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Adolescent self-reported health in relation to school factors: a multilevel analysis.

https://arctichealth.org/en/permalink/ahliterature261997
Source
J Sch Nurs. 2014 Apr;30(2):114-22
Publication Type
Article
Date
Apr-2014
Author
Karina Nygren
Erik Bergström
Urban Janlert
Lennart Nygren
Source
J Sch Nurs. 2014 Apr;30(2):114-22
Date
Apr-2014
Language
English
Publication Type
Article
Keywords
Adolescent
Bullying - psychology
Child
Female
Health status
Health Surveys - methods - statistics & numerical data
Humans
Interpersonal Relations
Juvenile Delinquency - psychology - statistics & numerical data
Male
Multilevel Analysis
Peer Group
Questionnaires
Schools
Self Report
Sex Distribution
Students - psychology - statistics & numerical data
Sweden
Abstract
The aim of the study was to examine school-related determinants of self-reported health among adolescents. Questionnaire survey data comprising 4,972 students, Grades 7 through 9, from 20 schools in northern Sweden were used. Also, complimentary data about each school were collected from the Swedish National Agency for Education. Using multilevel logistic regression analyses, results showed that most variation in self-reported health was explained by individual-level differences. Truancy, bullying, and poor relations with teachers significantly increased the odds ratio of reporting poor general health, for boys and for girls. Most variables at the school level, for example, school size and student-teacher ratio, did not render significant associations with students' self-reported health. In conclusion, this study indicates that health promotion at school, including school health services, may benefit from focusing primarily on individual-level determinants of health, that is, students' relations to peers and teachers, without ignoring that bullying and weak student-teacher relationships also may induce school-level interventions.
PubMed ID
23674554 View in PubMed
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Adolescents from affluent city districts drink more alcohol than others.

https://arctichealth.org/en/permalink/ahliterature278664
Source
Addiction. 2015 Oct;110(10):1595-604
Publication Type
Article
Date
Oct-2015
Author
Willy Pedersen
Anders Bakken
Tilmann von Soest
Source
Addiction. 2015 Oct;110(10):1595-604
Date
Oct-2015
Language
English
Publication Type
Article
Keywords
Adolescent
Alcoholic Intoxication - epidemiology
Alcoholism - epidemiology
Cities
Cross-Sectional Studies
Female
Humans
Income - statistics & numerical data
Linear Models
Male
Multilevel Analysis
Norway - epidemiology
Parents
Religion
Residence Characteristics - statistics & numerical data
Social Class
Social norms
Socioeconomic Factors
Surveys and Questionnaires
Underage Drinking - statistics & numerical data
Abstract
To estimate the level of alcohol consumption and problems among adolescents in city districts in Oslo, Norway with different socio-economic composition; to test whether differences in alcohol consumption are related to district differences in socio-demographic characteristics; and to analyse whether such associations remain significant after controlling for individual-level variables.
Cross-sectional survey using multi-level linear regression analyses with individual responses at the lowest level and city-district data at the highest level.
Oslo, Norway.
A total of 6635 secondary school students, in 62 schools, living in 15 different city districts.
Frequency of alcohol consumption and alcohol intoxication; alcohol problems; and individual characteristics such as immigrant status, religious involvement and parental norms with regard to alcohol. Socio-economic indicators in city districts, such as education, income and unemployment, were combined into a district-level socio-economic index (DLSI).
DLSI scores were related positively to alcohol use (r?=?0.31, P?
PubMed ID
26032427 View in PubMed
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Adolescents' utilisation of psychiatric care, neighbourhoods and neighbourhood socioeconomic deprivation: a multilevel analysis.

