Parental unemployment and educational outcomes in late adolescence: the importance of family cohesion, parental education, and family income in a Norwegian study.

AIMS: The study aimed to investigate the association between parental unemployment and grade point average and school completion in adolescence, and the importance of family cohesion, parental education, and family income in explaining these associations. METHODS: Data stem from the Norwegian cross-sectional 2012 youth@hordaland-survey including 8437 adolescents (53.4% girls). Information on grade point average, school completion, parental education, and family income were retrieved from the National Education Database. Parental work status and family cohesion were assessed by adolescent self-report. RESULTS: Adolescents with at least one unemployed parent had lower grade point averages (3.49 compared with 3.92, P<0.001) and rates of school completion (71.9% compared with 86.6%, P<0.001) compared with adolescents with two working parents. The associations between parental unemployment and both grade point average (b = -0.22, 95% confidence interval -0.32, -0.12) and school completion (odds ratio 0.59, 95% confidence interval 0.46, 0.76) partly attenuated but remained significant when taking family cohesion, parental education, and family income into account. There was a significant interaction between parental unemployment and family cohesion on grade point average, in which the positive association between family cohesion and grade point average was weaker for adolescents with unemployed parents. CONCLUSIONS: Adolescents with parents outside of the workforce are at higher risk of poorer educational outcomes than peers with working parents. Combined with the positive associations between parental education, family cohesion, family income, and educational outcomes, this underscores the importance of parents for adolescent educational outcomes, and suggests that parents and the family situation should be considered when providing academic support for adolescents who struggle in upper secondary school.

Using Norwegian National Patient Registry data to understand associations between potentially traumatic life experiences and mental health care use in adolescence.

Exposure to potentially traumatic experiences (PTEs) is common among children and adolescents and associated with an increased risk of psychiatric diagnoses. This study aimed to ascertain how the number of PTEs differed across adolescent psychiatric diagnoses. Data on PTE exposure were derived from the youth@hordaland survey, and Axis 1 data were from the linked Norwegian National Patient Registry (NPR). Among 10,257 total adolescents, 9,555 (age range: 16-19 years, 53.9% female) consented to register linkage, 8,845 of whom were included in the analyses. Having contact with Child and Adolescent Mental Health Services (CAMHS) predicted more PTEs (estimated marginal mean [EMM] = 1.04, SE = 0.05) and exposure to two or more PTEs compared to having no CAMHS contact (EMM = 0.60) after adjusting for age, ethnicity, sex, and parental education. Adolescents diagnosed with attention-deficit/hyperactivity disorder, depression, trauma-related disorders, conduct disorder, and anxiety experienced significantly more PTEs (EMMs = 0.90-1.63) than those with no CAMHS contact (EMM = 0.57, SE = 0.01). All diagnostic categories except psychosis, autism spectrum disorders, and eating disorders had a significantly higher rate of PTEs compared with adolescents with no CAMHS contact. The study highlights the potential role of exposure to multiple PTEs as a transdiagnostic risk factor, although the level of risk varies between diagnoses.

Developmental trajectories of conduct problems and time-varying peer problems: the Bergen child study.

BACKGROUND: While it is increasingly acknowledged that conduct problems and peer problems often co-occur in development, less is known about the ways in which peer problems may alter the developmental course of conduct problems for distinct subgroups. METHODS: Using data from a large population-based study in Norway (the Bergen Child Study/youth@hordaland; 47.4% males), we estimated group-based trajectories of conduct problems and the presence of time-varying peer problems on the developmental progression of conduct problems between seven and 19 years of age. Risk factors for group membership were also examined. RESULTS: A 3-group model of conduct problems best fit the data (non-engagers, low-engagers, moderate-stable). The presence of peer problems increased the estimated level of conduct problems for both the low-engagers and moderate-stable groups across adolescence. No differences in conduct problems were observed when peer problems were present in childhood or preadolescence for these two groups, nor for the non-engagers group at any point. Being male, having lower perceived economic wellbeing, and lower levels of parental education predicted group membership for the moderate-stable group, whilst lower paternal education predicted membership for the low-engagers group. CONCLUSIONS: Support for developmental 'turning points' was found, suggesting that adolescence is a particularly salient time for those with conduct problems. In particular, the presence of peer problems can increase observed conduct problems at this stage in development.

