Profiles

Mikael Rostila

Mikael Rostila

Prefekt, professor

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Arbetar vid Institutionen för folkhälsovetenskap
Telefon 08-16 44 16
E-post mikael.rostila@su.se
Besöksadress Sveavägen 160, Sveaplan
Rum 338
Postadress Institutionen för folkhälsovetenskap 106 91 Stockholm

Om mig

Mikael är professor i folkhälsovetenskap, docent i sociologi och prefekt vid institutionen för folkhälsovetenskap. Han är även föreståndare för Centrum för forskning om ojämlikhet i hälsa (CHESS) vid institutionen. Mikael leder ett stort forskningsprogram finansierat av FORTE ”Sociala determinanter för hälsa hos individer med utländsk bakgrund: Samhälleliga och individuella perspektiv” (SMASH) (2017-2022). Han leder också forskningsprojektet ”Ett livsförloppsperspektiv på förlust av anhörig i barndomen och hälsa i vuxen ålder” finansierat av Vetenskapsrådet (2018-2020).

 

Mikael’s forskning handlar brett om ojämlikhet i hälsa och hälsans sociala bestämningsfaktorer. Han har bland annat publicerat en populär bok inom området tillsammans med Susanna Toivanen, Den Orättvisa Hälsan – Om socioekonomiska skillnader i hälsa och livslängd (Liber). Han har även skrivit en bok om hur socialt kapital påverkar hälsa och ojämlikhet i hälsa i Europeiska välfärdsstater, Social capital and health inequality in European Welfare States (Palgrave MacMillan).

 

Mer specifikt handlar Mikael’s forskning bland annat om:

  • Hälsa bland personer med utländsk bakgrund och dess sociala determinanter

  • Hur sociala nätverk och socialt kapital påverkar hälsa och hälsobeteenden

  • Inkomstojämlikhet och konsekvenser för hälsa och dödlighet

  • Sjukdom och dödlighet efter förlust av anhörig

  • Hur syskonordning påverkar vår hälsa och livslängd

Publikationer

I urval från Stockholms universitets publikationsdatabas
  • 2018. Sol P. Juárez (et al.). SSM - Population Health 6, 16-25

    Background: A mortality advantage has been observed among recently arrived immigrants in multiple national contexts, even though many immigrants experience more social disadvantage compared to natives. This is the first study to investigate the combined influence of duration of residence and age at arrival on the association between region of origin and all-cause mortality among the adult immigrant population in Sweden.

    Methods: Using population-based registers, we conducted a follow-up study of 1,363,429 individuals aged 25-64 years from 1990 to 2008. Gompertz parametric survival models were fitted to derive hazard ratios (HR) for all-cause mortality.

    Results: Compared to native Swedes, we observed a health advantage in all group of immigrants, with the exception of individuals from Finland. However, when information on age at arrival and duration of residence was combined, an excess mortality risk was found among immigrants who arrived before age 18, which largely disappeared after 15 years of residence in Sweden. Non-European immigrants over age 18 showed similar or lower mortality risks than natives in all categories of age at arrival, regardless of duration of residence.

    Conclusions: The findings suggest that the mortality advantage commonly observed among immigrants is not universal. Combined information on age at arrival and duration of residence can be used to identify sensitive periods and to identify possible selection bias. The study also suggests that young immigrants are a vulnerable subpopulation. Given the increased number of unaccompanied minors arriving in Europe, targeted health or integration policies should be developed or reviewed.

  • 2018. Viviane S. Straatmann (et al.). PLoS ONE

    We investigated the stability and the directionality of being body bullied and a set of four variables– 1) Body Mass Index (BMI), 2) moderate and vigorous physical activity (MVPA), 3) television time (TV) and 4) video game/computer time (VG)-, termed in the present study as ‘health-related state and behaviours (HRSB)’–across adolescence. The Adolescent Nutritional Assessment Longitudinal Study (ELANA) is a cohort study conducted among middle school students from two public and four private schools in Rio de Janeiro-Brazil. We analysed data from 2010 (T1) and 2012 (T2) among 810 adolescents (aged 9–15 at T1). Gender-specific structural equation models (SEM) were estimated, including autoregressive paths for the HRSB and being body bullied over time, correlations at T1 and T2, respectively, and cross-lagged effects. The results presented significant stability coefficients for almost all variables over time in both genders (except for MVPA in boys and girls and TV time among girls). There were positive correlations between BMI and being body bullied, as well as between TV and VG for boys (0.32, p<0.001 and 0.24, p<0.001, respectively) and girls (0.30, p<0.001 and 0.30, p<0.001, respectively) at T1. It remained significant at T2 (boys: 0.18, p<0.05 and 0.16, p<0.01; girls: 0.21, p<0.01 and 0.22, p<0.01, respectively). Examining the cross-lagged paths between being body bullied and HRSB, we observed that the reciprocal model provided the best fit for boys, indicating that BMI at T1 had a significant effect in being body bullied at T2 (0.12, p<0.05) and being body bullied at T1 had an effect on VG at T2 (0.14, p<0.01). Among girls the forward causation model showed the best fit, demonstrating a significant effect of being body bullied at T1 on VG at T2 (0.16, p<0.01). Apart from MVPA, both being body bullying and HRSB were largely stable across adolescence. For boys and girls alike, exposure to being body bullied seemed to increase their time spent on VG, while for boys BMI also predicted being body bullied. This study highlighted the complex interplay between being body bullied and HRSB and the importance of acknowledging gender differences in this context.

  • 2018. Fjalar Finnas, Mikael Rostila, Jan Saarela. Population Studies 72 (1), 41-51

    Most studies that have examined whether a child's death influences parental relationship stability have used small-scale data sets and their results are inconclusive. A likely reason is that child loss affects not only the risk of parental separation, but also the risk of having another child. Hence parity progression and separation must be treated as two competing events in relation to child loss. The analysis in this paper used Finnish register data from 1971 to 2003, covering over 100,000 married couples whose durations of both first marriage and parenthood could be observed. We ran parity-specific Cox regressions in which process time started from the birth of each additional child. All marriages included women of childbearing age, none of whom had experienced any child death on entering the analysis. We find that child loss only modestly influences the divorce risk, whereas its effect on the risk of parity progression is considerable.

  • 2018. Mikael Rostila, Netta Maki, Pekka Martikainen. PLoS ONE 13 (5)

    Background Several studies have found that the loss of a child is associated with psychiatric health problems, yet few studies examined whether child loss influences psychotropic medication use. This study examined short-and long-term use of psychotropic medication, both before and after the death of a child, and its potential effect modifiers. Methodology/Principal findings A random sample of 205,456 parents, including 902 bereaved parents, were selected from a Finnish total population registry. The analyses were based on linear regressions using generalised estimation equations (GEE) and adjusted for sociodemographic factors. Annual psychotropic use was defined as having purchased prescribed psychotropic medication between 1996 and 2012. Bereaved parents were followed for four years prior to and up to four years after the death of their child. An increase in the use of antidepressants and anxiolytics was found in parents following their loss. The highest percentage of use was found around one year after bereavement, followed by a steady decrease although this remained higher than the level of use among non-bereaved four years after the death. Between 20-25% of bereaved mothers and 10-15% of bereaved fathers used antidepressants or anxiolytics one year after bereavement while the corresponding number in non-bereaved was 5-10%. An increase in psychotropic medication was also found several years before the disease-related loss of a child. Conclusions/Significance The use of psychotropic medication is markedly higher among parents after losing a child. Patterns of use leading up to and following the death of a child should be further examined in relation to clinical risk factors so as to identify at risk populations.

  • 2018. Andrea C. Dunlavy, Sol Juárez, Mikael Rostila. European Journal of Public Health

    Background: The association between exposure to unemployment and increased risk of mortality is well established. Yet migrants and their children often experience a number of stressors in the country of residence which could exacerbate the negative effects of job loss or unemployment. This study examined the extent to which region of origin and generational status modified associations between employment status and risk of all-cause mortality. Methods: Using population-based registers, an open cohort of 2 178 321 individuals aged 25-64 years was followed from 1993 to 2008. Hazard ratios for mortality were calculated using Cox regression. Employment status and socio-demographic covariates were included as time-varying variables in all models. Results: Relative to employed native-origin Swedes, excess risk of mortality was found among most groups of unemployed persons. The excess risk of mortality found among African women exposed to long-term unemployment (HR = 3.26, 95% CI: 2.30-4.63), Finnish men exposed to short-and long-term unemployment (HR = 2.74, 95% CI: 2.32-3.24 and HR = 2.39, 95% CI: 2.12-2.69), and second generation Swedish men exposed to short-term unemployment (HR = 2.34, 95% CI: 2.06-2.64) was significantly greater (P < 0.05) than that found among their unemployed native-origin counterparts. Excess risk of mortality among the unemployed in other foreign-origin groups was of a similar or lower magnitude to that found in unemployed native-origin Swedes. A decreased risk of mortality was observed among the employed in nearly all foreign-origin groups. Conclusions: With some exceptions, mortality risk in foreign-origin individuals across all categories of employment status was generally similar to or lower than the risk observed in native-origin Swedes.

  • 2018. Charisse M. Johnson-Singh (et al.). Health and Place 52, 70-84

    Introduction

    Ethnic heterogeneity has been linked to both protective and detrimental effects on mental health. Few studies have investigated the role of social capital in this relationship and none have found that it has an explanatory role. The aim of this study is to investigate the relationship between two measures of ethnic heterogeneity and psychological distress in Stockholm County, as well as the explanatory role of social capital for individuals with Swedish-background, foreign-background and those who are foreign-born.

