Heterogeneous effects of increased availability of alcohol on hospitalisation due to external causes. Quasi-experimental evidence from the introduction of Saturday opening at Swedish alcohol retail stores.

Responses to increased alcohol availability may vary across the population as a function of differential vulnerability. This study therefore aimed to examine the effects of the implementation of Saturday opening at the Swedish alcohol retail monopoly in 2000 on risks of hospitalisation due to external causes (HEC) among different population subgroups. Leveraging the experimental design of the reform, longitudinal difference-in-differences analyses were applied to a register-based cohort of individuals aged 20-40 at the time of implementation. The population was stratified into groups of Swedish, Finnish, and Middle Eastern origin, known to represent different levels of alcohol consumption and rates of alcohol-related morbidity. Results showed a 17.7% increase (p<0.029) in the risk of HEC among individuals of Finnish origin, as jointly caused by both increased prevalence in the experiment area and decreased prevalence in the control area. The increase was primarily driven by younger men with lower levels of education. Those of Swedish origin exhibited largely similar patterns (9.7% increase; p<0.001) while no measurable impact was observed among individuals of Middle Eastern origin (-21.4% decrease; p<0.076). The findings confirm that increasing alcohol availability contributes to the disease burden related to alcohol among population subgroups already susceptible to its effects.

Effects of a multi-component alcohol prevention program in the workplace on hazardous alcohol use among employees.

BACKGROUND: The workplace can be affected negatively by hazardous alcohol use, and intervening at an early stage remains a challenge. Recently, a multi-component alcohol prevention program, Alcohol Policy and Managers' skills Training (hereafter, 'APMaT'), was delivered at the organizational level. In a previous outcome evaluation, APMaT appeared to be effective at the managerial level. The current study takes a step further by aiming to evaluate the effectiveness of APMaT in decreasing the alcohol risk level among employees. METHODS: Data from 853 employees (control: n = 586; intervention: n = 267) were gathered through a cluster-randomized study. To analyze changes in the odds of hazardous alcohol use among employees, multilevel logistic regression was applied using group (control vs. intervention), time (baseline vs. 12-month follow-up), and the multiplicative interaction term (group × time) as the main predictors. The intervention effect was further adjusted for sociodemographic characteristics and policy awareness. RESULTS: No statistically significant difference was observed in the odds of hazardous alcohol use, although employees in the intervention group showed a larger decrease compared to the control group. This remained even after adjusting for several factors, including the sociodemographic factors and policy awareness. CONCLUSIONS: The findings are insufficient to determine the effectiveness of APMaT at the employee level at the current stage of the evaluation. Future studies should strive to identify issues with implementation processes in workplace-based alcohol interventions. TRIAL REGISTRATION: The trial was retrospectively registered on 11/10/2019; ISCRTN ID: ISRCTN17250048.

Is there a peer status gradient in mortality? Findings from a Swedish cohort born in 1953 and followed to age 67.

BACKGROUND: Similar to having a less advantaged socioeconomic position, children in lower peer status positions typically experience a situation characterized by less power, influence and command over resources, followed by worse health outcomes. The aim of this study was to examine whether peer status position is further associated with increased risks for premature all-cause mortality. METHODS: Data were drawn from a 1953 cohort born in Stockholm, Sweden. Peer status positions were established through survey data on peer nominations within the school class at age 13, whereas national registers were used to identify all-cause mortality across ages 14-67. Differences in hazard rates and median survival time, according to peer status position, were estimated with Cox regression and Laplace regression, respectively. RESULTS: Although differences in hazard rates were not large, they were consistent and clear, also after taking childhood socioeconomic status into account. Regarding median survival time, the number of years lost increased gradually as peer status decreased, with a difference of almost 6 years when comparing individuals in the lowest and highest positions. CONCLUSIONS: Children's positions in the peer status hierarchy play a role for their chances of health and survival, pointing to the relevance of addressing opportunities for positive peer interaction and mitigating any adverse consequences that may stem from negative experiences within the peer context.

The impact of an unemployment insurance reform on incidence rates of hospitalisation due to alcohol-related disorders: a quasi-experimental study of heterogeneous effects across ethnic background, educational level, employment status, and sex in Sweden.

