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1.  Television Viewing and Low Leisure-Time Physical Activity in Adolescence Independently Predict the Metabolic Syndrome in Mid-Adulthood 
Diabetes Care  2013;36(7):2090-2097.
We investigated whether television (TV) viewing and low leisure-time physical activity in adolescence predict the metabolic syndrome in mid-adulthood.
TV viewing habits and participation in leisure-time physical activity at age 16 years were assessed by self-administered questionnaires in a population-based cohort in Northern Sweden. The presence of the metabolic syndrome at age 43 years was ascertained in 888 participants (82% of the baseline sample) using the International Diabetes Federation criteria. Odds ratios (ORs) and CIs were calculated using logistic regression.
The overall prevalence of the metabolic syndrome at age 43 years was 26.9%. Adjusted OR for the metabolic syndrome at age 43 years was 2.14 (95% CI 1.24–3.71) for those who reported “watching several shows a day” versus “one show/week” or less and 2.31 (1.13–4.69) for leisure-time physical activity “several times/month” or less compared with “daily” leisure-time physical activity at age 16 years. TV viewing at age 16 years was associated with central obesity, low HDL cholesterol, and hypertension at age 43 years, whereas low leisure-time physical activity at age 16 years was associated with central obesity and triglycerides at age 43 years.
Both TV viewing and low leisure-time physical activity in adolescence independently predicted the metabolic syndrome and several of the metabolic syndrome components in mid-adulthood. These findings suggest that reduced TV viewing in adolescence, in addition to regular physical activity, may contribute to cardiometabolic health later in life.
PMCID: PMC3687313  PMID: 23340896
2.  When Does Hardship Matter for Health? Neighborhood and Individual Disadvantages and Functional Somatic Symptoms from Adolescence to Mid-Life in the Northern Swedish Cohort 
PLoS ONE  2014;9(6):e99558.
A large body of research has shown that health is influenced by disadvantaged living conditions, including both personal and neighborhood conditions. Little is however known to what degree the health impact of different forms of disadvantage differ along the life course. The present study aims to examine when, during the life course, neighborhood and individual disadvantages relate to functional somatic symptoms. Participants (n = 992) came from The Northern Swedish Cohort and followed from age 16, 21, 30 until 42 years. Functional somatic symptoms, socioeconomic disadvantage, and social and material adversity were measured through questionnaires and linked to register data on neighborhood disadvantage. Data was analyzed with longitudinal and cross-sectional multilevel models. Results showed that neighborhood disadvantage, social and material adversity and gender all contributed independently to overall levels of symptoms across the life course. Cross-sectional analyses also suggested that the impact of disadvantage differed between life course periods; neighborhood disadvantage was most important in young adulthood, and the relative importance of material versus social adversity increased as participants grew older. In summary, the study suggests that disadvantages from different contextual sources may affect functional somatic health across the life course, but also through life course specific patterns.
PMCID: PMC4055700  PMID: 24924384
3.  History of labour market attachment as a determinant of health status: a 12-year follow-up of the Northern Swedish Cohort 
BMJ Open  2014;4(2):e004053.
The present study aims at using trajectory analysis to measure labour market attachment (LMA) over 12 years and at examining whether labour market tracks relate to perceived health status.
Data were retrieved from a 26-year prospective cohort study, the Northern Swedish Cohort.
Setting and participants
All ninth grade students (n=1083) within the municipality of Luleå in northern Sweden were included in the baseline investigation in 1981. The vast majority (94%) of the original cohort participated at the fourth follow-up. In this study, 969 participants were included.
Perceived health status (psychological distress and non-optimal self-rated health) at age 42 and the data obtained from questionnaires.
We have identified four tracks in relation to LMA across the 12-year period: ‘permanent’, ‘high level’, ‘strengthening’ and ‘poor level’ of attachment. LMA history relates to psychological distress. High level (OR 1.55 (95% CI 1.06 to 2.27)), strengthening (OR 1.95 (95% CI 1.29 to 2.93)) and poor attachment (OR 3.14 (95% CI 2.10 to 4.70) involve higher OR for psychological distress compared with permanent attachment. The overall p value remained significant in the final model (p=0.001). Analyses regarding non-optimal self-rated health displayed a similar pattern but this was not significant in the final model.