    Methods

    This study used data collected from respondents aged 18-64 to the 2002, 2006, 2010 baseline questionnaires of the Stockholm Public Health Cohort and was linked with individual and area-level register information. Ethnic heterogeneity was the main exposure, measured by: 1) ethnic density, defined as the proportion of first and second generation immigrants with 2 foreign-born parents; and 2) ethnic diversity, using the fragmentation index. Social capital measures of individual and contextual-level social support and horizontal trust were the main explanatory factors of interest. The outcome, psychological distress, was assessed using the General Health Questionnaire-12 with a 2/3 cut-off. Prevalence ratios with 95% confidence intervals were estimated using multi-level poisson regression with robust variances.

    Results

    Age and sex adjusted analyses for the whole study population demonstrated that a 10% increase in ethnic density or diversity was associated with a 1.06 (1.05-1.07) times higher prevalence of psychological distress. In the stratified analyses, both foreign-born respondents and those with Swedish-background showed increasing prevalence of psychological distress with increasing ethnic heterogeneity. However, this trend was entirely explained by socioeconomic factors in the Swedish-background respondents and by additional adjustments for individual and contextual social support and horizontal trust for the foreign-born. Further adjustment for contextual horizontal trust showed ethnic heterogeneity to be protective for respondents Swedish-background. There was no clear trend between ethnic heterogeneity and psychological distress for respondents with foreign-background.

    Conclusion

    The association between ethnic heterogeneity and psychological distress differs by ethnic background. There was no difference in this association based on the measure of ethnic heterogeneity used, nor in the explanatory role of social capital between ethnic heterogeneity measures. Socioeconomic indicators and some elements of individual and contextual social capital are important explanatory factors of the excess risk of psychological distress with regards to ethnic heterogeneity.

  • 2017. Alexander Miething, Mikael Rostila, Jens Rydgren. Social Science and Medicine 190, 207-216

    Social capital research has recognized the relevance of occupational network contacts for individuals’ life chances and status attainment, and found distinct associations dependent on ethnic background. A still fairly unexplored area is the health implications of occupational networks. The current approach thus seeks to study the relationship between access to occupational social capital and depressive symptoms in early adulthood, and to examine whether the associations differ between persons with native Swedish parents and those with parents born in Iran and the former Yugoslavia.

    The two-wave panel comprised 19- and 23-year-old Swedish citizens whose parents were born in either Sweden, Iran or the former Yugoslavia. The composition of respondents’ occupational networks contacts was measured with a so-called position generator. Depressive symptoms were assessed with a two-item depression screener. A population-averaged model was used to estimate the associations between depressive symptoms and access to occupational contact networks.

    Similar levels of depressive symptoms in respondents with parents born in Sweden and Yugoslavia were contrasted by a notably higher prevalence of these conditions in those with an Iranian background. After socioeconomic conditions were adjusted for, regression analysis showed that the propensity for depressive symptoms in women with an Iranian background increased with a higher number of manual class contacts, and decreased for men and women with Iranian parents with a higher number of prestigious occupational connections. The respective associations in persons with native Swedish parents and parents from the former Yugoslavia are partly reversed.

    Access to occupational contact networks, but also perceived ethnic identity, explained a large portion of the ethnic variation in depression. Mainly the group with an Iranian background seems to benefit from prestigious occupational contacts. Among those with an Iranian background, social status concerns and expected marginalization in manual class occupations may have contributed to their propensity for depressive symptoms.

  • 2017. Andrea Dunlavy, Mikael Rostila. Arbetsmarknad & Arbetsliv 23 (1), 46-65

    Denna artikel syftar till att utöka kunskapen kring arbetsmiljöförhållanden bland utlandsfödda på den svenska arbetsmarknaden. Studien undersöker hur exponering för bristfälliga psykosociala, strukturella och fysiska arbetsmiljöförhållanden varierar mellan olika grupper av anställda kvinnor och män beroende på födelseland. Resultaten visar skillnader när det gäller exponering för bristfälliga arbetsmiljöförhållanden mellan utlandsfödda och inrikes födda anställda på den svenska arbetsmarknaden. Dessa skillnader beror på den grupp som undersöks och det arbetsmiljöproblem som studeras.

  • 2017. Anders Hjern (et al.).
  • 2017. Mikael Rostila (et al.). American Journal of Epidemiology 185 (12), 1247-1254

    Although there is some evidence of an association between loss of a sibling in adulthood and subsequentmortality, there have been no previous studies in which investigators have examined whether the death of a sibling in childhood is associated with adult mortality using total population data. Data on a national cohort born in Sweden in 1973-1982 (n = 717,723) were prospectively collected from the Cause of Death Register until 2013 (i.e., from the ages of 18 years to 31-40 years). Cox proportional hazards models were used to analyze the association between sibling loss during childhood and death in young adulthood. After adjustment for sociodemographic confounders and parental psychosocial covariates, the hazard ratio for all-cause mortality in bereaved siblings versus nonbereaved siblings was 1.39 (95% confidence interval: 1.14, 1.69). Risks were more pronounced for those who lost a noninfant sibling (i.e., > 1 year of age) (hazard ratio = 1.53, 95% confidence interval: 1.18, 1.95) and those who lost a sibling in adolescence (i.e., between the ages of 12 and 18 years) (hazard ratio = 1.71, 95% confidence interval: 1.24, 2.35). Excess mortality risk was found for concordant causes of death (i. e., siblings dying from the same causes) but not for discordant causes.

  • 2017. Mikael Rostila (et al.). European Journal of Public Health 27 (Suppl. 3)

    Background

    Sibling loss has received scant attention in the bereavement literature. A previous study suggested an overall increased risk of mortality in siblings bereaved during childhood. However, the underlying disease pattern behind increased mortality is unclear. We studied the influence of sibling loss during childhood on in and outpatient care with an underlying psychiatric diagnosis in adulthood.

    Methods

    A national cohort born in Sweden in 1973-1982 (N = 717,723) was followed prospectively in the Cause of Death Register until 2013, i.e. from ages 18 years to 31-40 years of age. Cox proportional hazards models were used to analyse the association between sibling loss during childhood and psychiatric in- and outpatient care during follow-up.

    Results

    After adjustment for socio-demographic confounders and parental psychosocial covariates, HR for psychiatric inpatient-and outpatient care in bereaved siblings versus non- bereaved siblings was fairly small and non-significant in women. Bereaved men had increased HR for both psychiatric inpatient- (HR 1.17, 95% CI 1.00-1.36) and outpatient care (HR 1.21, 95% CI 1.10-1.33). Risks were however more pronounced when exposed to loss of a sibling in adolescence (i.e. in the ages 12-18 years) in both men and women.

    Conclusions

    The death of a sibling in childhood was associated with slightly increased risk of psychiatric in and out-patient care in surviving siblings in adulthood in men but not in women. Individuals experiencing the loss of a sibling in childhood may need particular attention from health care services.

  • 2017. Alexander Miething (et al.). Scandinavian Journal of Public Health 45 (3), 244-252

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

  • 2017. Hélio Manhica (et al.). BMC Public Health 17

    Background

    Psychological distress and lack of family support may explain the mental health problems that are consistently found in young unaccompanied refugees in Western countries. Given the strong relationship between poor mental health and alcohol misuse, this study investigated hospital admissions due to alcohol related disorders among accompanied and unaccompanied young refugees who settled in Sweden as teenagers.

    Methods

    The dataset used in this study was derived from a combination of different registers. Cox regression models were used to estimate the risks of hospital care due to alcohol related disorders in 15,834 accompanied and 4376 unaccompanied young refugees (2005–2012), aged 13 to 19 years old when settling in Sweden and 19 to 32 years old in December 2004. These young refugees were divided into regions with largely similar attitudes toward alcohol: the former Yugoslavian republics, Somalia, and the Middle East. The findings were compared with one million peers in the native Swedish population.

    Results

    Compared to native Swedes, hospital admissions due to alcohol related disorders were less common in young refugees, with a hazard ratio (HR) of 0.65 and 95% confidence interval (CI) between 0.56 and 0.77. These risks were particularly lower among young female refugees. However, there were some differences across the refugee population. For example, the risks were higher in unaccompanied (male) refugees than accompanied ones (HR = 1.49, 95% CI = 1.00–2.19), also when adjusted for age, domicile and income. While the risks were lower in young refugees from Former Yugoslavia and the Middle East relative to native Swedes, independent of their length of residence in Sweden, refugees from Somalia who had lived in Sweden for more than ten years showed increased risks (HR = 2.54, 95% CI = 1.71–3.76), after adjustments of age and domicile. These risks decreased considerably when income was adjusted for.

    Conclusion

    Young refugees have lower risks of alcohol disorders compared with native Swedes. The risks were higher in unaccompanied young (male) refugees compared to the accompanied ones. Moreover, Somalian refugees who had lived in Sweden for more than ten years seems to be particularly vulnerable to alcohol related disorders.

  • 2017. Andrea Dunlavy (et al.). European Journal of Public Health 27 (Suppl. 3)

    Background

    Persons of foreign-origin have higher rates of unemployment compared to those of native-origin, yet few studies have assessed relationships between unemployment and mental health in persons of foreign-origin relative to the native-origin. This study aims to examine the extent to which generational status, region of origin, age at arrival, and duration of residence modify the relationship between employment status and suicide risk.

    Methods

    Population-based registers were used to conduct a longitudinal, open cohort study of native-origin and foreign-origin Swedish residents of working age (25-64 years) from 1993-2008. Hazard ratios and 95% confidence intervals for suicide mortality were estimated using gender-stratified Cox proportional hazards models.