Mental health problems and suicidal behavior from adolescence to young adulthood in college: linking two population-based studies.

It is well established that mental health problems are highly recurrent and persistent from childhood to adolescence, but less is known to what extent mental health problems also persist from adolescence into young adulthood. The aim of the current study was therefore to examine the chronicity and risk of mental health problems and suicidality from adolescence to young adulthood. Data stem from two Norwegian population-based studies conducted 6 years apart; the youth@hordaland study from 2012 (age 16-19) and the SHoT2018 study (age 22-25). These two data sources were linked to produce a longitudinal sample of 1257 individuals. A wide range of self-reported mental health and suicidality instruments (used both continuously and categorically) were analyzed using log-link binomial regression analysis, adjusting for age, sex, parental education, and financial problems. We found that high levels of mental health problems in late adolescence were a significant risk factor for reporting poor mental health 6 years later. Internalizing and externalizing problems in adolescence were associated with a 2.8-fold and 1.9-fold increased risk, respectively, of reporting a mental disorder 6 years later. Similarly, self-harm in adolescence was associated with a 2.1-fold increased risk of suicidal thoughts 6 years later. The magnitudes of the adjusted risk ratios were generally similar across the various mental health and suicidality measures used at the two assessment points. Adjustment for confounders did not, or only slightly, attenuate the risk ratios, and all associations remained statistically significant in the adjusted analyses. This longitudinal study provides new evidence of the chronicity of mental health problems and suicidality from adolescence to adulthood in Norway. The results emphasize the importance of early identification and timely interventions to reduce the prevalence and impact of mental health problems and suicidality.

Protective factors associated with resilience among unaccompanied refugee minors after settling in Norway: a matched cross-sectional study.

This study aimed to examine protective factors associated with resilience among unaccompanied refugee minors in comparison to their Norwegian peers and to examine associations between resilience factors and characteristics related to positive outcomes among unaccompanied minors. Data stem from the Pathways to Independence study conducted in Bergen municipality, Norway in 2018-2019 where 81 unaccompanied minors aged 15-20 participated (83.3% male; 80% response rate). An age- and sex-matched control group of 324 adolescents was retrieved from the youth@hordaland study conducted in Norway in 2012. Resilience factors were assessed by the Resilience Scale for Adolescents. Unaccompanied minors reported lower scores on Goal Orientation (d = 0.4), Social Competence (d = 0.4), and Social Support (d = 0.7) compared to Norwegian adolescents. Being male was associated with lower scores on Goal Orientation (standardized mean difference [SMD] = - 0.9) and Social Support (SMD = - 0.9) among unaccompanied minors, while being in frequent contact with family in the home country was associated with higher scores on all resilience factors (SMD range = 0.6-1.1). The number of leisure activities was associated with Social Competence (SMD = 0.22). There were no significant associations between the resilience factors and amount of support in the living arrangements or contact with the child welfare services. Unaccompanied minors reported fewer resilience factors compared to Norwegian adolescents, indicating that they may have different needs compared to other adolescents. Our study also suggests that frequent contact with family in the home country may be important to bolster positive development for unaccompanied minors after settlement.

Associations Between Distinct Trauma Classes and Mental Health Care Utilization in Norwegian Adolescents: A National Registry Study.

