Citizenship matters: Translating and adapting the Citizenship Measure to Norwegian.

Citizenship is considered intertwined with recovery, and may be a useful perspective for advancing quality of life among marginalised groups. Yet, matters of citizenship among persons with co-occurring substance use and mental health problems are underrepresented both in research and practice. Aims: In order to measure citizenship among persons with co-occurring problems in a Norwegian study, a measure of citizenship was translated from English to Norwegian. The aims of the study were to 1) translate and adapt the Citizenship Measure, developed by Rowe and colleagues at the Yale Program for Recovery and Community Health, to Norwegian, and 2) to assess the internal consistency and convergent validity of the Norwegian translated measure. Methods: The translation process was carried out using forward and back translation procedures. To examine measurement properties, a convenience sample of 104 residents with co-occurring problems living in supported housing completed the measure. Results: Two factors were identified, related to rights, and to relational citizenship. The Norwegian translation of the Citizenship Measure showed high internal consistency and adequate convergent validity. Conclusions: We argue that the measure can be useful in assessing perceived citizenship, and in initiating efforts to support citizenship among persons with co-occurring problems.

Disentangling how the built environment relates to children's well-being: Participation in leisure activities as a mediating pathway among 8-year-olds based on the Norwegian Mother and Child Cohort Study.

There is scarce insight into the role of the built environment for children's subjective well-being. In an attempt to increase our knowledge on this matter, we conducted a cross-sectional study comprising 23,043 children from the Norwegian Mother and Child Cohort Study. Information about children's leisure activities and their moods and feelings were linked to geospatial data on green space, facilities and population density to assess whether these built characteristics are related to subjective well-being and if participating in leisure activities is a mediator in such relations. We found that children having a park and more playgrounds/sports fields in the neighborhood, as well as those living in more densely populated areas, had more depressive moods and negative feelings. However, participating in leisure-time physical activity, organized activities and social activity with friends mediated these relations and contributed to counterbalancing some of the negative associations observed. The findings suggest that planners and policy makers should focus on ensuring children have neighborhood resources and venues that could support engagement in leisure activities that add positive experiences for their subjective well-being.

Promoting activity participation and well-being among children and adolescents: a systematic review of neighborhood built-environment determinants.

OBJECTIVE: The objective of this review was to identify, evaluate, and synthesize the findings on built-environment determinants and their relation to participation in different domains of activities, including physical activity, recreational and social activities, and well-being in childhood and adolescence. INTRODUCTION: Creating supportive environments for children and adolescents is a priority in society. To ensure informed decision making and policy changes, initiatives need to rely on systematic development and the use of evidence-based knowledge. Thus, it is necessary to critically review the current evidence on the relationship between features of the built environment and health in a more specific and detailed manner to better understand the health-promoting potential of neighborhood built environments. INCLUSION CRITERIA: This review included studies on children and adolescents between five and 18 years of age, which examined relationships between one or several neighborhood built-environment determinants and participation in activities and/or well-being. The studies had to report test statistics for associations between built-environment determinants and the outcomes, which means that descriptive cross-sectional studies were not eligible for inclusion. METHODS: A four-step search strategy was utilized to identify peer-reviewed studies within six databases. The search was limited to English articles published since January 2010. A data extraction form was developed and used to mine the descriptive details of each included study. The included studies were further assessed for methodological quality by three reviewer pairs independently, using the standard critical appraisal tools from JBI. Due to the methodological heterogeneity of the included studies, a narrative summary of the quantitative findings was conducted. RESULTS: The 127 studies included in the review were mainly cross-sectional (87.4%). The built environment was most extensively studied in relation to the outcomes active travel (n = 54) and unspecified physical activity (n = 46). The evidence suggests that a composite determinant of facilities and amenities is related to more unspecified physical activity. Furthermore, less traffic exposure and more safety features, pedestrian infrastructure for walking and cycling, shorter distances to facilities and greater walkability supported active travel behavior. Fewer studies (n = 11) examined the built-environment determinants of organized sports and well-being, and limited, as well as contradictory, evidence existed for the relationship between the built environment and well-being. CONCLUSION: The following determinants potentially support active travel behavior: less traffic exposure and more safety features, pedestrian infrastructure for walking and cycling, shorter distances to facilities and greater walkability. A high facility and amenity index might promote unspecified physical activity. Policies and planning processes should consider these determinants to strengthen children's and adolescents' health and well-being. However, there are remaining research gaps and important avenues for future research that need to be addressed before more specific and robust conclusions can be drawn.