BACKGROUND: Many Western countries have scaled back social and health expenditure, including decreases in the generosity and coverage of unemployment insurance, resulting in negative effects on general health and well-being at the aggregate level. Yet, research has not sufficiently looked into heterogeneity of such effects across different subgroups of the population. In Sweden, the 2006 unemployment insurance reform, implemented on the 1st of January 2007, encompassed a drastic increase of insurance fund membership fees, reduced benefit levels, and stricter eligibility requirements. As this particularly affected already socioeconomically disadvantaged groups in society, such as foreign-born and low-educated individuals, the current study hypothesise that the reform would also have a greater impact on health outcomes in these groups. METHODS: Based on register data for the total population, we utilise a quasi-experimental approach to investigate heterogeneous health effects of the reform across ethnic background, educational level, employment status, and sex. Due to behaviourally caused diseases having a relatively shorter lag time from exposure, hospitalisation due to alcohol-related disorders serves as the health outcome. A series of regression discontinuity models are used to analyse monthly incidence rates of hospitalisation due to alcohol-related disorders among individuals aged 30-60 during the study period (2001-2012), with the threshold set to the 1st of January 2007. RESULTS: The results suggest that, in general, there was no adverse effect of the reform on incidence rates of hospitalisation due to alcohol-related disorders. A significant increase is nonetheless detected among the unemployed, largely driven by Swedish-born individuals with Swedish-born or foreign-born parents, low-educated individuals, and men. CONCLUSIONS: We conclude that the Swedish 2006 unemployment insurance reform generally resulted in increasing incidence rates of hospitalisation due to alcohol-related disorders among unemployed population subgroups known to have higher levels of alcohol consumption.

Parental death in childhood and pathways to increased mortality across the life course in Stockholm, Sweden: A cohort study.

BACKGROUND: Previous studies have shown that the experience of parental death during childhood is associated with increased mortality risk. However, few studies have examined potential pathways that may explain these findings. The aim of this study is to examine whether familial and behavioural factors during adolescence and socioeconomic disadvantages in early adulthood mediate the association between loss of a parent at age 0 to 12 and all-cause mortality by the age of 63. METHODS AND FINDINGS: A cohort study was conducted using data from the Stockholm Birth Cohort Multigenerational Study for 12,615 children born in 1953, with information covering 1953 to 2016. Familial and behavioural factors at age 13 to 19 included psychiatric and alcohol problems in the surviving parent, receipt of social assistance, and delinquent behaviour in the offspring. Socioeconomic disadvantage in early adulthood included educational attainment, occupational social class, and income at age 27 to 37. We used Cox proportional hazard regression models, combined with a multimediator analysis, to separate direct and indirect effects of parental death on all-cause mortality. Among the 12,582 offspring in the study (men 51%; women 49%), about 3% experienced the death of a parent in childhood. During follow-up from the age of 38 to 63, there were 935 deaths among offspring. Parental death was associated with an elevated risk of mortality after adjusting for demographic and household socioeconomic characteristics at birth (hazard ratio [HR]: 1.52 [95% confidence interval: 1.10 to 2.08, p-value = 0.010]). Delinquent behaviour in adolescence and income during early adulthood were the most influential mediators, and the indirect associations through these variables were HR 1.03 (1.00 to 1.06, 0.029) and HR 1.04 (1.01 to 1.07, 0.029), respectively. After accounting for these indirect paths, the direct path was attenuated to HR 1.35 (0.98 to 1.85, 0.066). The limitations of the study include that the associations may be partly due to genetic, social, and behavioural residual confounding, that statistical power was low in some of the subgroup analyses, and that there might be other relevant paths that were not investigated in the present study. CONCLUSIONS: Our findings from this cohort study suggest that childhood parental death is associated with increased mortality and that the association was mediated through a chain of disadvantages over the life course including delinquency in adolescence and lower income during early adulthood. Professionals working with bereaved children should take the higher mortality risk in bereaved offspring into account and consider its lifelong consequences. When planning and providing support to bereaved children, it may be particularly important to be aware of their increased susceptibility to delinquency and socioeconomic vulnerability that eventually lead to higher mortality.

Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) participant's profile regarding self-rated health: a multiple correspondence analysis.