https://arctichealth.org/en/permalink/ahliterature106043
Source
PLoS One. 2013;8(11):e81127
Publication Type
Article
Date
2013
Author
Anna-Karin Ivert
Marie Torstensson Levander
Juan Merlo
Author Affiliation
Faculty of Health and Society, Malmö University, Malmö, Sweden.
Source
PLoS One. 2013;8(11):e81127
Date
2013
Language
English
Publication Type
Article
Keywords
Adolescent
Databases, Factual
Delivery of Health Care - organization & administration
Female
Hospitals, Psychiatric - utilization
Humans
Male
Mental Disorders - psychology
Mental Health - statistics & numerical data
Multilevel Analysis
Poverty Areas
Residence Characteristics
Social Adjustment
Social Environment
Socioeconomic Factors
Sweden
Abstract
Mental health problems among adolescents have become a major public health issue, and it is therefore important to increase knowledge on the contextual determinants of adolescent mental health. One such determinant is the socioeconomic structure of the neighbourhood. The present study has two central objectives, (i) to examine if neighbourhood socioeconomic deprivation is associated to individual variations in utilisation of psychiatric care in a Swedish context, and (ii) to investigate if neighbourhood boundaries are a valid construct for identifying contexts that influence individual variations in psychiatric care utilization. Data were obtained from the Longitudinal Multilevel Analysis in Scania (LOMAS) database. The study population consists of all boys and girls aged 13-18 years (N=18,417), who were living in the city of Malmö, Sweden, in 2005. Multilevel logistic regression analysis was applied to estimate the probability of psychiatric care utilisation. The results from the study indicate that the neighbourhood of residence had little influence on psychiatric care utilisation. Although we initially found a variation between neighbourhoods, this general contextual effect was very small (i.e. 1.6%). The initial conclusive association between the neighbourhood level of disadvantage and psychiatric care utilisation (specific contextual effect) disappeared following adjustment for individual and family level variables. Our results suggest the neighbourhoods in Malmö (at least measured in terms of SAMS-areas), do not provide accurate information for discriminating adolescents utilisation of psychiatric care. The SAMS-areas appears to be an inappropriate construct of the social environment that influences adolescent utilisation of psychiatric care. Therefore, public health interventions should be directed to the whole city rather than to specific neighbourhoods. However, since geographical, social or cultural contexts may be important for our understanding of adolescent mental health further research is needed to identify such contexts.
Notes
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PubMed ID
24260548 View in PubMed
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Alcohol outlet densities and alcohol price: the British Columbia experiment in the partial privatization of alcohol sales off-premise.

https://arctichealth.org/en/permalink/ahliterature117275
Source
Alcohol Clin Exp Res. 2013 May;37(5):854-9
Publication Type
Article
Date
May-2013
Author
Andrew J Treno
William R Ponicki
Tim Stockwell
Scott Macdonald
Paul J Gruenewald
Jinhui Zhao
Gina Martin
Alissa Greer
Author Affiliation
Pacific Institute for Research and Evaluation, Berkeley, CA 94704, USA. andrew@prev.org
Source
Alcohol Clin Exp Res. 2013 May;37(5):854-9
Date
May-2013
Language
English
Publication Type
Article
Keywords
Alcohol Drinking
Alcohol-Related Disorders
Alcoholic Beverages - economics - supply & distribution
British Columbia
Commerce - economics - statistics & numerical data
Humans
Marketing
Multilevel Analysis
Privatization - economics - statistics & numerical data
Public Policy - economics
Restaurants - economics - statistics & numerical data
Taxes - economics
Abstract
Alcohol beverage prices or taxes have been shown to be related to alcohol sales and use and related problems. What is not clear are the mechanisms underlying these relationships.
This study examines the relationship between alcohol outlet density under conditions of the partial privatization of off-premise consumption in British Columbia (BC) occurring over the past decade. Two hypotheses are tested. First, reflecting basic supply-demand principles, greater geographic densities of alcohol outlets will be directly related to reductions in beverage prices in response to greater competition. Second, reflecting the effects of niche marketing and resulting market stratification, increased densities of private liquor stores will be especially related to reductions in beverage prices within this outlet category. Data were collected from: (i) a survey of BC private store prices and practices, (ii) alcohol outlet location information, and (iii) data on demographic characteristics. Multilevel models examine the relationships between prices at individual private liquor stores and the densities of government liquor stores, private liquor stores, bars, and restaurants, controlling for background demographics and geographic unit level effects. Spatial dependencies were also examined.
Increased densities of private liquor stores were associated with lower mean prices of beer and all alcohol aggregated across brands at the store level. There appeared to be no outlet level effect on discounting patterns, however, with the mean price differences apparently reflecting differences in the quality of brands carried rather than unequal prices for any given brand.
Increased densities of private off-sale alcohol outlets appear to result in lower prices charged at said establishments independently of other types of alcohol outlets suggesting that they represent an emerging marketing niche in the context of off-sale outlet privatization.
PubMed ID
23316802 View in PubMed
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Alcohol use and social interactions among adolescents in Sweden: do peer effects exist within and/or between the majority population and immigrants?

