The majority of Swedish boys and girls have good psychosomatic health. Despite that the risk of mental health problems such as nervousness, feeling low and sleeping difficulties has increased steadily in recent decades. Moreover, previous surveys on health and well-being indicate that boys and girls of foreign extraction in Sweden are at increased risk of ill health compared to boys and girls of Swedish background.   The main aim of this thesis was to analyse health and social determinants among boys and girls of foreign extraction in Sweden. The factors explored in papers I–IV include parental background, family affluence and gender and their associations with subjective health complaints, psychosomatic problems or health risk behaviours. Other included risk factors for ill health were involvement in bullying, low participation and discrimination at school. This thesis takes an intersectional perspective, with ambitions to be able to emphasize the interplay between different power relations (i.e. gender, social class and parental background).   Two sets of cross-sectional data were used. Three papers were based on the Swedish part of the World Health Organization’s Health Behaviour in School-Aged Children. The sample consisted of 11,972 children (boys n = 6054; girls n = 5918) in grades five, seven and nine from the measurement years 1997/98, 2001/02 and 2005/06. The response rate varied between 85 and 90%. About one fifth of the included children were of foreign extraction. For the fourth paper regional data from Northern Sweden were used. Boys (n = 729) and girls (n = 798) in grades six to nine answered a questionnaire in 2011 and the response rate was 80%. About 14% of the included children were of foreign extraction. Statistical methods used were chi-square test, correlation analyses, logistic regression analyses, cluster analyses and test of mediating factor.   The results showed that girls of foreign background were at increased risk of subjective health complaints (SHC) and boys of mixed background were at increased risk of psychosomatic problems (PSP). Increased risk of allocation to the cluster profile of multiple risk behaviour was shown in boys and girls of mixed background, in girls of foreign background and in girls of low family affluence. Increased risk of allocation to the cluster profile of inadequate tooth brushing was shown in boys and girls of foreign background and in girls of low family affluence. General risk factors for increased risk of ill health for boys and girls in Sweden were: any form of bullying involvement, low family affluence, low participation and discrimination at school, of which the latter also was a mediating factor for ill health. Living with a single parent was a risk factor for ill health among girls.   The results can function as a basis for developing health promotion programmes at schools that focus on social consequences of foreign extraction, family affluence, participation as well as health risk behaviours and gender. / Majoriteten av flickorna och pojkarna i Sverige har en god psykosomatisk hälsa. Trots det har risken för psykiska hälsosymptom såsom nervositet, att känna sig nere och sömnsvårigheter ökat successivt de senaste årtiondena. Dessutom indikerar tidigare forskning angående hälsa och välmående att flickor och pojkar med utländsk härkomst har ökad risk för ohälsa jämfört med flickor och pojkar med svensk härkomst.   Denna avhandlings huvudsyfte var att analysera hälsa och sociala bestämningsfaktorer bland flickor och pojkar i Sverige, med fokus på föräldrabakgrund. Artiklarnas (I–IV) syften inkluderar föräldrahärkomst, familjens materiella tillgångar och genus samt dess samband med subjektiva hälsobesvär, psykosomatiska problem eller hälsoriskbeteenden. Andra riskfaktorer för ohälsa som inkluderades var inblandning i mobbning, lågt deltagande och förekomst av diskriminering på skolan. Denna avhandling beaktar ett intersektionellt perspektiv med ambitionen att kunna tydliggöra samspelet mellan olika maktordningar (dvs. genus, social klass och föräldrabakgrund).   Två dataset från tvärsnittsstudier har använts. I de tre första artiklarna användes World Health Organization – Health Behaviour in School-Aged Children, som i Sverige heter Svenska skolbarns hälsovanor. Studiepopulationen bestod av 11 972 barn (flickor n = 5918; pojkar n = 6054) i årskurserna fem, sju och nio undersöknings år 1997/98, 2001/02 och 2005/06. Svarsfrekvensen var mellan 85 och 90 %. Ungefär en femtedel av barnen som deltog hade utländsk härkomst. I den fjärde artikeln användes regional data från norra Sverige. Flickor (n = 798) och pojkar (n = 729) i årskurserna sex till nio deltog i studien år 2011, svarsfrekvensen var 80 %. Omkring 14 % av barnen hade utländsk härkomst. De statistiska metoder som användes var sambandstest (chi-två), test av linjära samband så kallade korrelationsanalyser, logistisk regressionsanalys, klusteranalys och test av medierande faktor.   Resultaten visade att flickor med utländsk bakgrund hade ökad risk för subjektiva hälsobesvär (SHC) och pojkar av mixbakgrund hade ökad risk för psykosomatiska problem (PSP). Ökad risk för att hamna i klusterprofilen multipelt hälsoriskbeteende hade flickor och pojkar med mixbakgrund, flickor med utländsk bakgrund samt flickor i familjer med låg nivå av materiella tillgångar. Ökad risk för att hamna i klusterprofilen bristande tandborstning hade flickor och pojkar med utländsk bakgrund och flickor i familjer med låg nivå av materiella tillgångar. Generella riskfaktorer för ohälsa bland flickor och pojkar i Sverige var: alla former av inblandning i mobbning, låg nivå av materiella tillgångar i familjen, lågt deltagande och förekomst av diskriminering på skolan, vilken den senare även var en medierande faktor för ohälsa. Att leva med en ensamstående förälder var en riskfaktor för ohälsa bland flickor.   Avhandlingens resultat kan ligga till grund för utformande av hälsofrämjande interventioner inom elevhälsan, till exempel interventioner som fokuserar på sociala konsekvenser av utländsk härkomst, familjens materiella tillgångar, deltagande och diskriminering samt hälsoriskbeteenden och genus.

