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  • 51.
    Lennernäs Wiklund, Maria
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Public health science.
    Gard, Gunvor
    Hälsovetenskaper, Medicinska fakulteten Lunds Universitet .
    Lindberg, Per
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Occupational health science. University of Gävle, Centre for Musculoskeletal Research.
    Olofsson, Niclas
    Region Västernorrland FoU.
    Risberg, Anitha
    Institutionen för Hälsovetenskap, Luleå Tekniska Universitet.
    Willmer, Mikaela
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Caring science.
    Hann du äta?: En enkät och intervjustudie av arbetsmåltidens förutsättningar och betydelse för hälsa och välbefinnande vid skift- och schemalagt arbete med nattarbete2018In: FALF KONFERENS 2018 Arbetet – problem eller potential för en hållbar livsmiljö?   10-12 juni 2018 Gävle: Program och abstracts / [ed] Per Lindberg, Gävle: Gävle University Press , 2018, p. 129-Conference paper (Refereed)
    Abstract [sv]

    Bakgrund

    Ohälsosamma matvanor och stress bidrar till sjukskrivningar och nedsatt arbetsförmåga genom övervikt, hjärtkärlsjukdom, diabetes typ 2 och psykisk ohälsa. Slimmade organisationer och flexibla arbetstider begränsar möjligheten att äta hälsosamt i samband med arbete. Särskilt utsatt är personal med skift- och schemalagt arbete. Att inte kunna på-verka när man äter under arbetspasset kan öka stress och irritation, med risk för sänkt prestations- och koncentrationsförmåga. Arbetsmiljöverkets föreskrifter om organisatorisk och social arbetsmiljö (AFS 2015:4) syftar till att främja en god arbetsmiljö och förebygga ohälsa på grund av organisatoriska och sociala förhållanden i arbetsmiljön. Det finns ingen lagstiftning angående matrastens längd eller utformningen av matrum. Arbetsgivaren har rätt att byta ut raster mot måltidsuppehåll, det senare innebär måltid om arbetssituationen medger det. Personal med ständig larmberedskap kan arbeta en hel natt utan möjlighet att äta. Detta är tveksamt med hänsyn till hälsa, säkerhet och arbetsförmåga.

    Syfte

    Studiens syfte är 1) att få en bättre förståelse av de faktorer som påverkar möjligheten och formerna för att äta i samband med natt- och skiftarbete och de val anställda gör utifrån de förutsättningar som finns 2) att öka förståelsen av hur arbetsmåltiden påverkas av organisatoriska och psykosociala förhållanden, och måltidens betydelse för återhämtning, välbefinnande och hälsa.

    Frågeställningar

    Hur gestaltas arbetsmåltider för personal med skift- och schemalagt arbete? Vilka strat-egier och handlingsutrymmen har personalen för att planera sina arbetsmåltider? Vi kommer särskilt att uppmärksamma vad personalen äter, under vilka omständigheter de äter samt vilken betydelse måltiden har för välbefinnande och gemenskap.

    Urval och metod

    Enkät riktas till anställda med dag-, skift- och schemalagt arbete inom industri och hemtjänst. Intervjuer genomförs med chefer inom dessa verksamheter.

    Resultat

    Studien startar våren 2018 med inledande intervjuer och test av enkät till målgrupper efter arbetsplatsbesök. Under konferensen kommer vi att kortfattat sammanfatta den forskning som finns inom ramen för våra frågeställningar samt att redovisa resultat från några intervjuer med chefer.

    Genom vårt deltagande vill vi bidra till att sätta arbetsmåltiden på agendan inom arbetsmiljöforskning och diskutera med andra forskare hur de ser på arbetsmåltiden ur ett arbetsmiljöperspektiv.

  • 52.
    Lennernäs Wiklund, Maria
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Public health science.
    Nyberg, Maria
    Högskolan Kristianstad, Forskningsmiljön Food and Meals in Everyday Life (MEAL).
    Johansson, Michael
    Högskolan Kristianstad, Avdelningen för Design och datavetenskap.
    Wetterstrand, Martin
    Högskolan Kristianstad, Avdelningen för Design och datavetenskap.
    Meals and shift work: food choice, time of day and meal environment - three important dimensions for rest and health2013Conference paper (Other academic)
  • 53.
    Lindberg, Mattias
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Public health science.
    Arbetsuppgifter, arbetsskador och upplevd arbetsmiljö: skiljer det sig mellan kvinnor och män på en könsneutral arbetsplats?: En tvärsnittsstudie från ett kontorslandskap 2016. Arbetsskador i förhållande till män och kvinnor2017Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background: Gender equaltiy and occupational injuries are an issue for the public health. Women are more often reported sick then men. There are some differences between the occupations you have and what injuries you developed. It is known that men and women performs a task different from eachother and that will expose them for different injuries.

    Objective: The aim of this study was to determine the relation between occupational injury and gender (Man and Woman) in a gender equality workplace.

    Methods: A group of 40 computerworkers, Men (N=16) and woman (N=24). They completed a questionare about their workenvironment and injuries. Analysis were about different variables crossing with gender.

    Results: You can see a difference between men and women between how much workload they take home. Women had a higher risk to take their workload home and continue to work at home.

    Conclusion: Although women had a higher risk to take their workload home, you can’t say that the gender was the factor but the level of stress was. So the higher level of stress that you experiencing the more was the risk of you taking home your work.

  • 54.
    Lindberg, Per
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Occupational health science. University of Gävle, Centre for Musculoskeletal Research.
    Anderzén, Ingrid
    Department of Public Health and Caring Sciences, Uppsala University.
    Karlsson, Thomas
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Occupational health science. University of Gävle, Centre for Musculoskeletal Research.
    Strömberg, Annika
    University of Gävle, Faculty of Health and Occupational Studies, Department of Social Work and Psychology, Social work.
    Gustafsson, Susanne
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Public health science.
    The birth, rise and success (or fall?) of an intervention project: GodA – a project set up to test a model of the prerequisites for a healthy workplace2014Conference paper (Refereed)
    Abstract [en]

    Conditions in today’s working life make new approaches necessary in order to limit negative health effects of working life and to enhance wellbeing and health at work. Despite rather progressive legislation, a century of labour inspections, and the efforts of thousands of occupational health personnel, still around 20% of the Swedish workforce report to have had work-related disorders other than accidents during the last year (1). Even if this "elimination approach" partly has succeeded it´s obvious that it is insufficient or inadequate for a working life where key issues for progress are motivation, cooperation and creativity (2). In order to achieve a sustainable working life, not the least to coop with issues related to the ageing population in the developed countries, it is likely that strategies and actions from different and new angles are needed.

    Healthy workplace has been defined as an organization that maximizes the integration of worker goals for wellbeing and company objectives for profitability and productivity(3). It is noteworthy that the notion healthy workplace is not a substitute for good work environment it is a consequence. Different models, e.g. the PATH-model by Grawitch et al.(4) shows a synthesis of earlier research in a number of different disciplines and frames how a healthy workplace with wellbeing for the individual and organizational improvements can be achieved. Five general categories of healthy workplace practices were identified in the literature: work-life balance, employee growth and development, health and safety, recognition, and employee involvement. Previous research also suggests that the link between these practices and employee and organizational outcomes is contingent on the effectiveness of communication within the organization and the alignment of workplace practices with the organizational context.

    The GodA-project aims at investigating if work place strategies in line with the PATH-model lead to better health and wellbeing among the employees as well as organizational improvements.

    The GodA project is a 2 year follow up study with a survey feedback design in three companies with both blue- and white collar workers within the energy sector. One of the companies serves as "intervention company", the other two as controls. The project started out with a pre-project, by means of focus groups and individual interviews, in 2012 in order to find out how employees and managers in the three companies describe the concept of a healthy work environment, what they consider to create well-being at work, and how they perceive their own work environment:

    What factors are important for well-being at work? presented by T. Karlsson

    In 2013 a baseline questionnaire where was sent out including items a) based on the results from the pre-study, and b) well-established questions and indices on health and work environment. The results from the survey have been reported back to the companies, which now are processing their results. Research question to be presented and discussed at the symposium:

    Is there a balance between factors of importance for wellbeing at work and the extent to which they are present at the workplace? presented by P. Lindberg.

    Is there a correlation between psychosocial work climate indicators and work-related well-

    The PATH-model emphasizes internal communication as critical in establishing a healthy workplace. As the baseline results show that the communication is not very well developed, this is the primary target for our intervention. We will demonstrate a method for how the survey data are presented back to the intervention company and how they are going to work with the results to improve their work environment, and at the same time enhance communication skills.

    After our presentation we invite the audience to discuss both the GodA-study and more general methodological issues when conducting intervention-studies, e.g:

    - When is a company ready (mature) to take part in research activities?

    - What are the pitfalls in workplace intervention studies?

    - To what degree can the researchers interact at the workplace and still be objective?

    - What is the value of focusing on the items that the employees responded to in the survey?

    References

    1. Swedish Work Environment Authority. Work -related disorders 2010 - Arbetsmiljöstatistisk Rapport 2010:4. Stockholm: Swedish Work Environment Authority. & Statistics Sweden 2010.

    2. Aronsson G, Gustafsson K, Hakanen J. On the development of a positive work-life psychology. In: Christensen M, editor. Validation and test of central concepts in positive work and organizatinal psychology The second report from the Nordic project 'Positive factors at work'. TemaNord 2009:564. Copenhagen: Nordic Council of Ministers; 2009. p. 93-4.

    3. Sauter S, Lim S, Murphy L. Organizational health: A new paradigm for occupational stress research at NIOSH. Japanese Journal of Occupational Mental Health. 1996;4:248-54.

    4. Grawitch MJ, Gottschalk M, Munz DC. The path to a healthy workplace: A critical review linking healthy workplace practices, employee well-being, and organizational improvements. Consulting Psychology Journal. 2006;58(3):129-47.

  • 55.
    Lindberg, Per
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Occupational health science. University of Gävle, Centre for Musculoskeletal Research.
    Karlsson, Thomas
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Occupational health science. University of Gävle, Centre for Musculoskeletal Research.
    Strömberg, Annika
    University of Gävle, Faculty of Health and Occupational Studies, Department of Social Work and Psychology, Social work.
    Gustafsson, Susanne
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Public health science.
    Anderzén, Ingrid
    Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Can a systematic participative method for procesing workplace survey data enhance organizational communication skills?2017Conference paper (Refereed)
    Abstract [en]

    Objectives

    The concept healthy workplace has been defined as an organization that maximizes the integration of worker goals for wellbeing and company objectives for profitability and productivity (Sauter, Lim, & Murphy, 1996). The PATH-model (Grawitch, Gottschalk, & Munz, 2006) shows a synthesis of earlier research in a number of different disciplines and frames how a healthy workplace with wellbeing for the individual along with organizational improvements can be achieved. The model suggests five general categories of healthy workplace practices: work-life balance, employee growth and development, health and safety, recognition, and employee involvement. In order for these workplace practices to have an influence on the employees and the organizational outcomes the effectiveness of communication within the organization is crucial as is the alignment of workplace practices with the organizational context. Effective organizational communication in this context means that the management communicates what the organization offers the employees in order to enable good performance and wellbeing at work as well as that the employees state their needs in order to do a good job. The ongoing GodA-project (a Swedish acronym for good work environments and healthy workplaces) aims at investigating if workplace strategies in line with the PATH-model add to better health and wellbeing among the employees as well as organizational improvements. The present study is part of the GodA-project and aims at exploring to which extent the specific “GodA-method” for processing workplace survey data influences organizational communication skills. 