Neighborhood green spaces, facilities and population density as predictors of activity participation among 8-year-olds: a cross-sectional GIS study based on the Norwegian mother and child cohort study.

BACKGROUND: A rapidly growing body of research suggests that qualities of the built environment can promote active living among children and youth. Nevertheless, shortcomings in the current evidence for understanding which built environment characteristics provide opportunities for taking part in activities in childhood remain. This study aimed to examine whether population density, green spaces, and facilities/amenities are associated with participation in leisure-time physical activity (PA), organized activities, and social activities with friends and peers in Norwegian 8-year-olds. METHODS: Data from a sample of 23,043 children from the Norwegian Mother and Child Cohort Study (MoBa) were linked with geospatial data about the built environment. The questionnaire data reported by mothers provided information on the children's leisure activities. We computed exposure to neighborhood population density and access to green spaces and facilities/amenities within 800- and 5000-m radii of the participants' home addresses using geographic information systems. Associations were estimated using logistic regression models. RESULTS: We found beneficial associations between having a park within 800-m and more leisure-time PA during the summer. Furthermore, children living in neighborhoods with higher proportions of green space participated in more PA during the winter. More densely populated areas and access to facilities were associated with participation in organized and social activities. Specifically, we observed that more playgrounds/sport fields in the neighborhood were the strongest and most consistent correlate of activity participation in Norwegian 8-year-olds by being related to more socialization with friends and peers. CONCLUSION: This population-based study underscores the importance of access to a variety of venues and opportunities for different activities in the immediate neighborhood surroundings and in the greater community to support participation in physical activity and organized and social activities in childhood.

A photovoice study of school belongingness among high school students in Norway.

Although high school graduation is important for living conditions and health throughout life, many students do not complete. In Norway's northern most county, Finnmark, up to 45% of students do not complete high school. Contrary to prior research that has primarily focused on causes for dropout, this study's aim was to deepen understanding of factors that support high school attendance. A strengths-based participatory approach using photovoice addressed attendance factors as perceived by seven participating students from one high school in Finnmark. Qualitative content analysis of data generated through group dialogue about participant-generated photos and individual interviews identified six factors important for students' school attendance: a supportive school environment, a good learning environment, recuperation and recreation, family and friends, goals and ambitions, and place attachment. Related aspects of a supportive environment and belongingness, where school staff made important contributions to promoting a positive environment, were essential.

The association between adolescent and parental use of non-prescription analgesics for headache and other somatic pain - A cross-sectional study.