Our results suggest that health status in mid-life, particularly psychological distress, is related to patterns of LMA history, to a large part independently of other social risk factors and previous health. Consideration of heterogeneity and time in LMA might be important when analysing associations with perceived health.
PMCID: PMC3927714  PMID: 24531448
Epidemiology; Occupational & Industrial Medicine; Public Health
4.  Residential Selection across the Life Course: Adolescent Contextual and Individual Determinants of Neighborhood Disadvantage in Mid-Adulthood 
PLoS ONE  2013;8(11):e80241.
Numerous cross-sectional studies have examined neighborhood effects on health. Residential selection in adulthood has been stressed as an important cause of selection bias but has received little empirical attention, particularly its determinants from the earlier life course. The present study aims to examine whether neighborhood, family, school, health behaviors and health in adolescence are related to socioeconomic disadvantage of one's neighborhood of residence in adulthood.
Based on the prospective Northern Swedish Cohort (analytical N = 971, 90.6% retention rate), information was collected at age 16 years concerning family circumstances, school adjustment, health behaviors and mental and physical health. Neighborhood register data was linked to the cohort and used to operationalize aggregated measures of neighborhood disadvantage (ND) at age 16 and 42. Data was analyzed with linear mixed models, with ND in adulthood regressed on adolescent predictors and neighborhood of residence in adolescence as the level-2 unit.
Neighborhood disadvantage in adulthood was clustered by neighborhood of residence in adolescence (ICC = 8.6%). The clustering was completely explained by ND in adolescence. Of the adolescent predictors, ND (b = .14 (95% credible interval = .07–.22)), final school marks (b = −.18 (−.26–−.10)), socioeconomic disadvantage (b = .07 (.01–.14)), and, with borderline significance, school peer problems (b = .07 (−.00–.13)), were independently related to adulthood ND in the final adjusted model. In sex-stratified analyses, the most important predictors were school marks (b = −.21 (−.32–−.09)) in women, and neighborhood of residence (ICC = 15.5%) and ND (b = .20 (.09–.31)) in men.
These findings show that factors from adolescence – which also may impact on adult health – could influence the neighborhood context in which one will live in adulthood. This indicates that residential selection bias in neighborhood effects on health research may have its sources in early life.
PMCID: PMC3837001  PMID: 24278263
5.  Is the core-periphery labour market structure related to perceived health? findings of the Northern Swedish Cohort 
BMC Public Health  2011;11:956.
There is controversy as to whether peripheral employment is related to poor health status or not. This study aims at examining whether 1) the accumulation of time in peripheral labour market positions is associated with psychological distress and poor or average self-rated health; 2) the proposed association is different among women than among men.
Participants in the 1995 and 2007 follow-up surveys of the Northern Swedish Cohort (n = 985) completed self-administered questionnaires about psychological and general health and about employment positions during the follow-up years. Associations between 12 year peripheral labour market positions (no, low, medium and high exposure) and health were examined using logistic regression.
Exposure to peripheral employment was positively related to psychological distress in both women and men (p-values for trend < 0.001). Adjustment for sociodemographics and psychological distress at baseline, as well as for unemployment and being out of the labour market at the follow-up, resulted in attenuation of the odds ratios, particularly in the group with high exposure to peripheral employment, although results remained significant in men in the fully adjusted model. Women and men with high exposure to peripheral employment had high odds of poor or average self-rated health, but the association was rendered non-significant after adjustment for the covariates.
Our findings suggest that exposure to peripheral employment positions has an impact particularly on mental health, partly due to the over-representation of other unfavourable social and employment conditions among those with substantial exposure to peripheral employment.
PMCID: PMC3315772  PMID: 22202436
Cohort; Employment; Health; Psychological distress; Public health
6.  Social and Material Adversity from Adolescence to Adulthood and Allostatic Load in Middle-Aged Women and Men: Results from the Northern Swedish Cohort 
Annals of Behavioral Medicine  2011;43(1):117-128.
Little is known about the theoretically assumed association between adversity exposure over the life course and allostatic load in adulthood.
This study aims to examine whether social and material adversity over the life course is related to allostatic load in mid-adulthood.
A 27-year prospective Swedish cohort (N = 822; 77% response rate) reported exposure to social and material adversities at age 16, 21, 30 and 43 years. At age 43, allostatic load was operationalized based on 12 biological parameters.