https://arctichealth.org/en/permalink/ahliterature97679
Source
Soc Sci Med. 2010 Jun;70(11):1858-64
Publication Type
Article
Date
Jun-2010
Author
Mikael Svensson
Author Affiliation
Orebro University, Orebro, Sweden. mikael.svensson@oru.se
Source
Soc Sci Med. 2010 Jun;70(11):1858-64
Date
Jun-2010
Language
English
Publication Type
Article
Keywords
Adolescent
Adolescent Behavior - psychology
Adolescent Psychology
Alcohol Drinking - epidemiology - ethnology
Emigrants and Immigrants - psychology - statistics & numerical data
Empirical Research
Female
Health Surveys
Humans
Interpersonal Relations
Logistic Models
Male
Multilevel Analysis
Peer Group
Schools
Social Environment
Sweden - epidemiology
Abstract
Are adolescents who attend schools with a high level of alcohol use and binge drinking more likely to use alcohol and binge drink themselves? This paper analyzes peer effects in adolescent drinking based on a survey of 13,070 adolescents conducted in Sweden in 2005. The empirical analysis uses a multi-level logistic model to account for non-observable heterogeneity between the schools and the results show that attending a school with a high level of alcohol use and frequent binge drinking is a strong predictor of alcohol use and binge drinking for the individual. Hardly any significant interaction effects are detected, implying that peer influence is similar across different adolescent sub-groups. Looking at adolescents with different ethnic backgrounds, it is found that the drinking-pattern of the Swedish majority population has a significant effect on drinking by Swedish individuals and immigrants from Nordic and European countries, but no effect on drinking by immigrants from non-European countries.
PubMed ID
20236746 View in PubMed
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Analysing the effect of area of residence over the life course in multilevel epidemiology.

https://arctichealth.org/en/permalink/ahliterature139188
Source
Scand J Public Health. 2010 Nov;38(5 Suppl):119-26
Publication Type
Article
Date
Nov-2010
Author
Oyvind Naess
Alastair H Leyland
Author Affiliation
National Institute of Public Health, Oslo, Norway. oena@fhi.no
Source
Scand J Public Health. 2010 Nov;38(5 Suppl):119-26
Date
Nov-2010
Language
English
Publication Type
Article
Keywords
Adult
Causality
Chronic Disease - epidemiology - mortality
Cohort Studies
Female
Health status
Humans
Longitudinal Studies
Male
Models, Statistical
Mortality
Multilevel Analysis
Norway - epidemiology
Residence Characteristics
Socioeconomic Factors
Abstract
In this paper we present multilevel models of individuals' residential history at multiple time points through the life course and their application and discuss some advantages and disadvantages for their use in epidemiological studies.
Literature review of research using longitudinal multilevel models in studies of neighbourhood effects, statistical multilevel models that take individuals' residential history into account, and the application of these models in the Oslo mortality study.
Measures of variance have been used to investigate the contextual impact of membership to collectives, such as area of residence, at several time points. The few longitudinal multilevel models that have been used suggest that early life area of residence may have an effect on mortality independently of residence later in life although the proportion of variation attributable to area level is small compared to individual level. The following multilevel models have been developed: simple multilevel models for each year separately, a multiple membership model, a cross-classified model, and finally a correlated cross-classified model. These models have different assumptions regarding the timing of influence through the life course.
To fully recognise the origin of adult chronic diseases, factors at all stages of the life course at both individual and area level needs to be considered in order to avoid biased estimates. Important challenges in making life course residential data available for research and assessing how changing administrative coding over time reflect contextual impact need to be overcome before these models can be implemented as normal practice in multilevel epidemiology.
PubMed ID
21062846 View in PubMed
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An Original Stepwise Multilevel Logistic Regression Analysis of Discriminatory Accuracy: The Case of Neighbourhoods and Health.