BACKGROUND AND PURPOSE: Over the last years, concern has been expressed about adolescents' possible liberal attitude towards - and use of - non-prescription analgesics. A high consumption of analgesics is unfortunate as it may lead to various harmful effects and worsening of headache. In order to address this challenge, it is necessary to achieve a more extensive knowledge about adolescent consumption. The main aim of this study was to examine the association between adolescent and parental use of non-prescription analgesics, taking into account headache as well as other somatic pain. The effects of parental prescription analgesics use was a secondary aim. METHODS: The study is based on data from two cross-sectional health studies conducted in 2005 and 2012 in Norway, including 646 adolescents and an accompanying parent. By using sample weights, the final weighted sample used in the analysis was 1326. Data was collected through postal questionnaires to parents and adolescents as well as parental telephone interviews. Questionnaires included questions on different pain locations and the pain for each location was graded according to how troubling the pain was. Medication data on prescription and non-prescription analgesics was from telephone interviews and was quantified based on the pattern over the past 4 weeks. Multivariate logistic regression models and complex samples analyses were used. RESULTS: 20% of adolescents were reported as using non-prescription analgesics during the previous 4 weeks. Girls were more often reported to use non-prescription analgesics than boys. Headache and all other somatic pain locations except back pain were reported more frequently among girls while boys more frequently reported back pain. There was a clear association between the use of non-prescription analgesics and headache with 34% of adolescents with headache using non-prescription analgesics versus 19% of adolescents with other somatic pain and 14% of adolescents not reporting pain. Among adolescents reporting headache, 9% were reported to use non-prescription analgesics daily or almost daily versus 3% and 2% among those reporting other somatic pain and reporting no pain respectively. In addition, parental use of non-prescription analgesics was a strong independent predictor of adolescent use (adjusted OR 1.69 for boys, 1.54 for girls). This relationship increased when the adolescents were less bothered by headache themselves. CONCLUSION: Headache is the dominant medication-driving pain for non-prescription analgesics among adolescents but parental medication use of non-prescription analgesics also strongly influences adolescent use. IMPLICATIONS: There is a need for health services to improve information to parents and adolescents about risks associated with use of analgesics and also to work on prophylactic strategies focusing on adolescents. Parents should be made aware that their medicine use strongly influences that of their children.

Associations between green area in school neighbourhoods and overweight and obesity among Norwegian adolescents.

The aim of the present study was to investigate the relationship between green areas and adolescents' body mass index (BMI). This is based on the notion that nature environment is known to have beneficial effects on human health, and that some of the explanation for this is that green areas are especially motivating or suitable as arenas for physical activity. We included 10,527 participants from the Norwegian Youth Study, which was conducted between 2001 and 2004. The participants reported body weight, height, and important potential confounding variables about lifestyle, family situation, and neighbourhood characteristics. Green area was assessed from land cover maps and we calculated the percentage of green areas within 1 km and 5 km buffers around the adolescents' schools. We found that the percentage of overweight and obese adolescents increased significantly when the percentage of green areas in the participants' surrounding increased (p < 0.001 for both outcomes and buffer sizes). The same results were found in logistic regression models where we adjusted for a large set of variables. As an example, the odds for being overweight was 1.38 times higher (95% CI: 1.02-1.85) for participants living in the most green surroundings compared to participants living in the least green surroundings (1 km buffer). Norwegian green areas are typically farmland, woods, and mountains, and we speculate if these areas are less accessible and attractive for adolescents, who might need more facilitated green areas for sport and physical activity.

The Relationship Between Violence and Psychological Distress Among Men and Women: Do Sense of Mastery and Social Support Matter?

The aims of this study were to examine associations between reported exposure to psychological and physical violence and psychological distress (PD) among men and women, and to explore the possible mediating or moderating roles of sense of mastery and social support. We used data from the nationally representative Norwegian Health and Level of Living Survey in 2005 and 2012 (Weighted N = 19,386). PD was measured with the Hopkins Symptom Checklist-25, using the subscales for anxiety and depression separately and in combination. Analyses were conducted using hierarchical logistic regression with complex sample adjustment. Altogether, 3.8% of men and 5.4% of women reported psychological violence during the last 12 months, while 2.3% and 1.6% reported physical violence, respectively. Both forms of violence were associated with excess risk of comorbid anxiety and depressive symptoms above clinical cut-point (CAD) in men and women alike, and CAD occurred more frequently than anxiety or depressive problems separately. Sense of mastery, but not social support, partly mediated the association between both forms of violence and CAD in men, whereas both partly mediated the association between psychological violence and CAD in women. No moderator role was indicated. Overall, the results provide evidence for excess risk of PD, particularly CAD, in men and women reporting exposure to violence. Sense of mastery and to a lesser degree social support were shown to constitute significant mediators, underscoring the importance of systems for strengthening coping strategies and social support among violence victims, such as psychological and practical support by the health services.

