Norsk Epidemiologi <p>Norsk Epidemiologi (The Norwegian Journal of Epidemiology) is published by the Norwegian Epidemiological Association (NOFE). The journal is normally published twice a year; each individual issue covers a specific theme and is edited by one or more guest editors. The guest editors invite prospective authors to submit articles within the specific theme, unsolicited articles are generally not accepted. The main aims for the thematic issues are to provide comprehensive scientific overviews of the specific fields, and of the work going on within these fields in Norway, and partly in other countries. The Board of NOFE approves the themes for the specific issues, and appoints guest editors. All members of NOFE can suggest topics and editors.</p> <p>The Norwegian Journal of Epidemiology is open access, and can be downloaded freely from this website. There is no submission or page charges for manuscripts accepted for publication. The Norwegian Journal of Epidemiology is double-blind peer reviewed and the journal is listed level 1 in the&nbsp;<a href=";bibsys=false&amp;request_locale=en">Norwegian scientific classification system</a>.</p> Norsk forening for epidemiologi - The Norwegian Epidemiological Association en-US Norsk Epidemiologi 0803-2491 <p>Norsk Epidemiologi licenses all content of the journal under a Creative Commons Attribution (CC-BY) licence. This means, among other things, that anyone is free to copy and distribute the content, as long as they give proper credit to the author(s) and the journal. For further information, see Creative Commons website for human readable or lawyer readable versions.</p><p><span>Authors who publish with this journal agree to the following terms:</span></p><p>1. Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a <a href="">Creative Commons Attribution License</a> that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.</p><p>2. Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.</p><p><span>3. Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See <a href="">The Effect of Open Access</a>).<br /></span></p> Innhold <p>innhold</p> - - ##submission.copyrightStatement## 2019-05-09 2019-05-09 28 1-2 10.5324/nje.v28i1-2.3044 Introduction <p><em>The guest editors: </em></p> <p><em>Ida Hydle, Institutt for barnevern og sosialt arbeid,<br>Norges arktiske universitet UiT <br></em></p> <p><em>Lars B. Kristofersen, Velferdsforskningsinstituttet NOVA,<br>OsloMet – Storbyuniversitetet</em></p> <p><em>Sidsel Sverdrup, Fakultet for helsefag,<br>VID vitenskapelige høgskole <br></em></p> Ida Hydle Lars Bjarne Kristofersen Sidsel Sverdrup ##submission.copyrightStatement## 2019-05-09 2019-05-09 28 1-2 10.5324/nje.v28i1-2.3045 Epistemology of epidemiology: the case of Ungdata <p>One of the most significant epidemiological tools for the perceived truth about contemporary Norwegian youth is in Ungdata, Youth Data. This is a continuous online-based survey grounded upon several and varying investigations of youth in Norwegian high schools, now extending to primary schools as well. The knowledge bases, epidemiological practices, technicalities, economic premises for the work and also data publishing is handled by social scientists at Norwegian Social Research, NOVA, located at Oslo Metropolitan University. State bureaucracies, e.g. ministries and directorates, municipalities etc. can ask for investigations and overviews. NOVA has an annual income for running the Youth Data through the Norwegian Directorate of Health of 3,3 mill. NOK (2018). The Youth Data registry has become a leading force in opinions, policies, polities and resource allocations for youth at municipal and state levels for several intended purposes. Based upon NOVA reports, media comments and interviews this article reflects upon some theoretical and methodological approaches to this unique epidemiological tool concerning youth, health and welfare. Questions arise such as: Is epidemiology a taken for granted neutral and objective kind of knowledge? Should there be ethical concerns for youth and their researchers as creators of knowledge, theory and policy – other than the normal ethical rules of scientific conduct? </p> Ida Hydle ##submission.copyrightStatement## 2019-05-09 2019-05-09 28 1-2 10.5324/nje.v28i1-2.3046 Forekomsten av angst- og depresjonssymptomer hos samiske og ikke-samiske elever i videregående skole i Finnmark i 1994 og 2014 <p>Kvernmo S, Bye RS. The prevalence of anxiety- and depression symptoms in Sami and non-Sami<br>high school students in Finnmark county in 1994 and 2014. Nor J Epidemiol 2019; 28 (1-2): 15-25.