BACKGROUND: Self-rated health (SRH) - one of the most common health indicators used to verify health conditions - can be influenced by several types of socioeconomic conditions, thereby reflecting health inequalities. This study aimed to evaluate the participant profiles regarding the association between self-rated health and social and occupational characteristics of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). METHODS: Cross-sectional design, including 11,305 individuals. Self-rated health was categorized as good, fair, and poor. The relationship between socio-demographic, psychosocial work environment, health-related variables, and self-rated health was analyzed by multiple correspondence analysis (stratified by age: up to 49 years old and 50 years old or more). RESULTS: For both age strata, group composition was influenced by socioeconomic conditions. Poor SRH was related to lower socioeconomic conditions, being women, black self-declared race/ethnicity, being non-married/non-united, low decision authority, low skill discretion, and obesity. CONCLUSION: To promote health, interventions should focus on reducing existing socioeconomic, race, and gender inequalities in Brazil.

Intergenerational patterns of mental health problems: the role of childhood peer status position.

BACKGROUND: Past research has established the intergenerational patterning of mental health: children whose parents have mental health problems are more likely to present with similar problems themselves. However, there is limited knowledge about the extent to which factors related to the child's own social context, such as peer relationships, matter for this patterning. The aim of the current study was to examine the role of childhood peer status positions for the association in mental health across two generations. METHODS: The data were drawn from a prospective cohort study of 14,608 children born in 1953, followed up until 2016, and their parents. Gender-specific logistic regression analysis was applied. Firstly, we examined the associations between parental mental health problems and childhood peer status, respectively, and the children's mental health problems in adulthood. Secondly, the variation in the intergenerational patterning of mental health according to peer status position was investigated. RESULTS: The results showed that children whose parents had mental health problems were around twice as likely to present with mental health problems in adulthood. Moreover, lower peer status position in childhood was associated with increased odds of mental health problems. Higher peer status appeared to mitigate the intergenerational association in mental health problems among men. For women, a u-shaped was found, indicating that the association was stronger in both the lower and upper ends of the peer status hierarchy. CONCLUSIONS: This study has shown that there is a clear patterning in mental health problems across generations, and that the child generation's peer status positions matter for this patterning. The findings also point to the importance of addressing gender differences in these associations.

Do trajectories of economic, work- and health-related disadvantages explain child welfare clients' increased mortality risk? A prospective cohort study.

BACKGROUND: Past research has shown that individuals who have had experiences of out-of-home care (OHC) in childhood have increased risks of premature mortality. Prior studies also suggest that these individuals are more likely to follow long-term trajectories that are characterised by economic, work-, and health-related disadvantages, compared to majority population peers. Yet, we do not know the extent to which such trajectories may explain their elevated mortality risks. The aim of this study is therefore to examine whether trajectories of economic, work-, and health-related disadvantages in midlife mediate the association between OHC experience in childhood and subsequent all-cause mortality. METHODS: Utilising longitudinal Swedish data from a 1953 cohort (n = 14,294), followed from birth up until 2008 (age 55), this study applies gender-specific logistic regression analysis to analyse the association between OHC experience in childhood (ages 0-19; 1953-1972) and all-cause mortality (ages 47-55; 2000-2008). A decomposition method developed for non-linear regression models is used to estimate mediation by trajectories of economic, work-, and health-related disadvantages (ages 39-46; 1992-1999), as indicated by social welfare receipt, unemployment, and mental health problems. To account for selection processes underlying placement in OHC, an alternative comparison group of children who were investigated by the child welfare committee but not placed, is included. RESULTS: The results confirm that individuals with experience of OHC have more than a two-fold increased risk of all-cause mortality, for men (OR: 2.10, 95% CI: 1.42-3.11) and women (OR: 2.23, 95% CI: 1.39-3.59) alike. Approximately one-third (31.1%) of the association among men, and one-fourth (27.4%) of the association among women, is mediated by the long-term trajectories of economic, work-, and health-related disadvantages. The group who were investigated but not placed shows similar, yet overall weaker, associations. CONCLUSIONS: Individuals who come to the attention of the child welfare services, regardless of whether they are placed in out-of-home care or not, continue to be at risk of adverse outcomes across the life course. Preventing them from following trajectories of economic, work-, and health-related disadvantages could potentially reduce their risk of premature death.