    Results

    Elevated hazard ratios for suicide were observed among the majority of foreign-origin persons exposed to unemployment. Second generation Swedish men exposed to unemployment demonstrated significantly greater (p < 0.05) excess risk of suicide (HR = 3.63, 95% CI: 2.90-4.54) than that observed among native-origin Swedish men exposed to unemployment (HR = 1.67, 95% CI: 1.29-2.16). In unemployed foreign-born men, younger age at arrival and longer duration of residence were associated with increased risk of suicide, whereas unemployed foreign-born men who arrived as adults and had a shorter duration of residence did not demonstrate excess suicide risk.

    Conclusions

    Analyses indicated that the majority of the foreign-origin exposed to unemployment demonstrated excess risk of suicide that was of a similar magnitude to that observed among their native-origin counterparts. Yet there were notable differences in patterns of association by generational status, region of origin, age at arrival, and duration of residence. The high excess risk observed in unemployed second generation men suggests that ensuring employment among this group may be of particular public health importance.

  • 2017. Helena Honkaniemi (et al.). BMC Public Health 17

    Background

    Immigration to the Nordic countries has increased in the last decades and foreign-born inhabitants now constitute a considerable part of the region’s population. Several studies suggest poorer self-reported health among foreign-born compared to natives, while results on mortality and life expectancy are inconclusive. To date, few studies have summarized knowledge on mortality differentials by country of birth. This article aims to systematically review previous results on all-cause and cause-specific mortality by country of birth in the Nordic countries.

    Methods

    The methodology was conducted and documented systematically and transparently using a narrative approach. We identified 43 relevant studies out of 6059 potentially relevant studies in August 2016, 35 of which used Swedish data, 8 Danish and 1 Norwegian.

    Results

    Our findings from fully-adjusted models on Swedish data support claims of excess mortality risks in specific categories of foreign-born. Most notably, immigrants from other Nordic countries, especially Finland, experience increased risk of mortality from all causes, and specifically by suicide, breast and gynaecological cancers, and circulatory diseases. Increased risks in people from Central and Eastern Europe can also be found. On the contrary, decreased risks for people with Southern European and Middle Eastern origins are found for all-cause, suicide, and breast and gynaecological cancer mortality. The few Danish studies are more difficult to compare, with conflicting results arising in the analysis. Finally, results from the one Norwegian study suggest significantly decreased mortality risks among foreign-born, to be explored in further research.

    Conclusions

    With new studies being published on mortality differentials between native and foreign-born populations in the Nordic countries, specific risk patterns have begun to arise. Regardless, data from most Nordic countries remains limited, as does the information on specific causes of death. The literature should be expanded in upcoming years to capture associations between country of birth and mortality more clearly.

  • 2017. Sol Juarez, Mikael Rostila. Sociologisk forskning 54 (4), 323-327

    Sweden has experienced a sharp increase in migration flows in the last decades. Projections estimate that the migrant population rate will continue to grow in the near future. Given the centrality of health for the successful engagement of individuals in society, health aspects of migration have emerged as an important area of study. In this research note, we present a brief overview of current knowledge and argue in favour of developing a social determinants perspective on health in future research.

  • 2017. Helena Honkaniemi (et al.). Metoder och verktyg för sociala nyttoberäkningar i kollektivtrafiken, 9-53

    Med skärpt fokusering på hållbar utveckling blir såväl politiskt ansvariga som akademiker allt mer sysselsatta inte enbart med infrastrukturens inverkan på ekonomi och miljö utan även dess sociala inverkan. Denna breda litteraturstudie har undersökt den sociala hållbarhetens roll i kollektivtrafikens infrastruktur. Den har siktat på att urskilja de olika komponenter i social hållbarhet som ingår i denna kontext, kvalitativa respektive kvantitativa analytiska metoder och deras krav på data samt tillämpbarheten av dessa rön i den svenska kontexten. Översikten utfördes med hjälp av indexeringstjänsten Web of Science, en kombinerad snöbollsmetod samt interna rekommendationer och analyser med hjälp av ett teoretiskt ramverk för hållbarhet anpassat från United Nations Environment Programme. Rönen ådagalade många kvantitativa tillvägagångssätt, däribland kostnads-/nyttoanalys [cost-benefit analyses (CBA)], tillämpningar av geografiska informationssystem (GIS), och jämlikhetsanalyser m.fl. Variabler för kollektivtrafik såsom tillgänglighet och rörlighet behandlades oftast tillsammans med sociala bestämningsfaktorer, liksom sociala utfallsvariabler däribland socialt utanförskap och socialt kapital. Kvalitativa infallsvinklar används däremot mer sällan i den här kontexten trots deras betydelse för att hjälpa till att fånga in användares erfarenheter och att urskilja nya sociala variabler. Utifrån dessa resultat och den rådande preferensen för kvantitativa metoder i svenska analyser av kollektivtrafik rekommenderar författarna mera fokus på de sociala utfallen av kollektivtrafikens infrastruktur genom att använda en blandning av kvantitativa och kvalitativa infallsvinklar.

  • 2017. Charisse M. Johnson (et al.). BMC Public Health 17

    Background

    Social capital may theoretically explain health inequalities between social groups, but empirical evidence is lacking. Some studies indicate that social capital may be particularly important for immigrant health. Nearly 16% of Sweden's population are foreign-born immigrants and research has shown them to be susceptible to psychological distress, though significant variation has been found between groups. In this study, we investigate the following hypotheses: 1) if non-refugees have better mental health than Swedish-born, and refugees experience worse mental health than Swedish-born; 2) if mental health status converges with that of Swedish-born with longer duration of residence; and 3) if social capital mediates the effect of immigrant status on psychological distress for different immigrant groups as compared to Swedish-born.

    Methods

    This cross-sectional study uses baseline data from the Stockholm Public Health Cohort and includes 50,498 randomly-selected individuals from Stockholm County in 2002, 2006, and 2010. Mental health was measured as psychological distress, using the 12-item General Health Questionnaire. Social capital was measured using indicators of bonding, bridging, and linking social capital. Both cognitive and structural aspects were measured for the latter two indicators. Mediation was tested using logistic regression and the Sobel test.

    Results

    The results show that refugees generally had greater odds of psychological distress than non-refugees compared to their respective Swedish-born counterparts. Among immigrant men, both refugees and non-refugees had significantly greater odds of psychological distress than Swedish-born men. Only refugee women in Sweden 10 years or more had significantly greater odds of psychological distress compared to Swedish-born women. The mediation analysis demonstrated that indicators of social capital mediated the association for all immigrant men (except non-refugees in Sweden 3-9 years) and for refugee women in Sweden 10 years or more. While bonding social capital showed the greatest mediatory role among the three social capital types, adding them together had the strongest explanatory effect.

    Conclusions

    Social capital explains differences in mental health for some immigrant groups, highlighting its role as a potentially important post-migration factor. Increased investment from policy-makers regarding how social capital can be promoted among new arrivals may be important for preventing psychological distress.

  • 2017. Hélio Manhica (et al.). Epidemiology and Psychiatric Sciences 26 (5), 526-534

    Aims. To investigate the patterns of use of different forms of psychiatric care in refugees who settled in Sweden as teenagers.

    Method. Cox proportional hazards models were used to estimate the use of different forms of psychiatric care from 2009 to 2012 in a population of 35 457 refugees, aged from 20 to 36, who had settled in Sweden as teenagers between 1989 and 2004. These findings were compared with 1.26 million peers from the same birth cohorts in the general Swedish population.

    Results. Unaccompanied and accompanied refugees were more likely to experience compulsory admission to a psychiatric hospital compared with the native Swedish population, with hazard ratios (HRs) of 2.76 (1.86–4.10) and 1.89 (1.53–2.34), respectively, as well as psychiatric inpatient care, with HRs of 1.62 (1.34–1.94) and 1.37 (1.25–1.50). Outpatient care visits by the young refugees were similar to the native Swedish population. The longer the refugees had residency in Sweden, the more they used outpatient psychiatric care. Refugees born in the Horn of Africa and Iran were most likely to undergo compulsory admission, with HRs of 3.98 (2.12–7.46) and 3.07 (1.52–6.19), respectively. They were also the groups who were most likely to receive inpatient care, with HRs of 1.55 (1.17–2.06) and 1.84 (1.37–2.47), respectively. Our results also indicated that the use of psychiatric care services increased with the level of education in the refugee population, while the opposite was true for the native Swedish population. In fact, the risks of compulsory admissions were particularly higher among refugees who had received a secondary education, compared with native Swedish residents, with HRs of 4.72 (3.06–7.29) for unaccompanied refugees and 2.04 (1.51–2.73) for accompanied refugees.

    Conclusions. Young refugees received more psychiatric inpatient care than the native Swedish population, with the highest rates seen in refugees who were not accompanied by their parents. The discrepancy between the use of inpatient and outpatient care by young refugees suggests that there are barriers to outpatient care, but we did note that living in Sweden longer increased the use of outpatient services. Further research is needed to clarify the role that education levels among Sweden's refugee populations have on their mental health and health-seeking behaviour.