<br>ENGLISH SUMMARY<br>As much as 15-20% of children and adolescents in Norway, aged 3-18 years, are suffering from anxiety,<br>depressive or behavioral problems. Recent studies have shown an increase in the prevalence of emotional<br>problems among adolescents during the last decades. The aim of this study is to examine the prevalence<br>and the sociodemographic and psychosocial predictors of anxiety and depression symptoms in Indigenous<br>Sami and non-Sami adolescents in 1994 to 2014.<br>Data from 1655 high school students in the Young in North (Ung i Nord) study from 1994 was compared<br>to data from 1856 high school students in Ungdata, conducted in 2014 in the same area. Similar and<br>comparable measures were applied in the two studies with SCL-12 as the main measure. The results<br>showed an increase in the prevalence of depression and anxiety symptoms from 1994 compared to 2014,<br>but a decrease in behavioral problems. At both years females reported more problems. No significant<br>ethnic differences occurred in rates of problems between indigenous Sami and non-Sami adolescents at any<br>time point. Across gender and ethnic groups, self-esteem and the students' relationship to the school were<br>the two strongest predictors.<br>Conclusion: This study confirmed findings from other studies of an increase of rates of anxiety and<br>depression symptoms in older adolescents over the last decades, but also in types of significant predictors.<br>Our findings entail a future need for prevention and treatment offers to adolescents suffering from anxiety<br>and depression problems.</p> Siv Kvernmo Ronja Sæterhaug Bye ##submission.copyrightStatement## 2019-05-09 2019-05-09 28 1-2 10.5324/nje.v28i1-2.3047 The social gradient in stress and depressive symptoms among adolescent girls: A systematic review and narrative synthesis <p><em>Aim:</em> Socioeconomic inequality is found to negatively influence mental health, but studies investigating the relationship between socioeconomic status (SES) and specific common mental health problems such as stress and depressive symptoms in the general adolescent population are needed. Moreover, gender gaps in mental health among adolescents are evident, but there is a lack of studies that investigate socioeconomic differences in mental health within genders. As girls report consistently more depressive symptoms than do boys, this systematic review specifically investigates whether socioeconomic status is associated with stress and depressive symptoms among adolescent girls in the general population.<br><em>Methods:</em> Eligible studies according to predefined inclusion criteria were identified from Medline, PsycINFO, ISI Web of Science, Svemed+ and Idunn. Eight studies were identified, whereby only two measured stress; hence, the evidence base for stress was too limited to perform an analysis. A narrative synthesis was conducted of the six studies that measured depressive symptoms.<br><em>Results:</em> A significant inverse social gradient in depressive symptoms among adolescent girls was revealed in all studies that applied parental employment status and perceived financial difficulties as SES measures, while parental educational level and Family Affluence Scale (FAS) gave inconsistent results. The relatively low number of studies may limit interpretation.<br><em>Conclusions</em>: Depressive symptoms were more common among adolescent girls with low SES compared to girls with higher SES. SES measures should be applied with care in studies of populations of adolescent girls, as the results can vary based on the chosen indicator. Actions to reduce depressive symptoms among adolescent girls in the general population should include targeting socioeconomic inequalities.</p> Janne Lund Anders J.W. Andersen Siri H. Haugland ##submission.copyrightStatement## 2019-05-09 2019-05-09 28 1-2 10.5324/nje.v28i1-2.3048 Comparison of risk-behaviors among young people who are not in education, employment or training (NEET) versus high school students. A cross-sectional study <p><em>Background</em>: Young people who are not in education, employment or training (NEET) have been identified as a vulnerable group at risk of poor social functioning, lower educational achievement, limited job opportunities and financial hardship. Being NEET has also been associated with increased risk of mental and physical health problems, but only a few studies have identified the prevalence of certain health-risk behaviors among NEET youth. The present study contributes to fill the existing knowledge gaps by investigating a broad range of risk behaviors in this vulnerable group compared to their high school peers.