Organisation of preventive child health services: Key to socio-economic equity in vaccine uptake?

Background: Measles has made a comeback in Western Europe, with more cases being reported each year. One factor behind this development is low vaccination coverage in socially disadvantaged segments of the population in many countries. This study investigates whether socioeconomic patterns of uptake of the measles, mumps and rubella (MMR) vaccine in the Nordic countries differ by national organisation of preventive health services for children. Methods: MMR vaccine uptake before the age of two years was analysed in register data from Denmark, Finland, Iceland and Sweden, linked to family indicators of socio-economic status (SES) from national registers. Results: Denmark, a country where child vaccinations are administered by general practitioners, presented the lowest overall coverage of MMR at 83%. It also had the greatest difference between subpopulations of low and high SES at 14 percentage points. Finland, Iceland and Sweden, countries where preschool children are vaccinated in 'well-baby' clinics, had a higher overall coverage at 91-94%, with a more equal distribution between SES groups at 1-4 percentage points. Conclusions: This study suggests that the organisation of preventive health care in special units, 'well-baby' clinics, facilitates vaccine uptake among children with low SES in a Nordic welfare context.

Economic conditions, hypertension, and cardiovascular disease: analysis of the Icelandic economic collapse.

Previous research has found a positive short-term relationship between the 2008 collapse and hypertension in Icelandic males. With Iceland's economy experiencing a phase of economic recovery, an opportunity to pursue a longer-term analysis of the collapse has emerged. Using data from a nationally representative sample, fixed-effect estimations and mediation analyses were performed to explore the relationship between the Icelandic economic collapse in 2008 and the longer-term impact on hypertension and cardiovascular health. A sensitivity analysis was carried out with pooled logit models estimated as well as an alternative dependent variable. Our attrition analysis revealed that results for cardiovascular diseases were affected by attrition, but not results from estimations on the relationship between the economic crisis and hypertension. When compared to the boom year 2007, our results point to an increased probability of Icelandic women having hypertension in the year 2012, when the Icelandic economy had recovered substantially from the economic collapse in 2008. This represents a deviation from pre-crisis trends, thus suggesting a true economic-recovery impact on hypertension.

[The prevalence of sexual abuse and sexual assault against icelandic adolescents].

INTRODUCTION: Sexual abuse and sexual assaults against children and adolescents is one of the most significant threats to their health. The aim of the current study was to investigate its prevalence and effects on Icelandic teenagers in the 10th grade. MATERIAL AND METHODS: The study is based on data collected for the Icelandic part of the HBSC-project (Health and behaviour of school- aged children). Standardized questionnaires were sent to all students in 10th grade in Iceland of which 3,618 participated. The students experience of sexual abuse or assaults was assessed by asking them how often they had been against their will a) touched in a sexual way, b) made to touch someone else in a sexual way, c) the subject of an attempted rape or d) subjected to rape. RESULTS: The results showed that 14.6% (527) participants had experienced sexual abuse or assault. Of these, 4.5% (162) had one such experience but 10.1% had either suffered certain type of abuse or assault more than once, or had experienced more than one kind. About 1% of participants (35) said that they had suffered many times from many forms of abuse and assaults. The prevalence of poor mental well-being and risk behaviour was much higher amongst those that had experienced sexual abuse or assault. CONCLUSION: Although the results show that the prevalence of sexual abuse and assault against Icelandic adolescents is similar to other Western countries, we find it to be higher than a previous study a decade ago. KEY WORDS: Sexual abuse, sexual assault, adolescents. Correspondence: Arsaell Mar Arnarsson, aarnarsson@unak.is.

Web-based versus traditional paper questionnaires: a mixed-mode survey with a Nordic perspective.