https://arctichealth.org/en/permalink/ahliterature280453
Source
PLoS One. 2016;11(4):e0153778
Publication Type
Article
Date
2016
Author
Juan Merlo
Philippe Wagner
Nermin Ghith
George Leckie
Source
PLoS One. 2016;11(4):e0153778
Date
2016
Language
English
Publication Type
Article
Keywords
Adult
Female
General practitioners
Humans
Logistic Models
Longitudinal Studies
Male
Middle Aged
Multilevel Analysis - methods
Psychotropic Drugs - therapeutic use
Public Health - statistics & numerical data
ROC Curve
Residence Characteristics - statistics & numerical data
Socioeconomic Factors
Sweden
Abstract
Many multilevel logistic regression analyses of "neighbourhood and health" focus on interpreting measures of associations (e.g., odds ratio, OR). In contrast, multilevel analysis of variance is rarely considered. We propose an original stepwise analytical approach that distinguishes between "specific" (measures of association) and "general" (measures of variance) contextual effects. Performing two empirical examples we illustrate the methodology, interpret the results and discuss the implications of this kind of analysis in public health.
We analyse 43,291 individuals residing in 218 neighbourhoods in the city of Malmö, Sweden in 2006. We study two individual outcomes (psychotropic drug use and choice of private vs. public general practitioner, GP) for which the relative importance of neighbourhood as a source of individual variation differs substantially. In Step 1 of the analysis, we evaluate the OR and the area under the receiver operating characteristic (AUC) curve for individual-level covariates (i.e., age, sex and individual low income). In Step 2, we assess general contextual effects using the AUC. Finally, in Step 3 the OR for a specific neighbourhood characteristic (i.e., neighbourhood income) is interpreted jointly with the proportional change in variance (i.e., PCV) and the proportion of ORs in the opposite direction (POOR) statistics.
For both outcomes, information on individual characteristics (Step 1) provide a low discriminatory accuracy (AUC = 0.616 for psychotropic drugs; = 0.600 for choosing a private GP). Accounting for neighbourhood of residence (Step 2) only improved the AUC for choosing a private GP (+0.295 units). High neighbourhood income (Step 3) was strongly associated to choosing a private GP (OR = 3.50) but the PCV was only 11% and the POOR 33%.
Applying an innovative stepwise multilevel analysis, we observed that, in Malmö, the neighbourhood context per se had a negligible influence on individual use of psychotropic drugs, but appears to strongly condition individual choice of a private GP. However, the latter was only modestly explained by the socioeconomic circumstances of the neighbourhoods. Our analyses are based on real data and provide useful information for understanding neighbourhood level influences in general and on individual use of psychotropic drugs and choice of GP in particular. However, our primary aim is to illustrate how to perform and interpret a multilevel analysis of individual heterogeneity in social epidemiology and public health. Our study shows that neighbourhood "effects" are not properly quantified by reporting differences between neighbourhood averages but rather by measuring the share of the individual heterogeneity that exists at the neighbourhood level.
Notes
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PubMed ID
27120054 View in PubMed
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Appropriate assessment of ethnic differences in adolescent use of psychotropic medication: multilevel analysis of discriminatory accuracy.

https://arctichealth.org/en/permalink/ahliterature289566
Source
Ethn Health. 2016 12; 21(6):578-95
Publication Type
Comparative Study
Journal Article
Research Support, Non-U.S. Gov't
Date
12-2016
Author
Anna-Karin Ivert
Shai Mulinari
Willemijn van Leeuwen
Philippe Wagner
Juan Merlo
Author Affiliation
a Faculty of Medicine, Unit for Social Epidemiology , CRC, Skåne University Hospital, Lund University , Malmö , Sweden.
Source
Ethn Health. 2016 12; 21(6):578-95
Date
12-2016
Language
English
Geographic Location
Sweden
Publication Type
Comparative Study
Journal Article
Research Support, Non-U.S. Gov't
Keywords
Adolescent
Adult
Developing Countries
Drug Utilization - statistics & numerical data
Female
Humans
Male
Mothers - statistics & numerical data
Multilevel Analysis
Psychotropic Drugs - economics - therapeutic use
ROC Curve
Registries
Risk factors
Socioeconomic Factors
Sweden - epidemiology
Young Adult
Abstract
In the present study, we used a multilevel approach to investigate the role of maternal country of birth (MCOB) in predicting adolescent use of psychotropic medication in Sweden.
Using the Swedish Medical Birth Register we identified all 428,314 adolescents born between 1987 and 1990 and who were residing in Sweden in the year they turned 18. We applied multilevel logistic regression analysis with adolescents (level 1) nested within MCOBs (level 2). Measures of association (odds ratio) and measures of variance (intra-class correlation (ICC)) were calculated, as well as the discriminatory accuracy by calculating the area under the Receiver Operator Characteristic (AU-ROC) curve.
In comparison with adolescents with Swedish-born mothers, adolescents with mothers born in upper-middle, lower-middle and low-income countries were less likely to use psychotropic medication. However, the variance between MCOBs was small (ICC = 2.5 in the final model) relative to the variation within MCOBs. This was confirmed by an AU-ROC value of 0.598.
Even though we found associations between MCOB and adolescent use of psychotropic medication, the small ICC and AU-ROC indicate that MCOB appears to be an inaccurate context for discriminating adolescent use of psychotropic medication in Sweden.
Notes
ErratumIn: Ethn Health. 2016 Dec;21(6):i PMID 26965376
PubMed ID
26884047 View in PubMed
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Appropriate assessment of ethnic differences in adolescent use of psychotropic medication: multilevel analysis of discriminatory accuracy.