<br><em>Methods</em>: This cross-sectional study included 96 NEET youth and 384 age and gender-matched high school students. A self-report questionnaire was used to assess differences in several risk behaviors, including substance use, low consumption of healthy food and high consumption of unhealthy food and beverages, low leisure time physical activity and low sleep duration. Logistic regression models were adjusted for gender, age and parental education.<br><em>Results</em>: NEET youth had higher odds of using cannabis (OR 2.2; 95% CI 1.1-4.3), smokeless tobacco (1.7;1.0-2.8), smoking cigarettes (2.6;1.5-4.4), having an irregular consumption of breakfast (2.6;1.5-4.5), lunch (3.1;1.8-5.4) and dinner (1.9;1.1-3.2), having low consumption of vegetables (3.0;1.3-6.7), fruit and berries (5.3;1.6-18.1) and fish (3.0;1.8-5.1) and short sleep duration on weekends (2.6;1.4-4.9) than students. On the other hand, being NEET was associated with decreased odds of short sleep duration on weekdays compared to their high school peers (0.3;0.2-0.5). No differences in alcohol intoxication, consumption frequency of evening meals, consumption of unhealthy food items and beverages and leisure time physical activity were shown between these groups.<br><em>Conclusions</em>: NEET youth have higher odds of using tobacco, short sleep duration on weekends and lower consumption of healthy food items including vegetables, fruit and fish compared to high school students. These results contribute to identify risk behaviors that are more prevalent among NEET youth compared to students and needs to be addressed through targeted intervention studies.</p> Tonje H. Stea Karin de Ridder Siri Håvås Haugland ##submission.copyrightStatement## 2019-05-09 2019-05-09 28 1-2 10.5324/nje.v28i1-2.3049 Mental well-being among students in Norwegian upper secondary schools: the role of teacher support and class belonging <p>Knowledge about factors in school that can promote adolescents’ mental health is of great value for national health policies and health promotion work. This cross-sectional study investigated levels of mental wellbeing measured with the Warwick-Edinburgh Mental Well-being Scale and the relationship with teacher support and class belonging among 574 Norwegian high school students, aged 16-17 (55.1% boys). The data stem from the COMPLETE-project. Results showed that students reported an average mental wellbeing of 3.50 (SD 0.88, range 1-5), with significant differences across gender, study specialization area and socioeconomic status groups. Class belonging partially mediated the observed relationship between teacher support and mental well-being after adjusting for covariates. The findings indicate that a supportive teacher may be a significant factor for both students’ class belonging and mental well-being, and suggests that school policies and programs should include a focus on promoting teachers’ supportive behavior.</p> Oda Lekve Brandseth Malin Torstveit Håvarstein Helga Bjørnøy Urke Ellen Haug Torill Larsen ##submission.copyrightStatement## 2019-05-09 2019-05-09 28 1-2 10.5324/nje.v28i1-2.3050 Self-esteem and mental health in adolescents – level and stability during a school year <p><em>Aim</em>: Adolescence represent an important period for positive mental health development. The aim of the present paper was to investigate gender differences as well as the level, stability and predictive role of mental health (symptoms of depression/anxiety and mental well-being) and self-esteem in adolescents during a school year.<br><em>Methods</em>: The study sample consisted of a cohort of 351 students aged 15–21 years in Mid-Norway. In a survey administrated at the beginning and end of the 2016/2017 school year, mental well-being was assessed with Warwick-Edinburgh Mental Well-Being Scale, depression/anxiety with Hopkins Symptom Checklist and self-esteem with the Rosenberg Self-Esteem Scale. Two models were tested for prediction; self-esteem on mental health (vulnerability model) and mental health on self-esteem (scar model).<br><em>Results:</em> Girls reported significantly higher depression/anxiety than boys and showed a slightly significant increase in depression/anxiety, stress and self-esteem during the two assessments. Boys scored significantly higher on mental well-being and self-esteem and reported stable mental health during the school year. Selfesteem significantly predicted depression/anxiety and mental well-being. Mental well-being and depression/ anxiety also significantly predicted self-esteem.