BACKGROUND: Survey response rates have been declining over the past decade. The more widespread use of the Internet and Web-based technologies among potential health survey participants suggests that Web-based questionnaires may be an alternative to paper questionnaires in future epidemiological studies. OBJECTIVE: To compare response rates in a population of parents by using 4 different modes of data collection for a questionnaire survey of which 1 involved a nonmonetary incentive. METHODS: A random sample of 3148 parents of Danish children aged 2-17 years were invited to participate in the Danish part of the NordChild 2011 survey on their children's health and welfare. NordChild was conducted in 1984 and 1996 in collaboration with Finland, Iceland, Norway, and Sweden using mailed paper questionnaires only. In 2011, all countries used conventional paper versions only except Denmark where the parents were randomized into 4 groups: (1) 789 received a paper questionnaire only (paper), (2) 786 received the paper questionnaire and a log-in code to the Web-based questionnaire (paper/Web), (3) 787 received a log-in code to the Web-based questionnaire (Web), and (4) 786 received log-in details to the Web-based questionnaire and were given an incentive consisting of a chance to win a tablet computer (Web/tablet). In connection with the first reminder, the nonresponders in the paper, paper/Web, and Web groups were also present with the opportunity to win a tablet computer as a means of motivation. Descriptive analysis was performed using chi-square tests. Odds ratios were used to estimate differences in response rates between the 4 modes. RESULTS: In 2011, 1704 of 3148 (54.13%) respondents answered the Danish questionnaire. The highest response rate was with the paper mode (n=443, 56.2%). The other groups had similar response rates: paper/Web (n=422, 53.7%), Web (n=420, 53.4%), and Web/tablet (n=419, 53.3%) modes. Compared to the paper mode, the odds for response rate in the paper/Web decreased by 9% (OR 0.91, 95% CI 0.74-1.10) and by 11% (OR 0.89, 95% CI 0.73-1.09) in the Web and Web/tablet modes. The total number of responders for NordChild declined from 10,291 of 15,339 (67.09%) in 1984 and 10,667 of 15,254 (69.93%) in 1996 to 7805 of 15,945 (48.95%) in 2011 with similar declines in all 5 Nordic countries. CONCLUSIONS: Web-based questionnaires could replace traditional paper questionnaires with minor effects on response rates and lower costs. The increasing effect on the response rate on participants replying for a nonmonetary incentive could only be estimated within the 2 Web-based questionnaire modes before the first reminder. Alternative platforms to reach higher participation rates in population surveys should reflect the development of electronic devices and the ways in which the population primarily accesses the Internet.

Increased stress among women following an economic collapse--a prospective cohort study.

There is a scarcity of data on mental health effects of the global economic recession. In this study, we investigated potential change in self-reported levels of psychological stress in the Icelandic population as a result of the major national economic collapse that occurred in 2008. We used a national cohort of 3,755 persons who responded to a survey administered in 2007 and 2009, including demographic questions and a stress measure (the 4-item Perceived Stress Scale). We used repeated-measures analysis of variance and logistic regression models to assess change in mean stress levels and risk of high stress levels (>90th percentile) in 2009 as compared with 2007. Age-adjusted mean stress levels increased between 2007 and 2009 (P = 0.004), though the increase was observed only for women (P = 0.003), not for men (P = 0.34). Similarly, the odds ratios for experiencing high stress levels were increased only among women (odds ratio (OR) = 1.37), especially among women who were unemployed (OR = 3.38), students (OR = 2.01), had middle levels of education (OR = 1.65), or were in the middle income bracket (OR = 1.59). The findings indicate that psychological stress may have increased following the economic collapse in Iceland, particularly among females in economically vulnerable groups.

Does neighbourhood social capital aid in levelling the social gradient in the health and well-being of children and adolescents? A literature review.