Friendship trust and psychological well-being from late adolescence to early adulthood: A structural equation modelling approach.

AIMS: This study explored the sex-specific associations between friendship trust and the psychological well-being of young Swedes from late adolescence to early adulthood. METHODS: A random sample of native Swedes born in 1990 was surveyed at age 19 years and again at age 23 years regarding their own well-being and their relationships with a maximum of five self-named peers. The response rate was 31.3%, resulting in 782 cases to be analysed. We used sex-stratified structural equation models to explore the associations between trust and well-being. Psychological well-being was constructed as the latent variable in the measurement part. The structural part accounted for the autocorrelation of trust with respect to well-being over time and incorporated the cross-lagged effects between late adolescence and early adulthood. RESULTS: It was found that trust increased while well-being decreased for young men and remained stable for young women from 19 to 23 years of age. The young women reported lower well-being at both time points, whereas no sex difference was found for trust. Based on model fit comparisons, a simple model without forward or reward causation was accepted for young men, whereas reversed causation from well-being to trust was suggested for young women. Subsequent analysis based on these assumptions confirmed the reversed effect for young women. CONCLUSIONS: The findings suggest that young people do not benefit from trustful social relations to the same extent as adult populations. Young women who express impaired well-being run a greater risk of being members of networks characterized by low friendship trust over time.

Hospital admissions due to alcohol related disorders among young adult refugees who arrived in Sweden as teenagers - a national cohort study.

BACKGROUND: Psychological distress and lack of family support may explain the mental health problems that are consistently found in young unaccompanied refugees in Western countries. Given the strong relationship between poor mental health and alcohol misuse, this study investigated hospital admissions due to alcohol related disorders among accompanied and unaccompanied young refugees who settled in Sweden as teenagers. METHODS: The dataset used in this study was derived from a combination of different registers. Cox regression models were used to estimate the risks of hospital care due to alcohol related disorders in 15,834 accompanied and 4376 unaccompanied young refugees (2005-2012), aged 13 to 19 years old when settling in Sweden and 19 to 32 years old in December 2004. These young refugees were divided into regions with largely similar attitudes toward alcohol: the former Yugoslavian republics, Somalia, and the Middle East. The findings were compared with one million peers in the native Swedish population. RESULTS: Compared to native Swedes, hospital admissions due to alcohol related disorders were less common in young refugees, with a hazard ratio (HR) of 0.65 and 95% confidence interval (CI) between 0.56 and 0.77. These risks were particularly lower among young female refugees. However, there were some differences across the refugee population. For example, the risks were higher in unaccompanied (male) refugees than accompanied ones (HR = 1.49, 95% CI = 1.00-2.19), also when adjusted for age, domicile and income. While the risks were lower in young refugees from Former Yugoslavia and the Middle East relative to native Swedes, independent of their length of residence in Sweden, refugees from Somalia who had lived in Sweden for more than ten years showed increased risks (HR = 2.54, 95% CI = 1.71-3.76), after adjustments of age and domicile. These risks decreased considerably when income was adjusted for. CONCLUSION: Young refugees have lower risks of alcohol disorders compared with native Swedes. The risks were higher in unaccompanied young (male) refugees compared to the accompanied ones. Moreover, Somalian refugees who had lived in Sweden for more than ten years seems to be particularly vulnerable to alcohol related disorders.

Support From Parents and Teachers in Relation to Psychosomatic Health Complaints Among Adolescents.

This study explores the relative contribution of parental and teacher support to adolescents' psychosomatic health complaints, with a particular focus on gender and age differences. Based on a survey of 49,172 ninth- and eleventh-grade students in Stockholm (2006-2014), structural equation modeling results demonstrated negative associations between parental and teacher support on psychosomatic health complaints. Parental support had a stronger association with the outcome among girls than boys. It was also more important than teacher support for psychosomatic health complaints. Parental support was more important for younger girls' health compared to older girls, with opposite patterns for teacher support. These findings highlight the need to consider gender and age to understand the links between social support and health during adolescence.

The role of social position and depressive symptoms in adolescence for life-course trajectories of education and work: a cohort study.