Social adversity accumulated over the life course was related to allostatic load in both women and men, independently of cumulative socioeconomic disadvantage. Moreover, social adversity in adolescence (in women) and young adulthood (in men) was related to allostatic load, independently of cumulative socioeconomic disadvantage and also of later adversity exposure during adulthood.
Exposure to adversities involving relational threats impacts on allostatic load in adulthood and operates according to life course models of cumulative risk and a sensitive period around the transition into adulthood.
Electronic supplementary material
The online version of this article (doi:10.1007/s12160-011-9309-6) contains supplementary material, which is available to authorized users.
PMCID: PMC3274686  PMID: 22031214
Allostatic load; Life course; Stressors; Prospective study
7.  Fetal and life course origins of serum lipids in mid-adulthood: results from a prospective cohort study 
BMC Public Health  2010;10:484.
During the past two decades, the hypothesis of fetal origins of adult disease has received considerable attention. However, critique has also been raised regarding the failure to take the explanatory role of accumulation of other exposures into consideration, despite the wealth of evidence that social circumstances during the life course impact on health in adulthood. The aim of the present prospective cohort study was to examine the contributions of birth weight and life course exposures (cumulative socioeconomic disadvantage and adversity) to dyslipidemia and serum lipids in mid-adulthood.
A cohort (effective n = 824, 77%) was prospectively examined with respect to self-reported socioeconomic status as well as stressors (e.g., financial strain, low decision latitude, separation, death or illness of a close one, unemployment) at the ages of 16, 21, 30 and 43 years; summarized in cumulative socioeconomic disadvantage and cumulative adversity. Information on birth weight was collected from birth records. Participants were assessed for serum lipids (total cholesterol, low- and high-density lipoprotein cholesterol and triglycerides), apolipoproteins (A1 and B) and height and weight (for the calculation of body mass index, BMI) at age 43. Current health behavior (alcohol consumption, smoking and snuff use) was reported at age 43.
Cumulative life course exposures were related to several outcomes; mainly explained by cumulative socioeconomic disadvantage in the total sample (independently of current health behaviors but attenuated by current BMI) and also by cumulative adversity in women (partly explained by current health behavior but not by BMI). Birth weight was related only to triglycerides in women, independently of life course exposures, health behaviors and BMI. No significant association of either exposure was observed in men.
Social circumstances during the life course seem to be of greater importance than birth weight for dyslipidemia and serum lipid levels in adulthood.
PMCID: PMC2936420  PMID: 20712860
8.  Is body size at birth related to circadian salivary cortisol levels in adulthood? Results from a longitudinal cohort study 
BMC Public Health  2010;10:346.
The hypothesis of fetal origins of adult disease has during the last decades received interest as an explanation of chronic, e.g. cardiovascular, disease in adulthood stemming from fetal environmental conditions. Early programming and enduring dysregulations of the hypothalamic-pituitary-adrenal (HPA axis), with cortisol as its end product, has been proposed as a possible mechanism by which birth weight influence later health status. However, the fetal origin of the adult cortisol regulation has been insufficiently studied. The present study aims to examine if body size at birth is related to circadian cortisol levels at 43 years.
Participants were drawn from a prospective cohort study (n = 752, 74.5%). Salivary cortisol samples were collected at four times during one day at 43 years, and information on birth size was collected retrospectively from delivery records. Information on body mass during adolescence and adulthood and on health behavior, medication and medical conditions at 43 years was collected prospectively by questionnaire and examined as potential confounders. Participants born preterm or < 2500 g were excluded from the main analyses.
Across the normal spectrum, size at birth (birth weight and ponderal index) was positively related to total (area under the curve, AUC) and bedtime cortisol levels in the total sample. Results were more consistent in men than in women. Descriptively, participants born preterm or < 2500 g also seemed to display elevated evening and total cortisol levels. No associations were found for birth length or for the cortisol awakening response (CAR).
These results are contradictory to previously reported negative associations between birth weight and adult cortisol levels, and thus tentatively question the assumption that only low birth weight predicts future physiological dysregulations.
PMCID: PMC2908578  PMID: 20553630
9.  The psychometric properties of the Trauma Symptom Checklist for Young Children in a sample of Swedish children 
European Journal of Psychotraumatology  2012;3:10.3402/ejpt.v3i0.18505.
To evaluate the psychometric properties of the Swedish version of Trauma Symptom Checklist for Young Children (TSCYC).
