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1.  Associations of Child Temperament with Child Overweight and Breakfast Habits: A Population Study in Five-Year-Olds 
Nutrients  2015;7(12):10116-10128.
This study examines the associations of child temperament with overweight/obesity and breakfast habits. Participants were 17,409 five-year-olds whose mothers partake in the Norwegian Mother and Child Cohort Study (MoBa), and completed a questionnaire at the child’s 5th birthday. Temperament was assessed as externalizing, internalizing and sociable temperament. Breakfast habits differentiated between “every day”, “4 to 6 times a week”, and “0 to 3 times a week”. The child’s weight status was determined by Body Mass Index-percentiles and categorized as normal weight versus overweight/obese. Children with externalizing temperament had higher odds of being overweight and higher odds of not eating breakfast daily. Children high in internalizing temperament had higher odds of not eating breakfast daily, but not of being overweight. Children with average scores of sociability were more prone to being overweight but had normal breakfast habits. All results were adjusted for key confounders. That five-year-olds high in externalizing temperament had a higher risk to be overweight adds important information to the literature. The association of externalizing temperament with child breakfast habits so early in life is intriguing, as parents mostly control eating patterns in children that young. Mechanisms mediating this association should be explored.
PMCID: PMC4690074  PMID: 26633494
children; temperament; overweight; obesity; breakfast; cross-sectional
2.  Maternal Sick Leave Due to Psychiatric Disorders Following the Birth of a Child With Special Health Care Needs 
Journal of Pediatric Psychology  2015;40(8):804-813.
Objective Child-related stress following the birth of a child with special health care needs (SHCN) can take a toll on parental health. This study examined how the risk of sick leave due to psychiatric disorders (PD) among mothers of children with SHCN compares with that of mothers of children without SHCN during early motherhood. Methods Responses from 58,532 mothers participating in the Norwegian Mother and Child Cohort Study were linked to national registries and monitored for physician-certified sick leave from the month of their child’s first birthday until the month of their child’s fourth birthday. Results As compared with mothers of children without SHCN, mothers of children with mild and moderate/severe care needs were at substantial risk of a long-term sick leave due to PD in general and due to depression more specifically. Conclusions Extensive childhood care needs are strongly associated with impaired mental health in maternal caregivers during early motherhood.
PMCID: PMC4536848  PMID: 25911588
child care; depression; employment; Norwegian Mother and Child Cohort Study; sick leave; special health care needs; work absence
3.  Relationship Satisfaction Among Mothers of Children With Congenital Heart Defects: A Prospective Case-Cohort Study 
Journal of Pediatric Psychology  2013;38(8):915-926.
Objective To assess the level of partner relationship satisfaction among mothers of children with different severity of congenital heart defects (CHD) compared with mothers in the cohort. Methods Mothers of children with mild, moderate, or severe CHD (n = 182) and a cohort of mothers of children without CHD (n = 46,782) from the Norwegian Mother and Child Cohort Study were assessed at 5 time points from pregnancy to 36 months postpartum. A 5-item version of the Relationship Satisfaction scale was used, and relevant covariates were explored. Results The trajectories of relationship satisfaction among mothers of children with varying CHD severity did not differ from the trajectories in the cohort. All women in the cohort experienced decreasing relationship satisfaction from 18 months after delivery up to 36 months after delivery. Conclusions Having a child with CHD, regardless of severity, does not appear to exacerbate the decline in relationship satisfaction.
PMCID: PMC3747714  PMID: 23792348
chronic illness in children; congenital heart defects; motherhood; partnership; relationship stability
4.  Employment Trends During Preschool Years Among Mothers of Term Singletons Born with Low Birth Weight 
Maternal and Child Health Journal  2014;18(9):2195-2201.