Adolescents who experience potentially traumatic experiences (PTEs) have an increased risk of psychopathology. PTEs often co-occur and may form interrelated patterns of exposure. This study investigated underlying classes of PTE exposure among Norwegian adolescent participants in the youth@hordaland study, and whether such classes were associated with contact with child and adolescent mental health services (CAMHS) and psychiatric diagnoses. The data stem from the population-based youth@hordaland study conducted in 2012 which was linked to the Norwegian Patient Registry (NPR, n = 8845). Exposure to PTEs was assessed by adolescent self-report whereas psychiatric disorders (Axis 1) were derived from the NPR. Latent Class Analysis was used to identify distinct classes of PTE exposure-patterns in the data. Logistic regression analyses were performed to investigate associations between classes of PTEs and contact with CAMHS and psychiatric diagnoses. Three classes of PTE exposure were identified based on model fit indices and theoretical considerations. Compared with participants in the low trauma class (88% of participants), those in the Situational-(6%) and Interpersonal trauma class (6%) had higher odds-ratios (ORs) for contact with CAMHS (OR = 2.27 (95% CI [1.78, 2.87])) and (OR = 3.26 (95% CI [2.61, 4.04])) respectively, and for being diagnosed with a psychiatric disorder in CAMHS (ORs ranged from 2.19 - 10.4) after adjusting for sex and parental education. There were more participants diagnosed with ADHD within the Interpersonal trauma class compared to the Situational trauma class when adjusting for sex and parental education (OR = 2.22 (95% CI [1.17, 4.40])). Three relatively homogeneous PTE classes, consisting of distinct patterns of trauma exposure were associated with a higher odds of contact with CAMHS and of being diagnosed with a psychiatric disorder in CAMHS. The study highlights the co-occurrence of PTEs and their impact across the diagnostic spectrum.

Client predictors of therapy dropout in a primary care setting: a prospective cohort study.

BACKGROUND: Therapy dropout poses a major challenge. Considerable research has been conducted on predictors of dropout, however none in the context of primary mental health services in Norway. The purpose of this study was to investigate which client characteristics can predict dropout from the service Prompt Mental Health Care (PMHC). METHODS: We performed a secondary analysis of a Randomized Controlled Trial (RCT). Our sample consisted of 526 adult participants receiving PMHC-treatment in the municipalities of Sandnes and Kristiansand, between November 2015 to August 2017. Using logistic regression, we investigated the association between nine client characteristics and dropout. RESULTS: The dropout rate was 25.3%. The adjusted analysis indicated that older clients had a lower odds ratio (OR) of dropping out compared to younger clients (OR = 0.43, [95% CI = 0.26, 0.71]). Moreover, clients with higher education had a lower odds ratio of dropping out compared to clients with lower levels of education (OR = 00.55, 95% CI [0.34, 0.88]), while clients who were unemployed were more likely to drop-out as compared the regularly employed (OR = 2.30, [95% CI = 1.18, 4.48]). Finally, clients experiencing poor social support had a higher odds ratio of dropping out compared to clients who reported good social support (OR = 1.81, [95% CI = 1.14, 2.87]). Sex, immigrant background, daily functioning, symptom severity and duration of problems did not predict dropout. CONCLUSION: The predictors found in this prospective study might help PMHC-therapists identify clients at risk of dropout. Strategies for preventing dropout are discussed.

Parental separation and school dropout in adolescence.

AIMS: To document the association between parental separation and school dropout in adolescence and to examine the factors that may potentially account for this association. METHODS: Data stem from the large youth@hordaland study that was linked to the Norwegian National Educational Database to obtain objective measures of educational outcomes and disposable income (N = 8323). Logistic regression analysis was used to investigate the association between parental separation and school dropout. A Fairlie post-regression decomposition was used to examine the influence of parental education, household income, health complaints, family cohesion, and peer problems in explaining the association between parental separation and school dropout. RESULTS: Parental separation was associated with a higher odds ratio (OR) of school dropout in crude and adjusted (adjusted odds ratio (AOR)) analyses (OR=2.16, 95% confidence interval (CI) =1.90-2.45; AOR = 1.72, 95% CI = 1.50-2.00). About 31% of the higher odds of school dropout among adolescents with separated parents was explained by the covariates. The decomposition analysis suggested that parental education (43%) and disposable income (20%) accounted for most of the explained differences in school dropout. CONCLUSIONS: Adolescents with separated parents are at higher risk for not completing secondary education. Parental education and disposable income accounted for most of the explained differences in school dropout between the groups. Still, the majority of the difference in school dropout remained unaccounted for, indicating that the link between parental separation and school dropout is complex and likely influenced by multiple factors.

