Desire to lose weight and need of weight loss support in the adult population-Results from a cross-sectional study in Sweden.

OBJECTIVE: Evidence-based methods to lose weight are important in tackling increasing obesity trends in adult populations. More knowledge about persons who want to lose weight and do not/do need weight loss support is necessary to design effective preventive practices. Thus, the aim of the study was to investigate the prevalence of desire to lose weight in the general population and the prevalence of health problems and health-related factors in persons with overweight or obesity who want to lose weight and believe that they do not/do need weight loss support. METHODS: The study included 14 126 persons aged 30 to 69 years who responded to a questionnaire sent to a random sample. Persons with overweight or obesity (BMI ≥ 25 kg/m2) were divided into three groups: those who do not want to lose weight (n = 1236), those who want to lose weight but do not believe they need support (n = 5484), and those who want to lose weight and believe they need weight loss support (n = 1462). RESULTS: In total, 69% of the women and 59% of the men reported that they wanted to lose weight. The prevalence of hypertension, musculoskeletal pain, poor self-rated health, anxiety/worry, and depression was highest among persons with overweight or obesity who wanted to lose weight and believed they need weight loss support. They were also more physically inactive and reported less social support. CONCLUSIONS: To want to lose weight is very common among adults. People with overweight or obesity who want to lose weight and believe they need weight loss support have higher frequency of various health problems, including mental health problems, and less social support.

Population health status based on the EQ-5D-Y-3L among adolescents in Sweden: Results by sociodemographic factors and self-reported comorbidity.

PURPOSE: The EQ-5D-Y-3L is a generic health-related quality of life (HRQoL) measure developed for youth from 8 years old. The aim of this study is to present population health status, based on the EQ-5D-Y-3L, among adolescents in Sweden, by sex, age, self-reported comorbidity and parents' occupational status. METHODS: Data were obtained from a cross-sectional total survey among students, aged 13-18 years, in a Swedish County year 2014. The survey included EQ-5D-Y-3L, questions regarding self-reported health, disease, functional impairment and mental distress. Parents' occupational status was used as a proxy for socio-economic status. RESULTS: A total of 6574 participants answered all the EQ-5D-Y-3L dimensions (mean age was 15.9 years, same proportion of boys and girls). Girls reported more problems than boys in the dimensions 'doing usual activities', 'having pain or discomfort' and 'feeling worried, sad or unhappy', and lower mean VAS score. Respondents with one or both parents unemployed reported more problems with usual activities, pain/discomfort and in the mood dimension than those with both parents employed. Those with comorbidity had in general more problems in all dimensions and lower mean VAS score. The highest impact on VAS score was found for adolescents who reported that they always felt depressed. CONCLUSIONS: Sex, age, self-reported comorbidity and parents' occupational status were associated with HRQoL determined by the EQ-5D-Y-3L in the general population of adolescents. The ability of EQ-5D-Y-3L to distinguish adolescents' health status based on these factors confirms the instrument's usefulness in assessment of HRQoL and as guidance for prioritization.

Obesity continues to increase in the majority of the population in mid-Sweden-a 12-year follow-up.

BACKGROUND: The aim was to investigate trends in the prevalence of obesity by age and level of education in the general population in mid-Sweden from year 2000 to 2012. METHODS: A postal questionnaire was sent to a random population sample aged 25-74 years in years 2000, 2004, 2008 and 2012. The overall response rates were 67%, 65%, 60% and 53%, respectively, and the study included 29 017, 27 385, 25 910 and 24 152 respondents, respectively. Obesity (BMI ≥ 30 kg/m(2)) was based on self-reported weight and height. RESULTS: The age-standardized prevalence of obesity increased from 13% to 17% in women and from 12% to 17% in men between 2000 and 2012. Obesity increased in all age groups from 2000 to 2008 and continued to increase among the middle aged (45-64 years) between 2008 and 2012. The socioeconomic gradient in obesity changed during the study period since the absolute increase in obesity was steepest at the middle educational level. In 2012, the prevalence of obesity was almost twice as high at both middle and low educational levels compared with high educational level. The 'true' prevalence of adult obesity, corrected for self-reported weight and height, was around 20% in 2012 for both men and women. CONCLUSION: In the majority, among the middle-aged and those with secondary education, the prevalence of obesity continued to increase even between 2008 and 2012.

What factors can be protective for both self-rated oral health and general health?