Caregivers' perception of factors associated with a healthy diet among people with intellectual disability living in community residences: A Concept mapping method.

BACKGROUND: Many people with intellectual disabilities (ID) living in community-based residences have been found to have unhealthy diet and weight disturbances. In Norway, a majority of people with ID live in such residences. AIMS: The aim of the study was to examine factors affecting the caregivers' opportunity to promote a healthy diet among the residents. METHODS AND PROCEDURES: A concept mapping methodology was adopted, including group-based brainstorming, idea synthesising, sorting, rating and analysis of the results. Informants were caregivers in four different community residences for people with mild to moderate ID in the southeast of Norway. A total of 13 informants were recruited (12 females and 1 male), and 10 informants completed two sessions. RESULTS: Eight clusters were identified as affecting the caregivers' ability to promote a healthy diet: "Availability and accessibility", "Guidance and autonomy", "Competence among staff", "Planning and involvement", "Customization", "External conditions affecting staff", "Legislation, rules and structure" and "Everyday challenges", each including both barriers and facilitators. CONCLUSIONS AND IMPLICATIONS: Multiple factors affect the caregivers' ability to promote a healthy diet. Caregivers' opportunity to promote a healthy diet is complex. Availability and accessibility of healthy food is crucial, but a healthy diet also requires time and competence among the caregivers.

Sense of mastery as mediator buffering psychological distress among people with diabetes.

AIMS: The purpose of this study was to examine the association between diabetes with or without other comorbid somatic diseases and depression and anxiety, and to explore the mediating role of sense of mastery and social support. METHODS: Data were obtained from a cross-sectional health survey conducted in Norway (n=6827). People with diabetes alone or with simultaneous comorbid somatic diseases were compared to a group with no known somatic diseases. RESULTS: Among people with diabetes alone, 16.3% reported having depression and anxiety. Having diabetes was associated with 3 times greater odds for anxiety compared to the control group, and 2 times greater odds for depression. Among individuals with diabetes and comorbid somatic diseases, 17.4% reported depression and 11.6% reported symptoms of anxiety. The odds for both were approximately 2 times greater than in the control group. Sense of mastery, but not social support, protected against depression in both groups and against anxiety in the diabetes with comorbidity group. CONCLUSIONS: Comorbidity between diabetes and other somatic diseases seems to be related to depression to a larger degree, whereas having diabetes alone relates more to anxiety. This can possibly be explained by the overall burden in the comorbidity group and the related absence of sense of mastery.

Coping strategies among adolescents with chronic headache and mental health problems: a cross-sectional population-based study.

To examine prevalence of mental health problems among adolescents with chronic headache and compare internal and external coping strategies in young people with chronic headaches with and without mental health problems. This study is based on a cross-sectional survey undertaken in Akershus County in Norway. A total of 19,985 adolescents were included in the study, covering lower secondary and upper secondary students, aged 13-19 years. Chronic headache was measured with a single item question based on headache frequency. Mental health was assessed by using the strengths and difficulties questionnaire (SDQ). Internal and external coping strategies were assessed through seven options for answering the question: What do you do/what happens when you are burdened by painful thoughts and feelings? Adolescents with chronic headaches showed more frequent mental health problems overall (23 %) compared to those without chronic headache (6 %). Logistic regression analyses showed that those adolescents having both chronic headaches and comorbid mental health problems more frequently used internal coping strategies, such as keeping feelings inside (OR 2.05), using abusive substances (OR 1.79) and talking oneself out of problems (OR 1.55), compared to those without mental health problems. Groups with mental health problems, especially with chronic headache, less frequently used the external strategy of talking to others about their problem than controls (OR 0.7-0.8). Factor analyses revealed significant differences in profiles of coping strategies between groups. We suggest that attention should be paid towards the high risk group that has both chronic headaches and mental health problems and their tendency to use destructive internal coping strategies.