BACKGROUND: Although most countries in the European Union are richer and healthier than ever, health inequalities remain an important public health challenge. Health-related problems and premature death have disproportionately been reported in disadvantaged neighbourhoods. Neighbourhood social capital is believed to influence the association between neighbourhood deprivation and health in children and adolescents, making it a potentially interesting concept for policymakers. METHODS: This study aims to review the role of social capital in health inequalities and the social gradient in health and well-being of children and adolescents. A systematic review of published quantitative literature was conducted, focussing on (1) the mediating role of neighbourhood social capital in the relationship between socio-economic status (SES) and health-related outcomes in children and adolescents and (2) the interaction between neighbourhood social capital and socio-economic characteristics in relation to health-related outcomes in children and adolescents. Three electronic databases were searched. Studies executed between 1 January 1990 and 1 September 2011 in Western countries (USA, New Zealand, Australia and Europe) that included a health-related outcome in children or adolescents and a variable that measured neighbourhood social capital were included. RESULTS: Eight studies met the inclusion criteria for the review. The findings are mixed. Only two of five studies confirmed that neighbourhood social capital mediates the association between neighbourhood deprivation and health and well-being in adolescents. Furthermore, two studies found a significant interaction between neighbourhood socio-economic factors and neighbourhood social capital, which indicates that neighbourhood social capital is especially beneficial for children who reside in deprived neighbourhoods. However, two other studies did not find a significant interaction between SES and neighbourhood social capital. Due to the broad range of studied health-related outcomes, the different operationalisations of neighbourhood social capital and the conceptual overlap between measures of SES and social capital in some studies, the factors that explain these differences in findings remain unclear. CONCLUSIONS: Although the findings of this study should be interpreted with caution, the results suggest that neighbourhood social capital might play a role in the health gradient among children and adolescents. However, only two of the included studies were conducted in Europe. Furthermore, some studies focussed on specific populations and minority groups. To formulate relevant European policy recommendations, further European-focussed research on this issue is needed.

High youth access to movies that contain smoking in Europe compared with the USA.

BACKGROUND: Based on evidence that exposure to smoking in movies is associated with adolescent smoking, the WHO has called on countries to assign a rating that restricts youth access to such movies. OBJECTIVE: To evaluate youth access to movies that portray smoking in European countries and compare with that in the USA. METHODS: The authors identified the most commercially successful movies screened in six European countries (Germany, Iceland, Italy, the Netherlands, Poland and UK) and the USA between 2004 and 2009. The authors coded the 464 movies that were screened in both Europe and the USA according to whether or not they portrayed smoking. RESULTS: 87% of the movies were 'youth' rated in Europe (ratings board classification as suitable for those younger than 16 years) compared to only 67% in the USA (suitable for those younger than 17 years). Smoking was portrayed in 319 (69%) movies. 85% of the movies that portrayed smoking were 'youth' rated in Europe compared with only 59% in the USA (p<0.001). CONCLUSIONS: Tobacco imagery is still common in popular films shown in European countries and the USA. None of the seven countries examined followed the WHO recommendations on restricting youth access to movies that portray smoking. Compared to the USA, European youths have access to substantially more movies in general, and this gives them access to more movies that portray smoking in particular.

Alcohol consumption in movies and adolescent binge drinking in 6 European countries.

OBJECTIVE: The goal of this study was to investigate whether the association between exposure to images of alcohol use in movies and binge drinking among adolescents is independent of cultural context. METHODS: A cross-sectional survey study in 6 European countries (Germany, Iceland, Italy, Netherlands, Poland, and Scotland) was conducted. A total of 16 551 pupils from 114 public schools with a mean (± SD) age of 13.4 (± 1.18) years participated. By using previously validated methods, exposure to alcohol use in movies was estimated from the 250 top-grossing movies of each country (years 2004-2009). Lifetime binge drinking was the main outcome measure. RESULTS: Overall, 27% of the sample had consumed >5 drinks on at least 1 occasion in their life. After controlling for age, gender, family affluence, school performance, television screen time, sensation seeking and rebelliousness, and frequency of drinking of peers, parents, and siblings, the adjusted ß-coefficient for lifetime binge drinking in the entire sample was 0.12 (95% confidence interval: 0.10-0.14; P < .001). The crude relationship between movie alcohol use exposure and lifetime binge drinking was significant in all countries; after covariate adjustment, the relationship was still significant in 5 of 6 countries. A sensitivity analysis revealed that the association is content specific, as there was no significant association between lifetime binge drinking and exposure to smoking in movies. CONCLUSIONS: The link between alcohol use in movies and adolescent binge drinking was robust and seems relatively unaffected by cultural contexts.