The aim of this study was to analyze if the same protective factors are significant for both self-rated health and oral health. It was hypothesized that these factors should be the same. The material is based on a population sample of 17 113 women and men aged 18-84 years in one county in central Sweden.The response rate was 61%. The data were collected through a postal questionnaire "Life and Health" in 2008. The questionnaire comprised of 149 questions and was divided into a number of areas, e.g. socioeconomic conditions, quality of life, social relations, lifestyle, and health. To analyze the strength of the protective factors whilst taking into account the relationships between the various independent variables, multivariate analyses were conducted using binary multiple logistic regression. The outcome measures with the strongest association to general health is belonging to the age group 18-34 years, positive faith in the future, good sleeping pattern and to be employed/self-employed/retired. The outcomes with the strongest association to oral health are good finances, belonging to the age group 18-34 years, to be born in Sweden and positive faith in the future. Conclusions. This study shows that, in general, the same protective factors are significant for both self-rated health and self-rated oral health, making it possible to use the same approach to strengthen both general health and oral health. One important outcome, not often considered, is having positive faith in the future. It is a task for the health care system to strengthen people's faith in the future, partly through a very high quality care when needed, but also through active health promotion that increases the chances of a healthy life, both from a public health perspective as from an oral health perspective.

Disparities in mental health among adolescents with and without impairments.

AIM: To analyse whether there are differences in mental health among adolescents with and without various kinds of impairments, taking into account the number of impairments and gender. METHODS: Data from the study Life & Health - Young People conducted in a Swedish county in 2011 was used. The survey included all students in grades 7 (13-14 years) and 9 (15-16 years) in compulsory school and grade 2 (17-18 years) in upper secondary school; there were 7793 respondents (81.0%). The students answered a questionnaire anonymously during school hours. Various measures of mental health were assessed in the groups: hard of hearing, visual impairment, motor impairment, difficulties in reading/writing/dyslexia, attention deficit hyperactive disorder/attention deficit disorder, other impairment, no impairment. RESULTS: Of the studied impairments, difficulties in reading/writing/dyslexia are the most common (6.3%), followed by hard of hearing (5.4%). To have at least one impairment is more common among boys (18.2%) than girls (15.4%). In the impairment group, 21.5% have multiple impairments. Adolescents with impairments have worse mental health than those without, and those with multiple impairments have particularly higher odds ratio to have worse mental health. There are also differences in mental health between number and various kinds of impairments and between girls and boys. CONCLUSION: Adolescents with impairments, particularly girls and those with multiple impairments, have considerably worse mental health than others. These inequalities in health are an immense challenge, not only for those directly involved with the impaired: they affect everyone involved with the goal health equity for the whole population.

Social inequalities in self-reported refraining from health care due to financial reasons in Sweden: health care on equal terms?

BACKGROUND: The main goal of the health care system in Sweden is good health and health care on equal terms for the entire population. This study investigated the existence of social inequalities in refraining from health care due to financial reasons in Sweden. METHODS: The study is based on 38,536 persons who responded to a survey questionnaire sent to a random sample of men and women aged 18-84 years in 2008 (response rate 59%). The proportion of persons who during the past three months due to financial reasons limited or refrained from seeking health care, purchasing medicine or seeking dental care is reported. The groups were defined by gender, age, country of origin, educational level and employment status. The prevalence of longstanding illness was used to describe morbidity in these groups. Differences between groups were tested with chi-squared statistics and multivariate logistic regression models. RESULTS: In total, 3% reported that they had limited or refrained from seeking health care, 4% from purchasing medicine and 10% from seeking dental care. To refrain from seeking health care was much more common among the unemployed (12%) and those on disability pension (10%) than among employees (2%). It was also more common among young adults and persons born outside the Nordic countries. Similar differences also apply to purchasing medicine and dental care. The odds for refraining from seeking health care, purchasing medicine or seeking dental care due to financial reasons were 2-3 times higher among persons with longstanding illness than among persons with no longstanding illness. CONCLUSIONS: There are social inequalities in self-reported refraining from health care due to financial reasons in Sweden even though the absolute levels vary between different types of care. Often those in most need refrain from seeking health care which contradicts the national goal of the health care system. The results suggest that the fare systems of health care and dental care should be revised because they contribute to inequalities in health care.

Domestic work and self-rated health among women and men aged 25-64 years: results from a population-based survey in Sweden.