    Methods

    The GodA study is a 2-year follow up study with a survey feedback design in three companies with both blue- and white collar workers. One of the companies serves as “intervention-company”, the other two as controls. The project started in 2012 with a pre-project by means of focus groups and individual interviews in order to find out how employees and managers in the three companies describe the concept of a healthy work environment and what contributes to their well-being at work. In 2013 a baseline questionnaire was sent out including items, a) based on the combined results of the pre-study and a comprehensive literature review (Lindberg & Vingård, 2012) , and b) well-established questions on health and work environment. The results from the survey were reported back to the companies, which have been processing their respective results. In spring 2015 another survey wave was administered. Parallel, data concerning the company’s key indicators and internal development have been collected.

     Baseline results in the GodA-study showed that the employees considered communication as a very important factor for their well-being at work. However, they also reported that the internal communication was not at all at desired level. Considering that the PATH-model emphasizes internal communication as critical in establishing a healthy workplace, the intervention was designed to enhance communication skills. The “GodA-method”, to process the survey feedback was developed in collaboration with the “intervention-company”. In short, the baseline results concerning health, and physical- and psychosocial factors at the workplace, as reported by respective working group, are split into nine themes. Each theme is designed small enough to be processed during the groups’ monthly staff meetings. At the meetings the employees discuss today’s theme, first without then together with their supervisor and decide upon one measurable action to be taken to improve their work environment. To begin each discussion without the supervisor was a chosen strategy in order to empower the employees and in an implicit way train communication skills. The intervention has been followed by process evaluation forms for the supervisors as well as group interviews with employees and supervisors, respectively.   

    Results

    Nine working groups, each with 7-13 employees, were studied. The individual groups performed heterogeneous. The degree to which the various groups actively took actions for improvements seemed to be associated with the closest supervisor’s understanding of the importance of respective themes and his/her capability to conduct group discussions.

    Communication was measured by a 5-item index showing the discrepancy between experienced and desirable communication level, where an index score of -0,5 to 0 (no discrepancy) was considered as good and a score below -.5 was considered undesirable. Preliminary results show that in groups (=5) performing 3-5 meetings the communication index in average deteriorated from -0.89 to -1.41, whereas groups (=4) performing 8-9 meetings the index improved or remained at a rather high level, in average from -0.92 to -0.71. Further analyses and results will be presented at the conference.

    Conclusion

    The results give support to the hypothesis that systematic and continuous training focusing on a mutual theme is a feasible method for improving communication skills.

    Practical implications

    Healthy workplaces are not created overnight. The GodA-method for processing employee surveys seems to be a useful way to systematically work with continuous improvements of the workplace. However, training of supervisors for group discussions seems necessary.

  • 56.
    Lindberg, Per
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Occupational health science. University of Gävle, Centre for Musculoskeletal Research.
    Karlsson, Thomas
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Occupational health science. University of Gävle, Centre for Musculoskeletal Research.
    Strömberg, Annika
    University of Gävle, Faculty of Health and Occupational Studies, Department of Social Work and Psychology, Social work.
    Gustafsson, Susanne
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Public health science.
    Anderzén, Ingrid
    Department of Public Health and Caring Sciences, Uppsala University.
    Can a systematic participative method for processing workplace survey data enhance organizational communication skills?2016In: Scientific programme: Book of Abstracts, 2016Conference paper (Refereed)
    Abstract [en]

    Objectives

    The PATH-model (1) frames how a healthy workplace with wellbeing for the individual along with organizational improvements can be achieved, suggesting five healthy workplace practices. In order for these practices to have the desired influence, the effectiveness of communication within the organization is crucial. The ongoing GodA-project (an acronym for good work environments and healthy workplaces) is set up to investigate different aspects of the PATH-model. The present sub-study aims at exploring to which extent the specific “GodA-method” for processing workplace survey data influences organizational communication skills. 

    Methods

    The GodA study is a 2-year follow up study with a survey feedback design in three companies with both blue- and white collar workers. In one of the companies the “GodA-method” for processing survey feedbacks was developed and tested. Baseline results concerning workplace factors were split into nine themes, small enough to be processed during respective working groups’ monthly staff meetings. At the meetings the employees discussed today’s theme, first without, then together with their supervisor and decided on one action for improvements. This strategy was chosen in order to empower the employees and implicitly train their communication skills. The intervention was followed by process evaluations.   

    Results

    Nine working groups, each with 7-13 employees, were studied. The degree to which the various groups actively took actions for improvements seemed to be associated with the closest supervisor’s understanding of the importance of respective themes and his/her capability to conduct group discussions.

    Communication was measured by a 5-item index showing the discrepancy between experienced and desirable communication level, where -0,5 – 0 was considered as good. In groups (=5) performing 3-5 meetings the communication index in average deteriorated from -0.89 to -1.41, whereas groups (=4) performing 8-9 meetings the index improved or remained at a rather high level, in average from -0.92 to -0.71.

    Conclusion

    The results give support to the idea that systematic and continuous training focusing on a mutual theme is a feasible method for improving communication skills. Training of supervisors for group discussions seems necessary.

  • 57.
    Lindberg, Per
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Occupational health science. University of Gävle, Centre for Musculoskeletal Research.
    Karlsson, Thomas
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Occupational health science. University of Gävle, Centre for Musculoskeletal Research.
    Strömberg, Annika
    University of Gävle, Faculty of Health and Occupational Studies, Department of Social Work and Psychology, Social work.
    Gustafsson, Susanne
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Public health science.
    Anderzén, Ingrid
    Department of Public Health and Caring Sciences, Uppsala University.
    GodA-metoden och dess inflytande på kommunikationsförmågan på arbetet2015In: Book of Abstracts: FALF 2015 : Conference10-12 June 2015, 2015Conference paper (Refereed)
    Abstract [sv]

    Trots en progressiv arbetsmiljölagstiftning, 10 år av arbetsmiljöinspektioner och ansträngningar från tusentals arbetsmiljöaktörer rapportera 24% av den arbetande befolkningen i Sverige att de haft arbetsrelaterade besvär under senaste året. Även om eliminationsstrategin delvis varit framgångrik är den otillräcklig eller inadek-vat i dagens arbetsliv där nyckelfaktorer för framgång är motivation, samarbete och kreativitet. För att nå ett hållbart arbetsliv är det troligt att det behövs strategier och åtgärder från andra och nya utgångspunkter. Begreppet ”frisk arbetsplats” har definierats som en organisation/företag som maximerar integrationen av ar-betstagarnas mål med företagets mål. PATH-modellen visar genom en syntes av forskning från olika discipliner hur en frisk arbetsplats kan uppnås. För att, enligt modellen, nå verksamhetseffekter av olika personalfrämjande åtgärder är det nödvändigt med en väl utvecklad kommunikation mellan anställda och ledning. Det pågående GodA-projektet syftar till att undersöka om arbetsplatstrategier i linje med PATH-modellen le-der till bättre hälsa och välbefinnande bland de anställda så väl som organisatoriska förbättringar. Föreliggande delstudie undersöker i vilken grad den s.k. ”GodA-metoden” för bearbetning av medarbetarundersökningar kan påverka kommunikationsförmågan i företaget.

  • 58.
    Macassa, Gloria
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Public health science.
    A Matter of Faith: Unravelling the role of religion on child survival in sub-Saharan Africa2012In: African Journal of Health Sciences, ISSN 1022-9272, E-ISSN 2306-1987, Vol. 22, no 3, p. 238-247Article in journal (Refereed)
    Abstract [en]

    This study has reviewed the role of religion on child mortality in subSaharan Africa using searches of electronic Databases. The review found only one study, which investigated the relationship between religion and child mortality in subSaharan Africa using religion as the “main” independent variable. In addition the review identified several areas (definition of religion, measurement and types of studies), which should be further addressed towards a better understanding of the role of religion on child health outcomes, especially child mortality.

  • 59.
    Macassa, Gloria
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Public health science.
    Can Geographic Information Systems Help us to Better Understand Inequalities in Health Outcomes in the Era of Sustainable Development?2018Report (Other academic)
    Abstract [en]

    The objective of this working paper is to describe how geographic information systems can help the understanding of inequalities in health outcomes, including health care, in the era of sustainable development. Geographic information systems can help to reduce both social and spatial disparities in health outcomes (including health care location-based disparities) globally (in developed, middle-income and low-income countries alike), thus contributing to sustainable population health for today’s and future generations.

  • 60.
    Macassa, Gloria
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Public health science.
    Responsible leadership Styles and Promotion of Stakeholders Health2019In: South Eastern European Journal of Public Health, ISSN 2197-5248, Vol. 11Article in journal (Refereed)
    Abstract [en]

    The aim of this short report is to stimulate a conversation on the potential role to be played by responsible leadership in promoting the health and well-being of stakeholders (employees and society at large).

    The report first describes responsible leadership styles and then briefly discusses the potential connection with health promotion within the lens of the wider determinants of health and intersectorial collaboration.

    Integrative responsible leadership and health promotion share a common vision: to alter the economic, environmental, and social contexts in which decisions relating to health and well-being are made, thus affecting health equity.

  • 61.
    Macassa, Gloria
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Public health science.
    Ahmadi, Nader
    University of Gävle, Faculty of Health and Occupational Studies, Department of Social Work and Psychology, Social work.
    Hiswåls, Anne-Sofie
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Public health science.
    Alfredsson, J.
    Samhällsmedicin, Landstinget Gävleborg.
    Soares, Joaquim
    Mittuniversitetet, Avdelningen för hälsovetenskap.
    Stankunas, M.
    Department of Health Management, Lithuanian University of Health Sciences, Kaunas, Lithuania.
    Differences in health care-seeking behavior during economic recession2014In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 24, no Suppl. 2Article in journal (Other academic)
    Abstract [en]

    Background

    In Europe, equitable access to high-quality healthcare constitutes a key challenge for health systems across the continent. However, the recent economic recession left many outside the labour market, causing many to fall in poverty and social exclusion. Unemployment is probably the main factor leading to social exclusion. Studies which analysed health seeking behaviour among unemployed people have reported a variety of results, from low to high utilization of health services. However, some researchers argue that during stressful economic and social circumstances can cause high utilization of the health care system due to increased psychological disorders masked by physical complaints. This study examined differences in health seeking behaviour in Gävleborg County, which at the pick of the economic recession had high levels of unemployment as compared to the national average.

    Methods

    The data for the study come from the 2010 Survey of Health in Equal terms carried out in Gävleborg County, Sweden. The sample included 4245 persons aged 16-65 years. Descriptive and binary logistic analysis was used to assess differences in health seeking behavior by employment status.

    Results

    There was a statistical significant relationship between employment status and health-seeking behavior. Compared to employed persons, people who were out of the labor market had odds ratio of 1.42 (1.12-1.62) for contact with health care services; of 1.30 (1.12-1.50) for contact with a doctor in a health care facility and 1.67 (1.42-1.97) for contact with a doctor in a hospital. Controlling for age, sex, marital status, education, income, smoking habits, physical activity, self-rated health, and long standing illness removed the statistical significance of the observed relationships. Thus, the odds for contact with health care services went from.

    Conclusions

    At the pic of the recent economic recession, people who were outside the labor market had more contact with health care services, with doctor in hospitals as well as primary health care services as compared to employed counterparts. The differences in health seeking behavior were explained by demographic, socioeconomic and health variables.

    Key Words: Employment status, Health care, Gävleborg, economic recession.

    Key messages

    • People who were out of labor market in Gävleborg County in 2010 had more contact with health care services, with a doctor in hospital and primary health care respectively.