  • 2016. Jan Saarela, Agneta Cederström, Mikael Rostila. Social Science and Medicine 158, 8-13

    Previous research has documented an association between birth order and suicide, although no study has examined whether it depends on the cultural context. Our aim was to study the association between birth order and cause-specific mortality in Finland, and whether it varies by ethno-linguistic affiliation. We used data from the Finnish population register, representing a 5% random sample of all Finnish speakers and a 20% random sample of Swedish speakers, who lived in Finland in any year 1987-2011. For each person, there was a link to all children who were alive in 1987. In total, there were 254,059 siblings in 96,387 sibling groups, and 9797 deaths. We used Cox regressions stratified by each siblings group and estimated all-cause and cause-specific mortality risks during the period 1987-2011. In line with previous research from Sweden, deaths from suicide were significantly associated with birth order. As compared to first-born, second-born had a suicide risk of 1.27, third-born of 1.35, and fourth- or higher-born of 1.72, while other causes of death did not display an evident and consistent birth-order pattern. Results for the Finnish-speaking siblings groups were almost identical to those based on both ethno-linguistic groups. In the Swedish-speaking siblings groups, there was no increase in the suicide risk by birth order, but a statistically not significant tendency towards an association with other external causes of death and deaths from cardiovascular diseases. Our findings provided evidence for an association between birth order and suicide among Finnish speakers in Finland, while no such association was found for Swedish speakers, suggesting that the birth order effect might depend on the cultural context.

  • 2016. Viviane S. Straatman (et al.). BMC Public Health 16

    Background

    Psychological well-being influences health behaviours differently in adolescent boys and girls. We evaluated the role of psychological well-being in early adolescence in the onset and persistence of insufficient physical activity and exceeding recommended screen time, depending on gender.

    Methods

    This work derives from a cohort study called Longitudinal Study of Adolescent Nutritional Assessment conducted among elementary school students from two public and four private schools in Rio de Janeiro, Brazil from 2010–2013. We analysed data from 2010 and 2012 from 526 adolescents. Physical activity was evaluated using the International Physical Activity Questionnaire. Those who performed less than 60 min per day of moderate to vigorous physical activity (MVPA) were classified as insufficiently active. Screen time was evaluated based on daily time spent in front of television, video games, and computers. Those who had 4 h or more screen time per day were classified as exceeding the recommended time. Psychological well-being was assessed using the psychological domain of the KIDSCREEN 27 questionnaire. Linear regression was used to estimate coefficient (β) and r 2 values for continuous variables. Relative risks (RR) and confidence intervals (95 % CI) for onset and persistence of insufficient activity and exceeding recommended screen time were estimated with Poisson regression models.

    Results

    Among girls, linear regression analyses showed a significant inverse association between psychological well-being and screen minutes per day at T2 (r 2 = 0.049/β = −3.81 (95 % CI −7.0, −0.9)), as well as an association between poor psychological well-being and onset of exceeding recommended screen time in categorical analyses (RR crude: 1.3; CI 95 % 1.1, 1.7; RR adjusted: 1.3; CI 95 % 1.0, 1.6). For boys, an association was found between psychological well-being and onset of insufficient activity 2 years later (RR crude: 1.3; CI 95 % 1.2, 1.4; RR adjusted: 1.2; CI 95 % 1.1, 1.4).

    Conclusion

    Adolescence is crucial for the development of unhealthy behaviours related to psychological well-being status in the context of a middle-income country. Gender differences are important because poor psychological well-being seems to affect sedentary behaviour in girls more than in boys, and predicts insufficient activity among boys.

  • 2016. Andrea C. Dunlavy, Anthony M. Garcy, Mikael Rostila. Social Science and Medicine 154, 36-44

    Foreign-born workers have been shown to experience poorer working conditions than native-born workers. Yet relationships between health and educational mismatch have been largely overlooked among foreign-born workers. This study uses objective and self-reported measures of educational mismatch to compare the prevalence of educational mismatch among native (n = 2359) and foreign born (n = 1789) workers in Sweden and to examine associations between educational mismatch and poor self-rated health. Findings from weighted multivariate logistic regression which controlled for social position and individual-level demographic characteristics suggested that over-educated foreign-born workers had greater odds ratios for poor-self rated health compared to native-born matched workers. This association was particularly evident among men (OR = 2.14, 95% CI: 1.04-4.39) and women (OR = 2.13, 95% CI: 1.12-4.03) from countries outside of Western Europe, North America, and Australia/New Zealand. Associations between under-education and poor-self rated health were also found among women from countries outside of Western Europe, North America, and Australia/New Zealand (OR = 2.02, 95% CI: 1.27-3.18). These findings suggest that educational mismatch may be an important work-related social determinant of health among foreign-born workers. Future studies are needed to examine the effects of long-term versus short-term states of educational mismatch on health and to study relationships over time.

  • 2016. Alexander Miething (et al.). BMC Psychology 4

    Background

    The importance of supportive social relationships for psychological well-being has been previously recognized, but the direction of associations between both dimensions and how they evolve when adolescents enter adulthood have scarcely been addressed. The present study aims to examine the gender-specific associations between self-reported friendship network quality and psychological well-being of young people during the transition from late adolescence to young adulthood by taking into account the direction of association.

    Methods

    A random sample of Swedes born in 1990 were surveyed at age 19 and again at age 23 regarding their own health and their relationships with a maximum of five self-nominated friends. The response rate was 55.3 % at baseline and 43.7 % at follow-up, resulting in 772 cases eligible for analysis. Gender-specific structural equation modeling was conducted to explore the associations between network quality and well-being. The measurement part included a latent measure of well-being, whereas the structural part accounted for autocorrelation for network quality and for well-being over time and further examined the cross-lagged associations.

    Results

    The results show that network quality increased while well-being decreased from age 19 to age 23. Females reported worse well-being at both time points, whereas no gender differences were found for network quality. Network quality at age 19 predicted network quality at age 23, and well-being at age 19 predicted well-being at age 23. The results further show positive correlations between network quality and well-being for males and females alike. The strength of the correlations diminished over time but remained significant at age 23. Simultaneously testing social causation and social selection in a series of competing models indicates that while there were no cross-lagged associations among males, there was a weak reverse association between well-being at age 19 and network quality at age 23 among females.

    Conclusions

    The study contributes to the understanding of the direction of associations between friendship networks and psychological well-being from late adolescence to young adulthood by showing that while these dimensions are closely intertwined among males and females alike, females’ social relationships seem to be more vulnerable to changes in health status.

  • 2016. Hélio Manhica (et al.). PLoS ONE 11 (11)

    Background

    High rates of mental health problems have been described in young refugees, but few studies have been conducted on substance misuse. This study aimed to investigate the patterns of hospital care and criminality associated with substance misuse in refugees who settled in Sweden as teenagers.

    Methods

    Gender stratified Cox regression models were used to estimate the risks of criminal convictions and hospital care associated with substance misuse from national Swedish data for 2005–2012. We focused on 22,992 accompanied and 5,686 unaccompanied refugees who were aged 13–19 years when they settled in Sweden and compared them with 1 million native Swedish youths from the same birth cohort.

    Results

    The risks of criminal conviction associated with substance misuse increased with the length of residency in male refugees, after adjustment for age and domicile. The hazard ratios (HRs) were 5.21 (4.39–6.19) for unaccompanied and 3.85 (3.42–4.18) for accompanied refugees after more than 10 years of residency, compared with the native population. The risks were slightly lower for hospital care, at 2.88 (2.18–3.79) and 2.52(2.01–3.01) respectively. Risks were particularly pronounced for male refugees from the Horn of Africa and Iran. The risks for all male refugees decreased substantially when income was adjusted for. Young female refugees had similar risks to the general population.

    Conclusion

    The risks of criminality and hospital care associated with substance misuse in young male refugees increased with time of residency in Sweden and were associated with a low level of income compared with the native Swedish population. Risks were similar in accompanied and unaccompanied refugees.

  • 2016. Hélio Manhica (et al.). British Journal of Psychiatry 2 (1), 6-9

    Background Migrants’ socioeconomic adversity has been linked to schizophrenia.

    Aims To investigate whether the more favourable socioeconomic situation of adoptees prevents them from the high risk of schizophrenia found in other migrants.

    Method Register study in a cohort of refugees and inter-country adoptees aged 16–40 years, born in East Africa (n=8389), Latin America (n=11 572) and 1.2 million native Swedes. Cox-regression models estimated hazard ratios (HRs) of schizophrenia in data from psychiatric care.

    Results Despite diverse income levels, HRs for schizophrenia were similar for refugees and adoptees, with East Africans having the highest HRs: 5.83 (3.30–10.27) and 5.80 (5.03–6.70), followed by Latin Americans: HRs 3.09 (2.49–3.83) and 2.31 (1.79–2.97), compared with native Swedes. Adjustment for income decreased these risks slightly for refugees, but not for adoptees.

    Conclusions This study suggests that risk factors associated with origin are more important determinants of schizophrenia than socioeconomic adversity in the country of settlement.

  • 2016. Lisa Berg, Mikael Rostila, Anders Hjern. Journal of Child Psychology and Psychiatry and Allied Disciplines 57 (9), 1092-1098

    Background

    There are few prospective, population-based studies on childhood parental death and psychiatric disorders in adulthood, and previous findings are inconclusive. This study investigated the association between parental death from natural and external (suicides, accidents or homicides) causes before 18 years and the risk of clinical depression in young adults, in relation to age at loss and gender of both child and parent.

    Methods

    In this register-based study, a national cohort born in Sweden during 1973–1982 (n = 862,554) was followed with regard to hospital admissions and outpatient care for depression during 2006–2013. Multivariate Cox proportional hazards models were used to estimate the impact of parental death, taking sociodemographic and parental psychosocial covariates into account.

    Results

    Maternal death from natural causes was associated with a hazard ratio (HR) of outpatient care for depression of 1.19 [95% confidence interval (CI), 1.02–1.40] in men and 1.15 (1.01–1.31) in women, after adjustment for sociodemographic confounders, with similar effect sizes for paternal natural death. Death from external causes consistently had higher effect size compared with natural deaths, in particular in relation to risk of hospital admissions for depression where they were as high as HR 3.23 (2.38–4.38) for men, and 1.79 (1.30–2.47) for women after a loss of a mother. Losing a parent in preschool age, compared with losing a parent as a teenager, was associated with higher risks of both hospitalization (p = .006) and outpatient care (p = .001) for depression.