Body weight dissatisfaction in the Icelandic adult population: a normative discontent?

BACKGROUND: Body weight dissatisfaction is a common problem in many modern societies and it appears to have grown over time. This study examined the prevalence and predictors of body weight dissatisfaction among 18- to 79-year-old Icelanders. The distribution of body weight dissatisfaction according to the WHO body mass index criteria for underweight, normal weight, overweight and obesity was also assessed. METHODS: The study was based on 5832 participants in the cross-sectional survey 'Health and Well-Being of Icelanders', administered by the Public Health Institute in Iceland in the fall of 2007. RESULTS: Around 43% of adult Icelanders are dissatisfied with their own body weight (50% of females; 35% of males) and 72% believe they need to lose weight (80% of females; 63% of males). Despite being in normal range according to the WHO-based BMI criteria, 64% of females in that category believe they need to lose weight. Multivariate results show that indicators of socio-economic status (SES) are not significantly associated with body weight dissatisfaction among females, while among males, those with university education are more often dissatisfied than those with secondary education (OR = 1.5, P < 0.05; for self-perceived need to lose weight, estimates are OR = 1.4, P < 0.05 for females, and OR = 2.5, P < 0.001 for males). CONCLUSION: The prevalence of body dissatisfaction is so prominent among Icelandic female adults that it can rightfully be labelled a normative discontent in this population.

Smoking in movies and adolescent smoking: cross-cultural study in six European countries.

AIM: To investigate whether the association between exposure to smoking in movies and smoking among youth is independent of cultural context. METHOD: Cross-sectional survey of 16,551 pupils recruited in Germany, Iceland, Italy, the Netherlands, Poland and Scotland with a mean age of 13.4 years (SD=1.18) and an equal gender distribution. School-based surveys were conducted between November 2009 and June 2010. Using previously validated methods, exposure to movie smoking was estimated from the 250 top-grossing movies of each country (years 2004-2009) and related to ever smoking. RESULTS: Overall, 29% of the sample had tried smoking. The sample quartile (Q) of movie smoking exposure was significantly associated with the prevalence of ever smoking: 14% of adolescents in Q1 had tried smoking, 21% in Q2, 29% in Q3 and 36% in Q4. After controlling for age, gender, family affluence, school performance, television screen time, number of movies seen, sensation seeking and rebelliousness and smoking within the social environment (peers, parents and siblings), the adjusted ORs for having tried smoking in the entire sample were 1.3 (95% CI 1.1 to 1.5) for adolescents in Q2, 1.6 (95% CI 1.4 to 1.9) for Q3 and 1.7 (95% CI 1.4 to 2.0) for Q4 compared with Q1. The adjusted relationship between ever smoking and higher movie smoking exposure levels was significant in all countries with a non-linear association in Italy and Poland. CONCLUSIONS: The link between smoking in movies and adolescent smoking is robust and transcends different cultural contexts. Limiting young people's exposure to movie smoking could have important public health implications.

Prevalence of dental erosion in children: a national survey.

OBJECTIVES: To measure the prevalence of dental erosion in permanent teeth in Iceland as part of the National Oral Health Survey. METHODS: A representative, nationwide sample of 2251 Icelandic children, 20% of those aged 6, 12 and 15 year, was examined. Dental erosion was recorded for all erupted permanent teeth and graded using the modified scale of Lussi. RESULTS: Erosion was not seen in the permanent teeth of six-year-olds, but was present in 15.7% of 12-year-olds, more frequently in boys than girls (19.9% boys, 11.0% girls; P < 0.001). Among 15-year-olds, dental erosion was seen among 30.7% of subjects (38.3% boys, 22.7% girls; P < 0.001). Severity of erosion was mostly scored as grade I, with only 5.5% of 15-year-olds scored as grade II, mostly on tooth 46 (4.3%) and 36 (4.2%). For 12-year-olds, 0.9% had erosion scores of grade II mostly on tooth 46 (0.8%) and 36 (0.7%). No subjects had erosion of grade III. The most common clinical manifestation of erosion was the appearance of cup-like lesions on the cusps of lower first molars. CONCLUSIONS: Dental erosion was frequently present by the age of 12; the prevalence doubled by age 15 and was seen almost twice as often among boys than girls. Teeth most frequently showing signs of erosion were the lower first molars. The rapidly growing prevalence of erosion demonstrated by this nationwide survey emphasizes the need for further research into the aetiology of erosion and possible methods of preventing and treating this emerging dental problem.