Study design: Pathways to Independence - A study of unaccompanied minor refugees settled in a Norwegian city municipality.

AIMS: The aim of the 'Pathways to Independence' study was to gain knowledge of how to facilitate a healthy development for unaccompanied refugee minors (URMs) after settling in Norwegian municipalities. METHODS: The project is located in the URM child welfare services (URM CWS) of the Bergen municipality. We invited 101 URMs older than 15 years connected to the URM CWS to participate in a comprehensive survey. Of the invited, 81 consented to participate. The survey included questions on the user's experiences and satisfaction with the URM CWS, and questions related to schooling, social support and activities after settlement. We also included standardized and validated questionnaires on potential traumatic events, mental and somatic health, protective factors and quality of life. These questionnaires have previously been used in two Norwegian epidemiological studies, the 'Youth@Hordaland' and 'Young in Foster care', facilitating comparison of the results with other youth populations in Norway. CONCLUSION: Results from the project will be valuable in the process of reaching knowledge-based recommendations for successful settlement of URMs.

Mental health among unaccompanied refugee minors after settling in Norway: A matched cross-sectional study.

Aims: To describe the mental health of unaccompanied refugee minors (URMs) settled in Norway and compare their responses to an age- and sex-matched sample of Norwegian young people. Methods: The data were from the Pathways to Independence study of URMs aged 15-20 years (n = 81; 82.7% male; response rate 80%) conducted in 2018-2019 in the Bergen municipality, Norway. The data from the URMs were linked to an age- and sex-matched group of young people from the Norwegian youth@hordaland study conducted in 2012 (n = 324). Mental health was assessed by the Strengths and Difficulties Questionnaire (SDQ). Results: URMs were more likely to agree with most items pertaining to emotional problems, peer problems and prosocial subscales than Norwegian young people. Few differences were found for items on the conduct problems and hyperactivity-inattention problems scales. Poor psychometric properties, including weak factor loadings and low internal consistency, were detected for the SDQ subscales among URMs, except for the emotional problems subscale, indicating that the originally proposed five-factor model fitted the data poorly. Conclusions: URMs appear to have moderately more emotional problems than Norwegian young people. They are more likely to report being alone, getting along better with adults than with their peers and being bullied, but also report being more helpful and sharing with others. Studies with larger samples of URMs should determine the most appropriate factor structure of the SDQ when administered to URM samples.

Health-related quality of life of children from low-income families: the new patterns study.

BACKGROUND: Child poverty has been gradually rising, and about 12% of all Norwegian children are living in a state of relative poverty. This study was part of the New Patterns project, which recruits low-income families requiring long-term welfare services. Included families receive integrated welfare services, with the help of a family coordinator. The current study objectives were to explore the associations between HRQoL, demographic variables (age, gender, immigration status) and leisure activities in children and adolescents in low-income families. METHODS: A cross-sectional survey was conducted among low-income families. Participating families had children (N = 214) aged 8-18 years.The family had a household income below 60% of the equivalized median population income for three consecutive years and needed long-term welfare services. HRQoL was measured using the KIDSCREEN-27 self-report instrument. Descriptive statistics, including means, standard deviations, and proportions, were calculated, and ordinary least squares regressions were performed, clustering standard errors at the family level. RESULTS: Compared with boys, girls reported lower HRQoL on only one out of five dimensions, physical wellbeing. In the regression analysis we found statistically significant positive associations between migrant status and HRQoL on all five dimensions: physical wellbeing, psychological wellbeing, parents and autonomy, peers and social support, and school environment. In addition, age was associated with school environment, and age, gender and participation in leisure activities was associated with better physical wellbeing. CONCLUSIONS: Baseline results regarding HRQoL among children and adolescents in low-income families indicate that they have overall good HRQoL, though some participants had low HRQoL scores, especially on the physical and social support dimensions. Children with an immigrant background report higher HRQoL than do children without an immigrant background.

Parental separation, negative life events and mental health problems in adolescence.