    Conclusions

    This study indicates that parental loss to death from natural causes during childhood is associated with a small increased risk of long-term consequences for psychological health. Children who lose their parents to death from external causes, that is suicides, accidents or homicides, and children losing a parent in young ages are, however, at particular risk and should be given priority in preventive interventions after parental loss.

  • 2016. Mikael Rostila (et al.). European Child and Adolescent Psychiatry 25 (10), 1103-1111

    Previous studies have shown that parental death influences health and mortality in bereaved offspring. To date, few studies have examined whether exposure to parental bereavement in childhood is associated with suicidality later in life. The aim of the present research was to investigate whether parental death during childhood influences self-inflicted injuries/poisoning in young adulthood. A national cohort born during 1973–1982 (N = 871,402) was followed prospectively in the National Patient Discharge Register from age 18 to 31–40 years. Cox regression analyses of proportional hazards, with adjustment for socio-demographic confounders and parental psychosocial covariates, were used to test hypotheses regarding parental loss and hospital admission due to self-inflicted injuries/poisoning. Parental deaths were divided into deaths caused by (1) external causes/substance abuse and (2) natural causes. Persons who had lost a parent to an external cause/substance abuse-related death had the highest risk of being admitted to a hospital for a self-inflicted injury/poisoning; HRs 2.03 (1.67–2.46) for maternal death and 2.03 (1.84–2.25) for paternal death, after adjustment for socio-demographic confounders and risk factors among surviving parents. Risks were also increased for parental death due to natural causes, but at a lower level: 1.19 (1.01–1.39) and 1.28 (1.15–1.43), respectively. Losing a father before school age was associated with a higher risk of hospital admission for a self-inflicted injury/poisoning than was loss at an older age for both genders. Maternal loss before school age was associated with a higher risk only for men, particularly maternal death by natural causes (p < 0.01).

  • 2016. Mikael Rostila (et al.).
  • 2016. Alexander Miething (et al.). PLoS ONE 11 (10)

    Objectives

    The present study examines how the composition of social networks and perceived relationship content influence peer clustering in smoking, and how the association changes during the transition from late adolescence to early adulthood.

    Methods

    The analysis was based on a Swedish two-wave survey sample comprising ego-centric network data. Respondents were 19 years old in the initial wave, and 23 when the follow-up sample was conducted. 17,227 ego-alter dyads were included in the analyses, which corresponds to an average response rate of 48.7 percent. Random effects logistic regression models were performed to calculate gender-specific average marginal effects of social network characteristics on smoking.

    Results

    The association of egos’ and alters’ smoking behavior was confirmed and found to be stronger when correlated in the female sample. For females, the associations decreased between age 19 and 23. Interactions between network characteristics and peer clustering in smoking showed that intense social interactions with smokers increase egos’ smoking probability. The influence of network structures on peer clustering in smoking decreased during the transition from late adolescence to early adulthood.

    Conclusions

    The study confirmed peer clustering in smoking and revealed that females’ smoking behavior in particular is determined by social interactions. Female smokers’ propensity to interact with other smokers was found to be associated with the quality of peer relationships, frequent social interactions, and network density. The influence of social networks on peer clustering in smoking decreased during the transition from late adolescence to early adulthood.

  • 2015. Anders Hjern (et al.). Att se barn som anhöriga, 117-132
  • 2015. Mikael Rostila. Att se barn som anhöriga, 135-155
  • Artikel Commentary
    2015. Mikael Rostila. Social Science and Medicine 131, 190-192
  • 2015. Mikael Rostila. The Palgrave Handbook of Social Theory in Health, Illness and Medicine, 644-659

    This chapter focuses on Esping-Andersen’s theory of ‘the three worlds of welfare capitalism’ and its contribution to the understanding of population health and health inequalities. Although several recent empirical studies have examined how population health and health inequalities vary within welfare states, it seems important to thoroughly discuss these issues from a theoretical point of view This chapter starts with a discussion of some central aspects of Esping- Andersen’s theory. Recent modifications/additions to Esping-Andersen’s welfare regime theory will also be touched upon, together with some critiques of his ideas. Furthermore, some of the potential pathways through which welfare states can influence health and health inequality are discussed, and some empirical studies that have examined such relationships are presented. Finally, some concluding remarks on the usefulness of including Esping-Andersen’s theory within health research are provided.

  • 2015. Nathalie Auguer, Emelie Le Serbon, Mikael Rostila. Scandinavian Journal of Public Health 43 (4), 340-347

    Aims: Sweden and Canada are known for quality of living and exceedingly high life expectancy, but recent data on how these countries compare are lacking. We measured life expectancy in Canada and Sweden during the past decade, and identified factors responsible for changes over time. Methods: We calculated life expectancy at birth for Canada and Sweden annually from 2000 to 2010, and determined the ages and causes of death responsible for the gap between the two countries using Arriaga's method. We determined how population growth, ageing, and mortality influenced the number of deaths over time. Results: During 2000-2010, life expectancy in Canada caught up with Sweden for men, and surpassed Sweden by 0.4 years for women. Sweden lost ground owing to a slower reduction in circulatory and tumour mortality after age 65 years compared with Canada. Nonetheless, population ageing increased the number of deaths in Canada, especially for mental and nervous system disorders. In Sweden, the number of deaths decreased. Conclusions: In only one decade, life expectancy in Canada caught up and surpassed Sweden due to rapid improvements in circulatory and tumour mortality. Population ageing increased the number of deaths in Canada, potentially stressing the health care system more than in Sweden.

  • 2015. Manhica Hélio (et al.). PLoS ONE 10 (2)
  • 2015. Fjalar Finnäs, Mikael Rostila, Jan Saarela.
  • 2015. Mikael Rostila (et al.). European Journal of Public Health 25 (Suppl. 3), 53-53

    Background

    Previous studies have found that the loss of a family member increases mortality among bereaved family members. Although, some previous evidence have found associations between loss of a sibling in adulthood and subsequent mortality few studies have studied whether sibling deaths in childhood is associated with all-cause and cause-specific mortality in young adulthood.

    Methods

    A national cohort born during 1973–1982 (N= 871 402) was followed prospectively in the Swedish Cause of Death Register from age 18 to 30–35. Multivariate Cox analyses of proportional hazards with adjustment for socio-demographic confounders were used to test the association between sibling loss and all-cause and cause-specific mortality in young adulthood. Sibling deaths were divided into deaths caused by external causes and natural causes and we studied mortality from CVD, cancer, other diseases, suicides and accidents among bereaved siblings.

    Results

    In men, the mortality risk for bereaved persons versus non bereaved persons during childhood/adolescence was 1.48 (95% CI: 1.17, 1.86), and in women it was 1.45 (95% CI: 1.01, 2.09) after adjustment for socio-demographic confounders. Losing anon-infant sibling (>1 years) was most detrimental for both men (HR: 1.65, 95% CI: 1.23, 2.23) and women (HR: 1.54,95% CI: 0.95, 2.50) while bereaved men (HR: 1.86, 95% CI:1.28, 2.72) and women (HR: 1.75, 95% CI: 0.97, 3.18) were most vulnerable when exposed to loss of a sibling inadolescence (12-18 years). Further, preliminary analyses showed that external causes of death were most detrimental for mortality among bereaved siblings.

    Conclusions

    Sibling death during childhood predicts mortality in young adulthood, particularly when persons are exposed in adolescence. Men and women are about equally vulnerable to sibling deaths at different stages of childhood.

  • 2015. Mikael Rostila (et al.). European Journal of Epidemiology 30 (3), 239-247

    Lingering grief associated with the death of a loved one has been hypothesized to precipitate acute health events among survivors on anniversary dates. We sought to study excess mortality risk in parents around the death date and birth date of a deceased child as an indication of a "bereavement effect". We conducted a population based follow-up study using Swedish registries including links between children and parents. All biological and Swedish-born parents who experienced the death of a minor child born were observed during the period 1973-2008 (n = 48,666). An increased mortality risk was found during the week of a child's death among mothers who lost a child aged 0-17 years (SMRR = 1.46, 95 % CI 0.98-2.17). The association was stronger among mothers who lost a child aged 1-17 years (SMRR = 1.89, 95 % CI 0.97-3.67) as compared to those who lost an infant (SMRR = 1.29, 95 % CI 0.78-2.12). Cardiovascular diseases and suicides were overrepresented as causes of death in mothers who died around the anniversary. We found no significant increase in the mortality risk around the date of child's birth, nor any suggestion of excess mortality risk among fathers, but rather a depression of paternal death (SMRR = 0.60, 95 % CI 0.34-1.03). Our study indicates an anniversary reaction among mothers who lost a young child. These results suggest that bereavement per se could have an effect on health and mortality which should be acknowledged by public health professionals working with bereaved people.

  • 2015. Mikael Rostila, Mikael Nygård, Fredrica Nyqvist. Social Capital as a Health Resource in Later Life: The Relevance of Context, 207-229
  • 2014. Mikael Rostila, Jan Saarela, Ichiro Kawachi. American Journal of Epidemiology 179 (12), 1450-1457

    Each year, almost 1 million people die from suicide, which is among the leading causes of death in young people. We studied how birth order was associated with suicide and other main causes of death. A follow-up study based on the Swedish population register was conducted for sibling groups born from 1932 to 1980 who were observed during the period 1981-2002. Focus was on the within-family variation in suicide risk, meaning that we studied sibling groups that consisted of 2 or more children in which at least 1 died from suicide. These family-fixed effects analyses revealed that each increase in birth order was related to an 18% higher suicide risk (95% confidence interval (CI): 1.14, 1.23, P = 0.000). The association was slightly lower among sibling groups born in 1932-1955 (hazard ratio = 1.13, 95% CI: 1.06, 1.21, P = 0.000) than among those born in 1967-1980 (hazard ratio = 1.24, 95% CI: 0.97, 1.57, P = 0.080). Further analyses suggested that the association between birth order and suicide was only modestly influenced by sex, birth spacing, size of the sibling group, own socioeconomic position, own marital status, and socioeconomic rank within the sibling group. Causes of death other than suicide and other external causes were not associated with birth order.