AIMS: This study investigated the association between domestic work and self-rated health among women and men in the general population. METHODS: The study is based on women (N = 12,910) and men (N = 9784) aged 25-64 years, who responded to a survey questionnaire in 2008 (response rate 56%). Logistic regression models were used to assess the association adjusting for age, educational level, employment status, family status and longstanding illness. Population attributable risks (PAR) were calculated to assess the contribution of domestic work to the prevalence of suboptimal self-rated health. RESULTS: More women (29%) than men (12%) spent more than 20 hours per week in domestic work. Women also experienced domestic work more often as burdensome. Disability pensioners and single mothers reported highest levels of burdensome domestic work. There was a strong independent association between burdensome domestic work and suboptimal self-rated health both in women and men. The PAR for burdensome domestic work was 21% in women and 12% in men and comparable to other major risk factors. CONCLUSIONS: The results suggest that domestic work should not be omitted when considering factors that affect self-rated health in the general population.

A selective follow-up study on a public health survey.

BACKGROUND: The non-response rates in surveys are increasing which is problematic as it means that a progressively smaller proportion of the population represents the majority, and it is uncertain how health survey results are affected. This follow-up was performed on the non-responders to the postal questionnaire in the public health survey Life and Health, conducted in Örebro County Council, Sweden, where large differences in response rates had been found between different socio-demographic groups and geographical areas. The main objective was to analyse non-response bias regarding self-rated health. METHODS: This follow-up study was conducted as a census to all non-responders in the area that had the lowest response rate and, in one other geographical area used as a control. It was carried out by telephone interviews, 49.3% (580 individuals) answered the follow-up. The outcome variable was self-rated health, a main variable in public health surveys. Differences in response patterns between responders and initial non-responders were approximated by prevalences with confidence intervals and adjusted odds ratios. RESULTS: Poor health was more common in the initial non-response group than among the responders, even with consideration given to sex, age, country of birth and education. However, good health was equally common among responders and initial non-responders. CONCLUSIONS: Public health surveys can be biased due to certain groups being under-represented or not represented at all. For this reason, in repeated public health surveys, we recommend selective follow-ups of such groups at regular intervals.

Neighbourhood characteristics, social capital and self-rated health--a population-based survey in Sweden.

BACKGROUND: In previous public health surveys large differences in health have been shown between citizens living in different neighbourhoods in the Örebro municipality, which has about 125000 inhabitants. The aim of this study was to investigate the determinants of health with an emphasis on the importance of neighbourhood characteristics such as the influence of neighbourhood social cohesion and social capital. The point of departure in this study was a conceptual model inspired by the work of Carpiano, where different factors related to the neighbourhood have been used to find associations to individual self-rated health. METHODS: We used data from the survey 'Life & Health 2004' sent to inhabitants aged 18-84 years in Örebro municipality, Sweden. The respondents (n = 2346) answered a postal questionnaire about living conditions, housing conditions, health risk factors and individual health. The outcome variable was self-rated health. In the analysis we applied logistic regression modelling in various model steps following a conceptual model. RESULTS: The results show that poor self-rated health was associated with social capital, such as lack of personal support and no experience of being made proud even after controlling for strong factors related to health, such as age, disability pension, ethnicity and economic stress. Also the neighbourhood factors, housing area and residential stability were associated with self-rated health. Poor self-rated health was more common among people living in areas with predominately large blocks of flats or areas outside the city centre. Moreover, people who had lived in the same area 1-5 years reported poor health more frequently than those who had lived there longer. CONCLUSIONS: The importance of the neighbourhood and social capital for individual health is confirmed in this study. The neighbourhoods could be emphasized as settings for health promotion. They can be constructed to promote social interaction which in turn supports the development of social networks, social support and social capital--all important determinants of health.

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

BACKGROUND: Alcohol consumption among adolescents is a serious public health concern. Research has shown that prevention programs targeting parents can help prevent underage drinking. The problem is that parental participation in these kinds of interventions is generally low. Therefore, the aim of the present study is to examine non-participation in a parental support program aiming to prevent underage alcohol drinking. The Health Belief Model has been used as a tool for the analysis. METHODS: To understand non-participation in a parental program a quasi-experimental mixed-method design was used. The participants in the study were invited to participate in a parental program targeting parents with children in school years 7-9. A questionnaire was sent home to the parents before the program started. Two follow-up surveys were also carried out. The inclusion criteria for the study were that the parents had answered the questionnaire in school year 7 and either of the questionnaires in the two subsequent school years (n = 455). Multinomial logistic regression analysis was used to examine reasons for non-participation. The final follow-up questionnaire included an opened-ended question about reasons for non-participation. A qualitative content analysis was carried out and the two largest categories were included in the third model of the multinomial logistic regression analysis. RESULTS: Educational level was the most important socio-demographic factor for predicting non-participation. Parents with a lower level of education were less likely to participate than those who were more educated. Factors associated with adolescents and alcohol did not seem to be of significant importance. Instead, program-related factors predicted non-participation, e.g. parents who did not perceive any need for the intervention and who did not attend the information meeting were more likely to be non-participants. Practical issues, like time demands, also seemed to be important. CONCLUSION: To design a parental program that attracts parents independently of educational level seems to be an important challenge for the future as well as program marketing. This is something that must be considered when implementing prevention programs.