https://arctichealth.org/en/permalink/ahliterature289724
Source
Ethn Health. 2016 12; 21(6):578-95
Publication Type
Comparative Study
Journal Article
Research Support, Non-U.S. Gov't
Date
12-2016
Author
Anna-Karin Ivert
Shai Mulinari
Willemijn van Leeuwen
Philippe Wagner
Juan Merlo
Author Affiliation
a Faculty of Medicine, Unit for Social Epidemiology , CRC, Skåne University Hospital, Lund University , Malmö , Sweden.
Source
Ethn Health. 2016 12; 21(6):578-95
Date
12-2016
Language
English
Publication Type
Comparative Study
Journal Article
Research Support, Non-U.S. Gov't
Keywords
Adolescent
Adult
Developing Countries
Drug Utilization - statistics & numerical data
Female
Humans
Male
Mothers - statistics & numerical data
Multilevel Analysis
Psychotropic Drugs - economics - therapeutic use
ROC Curve
Registries
Risk factors
Socioeconomic Factors
Sweden - epidemiology
Young Adult
Abstract
In the present study, we used a multilevel approach to investigate the role of maternal country of birth (MCOB) in predicting adolescent use of psychotropic medication in Sweden.
Using the Swedish Medical Birth Register we identified all 428,314 adolescents born between 1987 and 1990 and who were residing in Sweden in the year they turned 18. We applied multilevel logistic regression analysis with adolescents (level 1) nested within MCOBs (level 2). Measures of association (odds ratio) and measures of variance (intra-class correlation (ICC)) were calculated, as well as the discriminatory accuracy by calculating the area under the Receiver Operator Characteristic (AU-ROC) curve.
In comparison with adolescents with Swedish-born mothers, adolescents with mothers born in upper-middle, lower-middle and low-income countries were less likely to use psychotropic medication. However, the variance between MCOBs was small (ICC = 2.5 in the final model) relative to the variation within MCOBs. This was confirmed by an AU-ROC value of 0.598.
Even though we found associations between MCOB and adolescent use of psychotropic medication, the small ICC and AU-ROC indicate that MCOB appears to be an inaccurate context for discriminating adolescent use of psychotropic medication in Sweden.
Notes
ErratumIn: Ethn Health. 2016 Dec;21(6):i PMID 26965376
PubMed ID
26884047 View in PubMed
Less detail

Associations between income inequality at municipality level and health depend on context - a multilevel analysis on myocardial infarction in Sweden.

https://arctichealth.org/en/permalink/ahliterature141814
Source
Soc Sci Med. 2010 Sep;71(6):1141-9
Publication Type
Article
Date
Sep-2010
Author
Göran Henriksson
Gunilla Ringbäck Weitoft
Peter Allebeck
Author Affiliation
Karolinska Institutet, Department of Public Health Sciences, Norrbackahuset, SE 17177 Stockholm, Sweden. goran.henriksson@ki.se
Source
Soc Sci Med. 2010 Sep;71(6):1141-9
Date
Sep-2010
Language
English
Publication Type
Article
Keywords
Adult
Cities - economics - statistics & numerical data
Female
Health status
Humans
Income - statistics & numerical data
Male
Middle Aged
Multilevel Analysis
Myocardial Infarction - epidemiology
Risk factors
Social Class
Sweden - epidemiology
Abstract
This study investigates whether a) income inequality in Swedish municipalities increases the risk of myocardial infarction (AMI); b) the association between income inequality and AMI is mediated by level of residential segregation, measured as homogeneity in parishes (as a proxy for neighbourhoods) within municipalities; and c) there is an interaction between parish homogeneity and individual level social position. The study population consisted of all individuals aged 40-64 years in 1990 who lived in municipalities with >50,000 inhabitants (n = 1,284,955). Data on socioeconomic, demographic information and diagnosis data on AMI were obtained by linkage between authority-administered registers and the National Patient Register. All individuals were followed from 1991 onwards until the first relevant discharge, death or end of observation period (1998). We used a multilevel Poisson model where individuals were nested within 729 parishes which in turn were nested in 41 municipalities. We found that the risk for AMI was lower in the municipalities with higher degree of income inequality. Segregation of households in the highest income quintile diluted, but did not eliminate, the association between income inequality and risk of AMI - the degree of parish affluence seemed to be more important as a mediator than other parish characteristics, even when individual level characteristics were added to the model. Interaction analyses showed that the divide between manual workers and non-manual employees became more apparent in parishes with a higher degree of parish affluence. This was more apparent in municipalities with higher income inequality and was due to a decreasing risk among high level non-manual employees and an unchanged risk among manual workers. The results give some support to the idea that income inequality might serve as a proxy for social stratification even in a comparatively egalitarian context.
PubMed ID
20674117 View in PubMed
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97 records – page 1 of 10.