  • 2014. K Engström, C Johnson, Mikael Rostila.
  • 2014. Ylva B. Almquist (et al.). Scandinavian Journal of Public Health 42 (2), 146-154

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

  • 2014. Aldair J. Oliveira (et al.). Revista de Saude Publica 48 (4), 602-612

    OBJECTIVE: To identify gender differences in social support dimensions' effect on adults' leisure-time physical activity maintenance, type, and time. METHODS: Longitudinal study of 1,278 non-faculty public employees at a university in Rio de Janeiro, RJ, Southeastern Brazil. Physical activity was evaluated using a dichotomous question with a two-week reference period, and further questions concerning leisure-time physical activity type (individual or group) and time spent on the activity. Social support was measured with the Medical Outcomes Study Social Support Scale. For the analysis, logistic regression models were adjusted separately by gender. RESULTS: A multinomial logistic regression showed an association between material support and individual activities among women (OR = 2.76; 95% CI 1.2; 6.5). Affective support was associated with time spent on leisure-time physical activity only among men (OR = 1.80; 95% CI 1.1; 3.2). CONCLUSIONS: All dimensions of social support that were examined influenced either the type of, or the time spent on, leisure-time physical activity. In some social support dimensions, the associations detected varied by gender. Future studies should attempt to elucidate the mechanisms involved in these gender differences.

  • 2014. Mikael Rostila, Johan Fritzell. American Journal of Public Health 104 (4), 686-695

    Objectives. We studied mortality differentials between specific groups of foreign-born immigrants in Sweden and whether socioeconomic position (SEP) could account for such differences. Methods. We conducted a follow-up study of 1 997 666 men and 1 964 965 women ages 30 to 65 years based on data from national Swedish total population registers. We examined mortality risks in the 12 largest immigrant groups in Sweden between 1998 and 2006 using Cox regression. We also investigated deaths from all causes, circulatory disease, neoplasms, and external causes. Results. We found higher all-cause mortality among many immigrant categories, although some groups had lower mortality. When studying cause-specific mortality, we found the largest differentials in deaths from circulatory disease, whereas disparities in mortality from neoplasms were smaller. SEP, especially income and occupational class, accounted for most of the mortality differentials by country of birth. Conclusions. Our findings stressed that different aspects of SEP were not interchangeable in relation to immigrant health. Although policies aimed at improving immigrants' socioeconomic conditions might be beneficial for health and longevity, our findings indicated that such policies might have varying effects depending on the specific country of origin and cause of death.

  • 2014. Lisa Berg (et al.). Pediatrics 133 (4), 682-689

    OBJECTIVES: Parental death during childhood has been linked to increased mortality and mental health problems in adulthood. School failure may be an important mediator in this trajectory. We investigated the association between parental death before age 15 years and school performance at age 15 to 16 years, taking into account potentially contributing factors such as family socioeconomic position (SEP) and parental substance abuse, mental health problems, and criminality.

    METHODS: This was a register-based national cohort study of 772117 subjects born in Sweden between 1973 and 1981. Linear and logistic regression models were used to analyze school performance as mean grades (scale: 1-5; SD: 0.70) and school failure (finished school with incomplete grades). Results are presented as -coefficients and odds ratios (ORs) with 95% confidence intervals (CIs).

    RESULTS: Parental death was associated with lower grades (ORs: -0.21 [95% CI: -0.23 to -0.20] and -0.17 [95% CI: -0.19 to -0.15]) for paternal and maternal deaths, respectively. Adjustment for SEP and parental psychosocial factors weakened the associations, but the results remained statistically significant. Unadjusted ORs of school failure were 2.04 (95% CI: 1.92 to 2.17) and 1.51 (95% CI: 1.35 to 1.69) for paternal and maternal deaths. In fully adjusted models, ORs were 1.40 (95% CI: 1.31 to 1.49) and 1.18 (95% CI: 1.05 to 1.32). The higher crude impact of death due to external causes (ie, accident, violence, suicide) (OR: -0.27 [90% CI: -0.28 to -0.26]), compared with natural deaths (OR: -0.16 [95% CI: -0.17 to -0.15]), was not seen after adjustment for SEP and psychosocial situation of the family.

    CONCLUSIONS: Parental death during childhood was associated with lower grades and school failure. Much of the effect, especially for deaths by external causes, was associated with socially adverse childhood exposures.

  • 2014. N. Kondo, Mikael Rostila, Monica Åberg Yngwe. Journal of Epidemiology and Community Health 68 (12), 1145-1150
  • 2014. Aldair J. Oliveira (et al.). PLoS ONE 9 (4), e95201

    Background: Previous findings suggest that the loss of a family member is associated with health and mortality. The purpose of this study was to investigate the association between bereavement experiences and BMI, and whether there are socio-demographic differences in this association.

    Objective: To investigate the association between bereavement experiences and BMI, and whether there are sociodemographic differences in this association.

    Methods: We used cross-sectional data with retrospective questions from the Swedish Level of Living Survey (LNU) of 2000, including 5,142 individuals. The bereavement experiences examined in the study include the loss of a sibling, a parent or a spouse, and time since the death of a parent. BMI (kg/m2) was calculated using self-reported measurements of weight and height. The association between bereavement and BMI was evaluated through linear regressions.

    Results:  After controlling for possible confounders, most of the models detected an association between bereavement and BMI. The fully-adjusted model showed that loss of parents was associated with a 0.45 increase in BMI (SE = 0.20). The effect also seemed to be dependent on time since the loss and social class position.

    Conclusions: The present study is the first to examine associations between different types of familial losses and BMI. We find an association between the death of a family member and BMI, but it appears to be related to time since the death, type of bereavement experience and social class.

  • 2014. Kerstin Bergh Johannesson (et al.).
  • 2014. Mikael Rostila, J. Saarela, I. Kawachi. Social Psychiatry and Psychiatric Epidemiology 49 (6), 919-927

    To study the association between loss of an adult sibling due to suicide and mortality from various causes up to 18 years after bereavement. We conducted a follow-up study between 1981 and 2002, based on register data representing the total population of Swedes aged 25-64 years (n = 1,748,069). An elevated mortality rate from all causes was found among men (RR 1.26; 95 % CI: 1.14-1.40) and women (1.27; 1.11-1.45) who had experienced a sibling's suicide. The standardized rate ratio of suicide of bereaved to non-bereaved persons was 2.46 (1.86-3.24) among men and 3.25 (2.28-4.65) among women. We also found some indications of an interrelation between sibling suicide and subsequent deaths from external causes other than suicide in men (1.77; 1.34-2.34) and deaths from cardiovascular disease in women (1.37; 0.99-1.91). An elevated all-cause mortality rate was found after the first year of bereavement in men, while bereaved women experienced higher mortality rates during the first 2 years and after 5 years of bereavement. Our study provides support for adverse health effects among survivors associated with sibling loss due to suicide. Sibling suicides were primarily associated with suicide in bereaved survivors, although there was an increased mortality rate from discordant causes, which strengthens the possibility that the observed associations might not be entirely due to shared genetic causes.

  • 2013. Anders Hjern (et al.).
  • 2013. Mikael Rostila.
  • 2013. Jan Saarela, Fjalar Finnäs, Mikael Rostila. Journal of family issues 34 (10), 1317-1334

    Using multigenerational population register data that cover the total Swedish population, we studied relative mortality of offspring whose parents had formed a new family with children. These primarily adult-age children are found to have lower death risks than those with divorced parents who did not form a new family, which highlights that the link between parental family formation and offspring health may be attributed not only to causal factors associated with family disruption but also to social selection in parents. The association differs notably according to whether sibling groups are determined according to the mother or the father. This finding is interpreted as reflecting varying environmental exposure, because most minor children who experience parental divorce remain with the mother. We approximate that parental social selection, which maliciously affects offspring health, raises the offspring mortality risk by 20%.

  • 2013. Mikael Rostila, Jan Saarela, Ichiro Kawachi. PLoS ONE 8 (2), e56994

    Background: Although less studied than other types of familial losses, the loss of a sibling could be a potential trigger of stroke as it represents a stressful life event. We studied the association between loss of a sibling and fatal stroke up to 18 years since bereavement. Methodology/Principal Findings: We conducted a follow-up study between 1981 and 2002, based on register data covering the total population of Swedes aged 40-69 years (n = 1,617,010). An increased risk of fatal stroke (1.31 CI: 1.05, 1.62) was found among women who had experienced the loss of a sibling. No increase in the overall mortality risk was found in men (1.11 CI: 0.92, 1.33). An elevated risk in the short term (during the second and third half-year after the death) was found among both men and women, whereas longer-term elevation in risk was found primarily for women. Both external (1.47 CI: 1.00, 2.17) and not external (1.26 CI: 1.00, 1.60) causes of sibling death showed associations among women. In men, an association was found only if the sibling also died from stroke (1.78 CI: 1.00, 3.17). However, among women, we found an increased risk of stroke mortality if the sibling died from causes other than stroke (1.30 CI: 1.04, 1.62). Conclusions/Significance: The findings suggest an increased risk of dying from stroke mortality after the death of a sibling, and that bereavement affects particularly women. It is important for health care workers to follow bereaved siblings and recognize potential changes of stress-levels and health related behaviours that could lead to risk of stroke.