Med en socialkonstruktivistisk och sociokulturell ansats, studeras skolkuratorers uppfattning om och erfarenhet av grundskoleelevers psykiska hälsostatus samt skolkuratorernas definieringar av psykisk hälsa/ohälsa. Studien problematiserar att det rapporteras från återkommande enkätstudier att mer än varannan grundskolelev uppger sig ha återkommande psykosomatiska symptom vid minst två tillfällen i veckan, samtidigt som knappt nio av tio grundskoleelever uppger sig ha gott eller mycket gott psykiskt välbefinnande. Mer än varannan grundskolelev lider av psykisk ohälsa är utgångspunkten i den offentliga debatten. Empirin består av intervjuer med skolkuratorer vilka inte delar den bild av grundskolelevers psykiska hälsostatus som utmålas i den offentliga debatten. Allmängiltiga definitioner av psykisk hälsa/ohälsa finns inte, vilket bidrar till delade meningar råder bland forskare, myndigheter, politiker, media, etcetera om vad begreppen innebär. Utifrån studien kan slutsatser dras att definitionsförvirring, otillräckliga mätinstrument och brist på hänsyn till samhällsutvecklingen bidrar till en missvisande bild av grundskolelevers psykiska hälsostatus.

This study examined temporal trends and socioeconomic differences in alcohol use and drunkenness among Swedish 15-year-old students between 2001/02 and 2017/18. Data were obtained from the Health Behaviour in School-aged Children (HBSC) study conducted in 2001/02, 2005/06, 2009/10, 2013/14 and 2017/18 (n ≈ 1500/year). Socioeconomic status (SES) was measured using two alternative indicators: educational aspirations and family affluence. Logistic regression models were used to investigate the relationships between drinking measures and SES indicators. The results showed a significant decline in alcohol use and drunkenness among Swedish 15-year-old students from 2001/02 to 2017/18. Educational aspirations almost consistently statistically negatively predicted regular alcohol use and drunkenness. Family affluence only had a weak effect on adolescent drinking behavior with a tendency for less affluent students reporting less alcohol use and drunkenness. Trend analyzes within the subgroups indicated that the downward trend was mirrored in all SES groups, but it was not equally steep in all groups. The decrease was generally weaker among students with lower educational aspirations but stronger among students from less affluent families. This study suggests that different aspects of SES may influence adolescent drinking in opposing directions. In future efforts aimed at reducing alcohol use and drunkenness among adolescents, students with lower educational aspirations should be the target population.

Introduction: Psychosomatic complaints have increased among adolescents in recent decades, as well as overweight and obesity rates, which have become a public health issue. The associations between weight status and psychosomatic complaints are not clear, therefore further research is needed. The aim of this study was to explore the associations between weight status and psychosomatic complaints among Swedish adolescents, and the possible buffering effect of family support. Methods: This study was based on cross-sectional data of the Swedish Health Behavior in School-aged Children (HBSC) of 2017/18, that included 3,133 boys and girls aged 11, 13 and 15 years. Weight status was based on self-reported information on weight and height, which was used to calculate body mass index (BMI) and construct the categories “non-overweight”, “overweight” and “obese”. Psychosomatic complaints were based on information on the frequency of eight different complaints, that was summed to an index. Family support was measured by three items that described the received support. An index was constructed which was dichotomized into two categories, low and high family support. Gender, age and family affluence were included as covariates. Linear regression analyses were performed to investigate the associations between weight status and psychosomatic complaints. Interaction analyses were used to see whether family support moderates the main association. Additional family support- and sex-stratified analyses were conducted. Results: The results revealed that obesity is associated with higher levels of psychosomatic complaints. Being non-overweight or overweight did not show any significant associations with the outcome. Girls reported higher levels of psychosomatic complaints compared to boys. Family support could buffer against obese girls’ psychosomatic complaints. Conclusions: The findings of this study highlight the importance of public health actions to prevent childhood obesity and additionally the significant role of family support in decreasing obese adolescents’ psychosomatic complaints. Furthermore, more research is needed for better understanding of these associations.