Children born at term with low birth weight (LBW) are regarded growth restricted and are at particular risk of adverse health outcomes requiring a high degree of parental participation in the day-to-day care. This study examined whether their increased risk of special health care needs compared to other children may influence mothers’ opportunities for participation in the labor market at different times after delivery. Data from 32,938 participants in the population-based Norwegian Mother and Child Cohort Study with singleton children born at term in 2004–2006 were linked to national registers in order to investigate the mothers’ employment status when their children were 1–3 years in 2007 and 4–6 years in 2010. Children weighing less than two standard deviations below the gender-specific mean were defined as LBW children. Although not significantly different from mothers of children in the normal weight range, mothers of LBW children had the overall highest level of non-employment when the children were 1–3 years. At child age 4–6 years on the other hand, LBW was associated with an increased risk of non-employment (RR 1.39: 95 % CI 1.11–1.75) also after adjustment for factors associated with employment in general. In accordance with employment trends in the general population, our findings show that while mothers of normal birth weight children re-enter the labor market as their children grow older, mothers of LBW children born at term participate to a lesser extent in paid employment and remain at levels similar to those of mothers with younger children.
PMCID: PMC4198803  PMID: 24643811
Birth weight; Child care; Employment; Special health care needs; Work participation
5.  Smoking During Consecutive Pregnancies Among Primiparous Women in the Population-Based Norwegian Mother and Child Cohort Study 
Nicotine & Tobacco Research  2012;15(2):428-434.
This study investigated changes in smoking behavior across pregnancies in a sample of 10,890 primiparous women participating in the prospective population-based Norwegian Mother and Child Cohort Study (MoBa) in order to identify risk factors that may inhibit smoking cessation and promote smoking during a woman’s second pregnancy.
Registry information regarding smoking, age, marital status, parity, and year of birth was applied, in addition to questionnaire assessments of own and partner’s smoking behavior, educational attainment, and symptoms of anxiety and depression at weeks 17 and 30 of gestation from both pregnancies.
The vast majority did not smoke in either of the pregnancies, and more women quit smoking than relapsed to smoking in their second pregnancy. Among smokers in the first pregnancy, 30.9% quit smoking by their second pregnancy. Women living with a nonsmoking partner or a partner who quit between pregnancies were more likely to quit smoking, as were women smoking occasionally in their first pregnancy. Symptoms of psychological distress and increasing number of years between pregnancies were negatively associated with smoking cessation. Among women not smoking in their first pregnancy, 2.3% did smoke during their second. Living with a smoking partner, low educational attainment, symptoms of psychological distress, and increasing number of years between pregnancies were all associated with smoking during the second pregnancy.
These findings, linking smoking behavior to changes taking place between pregnancies, offer new and additional insight into modifiable risk factors that may help facilitate more targeted smoking cessation interventions for women at the highest risk.
PMCID: PMC3611994  PMID: 22855885
6.  Mixed Impact of Firearms Restrictions on Fatal Firearm Injuries in Males: A National Observational Study 
Introduction: Public health organizations have recommended restricted access and safe storage practices as means to reduce firearm injuries and deaths. We aimed to assess the effect of four firearm restrictions on firearm deaths in Norway 1969–2009. Methods: All deaths due to firearm discharge were included (5,660 deaths, both sexes). The statistical analysis to assess impact of firearm legislations was restricted to males because of the sex disproportionality (94% were males). Results: A total of 89% of firearm deaths (both sexes) were classified as suicide, 8% as homicide, and 3% as unintentional (accident). During the past four decades, male accidental firearm death rates were reduced significantly by 90%. Male firearms suicide rates increased from 1969 to 1991 by 166%, and decreased by 62% from 1991 to 2009. Despite the great reduction in male accidental firearm deaths, we were unable to demonstrate effects of the laws. In contrast, we found that a 1990 regulation, requiring a police permit before acquiring a shotgun, had a beneficial impact on suicide in the total sample and in those aged 15–34 years. Male firearm homicides decreased post-2003 regulation regarding storing home guard weapons in private homes. Conclusions: Our findings suggest that two laws could have contributed to reduce male firearm mortality. It is, however, a challenge to measure the role of four firearm restrictions. The null findings are inconclusive, as they may reflect no true impact or study limitations.