<br><em>Conclusion</em>: The results suggest that self-esteem and mental health are reciprocally associated. The results underline the gender differences in overall mental health in adolescents and thus the potential importance of acknowledging gender when working on universal strategies for positive mental health development.</p> Unni Karin Moksnes Randi Johansen Reidunsdatter ##submission.copyrightStatement## 2019-05-09 2019-05-09 28 1-2 10.5324/nje.v28i1-2.3052 «Jeg har aldri spurt om å kunne slutte selv». En kvalitativ studie av en gruppe jenters vei mot frafall i videregående skole <p>In this article we explore the school history of girls who are dropping out from upper secondary school, recorded with mental problems. The study has a qualitative, exploratory design with an inductive approach. Interviews were conducted with life-line method, with some supplemental questions. Most of the girls experience weak relations to both school-peers and teachers in primary school. Some of them are bullied and describe a school without capability to deal with the problems and work for an including school environment. When they reach upper secondary school they have a high absence rate and most of them are requested to terminate school, partly due to the risk of losing part of their statutory right to upper education. The findings are discussed in resilience- and bio-ecological perspectives.</p> Sissel Elisabeth Edvardsen Hege Hovland Anne Brita Thorød ##submission.copyrightStatement## 2019-05-09 2019-05-09 28 1-2 10.5324/nje.v28i1-2.3053 Promoting academic achievement within a positive youth development framework <p>School dropout has both individual and economic implications. Current statistics reveal higher dropout rates among boys. Schools have a unique position to address youth development. Research from the US on positive youth development shows positive relationships between developmental assets (e.g. support at school) and academic achievement. The present paper examined these relationships among 591 Norwegian high school students (55% girls), aged 15-19 (mean = 16.70) with data from a cross-sectional study. Results indicated that girls reported more assets than boys did. Furthermore, while positive correlations occurred among assets and academic achievement, some assets (i.e. commitment to learning, support and positive identity) were better predictors of academic achievement in regression analysis. Schools can play a significant role in nurturing developmental assets that will promote academic achievement in both genders, as well as have implications for youth and consequently economic development.</p> Marianne Beck Nora Wiium ##submission.copyrightStatement## 2019-05-09 2019-05-09 28 1-2 10.5324/nje.v28i1-2.3054 Do young people who are not in education, employment or training (NEET) have more health problems than their peers? A cross-sectional study among Norwegian adolescents <p><em>Objectives</em>: An increasing proportion of young Norwegians are categorised as too ill to attend upper secondary education, and poor physical and mental health may reduce their opportunities to return to school or find paid employment. This study examined the differences in self-perceived health, mental health, and prevalence of pain between Norwegian adolescents, who are not in education, employment or training (NEET) compared to adolescents who attend upper secondary school (age 16-21 years).<br><em>Design</em>: Cross-sectional study.<br>Participants and setting: A total of 96 NEET youth and 384 age and gender matched adolescents attending upper secondary school in the south of Norway participated in the study.<br><em>Main outcome measures</em>: Self-perceived health, mental health and pain.<br><em>Results</em>: Multivariable analyses, adjusted for parental education, showed that more NEET girls reported poor self-perceived health (odds ratio 3.2; 95% CI 1.4–7.5) and poor mental health (2.4;1.0–5.2) when compared to girls who were attending school. The results showed no difference in the prevalence of various types of pain between girls who were attending or not attending school, and among boys the results showed no differences in health problems assessed in this study.