    • Future studies are warranted that can assess trends in health-seeking behavior among people outside Gävleborgs labor market.

  • 62.
    Macassa, Gloria
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Public health science. Department of Health Sciences, Mid-Sweden University, Sweden; Epidemiology Unit-ISPUP, University of Porto Medical School, Portugal.
    Bergström, Helena
    Department of Public Health Sciences, Karolinska Institute, Sweden.
    Malstam, Emelie
    Hiswåls, Anne Sofie
    Soares, Joaquim
    Department of Health Sciences, Mid-Sweden University, Sweden.
    Ahmadi, Nader
    University of Gävle, Faculty of Health and Occupational Studies, Department of Social Work and Psychology, Social work.
    Marttila, Anneli
    Department of Public Health Sciences, Karolinska Institute, Sweden.
    Experiences of employment precariousness and psychological well-being in East Central Sweden2017In: Health Science Journal, ISSN 1791-809X, Vol. 11, no 2, article id 491Article in journal (Refereed)
    Abstract [en]

    Background: In the past decade, temporary employment arrangements, including fixed-term and sub-contracted jobs, as well as project work, on-call work and work via temporary-help agencies have increased in developed countries, including Sweden. The objective of this study was to explore precariously employed individuals’ experiences and perceptions of employment strain and its effect on their psychological well-being in Gävleborg County, Sweden. Methods: Semi-structured interviews were conducted with 16 respondents residing in Gävleborg County about their experiences of precarious employment and their perceptions of the relationship between their precarious employment and psychological well-being. Thematic analysis was conducted to relate the results to the employment strain framework. Results: The main theme to emerge in the data was managing stress. Respondent’s perceived significant stress related to keeping employment as well as having future work. In addition, they had difficulties in coping with everyday life because of economic strain, lack of work opportunities and isolation. Conclusions: The results of this study highlight how precariously employed individuals are unable to cope with the stress related to uncertainty in maintaining their current work or having control of their working hours. In addition, the results indicate that precariously employed workers experience economic strain related to income uncertainty, which affects their ability to cope with daily life.

  • 63.
    Macassa, Gloria
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Public health science. Epidemiology Unit (EPIUnit) – Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal.
    Francisco, Jose
    Universidade Eduardo Mondlane, Maputo, Moçambique.
    Mcgrath, Cormac
    Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden; Department of Education, Stockholm University, Sweden.
    Corporate Social Responsibility and Population Health2017In: Health Science Journal, ISSN 1791-809X, Vol. 11, no 5, article id 528Article, review/survey (Refereed)
    Abstract [en]

    In recent decades, corporate social responsibility (CSR) aspart of socially sustainable business organizations operations has become a common practice across developed and developing countries. The objective of this mini review is to reflect on the potential role that CSRmight have on the health of stakeholders (employees and society in general). We suggest that there is an opportunity for business to become agents of change and contribute to improved population health. Therefore, public health researchers need to explore how business organizations can, through CSR impact population health currently and in years to come. This would occur through helping to address global challenges in the workplace and immediate local communities, but above all through identifying the role businesses play in contributing to sustainable development and sustainable population health/health promotion across entire societies regardless of their stage of economic development.

  • 64.
    Macassa, Gloria
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Public health science. Mittuniversitetet, Institutionen för hälsovetenskap.
    Ghilagaber, Gebreneus
    Stockholm university.
    Charsmar, Harry
    Stockholm university.
    Walander, A
    Sundin, Örjan
    Mittuniversitetet, Institutionen för samhällsvetenskap.
    Soares, Joaquim
    Mittuniversitetet, Institutionen för hälsovetenskap.
    Geographic differentials in mortality of children in Mozambique: their implications for achievement of millenium development goal 42012In: Journal of Health, Population and Nutrition, ISSN 1606-0997, E-ISSN 2072-1315, Vol. 30, no 3, p. 331-345Article in journal (Refereed)
    Abstract [en]

    In the light of Mozambique's progress towards the achievement of Millennium Development Goal 4 of reducing mortality of children aged less than five years (under-five mortality) by two-thirds within 2015, this study investigated the relationship between the province of mother's residence and under-five mortality in Mozambique, using data from the 2003 Mozambican Demographic and Health Survey. The analyses included 10,326 children born within 10 years before the survey. Results of univariate and multivariate analyses showed a significant association between under-five mortality and province (region) of mother's residence. Children of mothers living in the North provinces (Niassa, Cabo Delgado, and Nampula) and the Central provinces (Zambezia, Sofala, Manica, and Tete) had higher risks of mortality than children whose mothers lived in the South provinces, especially Maputo province and Maputo city. However, controlling for the demographic, socioeconomic and environmental variables, the significance found between the place of mother's residence and under-five mortality reduced slightly. This suggests that other variables (income distribution and trade, density of population, distribution of the basic infrastructure, including healthcare services, climatic and ecologic factors), which were not included in the study, may have confounding effects. This study supports the thought that interventions aimed at reducing under-five mortality should be tailored to take into account the subnational/regional variation in economic development. However, research is warranted to further investigate the potential determinants behind the observed differences in under-five mortality.

  • 65.
    Macassa, Gloria
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Public health science. Division of Social Medicine, Department of Public Health Sciences, Karolinska Institutetet, Stockholm, Sweden.
    Hallqvist, Johan
    Division of Social Medicine, Department of Public Health Sciences, Karolinska Institutetet, Stockholm, Sweden.
    Lynch, John William
    Department of Epidemiology, Biostatistics and Occupational Health, McGill University.
    Inequalities in Child Mortality in Sub-Saharan Africa: a Social Epidemiologic Framework2011In: African Journal of Health Sciences, ISSN 1022-9272, E-ISSN 2306-1987, Vol. 18, no 1-2, p. 14-26Article in journal (Refereed)
    Abstract [en]

    In the past twenty years or so, the study of the determinants of child survival in low-income countries has been based on demographic conceptual frameworks. The most widely known has been the Mosley and Chen framework (1). In that framework, the key concept was a set of proximate determinants, or intermediate variables, that directly influence the risk of morbidity and mortality. It assumes that all the more distal social and economic determinants must operate through these variables to affect child survival. However the Mosley and Chen framework has failed to directly incorporate the complex social dimension of health.The objective of this paper is to link more distal causes for child health by describing a framework that conceptualises the relation between distal and proximal factors and how they operate to cause inequalities in child mortality within sub-Saharan Africa. Additionally the framework defines policy entry points needing support of empirical evidence. Furthermore the paper acknowledges that the social context plays an important role for inequalities in children’s chances of survival. However, the relative importance of the mechanisms presented in the proposed framework may vary among the different countries of sub-Saharan Africa, thus researchers should empirically adapt the framework to their specific context.

  • 66.
    Macassa, Gloria
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Public health science. Department of Health Science, Section of Public Sci ence, Mid-Sweden University, Sundsvall, Sweden; Department of Public Health Sciences, Karolinska In stitute, Stockholm, Sweden .
    Hiswåls, Anne-Sofie
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Public health science.
    Ahmadi, Nader
    University of Gävle, Faculty of Health and Occupational Studies, Department of Social Work and Psychology, Social work.
    Alfredsson, Johanna
    Department of Community Medicine, Gävleborg County Council, Gävle, Sweden .
    Soares, Joaquim F. J.
    Mittuniversitetet, Avdelningen för Folkhälsovetenskap.
    Stankunas, Mindaugas
    University of Health Sciences, Kaunas, Lithuania.
    Employment status and health care utilization in a context of economic recession: Results of a population based survey in East Central Sweden2014In: Science Journal of Public Health, ISSN ISSN 2328-7942, EISSN 2328-7950, Vol. 2, no 6, p. 610-616Article in journal (Refereed)
    Abstract [en]

    Introduction: The most recent economic recession left many people outside the labour market world-wide, causing widespread poverty and social exclusion. Gävleborg County in East Central Sweden experienced massive layoffs caused by closure of various industries. Objective: The objective of this study was to investigate differences in health-care use according to employment status at the pick of the recent economic recession. Methods: The study used data from a cross-sectional survey “Health in Equal Terms” carried out in Gävleborg County in 2010. The sample included 4245 persons aged 16-65 years. Descriptive and logistic regression analyses were used to assess differences in health-care seeking behaviour by employment status. Results: Employment status was statistically significantly associated with health-care use in Gävleborg County. In the bivariate analysis people who were not employed had odds ratio of 1.62 (CI 1.18-1.72) for health care use as compared to their employed counterparts. Controlling for other variables in Model II to IV removed the statistical significance and reduced the odds to 0.44(CI 0.20-1.00). Conclusions: This study found that at the pick of the most recent economic recession, people who were out of work used more often health services as compared with their employed counterparts. The observed differences in health-care use were explained by demographic, socio-economic and health-related variables. Further studies are needed to analyze trends of healthcare utilization according to employment nationally, particularly at the county level.

  • 67.
    Macassa, Gloria
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Public health science. Epidemiology Unit - ISPUP, University of Porto Medical School, Porto, Portugal.
    Hiswåls, Anne-Sofie
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Public health science.
    Ahmadi, Nader
    University of Gävle, Faculty of Health and Occupational Studies, Department of Social Work and Psychology, Social work.
    McGrath, Cormac
    Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden.
    Educating Public Health Professionals for an Unknown Future: Insight from a New Bachelor Programme Linking Health Promotion and Sustainable Development2017In: Research in Health Science, ISSN 2470-6205, Vol. 2, no 2, p. 70-78Article in journal (Refereed)
    Abstract [en]

    This paper aims to provide a description of the new bachelor programme “Health Promotion through Sustainable Development”, which started in autumn 2016 at the University of Gävle, Faculty of Health and Working Life. The programme was built integrating public health and biology through a thread of health promotion and sustainable development across the three years of study. In the era of sustainable development and more complex health threats, future public health professionals need to be equipped with the right knowledge and skills that will enable them to promote a sustainable population health.

  • 68.
    Macassa, Gloria
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Public health science. Department of Health Science, Section of Public Health, Mid-Sweden University, Sundsvall, Sweden.
    Olofsson, Niclas
    Center for Public Health, Västernorrland County Council, Härnösand, Sweden.
    Soares, Joaquim J. F.
    Department of Health Science, Section of Public Health, Mid-Sweden University, Sundsvall, Sweden.
    Ahmadi, Nader
    University of Gävle, Faculty of Health and Occupational Studies, Department of Social Work and Psychology, Social work.
    Socioeconomic Position and Suicidal Ideation: Going Beyond Education, Occupation and Income2016In: Mid-Sweden Journal of Public Health, article id 150Article in journal (Refereed)
    Abstract [en]

    Objective: Suicidal ideation have been found to be a strong predictor of suicide attempt as well as completed suicide. Currently, there is  an on-going debate on the impact of the recent economic recession on mental health outcomes, including suicide behaviours. Northern Sweden continues to bear the consequences of the recent recession which started in 2008.Thus, this study investigates differentials in twelve months suicidal ideation by socio-economic position (SEP) among economically active persons residing in Västernorland County. In addition, the study discusses the importance of employment status as a fourth measure of socio-economic position in the context of economic hardship.

     Method: The study uses cross-sectional data from the 2010 Västernorrland in 2010 “Health on Equal Terms Survey”, which consisted of 5,050 in economically active persons aged 16-65 years. Descriptive and weighted regression analyses were performed and results are presented as OR´s (with 95% confidence intervals).