BACKGROUND: Parental separation is associated with mental health problems in adolescence. One suggested pathway for this association is through the accumulated exposure to stress and other negative life events. This study aimed to document the distribution of negative life events among adolescents with separated compared to non-separated parents, and to assess the direct and interactive associations between parental separation, negative life events, and mental health problems in adolescence. METHODS: Data stem from the cross-sectional population-based youth@hordaland study of adolescents (aged 16-19) conducted in Norway in 2012, providing self-reported information about parental separation, negative life events, and depression-, anxiety-, conduct-, and ADHD symptoms. Regression analyses were used to assess the direct and interactive associations between parental separation, negative life events, and mental health problems. RESULTS: Adolescents with separated parents had more mental health problems across all symptom scales compared to peers with non-separated parents, with standardized mean differences [SMDs] ranging from 0.15 to 0.20. Negative life events moderately attenuated these differences (reduced the SMDs with about 0.04-0.08, depending on the outcome). However, none of the interactions between parental separation and negative life events on mental health problems were statistically significant. CONCLUSIONS: Higher exposure to negative life events explains parts of the association between parental separation and mental health problems in adolescence. However, a parental separation does not seem to increase the vulnerability of the effects of negative life events on adolescents' mental health. Assessing exposure to negative life events is important when providing mental health services to adolescents, particularly to those who have parents separated.

Potential traumatic events and symptoms of post-traumatic stress in unaccompanied refugee minors-a comparison with youth in foster care.

Building knowledge on how child welfare services (CWS) should tailor services for unaccompanied refugee minors (URMs) is important. URMs and youth in foster care are high-risk groups taken care of by the CWS in Norway. Little is known on whether knowledge gained from youth in foster care can inform services for URMs, and if these groups are comparable in terms of experiences of potential traumatic events (PTEs) and post-traumatic stress disorder (PTSD) symptom load. Eighty-one URMs reported PTEs and PTSD-symptoms using an adapted version of the Child and Adolescent Trauma Screen (CATS). Responses were described and compared with a sample of 303 youth in foster care in linear regression models. We present relative risks (RR) and standardized mean differences (SMD) for the PTEs and the PTSD subscale and total score between the groups in forest plots. URMs had experienced a mean (standard deviation) of 6.4 (3.4) PTEs and 43.9% reported to have PTSD-symptoms at or above the clinical cut off. Compared to the foster youth, URMs reported more exposures of interpersonal violence outside of the family (RRs ranging from 66.4 [95%CI 18.1; 243.5) to 1.3 (1.0, 1.5)], and more PTSD-symptoms in the re-experiencing subscale [SMD = 0.3 (95% CI 0.1, 0.6)]. The frequency and types of PTEs and the PTSD-symptom load and profile among URMs and youth in foster care differed. Findings underscore the importance of qualified and targeted care for URMs, and that this care should differ to that of other high-risk groups in the CWS.

Sleep problems among adolescents within child and adolescent mental health services. An epidemiological study with registry linkage.

Sleep problems are prevalent among adolescents, especially among those diagnosed with mental health disorders. There is insufficient knowledge about sleep among adolescents within child and adolescent mental health services (CAMHS) in comparison to the general population. The data are drawn from the youth@hordaland study, a large population-based study conducted in 2012, linked to the Norwegian Patient Registry (NPR) (n = 9077). Psychiatric disorders were based on clinical diagnoses from the NPR, while insomnia, delayed sleep-wake-phase disorder (DSWPD), and other sleep problems/patterns were assessed by self-report questionnaires from youth@hordaland. The prevalence of diagnosed sleep disorders among adolescents seeking mental health services was 0.6%, yielding an estimated prevalence of 0.07% of the population. However, questionnaire-based measurement of insomnia from the youth@hordaland study indicated that insomnia was highly prevalent across disorders in comparison to a reference group of adolescents who were not within mental health care. Insomnia ranged from 29% among adolescents diagnosed with ADHD (PR = 1.79; 95% CI 1.41-2.29) to 48% among adolescents diagnosed with depression (PR = 2.53, 95% CI 2.19-2.92). All diagnostic groups had a mean sleep efficiency below (85%), indicating poor sleep quality. Insomnia, delayed sleep-phase wake disorder, and poor sleep efficiency were confirmed as transdiagnostic sleep problems across psychiatric disorders. In addition, some disorder-specific patterns emerged, such as a higher prevalence of insomnia among adolescents with depression, and DSWPS among adolescents with conduct disorder. This underscores the need for treating sleep problems in CAMHS, and transdiagnostic treatment approaches are warranted.