PMCID: PMC3924456  PMID: 24380979
accident; firearm deaths; firearms legislation; gun control; means restriction; military; suicide; unintentional firearm deaths
7.  Associations Between Temperament at Age 1.5 Years and Obesogenic Diet at Ages 3 and 7 Years 
To investigate whether temperament in 1.5-year-olds predicts their consumption of potentially obesogenic foods and drinks at ages 3 and 7 years.
Participants were 6 997 mothers and infants from the Norwegian Mother and Child Cohort Study. Questionnaires were collected during pregnancy, at birth, and at child ages 6 months and 1.5, 3, and 7 years. Predictor variables: children’s temperament at age 1.5 (internalizing, externalizing, surgent) and mothers’ negative affectivity. Outcome variables: children’s consumption of sweet foods, sweet drinks, and fruits/vegetables at ages 3 and 7 (dichotomized at the 85th percentile).
Controlling for covariates, internalizing 1.5-year-olds (anxious, dependent) were 77% and 63% more likely to consume sweet drinks daily at ages 3 and 7, respectively; they were 55% and 43% more likely to consume sweet foods daily at ages 3 and 7, respectively. Externalizing 1.5-year-olds (hyperactive, aggressive) were 34% more likely to consume sweet drinks daily at age 7, 39% and 44% more likely to consume sweet foods daily at ages 3 and 7, respectively, and they were 47% and 33% less likely to consume fruits/vegetables daily at ages 3 and 7, respectively. Surgent 1.5-year-olds (active, sociable) were 197% and 78% more likely to consume two portions of fruits/vegetables daily at ages 3 and 7, respectively. The association of maternal negative affectivity was limited to the child’s consumption of sweet foods at 3 and 7 years.
Early child temperament is a risk factor for obesogenic diet in later childhood. Mechanisms explaining this association need to be explored.
PMCID: PMC3492946  PMID: 23117597
child; temperament; obesity; diet; eating
8.  The Impact of Child Behaviour Problems on Maternal Employment: A Longitudinal Cohort Study 
This prospective population-based study examined associations between children’s behaviour problems and maternal employment. Information on children’s behaviour problems at 3 years from 22,115 mothers employed before pregnancy and participating in the Norwegian Mother and Child Cohort Study were linked to national register data on employment and relevant social background factors, mothers’ self-reported susceptibility to anxiety/depression and mother-reports of day-care attendance and fathers’ income. Mothers reporting their child to have severe (>2 SD) internalizing or severe combined behaviour problems (5 %) had excess risk of leaving paid employment irrespective of other important characteristics generally associated with maternal employment (RR 1.24–1.31). The attributable risk percent ranged from 30.3 % (internalizing problems) to 32.4 % (combined problems). Externalizing behaviour problems were not uniquely associated with mothers leaving employment.
PMCID: PMC4141146  PMID: 25165417
Employment; Behaviour problems; Child care; Child health; Work participation
9.  Trajectories of Maternal Mental Health: A Prospective Study of Mothers of Infants With Congenital Heart Defects From Pregnancy to 36 Months Postpartum 
Journal of Pediatric Psychology  2012;37(6):687-696.
Objective To chart mothers’ trajectories of mental health from pregnancy to 36 months postpartum in order to investigate the association between infants’ congenital heart defects (CHD) and compromised maternal mental health. Methods Mothers of infants with mild, moderate, or severe CHD (n = 141) and mothers (n = 36,437) enrolled in the Norwegian Mother and Child Cohort Study were assessed at regular intervals from pregnancy up to 36 months postpartum, including measurements at 6 and 18 months, using an 8-item version of the Hopkins Symptom Checklist-25. Results Mean score trajectories of SCL-8 for mothers of infants with severe CHD deviated significantly from cohort controls 6, 18, and 36 months postpartum, indicating heightened symptoms of depression and anxiety. Conclusions Mothers of infants with severe CHD are at risk of compromised mental health from delivery to 36 months postpartum. Strain due to CHD-related interventions is identified as a possible partial mediator of the distress.