    Results: Suicidal ideation was statistically significantly associated with SEP as measured by education, occupation, income and employment status. Respondents who had primary education, were manual workers, or had lower income and  were out of work had odds ratios of 2.19 (CI 1.51-3.16); 2.95 (CI 2.04-4.27); 3.40 (CI 2.41-4.79) and 3.24 (CI 2.84-4.21), respectively. Controlling for demographic, socio-economic and health-related variables only eliminated the statistical significance for education and income.

    Conclusion: SEP as measured by education, occupation, income and employment was associated with suicide ideation in Västernorrland County. Also, employment status was found to be an important measure of SEP within the context of economic recession. There is a need for social protective policies for the less privileged in the population at all times, but especially during times of economic crises.

  • 69.
    Macassa, Gloria
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Public health science.
    Salvador, Elsa Maria
    Eduardo Mondlane University, Maputo, Moçambique.
    da Cruz Francisco, Jose
    Eduardo Mondlane University, Maputo, Moçambique.
    Food Insecurity in Mozambique: What Do We Know? And what Can Be Done?2018Report (Other academic)
    Abstract [en]

    Household food insecurity is defined as inadequate or insecure access to food because of financial constraints. The objective of this short article is to highlight the prevalence and determinants of food insecurity in Mozambique during the past three years. Food insecurity is an important societal and public health problem in Mozambique, and its main determinants are climate change, transportation, and poverty. There is a urgent need for research that can provide a deeper understanding of the determinants of food insecurity in the country and disentangle potential relationships with physical and psychological health outcomes.

  • 70.
    Macassa, Gloria
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Public health science. Mittuniversitetet, Institutionen för hälsovetenskap.
    Sundin, Örjan
    Mittuniversitetet, Avdelningen för psykologi.
    Viitasara, Eija
    Mittuniversitetet, Avdelningen för hälsovetenskap.
    Barros, H
    Department of Hygiene and Epidemiology, University of Porto Medical School, Porto, Portugal.
    Torres Gonzales, F
    Departmental Section of Psychiatry and Psychological Medicine, University of Granada, Granada, Spain.
    Ioannidi-Kapolou, E
    Department of Sociology, National School of Public Health, Athens, Greece.
    Melchiorre, MG
    Italian National Institute of Health and Science on Aging (INRCA), Ancona, Italy.
    Lindert, J
    Protestant University of Applied Sciences, Ludwigsburg, Germany.
    Stankunas, M
    Department of Health Management, Lithuanian University of Health Sciences, Kaunas, Lithuania.
    Soares, Joaquim
    Mittuniversitetet, Avdelningen för hälsovetenskap.
    Psychological abuse among older persons in Europe: A cross-sectional study2013In: Journal of Aggression, Conflict and Peace Research, ISSN 1759-6599, Vol. 5, no 1, p. 16-34Article in journal (Refereed)
    Abstract [en]

    Purpose – Elder abuse is an issue of great concern world-wide, not least in Europe. Older people are increasingly vulnerable to physical, psychological, financial maltreatment and sexual coercion. However, due to complexities of measurement, psychological abuse may be underestimated. The purpose of this study is to investigate the prevalence of psychological abuse toward older persons within a 12 month period.

    Design/methodology/approach – The study design was cross-sectional and data were collected during January-July 2009 in the survey “Elder abuse: a multinational prevalence survey, ABUEL”. The participants were 4,467 randomly selected persons aged 60-84 years (2,559 women, 57.3 per cent) from seven EU countries (Germany, Greece, Italy, Lithuania, Portugal, Spain, Sweden). The sample size was adapted to each city according to their population of women and men aged 60-84 years (albeit representative and proportional to sex-age). The participants answered a structured questionnaire either through a face-to-face interview or a mix of interview/self-response. The data were analysed using descriptive statistics and regression methods.

    Findings – The prevalence of overall psychological abuse was 29.7 per cent in Sweden, followed by 27.1 per cent in Germany; 24.6 per cent in Lithuania and 21.9 per cent in Portugal. The lowest prevalence was reported in Greece, Spain and Italy with 13.2 per cent, 11.5 per cent and 10.4 per cent, respectively. Similar tendencies were observed concerning minor/severe abuse. The Northern countries (Germany, Lithuania, Sweden) compared to Southern countries (Greece, Italy, Portugal, Spain) reported a higher mean prevalence (across countries) of minor/severe abuse (26.3 per cent/11.5 per cent and 12.9 per cent/5.9 per cent, respectively). Most perpetrators (71.2 per cent) were spouses/partners and other relatives (e.g. children). The regression analysis indicated that being from Greece, Italy, Portugal and Spain was associated with less risk of psychological abuse. Low social support, living in rented housing, alcohol use, frequent health care use, and high scores in anxiety and somatic complaints were associated with increased risk of psychological abuse.

    Social implications – Psychological abuse was more prevalent in Northern than Southern countries and factors such as low social support and high anxiety levels played an important role. Further studies are warranted to investigate the prevalence of psychological abuse and risk factors among older persons in other EU countries. Particular attention should be paid to severe abuse. Such research may help policy makers and health planers/providers in tailoring interventions to tackle the ever growing problem of elder abuse.

    Originality/value – The paper reports data from the ABUEL Survey, which collected population based data on elderly abuse.

  • 71.
    Macassa, Gloria
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Public health science. Mittuniversitetet, Institutionen för hälsovetenskap.
    Walander, A
    Department of Public Health Sciences, Division of Social Medicine, Karolinska Institutet, Stockholm, Sweden .
    Soares, Joaquim JF
    Mittuniversitetet, Avdelningen för hälsovetenskap.
    Violence against women in Stockholm County: Does marital status matter?2013In: Journal of Aggression, Conflict and Peace Research, ISSN 1759-6599, Vol. 5, no 2, p. 101-111Article in journal (Refereed)
    Abstract [en]

    Purpose: The purpose of this paper is to investigate differences in victimization among single and married mothers using data (n=6,388 women) from the 2006 Stockholm County Public Health Survey (SCPHS), a cross-sectional survey based on a self-administered postal questionnaire. Design/methodology/approach: Results showed higher odds of victimization among lone mothers compared to married ones. Additionally, the greatest odds of victimization were observed among those with low education, low income, and decreased social and practical support. Findings: In Sweden, particularly in Stockholm, there is a need for future population-based surveys regarding the prevalence of violence and to identify high risk groups. Furthermore, it is crucial that these surveys include items that will enable investigation of direct links between violence and health effects, and the utilization of health care for these women. Originality/value: This paper is original and it addresses for the first time violence among single mothers within a social epidemiology perspective.

  • 72.
    Macassa, Gloria
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Public health science.
    Walander, Anders
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences.
    Hiswåls, Anne-Sofie
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Public health science.
    Living in the Municipality of Gävle: Report on the Gävle Household, Labour Market Dynamics and Health Outcomes Survey - Wave 12013Report (Other academic)
    Abstract [en]

    In many industrialized countries including those in Europe, there is an established relationship between work conditions and health. For instance employment status and conditions have been reported to influence physical health (self-assessed health, pain and various somatic conditions), as well as mental health outcomes such as anxiety and depression, even if debate is still ongoing. Employment conditions have been suggested to be a key determinant of health inequalities, although this factor has been less researched than have education and income. Therefore, a study of the role played by employment status/conditions in a small geographical area such as Gävle Municipality (with its pattern of industries, plant and services closures, and high levels of unemployment) could contribute to knowledge on ways to reduce ill health related to labour market. 

     The overall aim of this study was to examine the relationship between employment status, household income and physical and psychological health outcomes among economically active people residing in Gävle Municipality, using data from Wave 1 of the Gävle Household, Labour Market Dynamics and Health Outcomes (GHOLDH) survey, a household panel survey carried out between April and June 2012. Data analysis was conducted using descriptive statistics and mixed multivariate models.

    There were differences in physical and psychological health by employment status. Individuals who were outside the labour market were more likely to report poor health, body pain and exhaustion than were individuals who were employed. In addition, those individuals who were outside work had a higher prevalence and risk of anxiety and depression. Data on household income also showed associations with physical and psychological health, with a concentration of poor self-reported health, somatic complaints, anxiety and depression in lower income households.

    Interestingly, the study findings revealed that anxiety was also prevalent among employed people, suggesting that people with insecure jobs might also be at risk of poor mental health. This finding requires further research to discern the role of precarious employment conditions on inequalities in physical and mental health outcomes. In addition, studies on the impact of gender on the relationship between employment status/conditions and physical and psychological health outcomes are warranted. To this end, the follow-up survey to be carried out in 2014 might provide additional knowledge pertaining to ways to reduce employment-related health inequalities within the municipality.

  • 73.
    Macassa, Gloria
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Public health science. Epidemiology Unit-ISPUP, University of Porto, Portugal.
    Winersjö, Rocio
    Swedish Board of Health and Social Welfare, Sweden.
    Wijk, Katarina
    Department of Research, Gävleborg Region, Sweden.
    MacGrath, Cormac
    LIME, Karolinska Institute, Sweden.
    Ahmadi, Nader
    University of Gävle, Faculty of Health and Occupational Studies, Department of Social Work and Psychology, Social work.
    Soares, Joaquim
    Department of Public Health, Mid-Sweden University, Sweden.
    Fear of crime and its relationships to self-reported health and stress among men2017In: Journal of Public Health Research, ISSN 2279-9028, E-ISSN 2279-9036, Vol. 6, no 3, p. 169-174, article id 1010Article in journal (Refereed)
    Abstract [en]

    Background: Fear of crime is a growing social and public health problem globally, including in developed countries such as Sweden. This study investigated the impact of fear of crime on self-reported health and stress among men living in Gävleborg County.Design and Methods: The study used data collected from 2993 men through a cross sectional survey in the 2014 Health in Equal Terms survey. Descriptive and logistic regression analyses were carried out to study the relationship between fear of crime and self-reported health and stress. Results: There was a statistically significant association between fear of crime and self-reported poor health and stress among men residing in Gävleborg County. In the bivariate analysis, men who reported fear of crime had odds of 1.98 (CI 1.47- 2.66) and 2.23 (CI 1.45-3.41) respectively. Adjusting for demographic, social and economic variables in the multivariate analysis only reduced the odds ratio for self-reported poor health to 1.52 (CI 1.05-2.21) but not for self-reported stress with odds of 2.22 (1.27-3.86). Conclusions: Fear of crime among men was statistically significantly associated with self-reported poor health and stress in Gävleborg County. However, the statistically significant relationship remained even after accounting for demographic, social and economic factors, which warrants further research to better understand the role played by other variables.

  • 74.
    Melchiorre, Maria Gabriella
    et al.
    Centre for Socio-Economic Research on Ageing, Italian National Institute of Health and Science on Aging, Ancona, Italy.
    Di Rosa, Mirko
    Scientific Direction, Italian National Institute of Health and Science on Aging, Ancona, Italy.
    Lamura, Giovanni
    Centre for Socio-Economic Research on Ageing, Italian National Institute of Health and Science on Aging, Ancona, Italy.
    Torres-Gonzales, Francisco
    Centro de Investigaciones Biomedicas en Red de Salud Mental (CIBERSAM), University of Granada, Granada, Spain.
    Lindert, Jutta
    Department of Public Health, University of Emden, Emden, Germany; Women's Studies Research Center, Brandeis University, Waltham, Massachusetts, USA.
    Stankunas, Mindaugas
    Department of Health Management, Lithuanian University of Health Sciences, Kaunas, Lithuania; Health Service Management Department, Centre for Health Innovation, School of Medicine, Griffith University, Gold Coast, Queensland, Australia.
    Ioannidi-Kapolou, Elisabeth
    Department of Sociology, National School of Public Health, Athens, Greece.
    Barros, Henrique
    Department of Hygiene and Epidemiology, Medical School, University of Porto, Porto, Portugal.
    Macassa, Gloria
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Public health science. Department of Public Health Sciences, Karolinska Institute, Stockholm, Sweden.
    Soares, Joaquim J F
    Department of Health Sciences, Section of Public Health Sciences, Mid Sweden University, Sundsvall.
    Abuse of older men in seven European countries: a multilevel approach in the framework of an ecological model2016In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 11, no 1, article id e0146425Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Several studies on elder abuse indicate that a large number of victims are women, but others report that men in later life are also significantly abused, especially when they show symptoms of disability and poor health, and require help for their daily activities as a result. This study focused on the prevalence of different types of abuse experienced by men and on a comparison of male victims and non-victims concerning demographic/socio-economic characteristics, lifestyle/health variables, social support and quality of life. Additionally, the study identified factors associated with different types of abuse experienced by men and characteristics associated with the victims.