Internalizing Symptoms Among Youth in Foster Care: Prevalence and Associations with Exposure to Maltreatment.

Among youth in foster care (N = 303, aged 11-17 years), we investigated prevalence of internalizing symptoms; associations between symptom level and maltreatment types and numbers; and the interaction between gender and maltreatment, on internalizing symptoms. Youth completed Spence Children Anxiety Scale, Short Mood Feelings Questionnaire, and Child and Adolescent Trauma Screen. Compared to community samples, symptom levels above clinical cut-off was more frequent, with social- and generalized anxiety (ES = 0.78-0.88) being most prevalent among youth in foster care. Girls reported more internalizing symptoms (ES = 0.59-0.93). Sexual abuse and neglect were associated with a broader range of internalizing symptoms (ES = 0.35-0.64). Increased incidence of maltreatment was associated with increased levels of symptoms (ES = 0.21-0.22). Associations between maltreatment and symptom level were stronger for girls. This study stresses the importance of broad screening of maltreatment and internalizing symptoms to meet the needs of youth in foster care.

The New Patterns study: coordinated measures to combat child poverty.

BACKGROUND: Child poverty rates are rising in Norway with potential negative consequences for children. Services for families with low income are often fragmented and poorly integrated, and few coordinated initiatives have been implemented and evaluated in Norway. AIMS: The aim of the current study is to evaluate how integrated and coordinated services provided over a prolonged period by a family coordinator are related to changes across a wide range of health, wellbeing and home environment indicators for the participants. METHODS: The study uses a mixed methods approach utilising survey and register data, as well as information from interviews and shadowing, to document and evaluate outcomes associated with the intervention and the process of implementation. Data are gathered at baseline and annually throughout the duration of the study. Participants are identified to facilitate longer-term follow-up using register data. CONCLUSIONS: This project will develop important knowledge about the implementation of coordinated services to families with a low income, and how this way of organizing services influences important outcomes for the family members in the short and long term.

Complex families and health complaints among adolescents: A population-based cross-sectional study.

Aims: The structure of adolescents' families has become more complex over the last decades in several western countries. In parallel, health complaints among adolescents appear to have risen in the Nordic countries. This study aimed to examine the association between family structure and health complaints among Norwegian adolescents while capturing biological, half-, and stepsiblings (sibship-type) in the families. Methods: Data stem from the youth@hordaland study, an epidemiological study of adolescents aged 16-19 years (N = 10,257; participation rate = 53%) conducted in 2012. This study is based on a subsample of 8808 adolescents who lived with parent(s). The adolescents provided detailed information on sociodemographics, family structure, sibship-type, and common health complaints among youth (headache, dizziness, and abdominal, neck, back, and shoulder pain). Results: Adolescents in nuclear families and joint physical custody (JPC) reported significantly lower levels of health complaints compared to peers in single- or stepparent families. Independent of family structure, biological siblings were associated with lower levels of health complaints, while stepsiblings were associated with higher levels of health complaints, but only among girls. These findings were robust to adjustments of sociodemographic variables. Conclusions: Health complaints are frequent but unequally distributed across family structures. Adolescents in nuclear families and JPC report lower levels of health complaints compared to peers in single- or stepparent families. Considering siblings appears to be relevant, as biological- and stepsiblings were related to adolescents' symptoms, independent of family structure. In combination, knowledge about family structure and sibship-type may aid the identification of adolescents at risk of experiencing health complaints.

Physical inactivity, non-participation in sports and socioeconomic status: a large population-based study among Norwegian adolescents.