BACKGROUND: While a vast amount of studies confirm the social reproduction of class and status from one generation to the next, less is known about the role of health in the child generation for these processes. Research has shown that particularly mental distress in adolescence is important for future life chances. This study aimed to examine the importance of parental socioeconomic position and depressive symptoms in youth for life-course trajectories of education and labour market attachment among men and women. METHODS: Based on four waves of questionnaire data from the Northern Swedish Cohort (n = 1,001), consisting of individuals born in 1965, three steps of gender-separate analyses were undertaken. First, the individual trajectories of education and labour market attachment from age 18 to 42 were mapped through sequence analysis. Second, cluster analysis was used to identify typical trajectories. Third, two indicators of parental socioeconomic position - occupational class and employment status - and depressive symptoms at age 16 were used in multinomial regression analyses to predict adult life-course trajectories. RESULTS: Four typical trajectories were identified for men, of which three were characterised by stable employment and various lengths of education, and the fourth reflected a more unstable situation. Among women, five trajectories emerged, characterised by more instability compared to men. Low parental occupational class and unemployment were significantly associated with a higher risk of ending up in less advantaged trajectories for men while, for women, this was only the case for occupational class. Youth levels of depressive symptoms did not significantly differ across the trajectories. CONCLUSIONS: This study found support for the intergenerational reproduction of social position, particularly when measured in terms of parental occupational class. Youth depressive symptoms did not show clear differences across types of trajectories, subsequently impeding such symptoms to trigger any selection processes. While this could be a consequence of the specific framework of the current study, it may also suggest that depressive symptoms in youth are not a root cause for the more complex processes through which how social position develops across life. The possible impact of welfare and labour market policies is discussed.

Friendship network characteristics and psychological well-being in late adolescence: exploring differences by gender and gender composition.

AIMS: The aim of the present study was to examine the association between friendship networks and psychological well-being among 19-year-olds. METHODS: The data used was a random sample of Swedish individuals born in 1990 who answered a questionnaire in 2009-2010. Friendship networks were considered in terms of three measures of emotional support. Six statements about the individual's emotional state were used to create a summary measure of psychological well-being. Gender and gender composition were included as potentially moderating factors. The association between friendship networks and psychological well-being was analysed by means of linear regression analysis (n = 1289). RESULTS: The results indicate that males' and females' friendship networks were similar with regard to quality and trust, whereas males' networks were characterized by less self-disclosure and a stronger preference for same-gender friendships. Gender composition did not matter for the support levels. Emotional support was associated with psychological well-being but there were gender differences: females seemed to benefit more health-wise from having high-quality (and trusting) networks. Moreover, whereas self-disclosure among males was positively linked to well-being, this was not the case among females. None of these associations were moderated by gender composition. CONCLUSIONS: In sum, friendship networks are beneficial for the psychological well-being among late adolescents, but there are some important differences according to gender.

Psychosocial working conditions: an analysis of emotional symptoms and conduct problems amongst adolescent students.

This study explored how psychosocial features of the schoolwork environment are associated with students' mental health. Data was drawn from 3699 ninth grade (15 year-old) Swedish students participating in the Health Behaviour in School-Aged Children survey. Using Structural Equation Modelling, perceived school demands, decision control and social support from teachers, classmates and parents were examined in relation to students' emotional and conduct problems. Higher demands were associated with greater emotional symptoms and conduct problems. Although weaker social support predicted emotional symptoms and conduct problems, the relative influence of teachers, classmates and parents differed. Teacher support was more closely associated with conduct problems, particularly for girls, while classmate support was more strongly related to emotional symptoms. The findings indicate that while excessive school pressure is associated with poorer mental health, social support can assist in optimising adolescents' emotional health and adaptive behaviour, as well as shaping perceptions of demands.

Cardiovascular Disease Events in Adults with a History of State Care in Childhood: Pooling of Unpublished Results from 9 Cohort Studies.