    METHODS: The cross-sectional data concerning abuse in the past 12 months were collected by means of interviews and self-response during January-July 2009, from a sample of 4,467 not demented individuals aged between 60-84 years living in seven European countries (Germany, Greece, Italy, Lithuania, Portugal, Spain and Sweden). We used a multilevel approach, within the framework of an Ecological Model, to explore the phenomenon of abuse against males as the complex result of factors from multiple levels: individual, relational, community and societal.

    RESULTS: Multivariate analyses showed that older men educated to higher levels, blue-collar workers and men living in a rented accommodation were more often victims than those educated to lower levels, low-rank white-collar workers and home owners, respectively. In addition, high scores for factors such as somatic and anxiety symptoms seemed linked with an increased probability of being abused. Conversely, factors such as increased age, worries about daily expenses (financial strain) and greater social support seemed linked with a decreased probability of being abused.

    CONCLUSIONS: Male elder abuse is under-recognized, under-detected and under-reported, mainly due to the vulnerability of older men and to social/cultural norms supporting traditional male characteristics of stoicism and strength. Further specific research on the topic is necessary in the light of the present findings. Such research should focus, in particular, on societal/community aspects, as well as individual and family ones, as allowed by the framework of the Ecological Model, which in turn could represent a useful method also for developing prevention strategies for elder abuse.

  • 75.
    Mälstam, Emelie
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Public health science.
    Bensing, S.
    Karolinska Institute, Department of Molecular Medicine and Surgery, Stockholm, Sweden.
    Asaba, E.
    Karolinska Institute, Department of Neurobiology, Care Sciences and Society, Stockholm, Sweden.
    Focusing on everyday life with Addison’s disease: Health promotion and secondary prevention2017In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 27, no Suppl. 3, p. 334-334Article in journal (Refereed)
    Abstract [en]

    The overal laim of this study was to generate knowledge about everyday life among people living with rare Addison’s disease (AD). Understanding experiences in contexts of everyday life are important for public health, equity in healthcare, and in order to design tailored health promotion programs, which are in line with EU policy. Addison’s disease is a rare disease and people with AD face challenges due to limited existing knowledge about the disease and often encounters health care providers who are not familiar with best practices in the area. Treatment and follow up of AD also vary greatly within Europe even though a European consensus exists and few reports of secondary and tertiary prevention have been published. AD is also usually monitored and treated in the specialist health care where individually delivered health care is dominant. In Sweden, it has been argued that all health care should integrate disease prevention and health promotion and that group-based self-management approaches could be compliments to traditional caring and curative health care. This study was conducted with qualitative methods and a participatory approach, engaging five participants with AD. Under seven weeks the participants photographed their everyday life and participated in weekly group-discussions. Preliminary results show that everyday life with AD can be more complex than previously thought and that extended information and self-management education about the disease and everyday life is perceived as important to maintain wellbeing. Also, participants perceived that health care could play a bigger role regarding health promotion and preventive actions through extended pharmacological and non-pharmacologica lparts of group-based interventions.

    Key messages:

    • Specialist health care can play a role regarding preventive self-management schooling for persons with rare Addison’s disease to improve wellbeing in everyday life.
    • Specialist health care can play a role regarding health promotion and disease prevention through extended self-management education for persons with rare Addison’s diseas.
  • 76.
    Mälstam, Emelie
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Public health science.
    Bensing, Sophie
    Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm; Department of Endocrinology, Metabolism and Diabetes , Karolinska University Hospital Solna, Stockholm, Sweden, Sweden; .
    Asaba, Eric
    Department of Neurobiology, Care Sciences and Society (NVS), Division of Occupational Therapy, Karolinska Institutet, Stockholm, Sweden; Unit for Research, Development, and Education, Stockholms Sjukhem Foundation, Stockholm, Sweden; Graduate School of Health Sciences, Tokyo Metropolitan University, Tokyo, Japan.
    Everyday managing and living with autoimmune Addison's disease: Exploring experiences using photovoice methods2018In: Scandinavian Journal of Occupational Therapy, ISSN 1103-8128, E-ISSN 1651-2014, Vol. 25, no 5, p. 358-370Article in journal (Refereed)
    Abstract [en]

    People with rare diseases are a minority group that faces risks for healthcare and work inequities because knowledge and resources on how to systematically support health or working life are limited. Integrating voices of persons living with rare diseases are an important aspect in inclusive and relevant healthcare practices. This study sought to actively involve persons with autoimmune Addison's disease (AAD), a rare condition, in exploring challenges and possibilities situated in everyday life. Photovoice methods were utilized to incorporate experiences through photographic documentation and group discussions with five persons over seven weeks. Data generated from group sessions were visually analyzed or transcribed and analyzed with thematic analysis. Five themes emerged: Individual and fine tuning in everyday life; It is not how it was; The power of knowledge and support; Becoming the expert in an uncertain context; and, Finding balance and paving new ways. The findings showed that everyday life with AAD was more complex than earlier portrayed; entailing several barriers and negotiations. In order to meet the needs of persons with AAD, more extensive and relevant information, support and self-management education is needed. Moreover, a complementary focus on everyday life to promote their health and wellbeing is also important.

  • 77.
    Nyberg, Maria
    et al.
    Högskolan Kristianstad.
    Lennernäs, Maria
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Public health science. Högskolan Kristianstad.
    Jahncke, Helena
    University of Gävle, Faculty of Engineering and Sustainable Development, Department of Building, Energy and Environmental Engineering, Buildning science - applied psychology.
    Ljung, Robert
    University of Gävle, Faculty of Engineering and Sustainable Development, Department of Building, Energy and Environmental Engineering, Buildning science - applied psychology.
    Personalrestaurangen som måltidsarena: uppfattningar om och attityder till maten och måltiden på arbetsplatsen2012Report (Other academic)
    Abstract [en]

    Summary in EnglishLennernäs M, Nyberg M Jahncke H, Ljung R. Staff Restaurant as a meal arena – perceptions of and attitudes towards food and meal at work. Kristianstad University and Gävle University in cooperation with the National Centre for Meals, Sweden, 2012.BackgroundWorking life and family life has changed in many ways during the last 50 years. Rules of the Organization of working hours are examples of such changes. Also more meals are eaten outside the home. Food choice and timing of meals affect health and well-being, and probably also work performance. Other factors than individual preferences are known to influence food choice and meal context at work. It might be structural factors such as working hours, meal breaks, the supply of food and also opportunities for self storage and cooking of food. Also the physical environment that surrounds the meal in the staff restaurant and staff place might affect the catering experience, social relations and the possibility of recovery during meal breaks.Aim and designA cross-sectional study was carried out to examine meal experiences at three different work places including attitudes to, and satisfaction with, staff restaurant and dining room (staff room). Other questions concerned the degree of own control over working meals. The overall objective of the study was to gain knowledge-base for the training of catering staff and unions and employers that influence over the breaks (timing and duration), place, space and atmosphere in connection with meals at work. This report also provides a brief literature review of safety legislation (physical meal environment and breaks) and also public health aspects in relation to meals at work.Work places and subjectsThree companies participated, a manufacturing base, a regiment (armed forces), as well as a regional hospital. The intention was to study the meal at work in different social environments and different activities. A total of 724 completed questionnaires were collected, the response rate was 78 %.MethodsQuestionnaires were distributed to persons who were in place at the time of the questionnaire's award, or distributed by contact persons internally. Physical measurements of noise and light conditions were done in staff restaurants when they were empty and also when they had most meals guests during the day. The questionnaire's 20 question areas included multiple choice questions, scales with seven increments as well as open questions. Survey questions concerning the physical meal place also stress and experiences in relation to the meals at work originates from established questionnaires in environmental psychology. Catering questions were designed inspired by FAMM (Five Aspect Meal Model), the Association Key hole criteria document for caterers (service types/categories and basic concepts), the National Food Administration's administrative report "good food at work", as well as Tellström & Jönsson definition of gastronomy. General questions about working times, meal times, lifestyle and health were added. A question about Diurnal Type was included. Attitudes and experiences were assessed by using9scaled questions from 1 to 7 with the endpoints “Are not at all satisfied to Very satisfied”; “Not at all” to “A very high degree”, “No control at all to Completely self-monitoring”. Low value is interpreted as a negative attitude, high value as a positive attitude.AnalysisData from the survey and the results from light and noise measurements in the staff room was imported to the statistical programme SPSS for in-depth analyses of statistically significant differences for any selected questions. Data is organized and interpreted according to the thematic analysis which includes seven aspects:Time (working hours, meal breaks, pauses); Room (where to eat – staff restaurant or staff room, physical environment, including the measurement of light and noise, planning in relation to the room); Product – food (including self-monitoring, values and planning in relation to the product). Meeting (colleagues, catering and service personnel). Logistics and planning. Atmosphere (subjective catering experience) and finally, Food, lifestyle and health.ResultsEmployees in industry and Defense (Regiment) worked during the day and a full-time basis, at the hospital had 69% work daytime, 6% had scheduled work night, 25% of circadian cycles, night hours. The majority (95%) had meal breaks with an opportunity to leave the work place (the rest had a meal pause). 13% spent less than 20 minutes at a working meal. 20-30 minutes was most common in the Industry, more than 45 minutes was the most common to the armed forces and 31-45 minutes at the hospital. One third of all had low control over the duration of their meal break. The shortest food breaks and minimum control was reported by industry.SummaryThe natural meal environment has a major impact on the choice of place to eat and catering experience. In the survey, staff experienced better recovery in staff rooms. Staff felt more happy, bright and has "loaded battery" better after a meal in the staff room compared to Staff Restaurant. Flavors and variety in the menu is more important than e.g. local or eco-labelled food. The taste is the most important factor for satisfaction in the staff restaurant. There was a large discrepancy between how important taste was estimated to be, and how tasty the food was perceived in staff restaurants. Participants have low self-control over the possibility to eat in desirable society or in isolation or when they are hungry. Environmental factors and culinary sensations, with the greatest impact on satisfaction with the meal, need to be improved, as well as service and friendliness from the catering staff. The cooperation between meal researchers and environmental psychologists resulted in a broader analysis of how the catering environment affects meal experiences and satisfaction with working meals.Conclusions and future recommendationsPeople need food and rest to hurricane work. Energy from foods and meals, as well access to psychological detachment from work probably counteracts stress disorders and also promotes health and cognitive performance. The most striking outcome of the study was the lack of recovery during meal pauses, and especially in the staff restaurant ambience. The study also shows that employees have a relatively low control over the opportunity to eat in privacy or in10desirable companion, and even low control over the length of the meal and the opportunity to eat when hungry. Other concerns were the queues and poor logistics in the staff restaurant, but also in the staff room at the hospital.Food in the workplace is an important issue for the company because as the lack of recovery might lead to poor work performance and contribute to long term stress disorders. Furthermore, inappropriate eating habits leading over time to ill health and reduced work performance.Keywords: Workplace, meals, staff restaurant, atmosphere, recovery, detachment, stress, noise, dining room, food service, restitution