BACKGROUND: Physical activity in adolescence is found to promote both immediate and long-term health, as well as school- and work performance. Previous studies suggest that parental socioeconomic status (SES) may influence the level of activity, although the results are inconsistent. The objective of this study was to examine the overall level of low physical activity/sports participation and the associations with parental SES and adolescent school program in a population-based study of older adolescents. METHODS: The youth@hordalandy study, a large population-based study in Hordaland county, Norway, conducted in 2012, included 10,257 adolescents aged 16-19 years (53% girls). Physical activity was examined by self-reported overall activity, and participation in organized team- and individual sports. Predictor variables were parental SES measured by youth self-reports of family economic well-being, parental education and work affiliation and self-reported current high school program (vocational versus general studies). Age, ethnicity, and family structure were included as covariates. RESULTS: Girls who reported lower parental education had small, but significant higher risk for physical inactivity and non-participation in individual sports compared with their counterparts who reported higher family education (RRs ranging from 1.04 to 1.12, p < 0.01). There were some, but inconsistent, evidence of an increased risk for physical inactivity and non-participation in sports among those (and particularly boys) with lower family economic well-being. Parental work status was largely unrelated with physical inactivity/non-participation in sports. Adolescents in vocational studies had a small but significantly increased risk of physical inactivity and non-participation in sports compared with individuals in general studies (RRs ranging from 1.03 to 1.05, all p < 0.05). CONCLUSIONS: We found some evidence of a social gradient for lower physical inactivity and non-participation in sports for adolescents. Although effect sizes were small, vocational studies was the most robust correlate for physical inactivity/non-participation in sports among the SES-variables, while the corresponding associations with parental education and family economic well-being differed by gender.

29 recommendations to combat social inequalities in health. The Norwegian Council on Social Inequalities in Health.

All political parties in Norway agree that social inequalities in health comprise a public health problem and should be reduced. Against this background, the Council on Social Inequalities in Health has taken action to provide specific advice to reduce social health differences. Our recommendations focus on the entire social gradient rather than just poverty and the socially disadvantaged. By proposing action on the social determinants of health such as affordable child-care, education, living environments and income structures, we aim to facilitate a possible re-orientation of policy away from redistribution to universalism. The striking challenges of the causes of health differences are complex, and the 29 recommendations to combat social inequality of health demand cross sectorial actions. The recommendations are listed thematically and have not been prioritized. Some are fundamental and require pronounced changes across sectors, whereas others are minor and sector-specific.

Sociodemographic characteristics associated with alcohol consumption and alcohol-related consequences, a latent class analysis of The Norwegian WIRUS screening study.

BACKGROUND: For alcohol, the association with socioeconomic status (SES) is different than for other public health challenges - the associations are complex, and heterogeneous between socioeconomic groups. Specifically, the relationship between alcohol consumption per se and adverse health consequences seems to vary across SES. This observation is called the 'alcohol harm paradox'. This study aims to describe different patterns of alcohol use and potential problems. Next, the associations between sub-groups characterized by different patterns of alcohol use and potential problems, and age, gender, educational level, full-time employment, occupational level and income is analysed. METHODS: Employing data from the ongoing cross-sectional WIRUS-study, N = 4311 participants were included in the present study. Individual response patterns of the ten-item Alcohol Use Disorders Identification Test (AUDIT) were analysed and latent class analysis (LCA) was used to identify latent groups. Next, the associations between the classes identified in the best fitting LCA-model and sociodemographic factors were analysed and presented. RESULTS: We identified three classes based on the response patterns on AUDIT. Class 1 was characterised by low-level alcohol consumption and very low probability of negative alcohol-related consequences related to their alcohol consumption. Class 2 was characterised by a higher level of consumption, but despite this, class 2 also had a relatively low probability of reporting negative alcohol-related consequences. Class 3, however, was characterised by high levels of alcohol consumption, and a high probability of reporting negative consequences of their consumption. The classes identified were systematically differentially associated with the included measures of SES, with class 3 characterised by younger age, more males and lower educational attainment. CONCLUSIONS: Our findings highlight the interconnectedness of alcohol consumption and alcohol-related consequences. Furthermore, the identified classes and SES yields further insights into to intricate relationship between various socioeconomic factors, alcohol use patterns and related negative consequences.