<br><em>Conclusion</em>: The study indicates that NEET girls have poorer self-perceived health and poorer mental health when compared to girls who are attending upper secondary school. It will be essential to identify the causes of these health problems. This may provide a basis for specially adapted measures that could help more people in the target group return to school or paid employment.</p> Tonje H. Stea Eirik Abildsnes Arve Strandheim Siri Håvås Haugland ##submission.copyrightStatement## 2019-05-09 2019-05-09 28 1-2 10.5324/nje.v28i1-2.3055 Frequency of tooth brushing and associated factors among adolescents in western Norway <p>Dental caries is the most prevalent disease in Norway and worldwide, and daily tooth brushing with fluoridated toothpaste is the main preventative measure when diets contain sugary foods. Tooth brushing is an important public health indicator, as the frequency of brushing also has been positively associated with good health in general. In Norway, brushing twice a day is the official recommendation. Our aim was to assess the frequency of tooth brushing among pupils in secondary school in two counties in western Norway, and to identify factors associated with brushing more than once a day. All 59 borough administrations in the two counties were invited to participate in the Ungdata survey in 2015-16; 26 agreed. In total 8,725 pupils filled in the electronic questionnaire (82%). Some 69% brushed their teeth more frequently than once a day, specifically 76% of whom were girls and 63% were boys (adjusted odds ratio=2.0). Of the boys, 6.5% did not brush daily. In 8-10th school grade 71% brushed more than once a day, compared to 65% in 11-13th grade. Out of 28 a priori selected factors, eight were independently associated with frequency of tooth brushing. Besides gender, the strongest associations observed were for frequency of brisk physical exercise, parents being informed about their adolescent’s whereabouts, and satisfaction with one’s own health.</p> Arild Vaktskjold ##submission.copyrightStatement## 2019-05-09 2019-05-09 28 1-2 10.5324/nje.v28i1-2.3056 May telephone surveys provide reliable public health surveillance data for municipalities? Mode effects differ between categories of questions. The HUNT Study, Norway <p><em>Background:</em> Availability of data on health and its determinants at the local area level is a prerequisite for developing interventions and public health campaigns locally. Collecting self-reported data by means of telephone interviews may rapidly provide relevant data. The reliability of such data may be questioned. In this study, we sought to compare exact similar questions addressed by a recent telephone survey with a previous large scale and very comprehensive population health survey (The Nord-Trøndelag Health Study 2006-08 – HUNT3), conducted a few years earlier in the same geographical region. This was done in order to examine the reliability of telephone interviews as a method to provide data on health and determinants to enable municipal authorities to get a sufficient overview.<br><em>Methods</em>: One rural and one urban municipality covered by HUNT3 using paper questionnaires were resurveyed through computer assisted telephone interviews. The weighted results for 34 dichotomized variables were compared using chi square tests.<br><em>Results:</em> The comparison of results between the rural and the urban samples and HUNT3 involved 68 chi square tests, 25 of which (38%) displayed significant differences. The ability of the telephone survey to replicate the results from HUNT3 was only moderate, but with differences between survey themes. Comparability was poor for adverse life events and mental health factors, fair for behavioural and risk factors, and skewed for general health and life satisfaction. The replication was good for reports on the less sensitive and subjective theme of cultural participation.<br><em>Conclusion</em>: The comparability of the data differed between themes. The differences may be ascribed to mode effects and to some extent the time lag between the surveys. Because replicability on issues that may be more embarrassing or stressful to recall appears to be poorer, and the more subjective self-assessments of health and well-being appear skewed, it is reasonable to conclude that there is an interviewer effect in the telephone survey. The use of a questionnaire through mail or web to monitor public health in municipalities should be considered as an alternative.</p> Mattias Tagseth Erik R. Sund Göran T.A. Hallman Jostein Holmen Kyrre Kvistad John Tore Vik Steinar Krokstad ##submission.copyrightStatement## 2019-05-09 2019-05-09 28 1-2 10.5324/nje.v28i1-2.3057