  • 78.
    Nyberg, Maria
    et al.
    Högskolan Kristianstad, Forskningsmiljön Food and Meals in Everyday Life (MEAL).
    Lennernäs Wiklund, Maria
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Public health science.
    I tid och otid - arbetsmåltidens betydelse för återhämtning och hälsa2013Conference paper (Other academic)
  • 79.
    Nyberg, Maria
    et al.
    School of Learning and Environment, Department of Human Sciences, Food and Meal Science, Kristianstad University, Kristianstad, Sweden.
    Lennernäs Wiklund, Maria
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Public health science.
    Impossible meals?: the food and meal situation of flight attendants in Scandinavia – a qualitative interview study2017In: Appetite, ISSN 0195-6663, E-ISSN 1095-8304, Vol. 113, no 1, p. 162-171Article in journal (Refereed)
    Abstract [en]

    The working conditions of flight attendants (FAs) often involve extended and irregular working hours, short rest periods, difficulties in planning for breaks and high demands of service provision. Moreover, work schedules including early check-in, shifts during circadian low and time-zone transitions imply constant exposure to alterations in circadian systems and related health risks. The aim of this explorative study was to investigate how the organisation of work, time and place influence the food and meal situation of FAs when at work, focusing on patterns, form and social context of meals. The research questions posed were how food and meals at work were characterised and perceived among the FAs, and what strategies were adopted to manage the food and meal situation. Qualitative, semi-structured interviews were conducted with fourteen FAs working in Scandinavia. The results indicated that the organisation of work, time and place have a major influence on the meal situation at work, and how food and meals are perceived and managed by FAs. The work was defined as fragmented and inconsistent regarding time and place resulting in scattered meals and a more snack-based form of eating. The meal situation was characterised by irregularity as well as unpredictability. Eating took place when food was available and when there was enough time to eat, rather than being guided by hunger or social context. Various strategies such as eating in prevention, using emergency food, avoiding certain food and drinks or eating little or nothing at all were used to manage the unpredictability of the meal situation as well as the gap between organisational and individual times. The findings demonstrated the individual responsibility to solve the meal at work, e.g. to solve organisational times.

  • 80.
    Okenwa Emegwa, Leah
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Public health science.
    Determinants of sick leave duration following occupational injuries among workers in the county of Gävleborg, Sweden2014In: Occupational Medicine & Health Affairs, ISSN 1463-502X, E-ISSN 2329-6879, Vol. 2, no 4, article id 176Article in journal (Refereed)
    Abstract [en]

    Background: Occupational injuries continue to add to the global burden of injuries. Recent global estimates show that up 317 million workers were injured in accidents at work that resulted in absence from work of four days or more. Whereas sick leave is important for rehabilitation and recovery, the duration of sick leave and consequent return to work is of concern in order to prevent negative outcomes. There is therefore a need to examine factors associated with sick leave duration among injured workers for effective rehabilitation. This study aimed to investigate the determinants of leave sick duration following occupational injuries. Method: The Swedish National Working Environment Agency keeps a record of all cases of occupational injuries requiring at least one day sick leave day and reported to Swedish Social Welfare Security Agency. The present study is register based using data from a total of 5291 cases of occupational injuries that occurred in the county of Gävleborg, Sweden between 2007 and 2012. Result: Sick leave longer than two weeks was highest for the self-employed and temporary workers although injury frequency was low for both groups. Fall injuries and injuries involving slip, trip and snapping or breaking of an object were more likely to lead to sick leave longer than two weeks. Shorter sick duration was observed among injured workers in the health and manufacturing sectors. Conclusions: Possible reasons for the observed results and the need for individual based rehabilitation process for effective and more meaningful return to work are discussed.

  • 81.
    Okenwa Emegwa, Leah
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Public health science.
    Trends in Work Place Injury and Consequent Absence from Work in the County of Gävleborg, Sweden2014In: / [ed] Massimo Cecaro, 2014Conference paper (Refereed)
    Abstract [en]

    Work related injuries continue to contribute to the global burden of disease and injuries. According to recent global estimates, about a million workers are injured and a thousand die per day due to work injuries. In Sweden, trends in reporting work place injuries have varied over time with various peaks and troughs.Differences have been observed between the reporting ofinjuries requiring sick leaves and those requiring no sick leaves, the so called ‘zero’ accidents.There are however few studies exploring the specific trends and patterns of occupational injuries in Sweden. Even problematic is the fact that available studies are very industry specific. Aim: To explore trends in workplace injuries and associated socio-demographic risk factors in the county of Gävleborg, Sweden.The study also aims to look at sick leave patterns in terms of total number of days absent from week and their determinants. Method: The study is based on retrospective longitudinal data comprising of all cases of work place accidents between 1992 and 2012 which were reported to the Swedish social insurance agency. A total of 24129 cases were reported across different industries. Data was analyzed using SPSS. Results: Preliminary results show that work place injuries vary by social demographic factors (such as age, sex, type of employment status) and industry.Results also show that age and sex are major determinants of total number of sick leave days. Conclusion: The implication for interventions and further research are discussed.

  • 82.
    Okenwa-Emegwa, Leah
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Public health science.
    Lawoko, Stephen
    Karolinska Institutet, Stockholm, Sweden.
    Jansson, Bjarne
    Karolinska Institutet, Stockholm, Sweden.
    Attitudes Toward Physical Intimate Partner Violence Against Women in Nigeria2016In: SAGE Open, ISSN 2158-2440, E-ISSN 2158-2440, Vol. 6, no 4, article id 2158244016667993Article in journal (Refereed)
    Abstract [en]

    Attitudes toward intimate partner violence (IPV) are known predictors of IPV victimization and perpetration with more women generally believed to justify IPV than men. An understanding of the determinants of justification of IPV may provide information necessary for holistic interventions. This study sought to examine the magnitude, extent, and predictors of justification of physical IPV against women among men and women in Nigeria. Data from 33,385 women and 15,486 men from the 2008 Nigerian demographic and health surveys were analyzed using chi-square test and multiple logistic regressions. Results show that although larger proportions of women justified physical IPV, certain categories of men such as poor, illiterate men, and men with secondary education justified abuse more than women. Contrary to expectations, access to radio/TV increased the odds of justifying abuse among women thus casting doubts on program content. The gender differences observed for predictors of attitudes to physical IPV suggest a need for gender-tailored interventions to change attitudes toward partner violence in Nigeria.

  • 83.
    Okenwa-Emegwa, Leah
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Public health science. Swedish Red Cross University College, Stockholm, Sweden.
    Saboonchi, F.
    Swedish Red Cross University College, Stockholm, Sweden.
    Tinghög, P.
    Swedish RedCross University; Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
    Depression and Low Labour Market and Social Expectations among Resettled Syrian Refugees in Sweden2017In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 27, no Suppl. 3, p. 377-377Article in journal (Refereed)
    Abstract [en]

    Background

    Large numbers of refugees have come to Europe in search of safety. For non-refugee migrants, expectations and the extent to which they are met are shown to be integral components of adaptation and wellbeing. This study aims to explore the prevalence of low expectations for labour market, economic and social integration among Syrian refugees recently resettled in Sweden and whether depression is associated with these expectations.

    Methods

    Arandomsampleof1215Syrianrefugesofworkingage recently resettled in Sweden responded to a questionnaire in Arabic. Expectations were asse ssed by three items developed for this study. Average item score of >1.80 on the depressive symptoms  in  Hopkins  Symptom  Checklist  indicated depression. Logistic regressions adjusted for demographic factors and social support were conducted. Weighted data was used to produce socio-demographically representative prevalence rates and odds ratios (ORs). Robust standard errors were used to obtain 95% confidence intervals for all estimates.

    Results

    Prevalence  of  low  economic,  social  and  labour  market expectations were 14.1% (95% CI 12.0-16.1), 13.4% (11.3- 15.4) and 10.9% (9.1-12.6) respectively. Approximately 40.2% (36.9-43.3) of the participants had depression. Those with depression were about four times more likely to have low economic expectations (OR 3.89, 95% CI 2.66-5.92), three times more likely to have low social (OR 3.1, 2.30-5.24), and labour market (OR 2.83, 1.90-4.47) expectations.

    Conclusions

    Low expectations, while not widespread, exist among Syrian refugees in Sweden. Notable proportions had depression which was also significantly associated with low expectations. The association between depression and low expectations in keys areas necessary for adaptation and wellbeing in a new land, indicates the need to address mental health issues in current societal  level  efforts  aimed  at  boosting  labour  market participation and social inclusion.

    Key messages:

    • Notable proportions of Syrian refugees in Sweden have low expectations in domains vital for adaptation and wellbeing in a new land. Depression is significantly associated with low expectations.
    • Low expectation among Syrian refugees in domains vital for adaptation and wellbeing and the association with depres- sion indicate need to address mental health in social and labour market interventions.
  • 84.
    Okenwa-Emegwa, Leah
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Public health science. epartment of Health Sciences, The Swedish Red Cross University College, Stockholm, Sweden.
    von Strauss, Eva
    Department of Health Sciences, The Swedish Red Cross University College, Stockholm, Sweden.
    Higher education as a platform for capacity building to address violence against women and promote gender equality: the Swedish example2018In: Public Health Reviews, ISSN 0301-0422, E-ISSN 2107-6952, Vol. 39, article id 31Article in journal (Refereed)
    Abstract [en]

    Violence against women is an acknowledged public and global health problem which has adverse consequences for women's health. Education, especially higher education, has long been identified as an important arena for addressing the problem and promoting gender equality. Two measures recently put in place in the Swedish higher education have brought the role of the sector into focus. The first is the inclusion of gender equality as a measurable outcome in quality assurance in higher education. The second measure is the amendment of the Swedish Higher Education Ordinance to include mandatory knowledge of VAW in the degree programme of seven selected relevant professional groups. The potentials of both measures to positively contribute to the gender equality discourse, as well as improving capacity building for the public health workforce who encounter VAW, are discussed.

  • 85.
    Ramezanian, Maryam
    et al.
    Department of Health Science, Mid-Sweden University, Sweden; Health Services Management Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.
    Soares, Joaquim
    Department of Health Science, Mid-Sweden University, Sweden.
    Khankeh, Hamid
    Research Center in Emergency and Disaster Health, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran; Department of Clinical Sciences and education, Karolinska Institute, Stockholm, Sweden .
    Macassa, Gloria
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Public health science. Department of Health Science, Mid-Sweden University, Sweden; Department of Public Health Sciences, Karolinska Institute, Stockholm, Sweden.
    Socioeconomic inequalities in health among school-aged adolescents in Tehran2016In: Medical Journal of the Islamic Republic of Iran, ISSN 1016-1430, E-ISSN 2251-6840, Vol. 30, no 1, article id 447Article in journal (Refereed)
    Abstract [en]

    Background: Socioeconomic status has been found to have a significant impact on the health as well as risk behaviors of adolescents across different contexts. This study was conducted to assess the effect of social relations adjusted by social class on physical and psychological well-being of adolescences in Teheran, Iran. Methods: This was a cross- sectional study and carried out on 1,742 adolescences living in Tehran during 2011. Adolescences were selected, using proportional stratified sampling method and a questionnaire was filled over an interview for data gathering. Data were analyzed, using SPSS18 logistic regression. Results: The prevalence of psychological symptoms was more than 24% and had a large range (24%-93%), while physical symptoms showed a lower prevalence with a smaller range (12%-33%). Furthermore, there was a significant relation between the adolescences gender and feeling the need for others' help (p<0.001). Factors related to feeling the need for others help, anxiety, and worrying were the most prevalent among both boys and girls. In the section of family social relations, talking to the mother and talking to the father had the lowest and the highest prevalence among girls and boys, respectively. With respect to relations, the number of close friends and after school gathering time with close friends had the highest prevalence among girls, while the number of close friends and E-communication with close friends had the lowest and the highest prevalence among boys, respectively. Conclusion: The physical and psychological symptoms were common among adolescents from families with high socioeconomic status.