Caries prevalence of permanent teeth: a national survey of children in Iceland using ICDAS.

OBJECTIVES: The Icelandic Oral Health Survey aimed to obtain new national data on the oral health of Icelandic children and teenagers. METHODS: A representative stratified random cluster sample of 2251 Icelandic children in first, seventh and 10th grade, aged approximately 6-, 12- and 15-years old was examined for caries prevalence using the ICDAS criteria. Bite-wing digital radiographs were obtained for the children in 7th and 10th grade. RESULTS: D(3)MFT scores by visual examination of 6-, 12- and 15-year olds were 0.12, 1.43 and 2.78 respectively but when including radiographs, the D(3)MFT rose to 2.11 at 12 years and 4.25 at 15 years. The Significant Caries Index, SiC, by visual examination for 12 and 15 y was 3.7 and 6.7 respectively but was 4.7 for 12 y and 8.9 for 15 y with radiographs. In all age groups and at most disease levels, caries was active in the majority of the lesions (58-100%). The percentage of children with no visually detectable caries at D(3)/D(1) level was 93%/74% for 6 years, 48%/22% for 12 years and 35%/16% for 15 years. When radiographs were included the percentage reduced to 34%/15% for 12 years and 20%/6% for 15 years. Approximately 80% of 12- and 15-year-olds had at least one of their first molars sealed, with the mean number of sealed first molars being 2.2 among 12 y and 2.0 among 15 y. CONCLUSIONS: Caries levels were higher than expected in this national survey and further away from the goals of the National Health Plan for 2010 than anticipated. Caries distribution was skewed with more than half of the children having low caries scores but a wide distribution of caries experience was seen among the remaining population.

The fertility contribution of Mexican immigration to the United States.

Crucial to the long-term contribution of immigration to a receiving country's population is the extent to which the immigrants reproduce themselves in subsequent, native-born generations. Using conventional projection methodologies, this fertility contribution may be poorly estimated primarily because of problems in projecting the number of immigrants who are at risk of childbearing. We propose an alternative method that obviates the need to project the number of immigrants by using the full sending-country birth cohort as the risk group to project their receiving-country childbearing. This "sending-country birth cohort" method is found to perform dramatically better than conventional methods when projecting to 1999 from base years both before and after the large increase in inflows of Mexican immigrants to the United States in the late 1980s. Projecting forward from 1999, we estimate a cumulative contribution of Mexican immigrant fertility from the 1980s to 2040 of 36 million births, including 25% to 50% more births after 1995 than are projected using conventional methods.

Modeling momentum in gradual demographic transitions.

The analysis of population momentum following a gradual decline in fertility to replacement level provides valuable insights into prospects for future population growth. Here, we extend recent work in the area by applying a new form of the quadratic hyperstable (QH) model, which relates exponentially changing fertility to the resultant exponentiated quadratic birth sequence. Modeling gradual transitions from an initial stable population to an ultimate stationary population indicates that such declines in fertility increase momentum by a product of two factors. The first factor is a previously noted continuation of stable growth for half the period of decline. The second is a not previously appreciated offsetting factor that reflects the interaction between the decline in fertility, the changing age pattern of fertility, and the changing age composition of the population. Numerical examples using both hypothetical and actual populations demonstrate that for declines of any length, the product of the two factors yields momentum values that closely agree with the results of population projections. The QH model can examine monotonic transitions between any two sets of constant vital rates. As a generalization of the fixed-rate stable model, it has great potential value in numerous areas of demographic analysis.