The study was composed of a total of 629 children—296 girls and 333 boys—aged 3–11, from a non-clinical population who were rated by their caretakers (26 of whom performed a re-test after 2 weeks) in addition to 59 children from a clinical population with known experience of sexual and/or physical abuse. The caretakers from the normal population completed the TSCYC and Lifetime Incidence of Traumatic Events Scale-parent scale (LITE-P) and the clinical-sample caretakers completed TSCYC. The psychometric properties of the TSCYC were examined, including reliability and validity.
The reliability (Cronbach's alpha) of the TSCYC, total scale, was α = 0.93 (normative group) and α = 0.96 (clinical group). For the clinical scales, this ranged between α = 0.55–0.88 and 0.77–0.93, respectively. Test-retest for the total scale was r=0.77. Regarding criterion-related validity, the clinical groups scored significantly higher than the normative group, and within the normative group significant relationships were found between exposure to traumatic events and TSCYC scores. Confirmatory factor analysis testing of the construction of the TSCYC indicated significant loadings on the original scales.
The Swedish version of TSCYC appears to be a screening instrument with satisfactory psychometric qualities for identifying symptoms after trauma in young children. The instrument can also be recommended to clinicians for screening purposes in a European context.
PMCID: PMC3409352  PMID: 22893848
post-traumatic stress; young children; assessment; trauma; TSCYC
10.  Do Peer Relations in Adolescence Influence Health in Adulthood? Peer Problems in the School Setting and the Metabolic Syndrome in Middle-Age 
PLoS ONE  2012;7(6):e39385.
While the importance of social relations for health has been demonstrated in childhood, adolescence and adulthood, few studies have examined the prospective importance of peer relations for adult health. The aim of this study was to examine whether peer problems in the school setting in adolescence relates to the metabolic syndrome in middle-age. Participants came from the Northern Swedish Cohort, a 27-year cohort study of school leavers (effective n = 881, 82% of the original cohort). A score of peer problems was operationalized through form teachers’ assessment of each student’s isolation and popularity among school peers at age 16 years, and the metabolic syndrome was measured by clinical measures at age 43 according to established criteria. Additional information on health, health behaviors, achievement and social circumstances were collected from teacher interviews, school records, clinical measurements and self-administered questionnaires. Logistic regression was used as the main statistical method. Results showed a dose-response relationship between peer problems in adolescence and metabolic syndrome in middle-age, corresponding to 36% higher odds for the metabolic syndrome at age 43 for each SD higher peer problems score at age 16. The association remained significant after adjustment for health, health behaviors, school adjustment or family circumstances in adolescence, and for psychological distress, health behaviors or social circumstances in adulthood. In analyses stratified by sex, the results were significant only in women after adjustment for covariates. Peer problems were significantly related to all individual components of the metabolic syndrome. These results suggest that unsuccessful adaption to the school peer group can have enduring consequences for metabolic health.
PMCID: PMC3384652  PMID: 22761778
11.  Social Adversity in Adolescence Increases the Physiological Vulnerability to Job Strain in Adulthood: A Prospective Population-Based Study 
PLoS ONE  2012;7(4):e35967.
It has been argued that the association between job strain and health could be confounded by early life exposures, and studies have shown early adversity to increase individual vulnerability to later stress. We therefore investigated if early life exposure to adversity increases the individual's physiological vulnerability job strain in adulthood.
Methodology/Principal Findings
In a population-based cohort (343 women and 330 men, 83% of the eligible participants), we examined the association between on the one hand exposure to adversity in adolescence, measured at age 16, and job strain measured at age 43, and on the other hand allostatic load at age 43. Adversity was operationalised as an index comprising residential mobility and crowding, parental loss, parental unemployment, and parental physical and mental illness (including substance abuse). Allostatic load summarised body fat, blood pressure, inflammatory markers, glucose, blood lipids, and cortisol regulation. There was an interaction between adversity in adolescence and job strain (B = 0.09, 95% CI 0.02 to 0.16 after adjustment for socioeconomic status), particularly psychological demands, indicating that job strain was associated with increased allostatic load only among participants with adversity in adolescence. Job strain was associated with lower allostatic load in men (β = −0.20, 95% CI −0.35 to −0.06).
Exposure to adversity in adolescence was associated with increased levels of biological stress among those reporting job strain in mid-life, indicating increased vulnerability to environmental stressors.
PMCID: PMC3338487  PMID: 22558285

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