Background: Individuals who were separated from their biological family and placed into the care of the state during childhood (out-of-home care) are more prone to developing selected physical and mental health problems in adulthood, however, their risk of cardiovascular disease (CVD) is uncertain. Accordingly, we pooled published and unpublished results from cohort studies of childhood care and adult CVD. Methods: We used two approaches to identifying relevant data on childhood care and adult CVD (PROSPERO registration CRD42021254665). First, to locate published studies, we searched PubMed (Medline) until November 2023. Second, with the aim of identifying unpublished studies with the potential to address the present research question, we scrutinised retrieved reviews of the impact of childhood state care on related adult health outcomes. All included studies were required to have prospective measurement of state care in childhood and a follow-up of CVD events in adulthood as the primary outcome (incident coronary heart disease and/or stroke). Collaborating investigators provided study-specific estimates which were aggregated using random-effects meta-analysis. The Newcastle-Ottawa Scale was used to assess individual study quality. Findings: Thirteen studies (2 published, 11 unpublished) met the inclusion criteria, and investigators from nine provided viable results, including updated analyses of the published studies. Studies comprised 611,601 individuals (301,129 women) from the US, UK, Sweden, Finland, and Australia. Relative to the unexposed, individuals with a care placement during childhood had a 50% greater risk of CVD in adulthood (summary rate ratio after basic adjustment [95% confidence interval]: 1.50 [1.22, 1.84]); range of study-specific estimates: 1.28 to 2.06; I2 = 69%, p = 0.001). This association was attenuated but persisted after multivariable adjustment for socioeconomic status in childhood (8 studies; 1.41 [1.15, 1.72]) and adulthood (9 studies, 1.28 [1.10, 1.50]). There was a suggestion of a stronger state care-CVD association in women. Interpretation: Our findings show that individuals with experience of state care in childhood have a moderately raised risk of CVD in adulthood. For timely prevention, clinicians and policy makers should be aware that people with a care history may need additional attention in risk factor management.

School performance as a precursor of adult health: exploring associations to disease-specific hospital care and their possible explanations.

AIMS: While past research has shown that school performance is associated with some specific health outcomes in adulthood, few studies have taken a general approach to the link between school performance and adult disease. The aim of the present study was therefore to investigate sixth grade school performance in relation to disease-specific hospital care in adulthood and, moreover, to examine whether other conditions in childhood could account for any such associations. METHODS: The data used was the Stockholm Birth Cohort, consisting of 14,294 individuals born in 1953. Associations between school performance and disease-specific hospital care were analysed by means of Cox regression. RESULTS: Poor school performance was shown to be linked to a variety of diseases in adulthood, e.g. drug dependence, stomach ulcer, cerebrovascular diseases, and accidents. Some differences according to gender were found. Most associations, but not all, were explained by the simultaneous inclusion of various family-related and individual factors (e.g. social class, cognitive ability, and behavioural problems). CONCLUSIONS: In sum, the results of this study suggest that poor school performance may be an essential part of risk clustering in childhood with important implications for the individual's health career.

Childhood adversity is associated with hospitalisations and survival following external causes and non-communicable diseases: a 46-year follow-up of a Stockholm birth cohort.

BACKGROUND: Childhood adversity indicated by involvement with child welfare services (ICWS) is associated with increased risks of disease and injuries in young adulthood. It is yet unknown whether such risks are limited to external causes and mental and behavioural disorders or whether they extend beyond early adulthood and to non-communicable diseases (NCDs) with later onset. Moreover, it has not been explored whether ICWS associates with decreased survival prospects following hospitalisation. METHODS: Based on prospective data for a 1953 Stockholm birth cohort (n=14 134), ICWS was operationalised distinguishing two levels in administrative child welfare records (ages 0-19; 'investigated' and 'placed' in out-of-home care (OHC)). Hospitalisations and all-cause mortality (ages 20-66) were derived from national registers. Hospitalisation records were categorised into external causes and NCDs, and nine subcategories. Negative binomial regression models were used to estimate differences in hospitalisation risks between those with and without experiences of ICWS and Cox survival models to estimate mortality after hospitalisation. RESULTS: Placement in OHC was associated with higher risks of hospitalisation due to external causes and NCDs and all investigated subcategories except cancers. Risks were generally also elevated among those investigated but not placed. ICWS was further linked to higher mortality risks following hospitalisation. CONCLUSION: Differential risk of morbidity and differential survival may explain inequalities in mortality following childhood adversity. We conclude that the healthcare sector might play an important role in preventing and mitigating the elevated risks of externally caused morbidity, disease and premature mortality observed among those with a history of ICWS.

Disentangling the multigenerational transmissions of socioeconomic disadvantages and mental health problems by gender and across lineages: Findings from the Stockholm Birth Cohort Multigenerational Study.