  • 2013. Andrea C. Dunlavy, Mikael Rostila. International Journal of Environmental Research and Public Health 10 (7), 2871-2887

    Employment and working conditions are key social determinants of health, yet current information is lacking regarding relationships between foreign background status, working conditions and health among workers in Sweden. This study utilized cross-sectional data from the 2010 Swedish Level of Living Survey (LNU) and the Level of Living Survey for Foreign Born Persons and their Children (LNU-UFB) to assess whether or not health inequalities exist between native Swedish and foreign background workers and if exposure to adverse psychosocial and physical working conditions contributes to the risk for poor health among foreign background workers. A sub-sample of 4,021 employed individuals aged 18–65 was analyzed using logistic regression. Eastern European, Latin American and Other Non-Western workers had an increased risk of both poor self-rated health and mental distress compared to native Swedish workers. Exposure to adverse working conditions only minimally influenced the risk of poor health. Further research should examine workers who are less integrated or who have less secure labor market attachments and also investigate how additional working conditions may influence associations between health and foreign background status.

  • 2013. Mikael Rostila, Jan Saarela. American Journal of Epidemiology 177 (7), 645-648

    In this issue of the Journal, Bjørngaard et al. give us new insights into the etiology of mental health by studying birth order and suicide risk (Am J Epidemiol. 2013;177(7):638–644). Although the authors provided empirical evidence that each increase in birth order (i.e., from first-born to second-born, second-born to third-born, etc.) is associated with a 46% higher suicide risk, they gave us very little information on the likely explanations. In our commentary, we draw attention to the possible mechanisms underlying a causal relationship between birth order and suicide. Given that Norway is one of the richest countries in the world, the findings of Bjørngaard et al. in a Norwegian cohort also call for a discussion of whether their results are representative of other societies that are similar or dissimilar with respect to economic institutions, social conditions, and political environment. We suggest that there are several plausible mechanisms to explain higher suicide rates among later-born children, but other mechanisms might also operate in the opposite direction, that is, have beneficial outcomes among later-born children. Specifically, there are reasons to expect a different relationship between birth order and psychiatric outcomes in poorer societal contexts.

  • 2013. Mikael Rostila, Jan Saarela, Ichiro Kawachi. Journal of the American Heart Association 2 (2), UNSP-e000046

    Background Death of a sibling represents a stressful life event and could be a potential trigger of myocardial infarction (MI). We studied the association between loss of an adult sibling and mortality from MI up to 18 years after bereavement.                       

    Methods and Results We conducted a follow‐up study for Swedes aged 40 to 69 years between 1981 and 2002, based on register data covering the total population (N=1 617 010). Sibling deaths could be observed from 1981 and on. An increased mortality rate from MI was found among women (1.25 CI 1.02 to 1.54) and men (1.15 CI 1.03 to 1.28) who had experienced death of an adult sibling. An elevated rate some years after bereavement was found among both women (during the fourth to sixth half‐years after the death) and men (during the second to sixth half‐years after the death), whereas limited support for a short‐term elevation in the rate was found (during the first few months since bereavement). External causes of sibling death were associated with increased MI mortality among women (1.54 CI 1.07 to 2.22), whereas nonexternal causes showed associations in men (1.23 CI 1.09 to 1.38). However, further analyses showed that if the sibling also died from MI, associations were primarily found among both women (1.62 CI 1.00 to 2.61) and men (1.98 CI 1.59 to 2.48).                       

    Conclusions Our study provided the first large‐scale evidence for mortality from MI associated with the death of a sibling at an adult age. The fact that findings suggested associations primarily between concordant causes of death (both died of MI) could indicate genetic resemblance or shared risk factors during childhood. Future studies on bereavement should carefully deal with the possibility of residual confounding.                       

  • 2013. Mikael Rostila (et al.). International Journal of Environmental Research and Public Health 10 (12), 6517-6533

    A large number of studies have shown that friends’ smoking behavior is strongly associated with an individual’s own risk for smoking. However, few studies have examined whether other features of social networks, independently or conjointly with friends’ smoking behavior, may influence the risk for smoking. Because it is characterized by the growing importance of friendship networks, the transition from adolescence to young adulthood may constitute a particularly relevant period on which to focus our investigation of network influences on smoking behavior. The aim of this study was therefore to examine the consequences of peer smoking as well as other network characteristics (friends’ other health behaviors, relationship content, and structural aspects of the network) on the risk for smoking among young adults. The data was based on a cross-sectional survey of Swedish 19-year-olds carried out in 2009 (n = 5,695) with a response rate of 51.6%. Logistic regression was the primary method of analysis. The results show that having a large percentage of smokers in one’s network was by far the most important risk factor for daily smoking. The risk of daily smoking was 21.20 (CI 14.24. 31.54) if 76%–100% of the network members smoked. Having a high percentage of physically active friends was inversely associated with daily smoking. The risk of smoking was 0.65 (CI 0.42. 1.00) if 76%–100% of the network members were physically active. No main associations between the other network characteristics (relationship content and structural aspects of the network) and smoking were found. However, there was an interaction between the percentage of smokers in the network and relationship content (i.e., trust, relationship quality and propensity to discuss problems): positive relationship content in combination with peer smoking may increase the risk of smoking. Women with a high percentage of smokers in their networks were also at higher risk of daily smoking than were men with many smoking friends. Hence, it is important to consider the interplay between peer smoking and other network characteristics on the risk of smoking, where features of networks which traditionally are seen as constructive may occasionally provide the impetus to smoke. Future studies should use longitudinal data to study whether these findings reflect peer selection or peer influence.

  • 2013. Mikael Rostila.

    This book sets out unique findings on whether social capital influences health and health inequalities in European welfare states. Drawing on cross-national data from the European Social Survey (ESS) as well as Swedish national survey data and registers, the book develops a new theoretical definition of social capital that guides the books empirical studies. The findings suggest that welfare state generosity is a decisive factor for social capital and that social capital is of significance for health inequalities both between and within European welfare states. The book also discusses the potential dark sides of social capital and examines evidence of circumstances in which social capital has negative health externalities.

  • 2013. Mikael Rostila.
  • 2013. Mikael Rostila, Jan Saarela, Ichiro Kawachi. BMJ Open 3 (4), e002618

    Objectives: The death of a sibling can trigger grief and depression. Sibling deaths from external causes may be particularly detrimental, since they are often sudden. We aimed to examine the association between the death of an adult sibling from external causes and the risk of suicide among surviving siblings up to 18 years after bereavement. We adjusted for intrafamily correlation in death risks, which might occur because of shared genetics and shared early-life experiences of siblings in the same family.

    Design: A follow-up study between 1981 and 2002 based on the total population.

    Setting: Sweden.

    Participants: Swedes aged 25–64 years (n=1 748 069).

    Primary and secondary outcome measures: Suicide from the Swedish cause of death register.

    Results: An increased risk of mortality from suicide was found among persons who had experienced the death of a sibling. In women, the suicide risk was 1.55 times that of non-bereaved persons (95% CI 0.99 to 2.44), and in men it was 1.28 times higher (95% CI 0.93 to 1.77). If one sibling committed suicide, the risk of the remaining sibling also committing suicide was 3.19 (95% CI 1.23 to 8.25) among women and 2.44 (95% CI 1.34 to 4.45) among men. Associations with other main causes of death—such as external other than suicide, cardiovascular diseases or cancer—were generally much smaller and statistically not significant in either sex. We found no clear support for a specific time pattern according to time since a sibling's death.

    Conclusions: Our study provided evidence for suicide risk associated with the death of a sibling at adult age, revealing that bereaved persons’ risk of suicide is higher when siblings die from suicide, even when adjusting for intrafamily correlation in death risks.

  • 2013. A.J. Oliveira (et al.). Obesity 21 (8), 1540-1547

    Objective: To investigate the effect of five dimensions of social relationships on obesity and potential sex differences in these associations.

    Design and Methods: This study used longitudinal data from the Swedish Level of Living Surveys (LNU) in 1991 and 2000. The sample included 3,586 individuals. The dimensions of social relationships examined in this study include emotional support, frequency of visiting friends, marital status, marital status changes, and a Social Relationships Index (SRI). Obesity status was based on BMI (kg/m(2)) and calculated with self-reported measurements. The association between social relationships and the incidence of obesity after 9 years of follow-up was evaluated through Poisson regressions.Results: After controlling for confounders, we found that the lack of emotional support (RR = 1.98; 95% CI, 1.1-4.6) influenced the incidence of obesity among men. In addition, men with the lowest levels of SRI (RR = 2.22; 95% CI, 1.1-4.4) had an increased risk of being obese. Among women, SRI was not significantly associated with obesity. Women who changed their marital status from married to unmarried had lower risk of obesity (RR = 0.39; 95% CI, 0.2-0.9).

    Conclusions: This study provides evidence for the effect of social relationships on the incidence of obesity, with significant differences by sex.

  • 2013. Mikael Rostila. Global perspectives on social capital and health, 277-305
  • 2012. Mikael Rostila, Susanna Toivanen.

    I vilken utsträckning är hälsan ojämlikt fördelad i Sverige och i övriga världen? Varför lever människor med högre social position längre än andra? Hur kan hälsan fördelas mer rättvist?Dessa är några av de frågor som denna unika svenska bok önskar besvara och klargöra. Boken handlar om hur människors position i samhällets hierarkiska strukturer är nära förknippad med systematiska skillnader i hälsa. Var vi råkar födas i världen, men även den sociala position vi har i ett givet samhälle, har stor betydelse för vår hälsa och livslängd. Trots att en jämlik hälsa borde vara en mänsklig rättighet har hälsans ojämlika fördelning ofta stått långt ned på den politiska dagordningen.

