means that learning and knowledge-production for public health must be comprehensive and include knowledge from four different domains: distribution of health, determinants or causal web, consequences, and intervention methods. Specification of development trends in cardiovascular prevention points at four generations of preventive programs; these include a clinical, a bioepidemiological, a socioepidemiological, and an environmental and policy-oriented generation. Generations differ in focus and strategy, in knowledge base - the art of making an impact - and evaluation. Comprehensive public health programs often comprise components from different generations, leading to the need for an expanded model for research and evaluation. There is an urgent need for learning and knowledge-production using both quantitative and qualitative approaches for developing the evidence base for public health action. In addition, epidemiological knowledge is necessary for making appropriate priorities.

Reasons for non-participation in a parental program concerning underage drinking: a mixed-method study

BackgroundAlcohol 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.MethodsTo 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.ResultsEducational 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.ConclusionTo 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.

Neighbourhood development and public health initiatives: who participates?

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

Academic practice–policy partnerships for health promotion research: Experiences from three research programs

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

A research strategy case study of alcohol and drug prevention by non-governmental organizations in Sweden 2003-2009.

BackgroundAlcohol 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.MethodsThe 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.ResultsA 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.ConclusionsThis 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.