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

BACKGROUND: Poor mental health has large social and economic consequences both for the individual and society. In Sweden, the prevalence of mental health symptoms has increased since the beginning of the 1990 s. There is a need for a better understanding of the area for planning preventive activities and health care. METHODS: The study is based on a postal survey questionnaire sent to a random sample of men and women aged 18-84 years in 2004. The overall response rate was 64%. The area investigated covers 55 municipalities with about one million inhabitants in central part of Sweden. The study population includes 42,448 respondents. Mental health was measured with self-reported symptoms of anxiety/depression (EQ-5D, 5th question). The association between socio-economic conditions, lifestyle factors and mental health symptoms was investigated using multivariate multinomial logistic regression models. RESULTS: About 40% of women and 30% of men reported that they were moderately or extremely anxious or depressed. Younger subjects reported poorer mental health than older subjects, the best mental health was found at ages 65-74 years. Factors that were strongly and independently related to mental health symptoms were poor social support, experiences of being belittled, employment status (receiving a disability pension and unemployment), economic hardship, critical life events, and functional disability. A strong association was also found between how burdensome domestic work was experienced and anxiety/depression. This was true for both men and women. Educational level was not associated with mental health symptoms. Of lifestyle factors, physical inactivity, underweight and risk consumption of alcohol were independently associated with mental health symptoms. CONCLUSION: Our results support the notion that a ground for good mental health includes balance in social relations, in domestic work and in employment as well as in personal economy both among men and women. In addition, physical inactivity, underweight and risk consumption of alcohol are associated with mental health symptoms independent of socio-economic factors.

Parental attitudes and behaviour concerning adolescent alcohol consumption: do sociodemographic factors matter?

AIMS: Parental attitudes and behaviour with regard to young people and alcohol are associated with teenagers' drinking behaviour. This study examined the association between sociodemographic factors among parents and parental attitudes and behaviour with regard to alcohol and adolescents. METHODS: Postal questionnaires were sent to parents of children aged 12-16 years in six Swedish municipalities. Seven hundred and ninety-five parents were included in the study. Seven sociodemographic factors and four questions identifying parental attitudes and behaviour were examined. Logistic regression was used to compute odds ratios and confidence intervals. RESULTS: The study showed that fathers were more likely than mothers to report that children had been drinking or tasting alcohol at home. Parents who answered the questionnaire together also stated that their children had been served alcohol at home to a larger extent than mothers. Fathers, single parents and parents with older children were more likely to have non-restrictive attitudes towards adolescents and alcohol than mothers, parents living in a household with more than one adult, and parents with younger children. Factors such as age of the parents, employment status and numbers of children in the household were not associated with either parental attitudes or behaviour. CONCLUSIONS: The sex of the responding parent was the only sociodemographic factor that was associated with both parental attitudes and behaviour. Fathers were more likely than mothers to have a non-restrictive attitude. The fathers also reported to a greater extent than mothers that children had been drinking or tasting alcohol at home.

Tinnitus and hearing loss in 15-16-year-old students: mental health symptoms, substance use, and exposure in school.

The current study assessed the responses from a survey titled 'Life and Health - Young People 2005', completed by 2878 15-16-year-old adolescents in mainstream schools in the county of Orebro, Sweden. Thirty-nine percent of students with hearing loss (slight, mild, or moderate) and 6% of students with normal hearing reported tinnitus often or always during the past three months. Almost no gender difference was observed among students with normal-hearing reporting tinnitus (boys 6.3%, girls 5.6%); however, a gender difference was noticed among hard-of-hearing (HH) students (boys 50%, girls 28%). Adolescents with both hearing loss and tinnitus reported considerably higher scores for mental health symptoms, substance use, and school problems than other students. Anxiety in the past three months, male gender, and alcohol consumption in the past year were associated with tinnitus in HH students; irritation and anxiety in the past three months, disability, use of illicit drugs, and truancy predicted tinnitus in the normal-hearing group. Consequently, students with a hearing loss and tinnitus are at high risk and should be monitored for subsequent problems.