The purpose of this study was to explore the association between problematic social media use (PSMU) and self-rated health (SRH) among Swedish adolescent boys and girls, and additionally to examine whether perceived familial social support buffers against poor health in the same association. The study was based on the Health Behaviour in School-aged Children (HBSC) survey from 2017/2018. The study sample consisted of 3371 adolescents from 213 schools across Sweden. PSMU was used as the exposure variable, SRH as theoutcome variable, age and gender as control variables, and perceived familial social support was applied as a moderator between PSMU and SRH. The analyses performed in the current study was cross-tabulations, binary logistic regression, multiplicative and additive interaction analysis. The results revealed that there is a significant association between PSMU and SRHamong Swedish adolescents. Adolescents with moderate level PSMU had 2.77 higher odds of reporting less than good health (95% CI 2.00-3.84) in comparison to adolescents with low levels of PSMU. Adolescents with high level PSMU had furthermore 4.16 odds of reporting less than good health PSMU (95% CI 2.41-7.20) in comparison to adolescents with low levelPSMU. The association between PSMU and SRH remained statistically significant even after adjusting for age, gender, and perceived familial social support. The interaction analyses did moreover reveal that perceived familial social support may play a crucial role by mitigating the effects of high level PSMU on SRH among Swedish adolescents. In a conclusion, it is of vital importance to understand PSMU in relation to the social context to better understand PSMU and prevent young people from poor SRH. Future research may address the same association but in relation to other social factors, such as socioeconomic status, to achieveenhanced understanding over the association between PSMU and SRH and how to better prevent poor health among young people. Policy makers could furthermore introduce support programs for families/parents who feel they lack confidence in the ability to act as sufficient support, which may reduce the risk for poor health among young people.

Introduction The health of young people in England is an area of concern, nationally and internationally. This has prompted a range of strategies and policies to try to address how health may be improved. However, there has not necessarily been agreement as to how this should best be done. There appeared a case for consideration of alternative or additional approaches to health promotion. Aim This research aimed to construct an assets based model to shape health promotion practice and policy for young people in England. Methods A narrative synthesis was undertaken and highlighted the lack of information regarding which assets might be important for young people’s health in England. This programme of research was developed from those initial findings. Quantitative and qualitative methods were employed to gain a more comprehensive understanding than could be gained by individual methods. This mixed methods research involved secondary data analysis of the Health Behaviours in School Aged Children (HBSC) dataset using regression analysis to identify the assets associated with life satisfaction for English youth. Focus groups and interviews were employed to capture the views of young people regarding assets, health and health promotion. Findings were discussed with practitioners to gather their ideas as to the potential of an assets approach. The different research methods were drawn together by the underpinning theoretical frameworks provided by Assets models and the New Social Studies of Childhood. Results Two themes emerged from the narrative synthesis providing suggestions for health promotion; the ecological approach acknowledged the range of settings that young people inhabit, whilst the holistic approach recognised the interrelationship between risks and assets. Critical discussion consolidated the research findings to propose a list of health promoting assets for young people in England; constructive relationships, safety, positive attributes, independence and opportunity. These findings were brought together into a descriptive model to guide health promotion policy and practice (Figure 1). Constructive relationships appeared as a core asset, providing a foundation from which young people could develop. Having positive attributes was also fundamental to this process, which emphasises the importance of promoting physical and mental health simultaneously. Safety was the third core asset identified through the research strands. There was variation between young people regarding the definition of, and priority assigned to, the additional assets of independence and opportunity. Figure 1: Assets model to shape health promotion with young people Conclusion This research contributes to previous work in the field of assets models by providing new insight into the relatively little researched area of assets approaches to health promotion with young people in England. The complex interrelationships between mental health and assets have been highlighted; providing challenge to frameworks that focus on the quantitative accumulation of assets. The inclusion of young people’s perspectives provided new depth to previous theoretical models and interpretation of quantitative findings. The variation highlighted within this research raises implications for tackling health inequalities. This assets based model provides a framework to shape professional practice and policy thus providing the potential to improve young people’s health and wellbeing in a sustainable and non-stigmatising way.

Opportunities to be and remain healthy are unequally distributed across socioeconomic groups and emerge and widen throughout childhood and adolescence. This thesis seeks to answer if social relationships are one of the mechanisms that operate in the association between socioeconomic status (SES) and health among Swedish adolescents, using the Health Behavior in School-Aged Children (HBSC) survey round 2009/10. It also aims to clarify which aspect of social relationships – its structure or function - matters more for health. Network structure includes its size and frequency of contact, and network function refers to resources received from those in the network, such as social support. The research questions guiding the thesis are: (1) Is higher socioeconomic status associated with higher self-rated health and wellbeing among Swedish adolescents? (2) Does the structure and the function of the child’s social relationships mediate in the associations in question 1? (3) Which aspect of social relationships (structure or function) mediates the associations in question 1 to the largest extent? Research questions are addressed by a mediation analysis using regression models to explore which indicators of social relationships mediate the associations between SES and health and wellbeing. Results showed a positive association between SES and health and wellbeing, and mainly three significant mediators were found which indicated that children with higher SES receive higher social support from their parents and peers and have a larger network which in turn lead to better health and wellbeing. Finally, results indicated that it is the function of social relationships rather than the structure that mediates to the largest extent.