PMCID: PMC3381713  PMID: 22408057
anxiety; critically ill children; depression; longitudinal research; parent stress
10.  Associations Between Maternal Stress and Smoking: Findings from a Population-Based Prospective Cohort Study 
Addiction (Abingdon, England)  2012;107(6):1168-1173.
To investigate associations between maternal stress and smoking prior to, during, and six months after the pregnancy.
A prospective population-based cohort study.
71,757 women in the Norwegian Mother and Child Cohort Study (MoBa) participating twice during pregnancy and at six months postpartum.
Respondents’ estimates of anxiety and depression, relationship discord, and negative life events were measured along with self-reports of smoking behaviour and demographic variables. Smoking was assessed at gestation weeks 17 and 30 and at six months postpartum.
Of the 27.5% women who smoked at conception, 55.8% quit smoking during pregnancy. At six months postpartum, 28.9% of quitters had relapsed to smoking. In total, 12.9% of the sample reported smoking during the pregnancy. Adjusted for well-known risk factors, women reporting high levels of anxiety and depression had a decreased likelihood of quitting smoking during pregnancy (OR 0.80: 95% CI 0.73, 0.88) and an increased likelihood of relapsing after delivery (OR 1.26: 95% CI 1.11, 1.44). Both relationship discord (OR 0.82: 95% CI 0.75, 0.90) and exposure to negative life events (OR 0.93: 95% CI 0.90, 0.96) had a negative influence on quitting smoking during pregnancy but had no influence on relapse to smoking postpartum.
Maternal stress and relationship discord may inhibit smoking cessation during pregnancy and promote resumption of smoking after pregnancy in women who have achieved abstinence.
PMCID: PMC3321079  PMID: 22188214
Anxiety; Depression; Pregnancy; Risk Factors; Smoking; Smoking Cessation
11.  Children and Eating: Personality and Gender are Associated with Obesogenic Food Consumption and Overweight in 6- to 12-Year-Olds 
Appetite  2012;58(3):1113-1117.
The role of children's personality traits in the consumption of potentially obesogenic foods was investigated in a sample of Norwegian children aged 6–12 years (N = 327, 170 boys, 157 girls). Mothers rated their child's personality on the traits of the Five Factor Model (i.e., Extraversion, Benevolence, Conscientiousness, Neuroticism, and Imagination). Mothers also completed a food frequency questionnaire assessing their child's consumption of sweet drinks, sweet foods, and fruit and vegetables, and reported their child's height and weight. Controlling for age and mothers' education, boys and girls who were less benevolent consumed more sweet drinks, and girls who were less conscientious and more neurotic consumed more sweet drinks. Boys and girls who were more benevolent and imaginative consumed more fruits and vegetables, and boys who were more extraverted, more conscientious, and less neurotic consumed more fruits and vegetables. Controlling for maternal education, boys and girls who were less extraverted, and girls who were less benevolent, less conscientious, and more neurotic were more likely to be overweight or obese. These findings suggest that children's personality traits play an important yet understudied role in their diet. Further investigation of mechanisms that relate child traits to obesogenic eating and overweight would be valuable.
PMCID: PMC3340452  PMID: 22425617
Eating; diet; food consumption; weight; obesity; personality; temperament; behavior problems; gender; children
12.  Infant Temperament is Associated with Potentially Obesogenic Diet at 18 Months 
This study investigated whether infants’ temperament at 18 months is associated with the feeding of foods and drinks that may increase the risk for later obesity.
This was a cross-sectional study of mothers and infants (N = 40,266) participating in the Norwegian Mother and Child Cohort Study conducted by the Norwegian Institute of Public Health. Data were collected by questionnaire. Predictor variables were: infants’ temperament at 18 months (internalizing, externalizing, and surgency/extraversion), and mothers’ negative affectivity. Outcomes variables were feeding of sweet foods, sweet drinks, and night-time caloric drinks at 18 months (all dichotomized). Confounders were child’s gender, weight-for-height at 18 months, breastfeeding, and mother’s level of education.