  • 86.
    Rydhage, Moa
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Public health science.
    Unga kvinnors syn på alkohol: En kvalitativ studie utförd på unga kvinnor i årskurs 92016Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Alcohol are commonly used by adolescents and linked with harmful health-related outcomes (e.g. injury, dependence). This study explored young women’s attitudes to alcohol consumption. The choice of young women as a study group was motivated by the fact that young women typically start to consume alcohol at an earlier age than young males in the same age group. The study consisted of two focus groups with a total of nine young women in ninth class from a public school in a small town in the south of Sweden. The result showed that the young women believed that the consumption of alcohol with other young women occurred due to a combination of peer pressure and the effect that parents have on their child. The young women thought that if there were clear rules in the home the children would know what was expected from themselves. The result also showed that a need to be accepted by other peers were believed to constitute an additional important reason behind alcohol consumption. In sum, both previous research and the results of this study converge to indicate that parents' influence on their youth and peer pressure have a major impact on how young people choose to act on various health related life-style choices.

  • 87.
    Salima, N.
    et al.
    Department of Public Health Sciences, Karolinska Institute, Stockholm, Sweden.
    Okenwa-Emegwa, Leah
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Public health science. Department of Health Sciences, The Swedish Red Cross University College, Stockholm, Sweden.
    Stephen, L.
    Department of Public Health Sciences, Karolinska Institute, Stockholm, Sweden; Department of Public of Health Sciences, Faculty of Health Sciences, Victoria University, Kampala, Uganda .
    HIV testing among women of reproductive age exposed to intimate partner violence in Uganda2018In: Open Public Health Journal, ISSN 1874-9445, Vol. 11, no 1, p. 275-287Article in journal (Refereed)
    Abstract [en]

    Background: Intimate Partner Violence (IPV) and Human Immunodeficiency Virus and Acquired Immune Deficiency Syndrome (HIV/AIDS) occur as dual epidemics with gender dimensions. IPV sometimes result in lack of decision making autonomy over one’s own health and this may negatively affect uptake HIV testing services. Objective: The study aimed to examine the association between exposure to IPV and HIV testing among women of reproductive age in Uganda. Method: The study is based on cross-sectional data from 2011 Uganda Demographic and Health Survey (UDHS). A sub-sample of 1705 ever-partnered women aged 15-49 who responded to the domestic violence module was examined in the study. Bivariate and multivariable (logistic regression) analyses were used to determine the association between exposure to IPV and HIV testing. Results: Up to 82.3% and 61.5% of the respondents were tested for HIV ever and in the past year, respectively. The prevalence of physical IPV and IPV of any form in the past year was 25.6% and 44% respectively. Exposure to physical IPV and emotional IPV in the past year was associated with HIV testing within the past year. In the multivariate analysis, exposure to physical IPV remained significantly associated with HIV testing within the past year (OR: 1.34; 95% CI: 1.03-1.73). Frequent access to newspapers remained a significant predictor of HIV testing uptake. Conclusion: HIV testing in the past year is associated with exposure to IPV among women of reproductive age in Uganda. There is a need to include IPV as a part of global strategy to address HIV/AIDS. © 2018 Salima et al.

  • 88.
    Sarenbrink, Hanna
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Public health science.
    Sambandet mellan användning av sociala medier, självskattad hälsa och kroppsfixering hos unga vuxna: En kvantitativ studie2017Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background: While there are many positive benefits of social media, studies have shown that the use of certain types such as Facebook and Instagram may have negative health outcomes for young people including depression and eating disorders. Not much however is known about the impact of frequent exposure to Facebook and Instagram on health outcomes such as self-rated health and body fixation.

     

    Objective: The purpose of this study is to investigate if there is an association between the frequent use of social media and self-rated health as well as body fixation among young adults between the ages of 18-25 years.

     

    Design and method: This study was a cross-sectional study using questionnaires anonymously answered via Facebook. There were 65 respondents in the survey. The analysis was performed by using descriptive statistics and chi-test in SPSS.

     

    Results: A larger proportion of those who frequently use social media had poorer self-rated health and more body fixation. After completing chi-squared tests, no statistically significant relationship was found for frequent use of social media and body fixation (p=0,164).

     

    Conclusion: Frequent use of social media specifically Facebook and Instagram, has no statistically significant association with body fixation and Self-rated health.

  • 89.
    Skogberg, Nina
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Public health science.
    Unga vuxnas erfarenheter av och åsikter om hälsoinformation: en enkätstudie2016Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Skogberg, N. (2016). Young adults’ experiences and opinions of health information. A survey study. Bachelor thesis in Public Health Science. Department of Occupational and Public Health Science. Faculty of Health and Occupational Studies. University of Gävle, Sweden.

    Objective: The objective of this study was to explore the experiences and opinions of health information among 40-100 young adults, aged 18-25 years.

    Method: A cross-sectional survey study was conducted, using a questionnaire in paper form as well as using a web questionnaire.

    Results: The results showed that the social media (for example Facebook and Instagram) was both the most used and preferred source of information. Most of the respondents thought that the information they found was useful and that the information was appealing and/or interesting. However, the majority of the respondents did feel that the information they found was lacking something.

    Conclusions: Social media can be a useful tool to reach out with health information to young adults. It is important that the information is perceived as accessible, reliable and credible. It is also important to make sure that young adults have access to information which has a scientific basis.

  • 90.
    Soares, Joaquim F J
    et al.
    Mittuniversitetet, Avdelningen för Folkhälsovetenskap.
    Fraga, Silvia
    University of Porto Medical School, Porto, Portugal..
    Viitasara, Eija
    Mittuniversitetet, Avdelningnen för Folkhälsovetenskap.
    Stankunas, Mindaugas
    University of Health Sciences, Kaunas, Lithuania.
    Sundin, Örjan
    Mittuniversitetet Avdelningen för Socialvetenskap.
    Melchiorre, Maria Gabriella
    Italian National Institute of Health and Science on Aging (INRCA), Ancona, Italy .
    Macassa, Gloria
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Public health science. Mittuniversitetet, Avdelningen för folkhälsovetenskap.
    Barros, Henrique
    University of Porto, Porto, Portugal.
    The chronicity and severity of abuse among older persons by country: a European study2014In: Journal of Aggression, Conflict and Peace Research, ISSN 1759-6599, Vol. 6, no 1, p. 3-25Article in journal (Refereed)
    Abstract [en]

    Purpose: – The purpose of this paper is to investigate chronicity (frequency) in different abuse types (e.g. psychological) and overall abuse (all abuse types) by severity (minor, severe, total) in seven European cities, and scrutinize factors associated with high chronicity levels (frequency on the median and higher) in psychological and overall abuse by severity.

    Design/methodology/approach: – The study design was cross-sectional. The sample consisted of 4,467 randomly selected women/men (2,559 women) aged 60-84 years from seven European cities, and data were analysed with bivariate and multivariate methods.

    Findings: – Chronicity varied across country and by abuse type. For instance, Germany had the highest chronicity means in physical and sexual abuse; Greece in physical, injury, sexual and overall abuse; Lithuania in physical, injury, financial and overall abuse; Portugal in physical abuse; Spain in physical, sexual and financial abuse; and Sweden in psychological, injury, financial and overall abuse. In general, Italy had the lowest chronicity means. The main perpetrators were people close to the respondents and women (in some cases).

    Research limitations/implications: – The independent relationship (regressions) between chronicity/ severity of abuse, country and other variables (e.g. depression) was examined only for psychological and overall abuse. More research into this issue with other types of abuse (e.g. sexual) is warranted.

    Originality/value: – The paper reports data from the ABUEL survey, which gathered population-based data on elderly abuse.

  • 91.
    Soares, Joaquim
    et al.
    Mittuniversitetet, Institutionen för hälsovetenskap.
    Grossi, Giorgio
    Stockholm University.
    Macassa, Gloria
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Public health science.
    Örjan, Sundin
    Mittuniversitetet, Institutionen för samhällsvetenskap.
    Psychological distress in a sample of Swedish women: a longitudinal study2014In: Scandinavian Journal of Psychology, ISSN 0036-5564, E-ISSN 1467-9450Article in journal (Refereed)
  • 92. Soares, Joaquim J. F.
    et al.
    Barros, Henrique
    Torres-Gonzales, Francisco
    Ioannidi-Kapolou, Elisabeth
    Lamura, Giovanni
    Lindert, Jutta
    Dios Luna, Juan de
    Macassa, Gloria
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Public health science.
    Melchiorre, Maria Gabriella
    Stankūnas, Mindaugas
    Abuse and Health Among Elderly in Europe2010Book (Other academic)
  • 93.
    Sundin, Örjan
    et al.
    Department of Social Sciences, Division of Psychology, Mid Sweden University, Sundsvall, Sweden.
    Soares, Joaquim
    Institution for Health Sciences, Mid Sweden University, Department of Public Health Sciences, Sundsvall, Sweden.
    Grossi, Georgio
    Stress Research Institute, Stockholm University, Stockholm, Sweden.
    Macassa, Gloria
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Public health science.
    The experiences of burnout among migrant and native Swedish women: a longitudinal study2011In: Women & health, ISSN 0363-0242, E-ISSN 1541-0331, Vol. 51, no 7, p. 643-660Article in journal (Refereed)
  • 94.
    Tahir, M. N.
    et al.
    Punjab Emergency Service, Punjab, Pakistan .
    Macassa, Gloria
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Public health science.
    Akbar, A. H.
    University of Engineering and Technology, Lahore, Pakistan .
    Naseer, R.
    Punjab Emergency Service (Rescue 1122), Punjab, Pakistan .
    Zia, A.
    Punjab Emergency Service, Punjab, Pakistan .
    Khan, S.
    Punjab Emergency Service, Punjab, Pakistan .
    Road traffic crashes in Ramadan: An observational study [Accidents de la circulation pendant le ramadan: Une étude d'observation]2013In: Eastern Mediterranean Health Journal, ISSN 1020-3397, Vol. 19, no Suppl. 3, p. S147-S151Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to investigate trends in road traffic crashes (RTCs) managed by an emergency service, Rescue 1122, in 2011 in Punjab, Pakistan. RTC data were collected from 35 districts of Punjab and reviewed retrospectively. Data analysis revealed that the service responded to 12 969 RTC emergencies during August 2011 (Ramadan), compared with an average of 11 573 RTCs per month from January to August 2011. The younger age group (11-27 years) was victims in 29% of RTCs; 39% were due to speeding and 43% occurred in peak rush hours (14: 00-18: 00) before iftar (breakfast).Results of the study showed that Rescue 1122 faced more RTCs during Ramadan compared with the preceding months. Road safety is an important public health issue in Pakistan. Although there have been great improvements in roads in the past few years, much work needs to be done to deal with mounting trends in RTCs. Public awareness, political will and stringent law enforcement are key factors.