There is a paucity of research examining the patterning of socioeconomic disadvantages and mental health problems across multiple generations. The current study therefore aimed to investigate the interconnected transmissions of socioeconomic disadvantages and mental health problems from grandparents to grandchildren through the parents, as well as the extent to which these transmissions differ according to lineage (i.e., through matrilineal/patrilineal descent) and grandchild gender. Drawing on the Stockholm Birth Cohort Multigenerational Study, the sample included 21,416 unique lineages by grandchild gender centered around cohort members born in 1953 (parental generation) as well as their children (grandchild generation) and their parents (grandparental generation). Based on local and national register data, socioeconomic disadvantages were operationalized as low income, and mental health problems as psychiatric disorders. A series of path models based on structural equation modelling were applied to estimate the associations between low income and psychiatric disorders across generations and for each lineage-gender combination. We found a multigenerational transmission of low income through the patriline to grandchildren. Psychiatric disorders were transmitted through both the patriline and matriline, but only to grandsons. The patriline-grandson transmission of psychiatric disorder partially operated via low income of the fathers. Furthermore, grandparents' psychiatric disorders influenced their children's and grandchildren's income. We conclude that there is evidence of transmissions of socioeconomic disadvantages and mental health problems across three generations, although these transmissions differ by lineage and grandchild gender. Our findings further highlight that grandparents' mental health problems could cast a long shadow on their children's and grandchildren's socioeconomic outcomes, and that socioeconomic disadvantages in the intermediate generation may play an important role for the multigenerational transmission of mental health problems.

Offspring hospitalization for substance use and changes in parental mental health: A Finnish register-based study.

Prior research indicates that parental psychiatric disorders increase their offspring's risk of substance use problems. Though the association is likely bidirectional, the effects of an adult child's substance use on parental mental health remain understudied. We examined parents' psychotropic medication use trajectories by parental sex and educational attainment before and after a child's alcohol- or narcotics-attributable hospitalization. We identified Finnish residents, born 1979-1988, with a first hospitalization for substance use during emerging adulthood (ages 18-29, n = 12,851). Their biological mothers (n = 12,283) and/or fathers (n = 10,765) were followed for the two years before and after the hospitalization. Psychotropic medication use was measured in three-month periods centered around the time of child's hospitalization, and the probability of psychotropic medication use at each time point was assessed using generalized estimating equations logit models. Among mothers, the prevalence of psychotropic medication use increased during the year before, peaked during the 0-3 months after hospitalization, and remained at a similarly elevated level until the end of follow-up. The prevalence among fathers increased gradually and linearly across follow-up, with minimal changes evident either directly before or after the hospitalization. Parents' educational attainment did not modify these trajectories. Our results highlight the importance of considering linked lives when quantifying substance use-attributable harms and underscore the need for future research examining the intergenerational spillover effects of substance use in both directions, particularly in mother-child dyads.

Childhood friendships and adult health: findings from the Aberdeen Children of the 1950s Cohort study.

BACKGROUND: Social relations are known to influence morbidity and mortality but few have studied this association from a life-course perspective specifically targeting the importance of social relations in childhood for adult health. In childhood, a key aspect of children's relationships is the number of friendships a child has in the school class, i.e. friendship quantity. The overall aim of this study was to examine the association between childhood friendships and adult self-rated health. METHODS: Data from a longitudinal study of children born in Aberdeen, Scotland, between 1950 and 1956 was used. Information on friendship quantity (1964) was derived from sociometric nominations among classmates and defined as mutual choices. The health outcome was based on self-ratings derived from a questionnaire in 2001-03. The study included various childhood and adult circumstances as possible explanatory factors. The analysis was based on ordinal logistic regression, producing odds ratios (n = 5814). RESULTS: The results demonstrated a gradient in women's self-rated health according to the number of friendships in the school class. A number of circumstances in childhood and adulthood were partial explanations. For men, only those without friends reported poorer self-rated health in adulthood. This finding was explained by adult socioeconomic status. CONCLUSION: It is concluded that childhood friendships are linked to health disparities in middle age, underlining the importance of such relationships and the need for a life-course perspective on health that integrates a variety of mechanisms as they interact across life.