After controlling for confounders, infant temperament dimensions at 18 months were significantly associated with mothers’ feeding of potentially obesogenic foods and drinks independent of mothers’ negative affectivity. Infants who were more internalizing were more likely to be given sweet foods (OR 1.47, CI 1.32–1.65), sweet drinks (OR 1.76, CI 1.56–1.98), and drinks at night (OR 2.91, CI 2.54–3.33); infants who were more externalizing were more likely to be given sweet food (OR 1.53, CI 1.40–1.67) and sweet drinks (OR 1.22, CI 1.11–1.34); and infants who were more surgent were more likely to be given drinks at night (OR1.66, CI 1.42–1.92).
The association between infant temperament and maternal feeding patterns suggests early mechanisms for later obesity that should be investigated in future studies.
PMCID: PMC3128685  PMID: 20854098
infant temperament; sweet foods; sweet drinks; night-time caloric drinks
13.  Long-Term Symptoms of Depression and Anxiety in Mothers of Infants with Congenital Heart Defects 
Journal of Pediatric Psychology  2010;36(2):179-187.
Objective To examine the relationship between the severity of infants’ congenital heart defects (CHD) and their mothers’ symptoms of depression and anxiety from pregnancy to 18 months postpartum. Methods Mothers of infants with mild, moderate, or severe CHD (n = 162) and mothers (n = 44 400) within the Norwegian Mother and Child Cohort Study were assessed with an eight-item short version (SCL-8) of the Hopkins Symptom Checklist-25 at the 30th week of gestation and at 6 and 18 months postpartum. Results Only the postpartum mental health trajectory of mothers of infants with severe CHD deviated from the mental health trajectory of the cohort at 6 and 18 months postpartum, showing significantly elevated levels of depression and anxiety symptoms. Conclusions The results elucidate the relationship between infants’ CHD severity and maternal symptoms of depression and anxiety, possibly identifying a specifically vulnerable patient dyad in need of postoperative interventions.
PMCID: PMC3042598  PMID: 20558484
anxiety; cardiology; depression; mental health; motherhood
14.  A prospective study of weight development and behavior problems in toddlers: the Norwegian Mother and Child Cohort Study 
BMC Public Health  2010;10:626.
Previous research has suggested that overweight children have a higher risk of behavior problems, but the causal direction of this relationship remains unclear. In a large prospective population study, we investigated whether child behavior problems and body mass index are associated in toddlers and whether overweight is a risk for behavior problems or vice versa.
The study was part of the Norwegian Mother and Child Cohort Study. The sample consisted of 10 860 toddlers, followed up to age 36 months. We used data from maternal questionnaires from gestation week 17 and at child ages 18 and 36 months, and data from the Medical Birth Registry of Norway. Child height and weight were assessed at child health stations and recorded by mothers. Behavior problems were assessed using shortened subscales from the Child Behavior Checklist. Statistical analyses were conducted using structural equation modeling.
Behavior problems in toddlers were not associated with higher body mass index cross-sectionally at either age 18 or 36 months, and there was no indication that behavior problems caused increasing body mass index over time or vice versa.
The association between behavior problems and body mass index found in older children did not appear in toddlers up to age 36 months. Future studies should focus on the age span from 3 to 6 years, which includes the period of adiposity rebound.
PMCID: PMC2972243  PMID: 20961446
15.  Mothers’ Negative Affectivity During Pregnancy and Food Choices for Their Infants 
To investigate whether maternal negative affectivity assessed in pregnancy is related to subsequent infant food choices.
Cohort study.
Mothers (N = 37, 919) and their infants participating in the Norwegian Mother and Child Cohort Study conducted by the Norwegian Institute of Public Health.
