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1.  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.
Introduction:
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.
Methods:
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.
Results:
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.
Conclusions:
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.
doi:10.1093/ntr/nts147
PMCID: PMC3611994  PMID: 22855885
2.  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.
doi:10.3390/ijerph110100487
PMCID: PMC3924456  PMID: 24380979
accident; firearm deaths; firearms legislation; gun control; means restriction; military; suicide; unintentional firearm deaths
3.  Associations Between Temperament at Age 1.5 Years and Obesogenic Diet at Ages 3 and 7 Years 
Objective
To investigate whether temperament in 1.5-year-olds predicts their consumption of potentially obesogenic foods and drinks at ages 3 and 7 years.
Methods
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).
Results
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.
Conclusion
Early child temperament is a risk factor for obesogenic diet in later childhood. Mechanisms explaining this association need to be explored.
doi:10.1097/DBP.0b013e31826bac0d
PMCID: PMC3492946  PMID: 23117597
child; temperament; obesity; diet; eating
4.  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.
doi:10.1093/jpepsy/jss044
PMCID: PMC3381713  PMID: 22408057
anxiety; critically ill children; depression; longitudinal research; parent stress
5.  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.
doi:10.1016/j.appet.2012.02.056
PMCID: PMC3340452  PMID: 22425617
Eating; diet; food consumption; weight; obesity; personality; temperament; behavior problems; gender; children
6.  Infant Temperament is Associated with Potentially Obesogenic Diet at 18 Months 
Objective
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.
Methods
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.
Results
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).
Conclusions
The association between infant temperament and maternal feeding patterns suggests early mechanisms for later obesity that should be investigated in future studies.
doi:10.3109/17477166.2010.518240
PMCID: PMC3128685  PMID: 20854098
infant temperament; sweet foods; sweet drinks; night-time caloric drinks
7.  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.
doi:10.1093/jpepsy/jsq054
PMCID: PMC3042598  PMID: 20558484
anxiety; cardiology; depression; mental health; motherhood
8.  A prospective study of weight development and behavior problems in toddlers: the Norwegian Mother and Child Cohort Study 
BMC Public Health  2010;10:626.
Background
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.
Methods
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.
Results
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.
Conclusions
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.
doi:10.1186/1471-2458-10-626
PMCID: PMC2972243  PMID: 20961446
9.  Prediction of posttraumatic stress in fathers of children with chronic diseases or unintentional injuries: a six-months follow-up study 
Background
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.
Methods
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.
Results
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.
Conclusion
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.
doi:10.1186/1753-2000-1-16
PMCID: PMC2235824  PMID: 18086307

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