Patients' recovery experiences of indoor plants and viewsof nature in a rehabilitation center.

BACKGROUND: There is an increasing interest in the possible healing factors connected to the presence of nature elements in health institutions. OBJECTIVE: The aim of the present study is to get a deeper understanding of how residents in a residential rehabilitation center experience the views through windows and the indoor plants, and whether and how the view and the plants can impact their recovery process. METHODS: In-depth individual and group interviews were conducted among 16 residents at a rehabilitation center in Norway. RESULTS: The participants said that the indoor plants and the view of nature were pleasant to look at and elicited feelings of relaxation and positive emotions which contributed to opportunities for reflection and contemplation. They expressed a feeling of connectedness to nature: a feeling of wholeness and spirituality elicited by the nature elements. They also expressed that the presence of nature elements contributed to a sense of being taken care of. CONCLUSIONS: The nature elements, such as a view of nature or indoor plants, seem to enhance opportunities for reflection, feelings of meaningfulness and sense of being taken care of which may strengthen their feeling of well-being and make them more resilient to the stressors in life.

The relationship between negative life events, psychological distress and life satisfaction: a population-based study.

PURPOSE: Negative life events may increase psychological distress and reduce life satisfaction (LS). This study investigates associations between negative life events and both positive and negative indicators of mental health and explores the extent to which these associations are buffered by sense of mastery and perceived social support. METHODS: Data were obtained from a large (N = 4,823), nationally representative sample of Norwegians aged 16 and older. Psychological distress was measured by The Hopkins Symptom Check List (HSCL-25), LS by a single question on overall satisfaction with life and negative life events by a 12-item list of threatening experiences. Moderating variables, sense of mastery and social support, were measured using standard instruments. RESULTS: Adjusting for age, sex, education and income, all of the negative life events were significantly associated with both psychological distress and LS, with the exception of events pertinent to bereavement. Of the life events examined, financial strain constituted the strongest predictor. Overall, negative life events were more closely associated with psychological distress than LS. Altogether, negative life events explained 22.3 and 11.4 % of the variance in psychological distress and LS, respectively. Sense of mastery, but not perceived social support, emerged as a moderating factor between financial strain and both psychological distress and LS. CONCLUSION: Negative life events are associated with higher psychological distress and lower LS, but the strength of the associations varies across events. The impact of financial strain and conflict appears particularly strong, but may be moderated by self-perceived mastery.

Health benefits of a view of nature through the window: a quasi-experimental study of patients in a residential rehabilitation center.

OBJECTIVE: To examine the health benefits of a bedroom window view to natural surroundings for patients undergoing a residential rehabilitation programme. DESIGN: Longitudinal quasi-experiment. SETTING: A residential rehabilitation centre. SUBJECTS: Two-hundred and seventy-eight coronary and pulmonary patients provided data at all measurement points during the programme. INTERVENTION: Blind, quasi-random allocation to a private bedroom with a panoramic view to natural surroundings or with a view either partially or entirely blocked by buildings. MAIN MEASURES: Self-reported physical and mental health (SF-12), subjective well-being, emotional states, use of the private bedroom and leisure activities. RESULTS: For women, a blocked view appeared to negatively influence change in physical health (time × view × gender interaction, F(4,504) = 2.51, P = 0.04), whereas for men, a blocked view appeared to negatively influence change in mental health (time × view × gender interaction, F(4,504) = 5.67, P < 0.01). Pulmonary patients with a panoramic view showed greater improvement in mental health than coronary patients with such a view (time × view × diagnostic group interaction, F(4,504) = 2.76, P = 0.03). Those with a panoramic view to nature more often chose to stay in their bedroom when they wanted to be alone than those with a blocked view (odds ratio (OR) = 2.32, 95% confidence interval (CI) 1.08-5.01). CONCLUSION: An unobstructed bedroom view to natural surroundings appears to have better supported improvement in self-reported physical and mental health during a residential rehabilitation programme, although the degree of change varied with gender and diagnostic group.