  • 2012. Mikael Rostila, Maria Kölegård, Johan Fritzell. Social Science and Medicine 74 (7), 1091-1098

    The number of studies analysing income inequality and health are voluminous. However, when empirically testing the income inequality hypothesis, the level of aggregation could be crucial for whether we find an association or not and for the mechanisms we believe are active. This study hence investigates: 1) the two-year lagged effect by income inequality on health at two levels of aggregation; municipalities and neighbourhoods in Sweden; 2) whether spending on social goods accounts for the association between income inequality and health; 3) the effect by income inequality among the affluent and the disadvantaged in municipalities and neighbourhoods, respectively. The empirical data is based on a Swedish public health survey in 2002 and includes residents of Stockholm aged 18-84 years. Primary method used is multi-level logistic regression.   The findings indicate a moderate effect by high income inequality on self-rated poor health at the municipality-level. The association, however, ceases after adjustment for spending on social goods. No detrimental effect by income inequality on self-rated health at the neighbourhood-level is found. In sum, the findings suggest that reduced spending on social goods could account for the association between income inequality and health at the municipality-level. The contrasting findings at the neighbourhood- and municipality-level indicate that it is important to consider the level of aggregation when studying health effects by income inequality.

  • Kapitel Inledning
    2012. Mikael Rostila, Susanna Toivanen. Den orättvisa hälsan, 13-26
  • 2012. Mikael Rostila, Anders Hjern. Den orättvisa hälsan
  • 2012. Mikael Rostila, Jan Saarela, Ichiro Kawachi. Journal of Epidemiology and Community Health 66 (10), 927-933

    Background: The death of a young child is so devastating that it can increase the risk of mortality in the grieving parent. Little is known about the impact of an adult child's death on the health of parents. Methods: The authors conducted a follow-up study between 1980 and 2002 based on a linked-registers database that contains the total Swedish population. The authors examined mortality from all causes, natural causes and unnatural causes among parents following the death of children aged 10-49 years. Results: An increased mortality risk (RR 1.31, 95% CI 1.02 to 1.68) in mothers following the death of a minor child (10-17 years) was found and especially following unnatural deaths (primarily accidents and suicides). Mothers also experienced elevated mortality following the death of an adult child aged 18-25 years (RR 1.15, 95% CI 1.03 to 1.29). Bereavement effects among fathers were more attenuated and chiefly found after >8 years of follow-up. From a short-term perspective (1-3 years), the death of an adult child (>25 years) was somewhat protective for parents. However, over longer follow-up periods, it approached (4-8 years) and exceeded (>8 years) the death risk of the general population. Conclusions: These findings corroborate and extend earlier findings suggesting elevated mortality risks also following the death of an adult child.

  • 2012. Mikael Rostila. Den orättvisa hälsan
  • 2012. Mikael Rostila, Jan Saarela, Ichiro Kawachi. American Journal of Epidemiology 176 (4), 338-346

    Previous findings have suggested that the loss of a family member is associated with mortality among bereaved family members. The least-studied familial relationship in the bereavement literature is that of siblings, although loss of a sibling may also involve health consequences. The authors conducted a follow-up study based on data from the Swedish total population register, covering the period 1981–2002. Using Cox regression, mortality risk ratios for bereaved and nonbereaved persons aged 18–69 years were estimated. All-cause mortality and cause-specific mortality (unnatural causes, natural causes, cardiovascular disease, cancer, suicide, accidents, and all other causes) were examined. In men, the mortality risk for bereaved persons versus nonbereaved persons was 1.26 (95% confidence interval: 1.22, 1.30), and in women it was 1.33 (95% confidence interval: 1.28, 1.39). An elevated mortality risk associated with a sibling's death was found in all age groups studied, but the association was generally stronger at younger ages and could be observed predominantly after more than 1 year of follow-up. There was also an increased mortality risk if the sibling had died from a discordant main cause, which may strengthen the possibility that the association observed is not due to confounding alone.

  • 2012. Mikael Rostila, Susanna Toivanen. Den orättvisa hälsan
  • 2011. Mikael Rostila. Social Theory & Health 9 (2), 109-129

    The overall aim of this article is to present a resource-based definition of social capital for health research that bridges the two notions of the concept the individual and the collective. Initially, the article reviews some of the most important theoretical definitions of social capital and discusses the development of the concept in health research. Furthermore, a model is presented that bridges the two facets of social capital. The model also suggests that the negative externalities of social capital chiefly arise when social networks and social structures are characterized by closure. The definition of social capital derived from the model claims that it comprises social resources that evolve in accessible social networks or social structures characterized by mutual trust. This definition may not definitively address the theoretical uncertainties in the health field; however, it could inspire the use of a resource-oriented theory of social capital in health research that more explicitly stresses the core of the concept: social resources. It may be relevant for health research, as it facilitates the formation of more specific mechanisms that link social capital and health, guide operationalization of social capital and specify the circumstances in which the negative health externalities of social capital arise.

  • 2011. Mikael Rostila, J. Saarela. Läkartidningen 108 (14), 813
  • 2011. Mikael Rostila, J. Saarela. Journal of Marriage and Family 73, 236-249

    People linked through social ties are known to have interdependent health. Our aim was to investigate such collateral health effects in the context of offspring mortality after a parent's death in children aged 10–59 years. The data (N = 3,753,368) were from a linked-registers database that contains the total Swedish population. In minor children, we found elevations in mortality risks associated with a parent's death. Adult offspring experienced a reduced mortality risk recently after a parent's death, which over time approached, and in some instances even exceeded, that of the general population. Mother's death tended to have a stronger influence than father's death, unnatural parental deaths had a stronger effect than natural ones, and male offspring were more vulnerable than female offspring.

  • 2011. Mikael Rostila, J. Saarela, I. Kawachi. Journal of Epidemiology and Community Health
  • 2011. Aldair J. Oliveira (et al.). International Journal of Behavioral Nutrition and Physical Activity 8, 77

    Background: Although social support has been observed to exert a beneficial influence on leisure-time physical activity (LTPA), multidimensional approaches examining social support and prospective evidence of its importance are scarce. The purpose of this study was to investigate how four dimensions of social support affect LTPA engagement, maintenance, type, and time spent by adults during a two-year follow-up. Methods: This paper reports on a longitudinal study of 3,253 non-faculty public employees at a university in Rio de Janeiro (the Pro-Saude study). LTPA was evaluated using a dichotomous question with a two-week reference period, and further questions concerning LTPA type (individual or group) and time spent on the activity. Social support was measured by the Medical Outcomes Study Social Support Scale (MOS-SSS). To assess the association between social support and LTPA, two different statistical models were used: binary and multinomial logistic regression models for dichotomous and polytomous outcomes, respectively. Models were adjusted separately for those who began LTPA in the middle of the follow up (engagement group) and for those who had maintained LTPA since the beginning of the follow up (maintenance group). Results: After adjusting for confounders, statistically significant associations (p < 0.05) between dimensions of social support and group LTPA were found in the engagement group. Also, the emotional/information dimension was associated with time spent on LTPA (OR = 2.01; 95% CI 1.2-3.9). In the maintenance group, material support was associated with group LTPA (OR = 1.80; 95% CI; 1.1-3.1) and the positive social interaction dimension was associated with time spent on LTPA (OR = 1.65; 95% CI; 1.1-2.7). Conclusions: All dimensions of social support influenced LTPA type or the time spent on the activity. However, our findings suggest that social support is more important in engagement than in maintenance. This finding is important, because it suggests that maintenance of LTPA must be associated with other factors beyond the individual's level of social support, such as a suitable environment and social/health policies directed towards the practice of LTPA.

  • 2011. Mikael Rostila. Journal for the Theory of Social Behaviour 41 (3), 308-326

    The emergence of the two facets of social capital, the individual and the collective, has contributed to much of the confusion in the field of social capital. The overall objective of this article is to elaborate on a theoretical model aiming at clarifying some bridges between the facets and dimensions of social capital previously suggested in the literature. Initially, the article shortly presents and discusses some important definitions of social capital. Furthermore, limitations and shortcomings of previous definitions are discussed. Moreover, a theoretical model is elaborated on suggesting that social capital comprises social resources that evolve in accessible social networks or social structures characterized by mutual trust. This model also emphasises some of the potential dark sides of social capital. The presented definition does not definitively address the theoretical uncertainties in the field; however, it suggests that a resource-oriented notion of social capital could be useful in bridging the facets of social capital.

  • 2010. Mikael Rostila. Sociology of Health and Illness 32 (3), 382-399

    Although studies show that health inequities between ethnic groups exist, few have expressed interest in the origins of these disparities. As homophily (the phenomenon that people principally form relationships with those who are similar to them) influences people’s norms and interactions, it might be an important property of migrants’ networks, and have implications on their health. The aim of this study is to examine health inequities between natives and immigrants in Sweden and the health consequences arising from participation in homogenous migrant networks. Using total population registers and representative survey data initial analyses show that migrants experience poorer health than native Swedes. The findings further suggest that homophily is a prominent feature of migrant social networks and that migrants in networks with a high proportion of other migrants experience poorer health than those who include a high proportion of natives in their networks. However, unhealthy behaviour and disadvantaged social conditions may account for a considerable share of their excess risk. Hence, network closure may reinforce and maintain norms leading to negative behaviour and social conditions in such networks.

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