Maternal negative affectivity assessed pre-partum (SCL-5 at week 17 and 30 of pregnancy), introduction of solid foods by month 3, and feeding of sweet drinks by month 6 (by mothers’ reports).
Mothers with higher negative affectivity were 64% more likely (95% CI 1.5–1.8) to feed sweet drinks by month 6, and 79% more likely (95% CI 1.6–2.0) to introduce solid foods by month 3. These odds decreased to 41% and 30%, respectively, after adjusting for mother’s age, body mass index, and education.
The maternal trait of negative affectivity is an independent predictor of infant feeding practices that may be related to childhood weight gain, overweight, and obesity.
PMCID: PMC2822132  PMID: 19918247
maternal feeding practices; negative affectivity; solid foods; sweet drinks
16.  Prediction of posttraumatic stress in fathers of children with chronic diseases or unintentional injuries: a six-months follow-up study 
While fathers were neglected for a long time in research investigating families of pediatric patients, there are now a few studies available on fathers' posttraumatic stress symptoms (PTSS) and posttraumatic stress disorder (PTSD). However, little is known about the course of PTSS and PTSD in fathers of pediatric patients. The present study aimed to compare the prevalence and course of PTSS and PTSD in fathers of children with different chronic and acute conditions and to identify factors that contribute to fathers' PTSS.
Sixty-nine fathers of children newly diagnosed with either cancer, type I diabetes mellitus, or epilepsy and 70 fathers of children suffering from an unintentional injury completed questionnaires at 4–6 weeks (Time 1) and six months (Time 2) after diagnosis or injury.
Noticeable PTSD rates were found in fathers of children with a chronic disease (26% at Time 1 and 21% at Time 2, respectively). These rates were significantly higher than rates found in fathers of children with unintentional injuries (12% at Time 1 and 6% at Time 2, respectively). Within six months after the child's diagnosis or accident a decrease in severity of PTSS was observed in both groups. Significant predictors of PTSS at Time 2 were the father's initial level of PTSS, the child's medical condition (injuries vs. chronic diseases) and functional status, the father's use of dysfunctional coping strategies, and father's level of neuroticism.
Our findings suggest that fathers with initially high PTSS levels are at greater risk to experience PTSS at follow-up, particularly fathers of children with a chronic disease. Sensitizing health care professionals to the identification of PTSS symptoms but also to indicators of neuroticism and the use of specific coping strategies early in the treatment course is essential for the planning and implementation of adequate intervention strategies.
PMCID: PMC2235824  PMID: 18086307
17.  Health-related quality of life in children with newly diagnosed cancer: a one year follow-up study 
Most studies on health-related quality of life (HRQOL) in children with cancer focussed on survivors. Only few studies have evaluated patients during ongoing oncological treatment. The aim of this study was a prospective assessment of HRQOL in children during the first year after diagnosis of cancer and an examination of demographic, medical, and parental predictors of HRQOL.
Fifty-two patients (mean age: 10.9 years) were assessed 6 weeks and 1 year after diagnosis with the TNO-AZL Questionnaire for Children's Health-Related Quality of Life. Parents completed the Brief Symptom Inventory.
Compared to a community sample, patients reported more physical complaints, reduced motor functioning and autonomy, and impaired positive emotional functioning 6 weeks after diagnosis. HRQOL significantly improved over the year. However, at 1 year, patients still showed reduced motor and emotional functioning. At 6 weeks, children with leukemia were most affected. At 1 year, patients with brain tumors complained about more physical symptoms than the other groups. Intensity of treatment and presence of medical complications mainly influenced HRQOL at 6 weeks but less at 1 year. Parental psychopathology was associated with better cognitive functioning in the child.
This prospective study found several domains of HRQOL to be compromised 6 weeks and 1 year after the diagnosis of cancer. Although HRQOL significantly increased over the year, there were important differences between diagnostic groups. The findings highlight the importance of repeated evaluation of HRQOL in children undergoing cancer treatment and consideration of specific differences between diagnostic groups.
PMCID: PMC1590012  PMID: 16987419

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