  • 95. Tahir, Navid
    et al.
    Macassa, Gloria
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Public health science.
    Naseer, Rizwan
    Durani, Mohsin
    Hashmi, Waseem
    Causes of Fire Emergencies managed by Rescue 1122 in Punjab, Pakistan2011Report (Other academic)
  • 96.
    Tahir, Navid
    et al.
    Punjab Emergency Service, Lahore, Pakistan .
    Naseer, Rizwan
    Punjab Emergency Service, Lahore, Pakistan.
    Khan, Samina Mohsin
    Division of Global Health, Karolinska Institute, Stockholm, Sweden .
    Macassa, Gloria
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Public health science. Department of Public Health Sciences, Karolinska Institute, Stockholm, Sweden .
    Hashimi, Waseem
    Punjab Emergency Service, Lahore, Pakistan .
    Durrani, Moshin
    Punjab Emergency Service, Lahore, Pakistan .
    Road traffic crashes managed by Rescue 1122 in Lahore, Pakistan2012In: International Journal of Injury Control and Safety Promotion, ISSN 1745-7300, E-ISSN 1745-7319, Vol. 19, no 4, p. 347-350Article in journal (Refereed)
    Abstract [en]

    The objective of this retrospective study was to describe demographic characteristics, injury patterns and causes of road traffic crashes (RTCs) managed by Rescue 1122 in Lahore, Pakistan during the period 2005–2010. In total 123,268 RTCs were reported and responded by Rescue 1122 ambulance service during the study period. Of the 132,504 victims of RTCs, there were 67% male and 33% female subjects, and the maximum share (65%) was reported among people aged 16–35 years. Motorcyclists were involved in 45% of crashes, with over-speeding (40%) found to be the major reason of these collisions. Similarly, minor injuries (65%) and fractures (25%) were the most reported outcome of these crashes. It is concluded that data from ambulance services, if appropriately collected, can provide valuable epidemiological information to monitor RTCs in developing countries. However, in Pakistan, the collection of data as well as the registration process needs further improvement.

  • 97.
    Winnersjö, Rocio
    et al.
    Department of Public Health Sciences, Karolinska Institute, and Division of Public Health Sciences, Mid-Sweden University, Sundsvall, Sweden.
    Ponce de Leon, Antonio
    Department of Public Health Sciences, Karolinska Institute, and Departmento de Epidemiologia, Universidade do Estado de Rio de Janeiro, Brazil.
    Soares, Joaquim F
    Department of Public Health Sciences, Karolinska Institute, and Division of Public Health Sciences, Mid-Sweden University, Sundsvall, Sweden.
    Macassa, Gloria
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Public health science.
    Violence and self-reported health: does individual socioeconomic position matter?2012In: Journal of Injury and Violence Research, ISSN 2008-2053, E-ISSN 2008-4072, Vol. 4, no 2, p. 87-95Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Violence is a major public health problem. Both clinical and population based studies shows that violence against men and women has physical and psychological health consequences. However, elsewhere and in Sweden little is known of the effect of individual socioeconomic position (SEP) on the relation between violence and health outcomes. Objective: This study aimed to assess the effect of individual SEP on the relation between violence and three health outcomes (general health, pain and anxiety) among women in Stockholm County.

    METHODS: The study used data from the Stockholm Public Health Survey, a cross-sectional survey carried out in 2006 for the Stockholm County Council by Statistic Sweden. 34 704 respondents answered the survey, the response rate was sixty one percent. Analyses were carried out using descriptive statistics and logistic regression analysis in SPSS v.17.0.

    RESULTS: Individual SEP increased the odds of reporting poor health outcomes among victimized women in Stockholm County. Regarding self-reported health women in low-SEP who reported victimization in the past twelve months had odds of 2,36 (95% CI 1.48-3.77) for the age group 18-29 years and 3.78 (95% CI 2.53-5.64) for the age group 30-44 years compared with women in high-SEP and non-victim. For pain the odds was 2,41 (95% CI 1,56-3,73) for the age group 18-29 years and 2,98 (95% CI 1,99-4,46) for women aged 30-44 years. Regarding anxiety the age group 18-29 years had odds of 2,53 (95% CI 1,58-4,03) and for the age group 30-44 years had odds of 3,87 (95% CI 2,55-5,87).

    CONCLUSIONS: Results showed that individual SEP (measured by occupation) matters to the relationship between violence and health outcomes such as general self-reported health, pain and anxiety. Women in lower SEP who experienced victimization in the past twelve months had increased odds of reporting poorer self-rated health, pain and anxiety compared to those in higher SEP with no experience of victimization. However, further exploration of the relationship between poverty, individual SEP is needed using other Swedish population samples.

  • 98.
    Yahaya, Ismael
    et al.
    Mid Sweden University, Sundsvall, Sweden, and London School of Hygiene and Tropical Medicine, London, UK .
    Uthman, Olalekan A
    Warwick-Centre for Applied Health Research and Delivery (WCAHRD), Division of Health Sciences, Warwick Medical School, The University of Warwick, United Kingdom, and Liverpool School of Tropical Medicine, International Health Group, Liverpool, Merseyside, UK .
    Soares, Joaquim
    Mid Sweden University, Sundsvall, Sweden, and Karolinska Institute, Stockholm, Sweden.
    Macassa, Gloria
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Public health science. Mid Sweden University, Sundsvall, Sweden, and Karolinska Institute, Stockholm, Sweden.
    Social disorganization and history of child sexual abuse against girls in Sub-Saharan Africa: A multilevel analysis2013In: BMC International Health and Human Rights, ISSN 1472-698X, E-ISSN 1472-698X, Vol. 13, no 33Article in journal (Refereed)
    Abstract [en]

    Background

    Child sexual abuse (CSA) is a considerable public health problem. Less focus has been paid to the role of community level factors associated with CSA. The aim of this study was to examine the association between neighbourhood-level measures of social disorganization and child sexual abuse CSA.

    Methods

    We applied multiple multilevel logistic regression analysis on Demographic and Health Survey data for 6,351 adolescents from six countries in sub-Saharan Africa between 2006 and 2008.

    Results

    The percentage of adolescents that had experienced CSA ranged from 1.04% to 5.84%. There was a significant variation in the odds of reporting CSA across the communities, suggesting 18% of the variation in CSA could be attributed to community level factors. Respondents currently employed were more likely to have reported CSA than those who were unemployed (odds ratio [OR] = 2.05, 95% confidence interval [CI] 1.48 to 2.83). Respondents from communities with a high family disruption rate were 57% more likely to have reported CSA (OR=1.57, 95% CI 1.14 to 2.16).

    Conclusion

    We found that exposure to CSA was associated with high community level of family disruption, thus suggesting that neighbourhoods may indeed have significant important effects on exposure to CSA. Further studies are needed to explore pathways that connect the individual and neighbourhood levels, that is, means through which deleterious neighbourhood effects are transmitted to individuals.

  • 99.
    Yahaya, Ismail
    et al.
    Department of Public Health Sciences, Midsweden University, Sweden, and Centre for Evidence-Based Global Health, Nigeria.
    Ponce de Leon, Antonio
    Division of Social Medicine, Department of Public Health Sciences, Karolinska Institute, Sweden.
    A. Uthman, Olalekan
    Warwick - Centre for Applied Health Research and Delivery (WCAHRD), Division of Health Sciences, Warwick Medical School, The University of Warwick, Coven try, CV4 7AL, United Kingdom.
    Soares, Joaquim
    Department of Public Health Sciences, Midsweden University, Sweden, and Division of Social Medicine, Department of Public Health Sciences, Karolinska Institute, Sweden.
    Macassa, Gloria
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Public health science. Department of Public Health Sciences, Midsweden University, Sweden, and Division of Social Medicine, Department of Public Health Sciences, Karolinska Institute, Sweden.
    Individual and community-level socioeconomic position and its association with adolescents experience of childhood sexual abuse: a multilevel analysis of sixcountries in Sub-Saharan Africa2013In: Journal of Injury and Violence Research, ISSN 2008-2053, E-ISSN 2008-4072, Vol. 6, no 1, p. 21-30Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Childhood sexual abuse (CSA) is a substantial global health and human rights problem and consequently a growing concern in sub-Saharan Africa. We examined the association between individual and community-level socioeconomic status (SES) and the likelihood of reporting CSA.

    METHODS: We applied multiple multilevel logistic regression analysis on Demographic and Health Survey data for 6,351female adolescents between the ages of 15 and 18 years from six countries in sub-Saharan Africa, between 2006 and 2008.

    RESULTS: About 70% of the reported cases of CSA were between 14 and 17 years. Zambia had the highest proportion of reported cases of CSA (5.8%). At the individual and community level, we found that there was no association between CSA and socioeconomic position. This study provides evidence that the likelihood of reporting CSA cut across all individual SES as well as all community socioeconomic strata.

    CONCLUSIONS: We found no evidence of socioeconomic differentials in adolescents’ experience of CSA, suggesting that adolescents from the six countries studied experienced CSA regardless of their individual- and community-level socioeconomic position. However, we found some evidence of geographical clustering, adolescents in the same community are subject to common contextual influences. Further studies are needed to explore possible effects of countries’ political, social, economic, legal, and cultural impact on Childhood sexual abuse.

  • 100.
    Yahaya, Ismail
    et al.
    Department of Public Health Sciences, Mid Sweden University, Sundsvall, Sweden; Centre for Evidence-Based Global Health, Nigeria.
    Ponce De Leon, Antonio
    Division of Social Medicine, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
    Uthman, Olalekan A.
    Centre for Applied Health Research and Delivery (WCAHRD), Division of Health Sciences, Warwick Medical School, The University of Warwick, Coventry, UK.
    Soares, Joaquim J. F.
    Department of Public Health Sciences, Mid Sweden University, Sundsvall, Sweden; Division of Social Medicine, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
    Macassa, Gloria
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Public health science. Department of Public Health Sciences, Mid Sweden University, Sundsvall, Sweden; Division of Social Medicine, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden .
    Childhood sexual abuse among girls and determinants of sexual risk behaviours in adult life in sub-Saharan Africa2015In: Journal of Aggression, Conflict and Peace Research, ISSN 1759-6599, E-ISSN 2042-8715, Vol. 7, no 2, p. 67-75Article in journal (Refereed)
    Abstract [en]

    Purpose The purpose of this paper is to investigate the relationship between child sexual abuse and sexual risk behaviours as well as its potential mediators.

    Design/methodology/approach This cross-sectional study used data from a cross-sectional study from 12,800 women between 15 and 49 years of age included in the 2008 Nigerian Demographic and Health Survey. Structural equation modelling (SEM) was applied to assess the association between childhood sexual abuse (CSA) and sexual risk behaviours.

    Findings The authors found that CSA was directly associated with sexual risk behaviours. In addition, the association between CSA and sexual risk behaviour was also partially mediated by alcohol and cigarette use.

    Research limitations/implications The results show that being abused in childhood is important for the subsequent development of sexual risk behaviours in adulthood and the association is mediated by alcohol and cigarette use.

    Practical implications The results may be helpful for policy makers and health care planners in designing cultural sensitive public health intervention that will reduce the burden of CSA, its long-term effects (sexual risk behaviours) and intervening mediators that increase the risks.

    Social implications These findings suggest that to reduce sexual risks, interventions to address sexual abuse needs to include other social problems (smoking, alcohol) that victims result to when faced with trauma.

    Originality/value The current study is the only one so far in sub-Saharan Africa to have explored the relation between CSA and sexual risk behaviours using SEM.

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