To Örebro University

Background: Health inequalities are an unjust and avoidable problem. Thiss tudy examines subnational geographical inequalities in all-cause years of life lost (YLLs) and the association of socioeconomic factors in pre-coronavirus European Economic Area (EEA) countries.

Methods: In this ecological study complimented with a longitudinal analysis, demographic and socioeconomic data for 1390 small regions and 285 basic regions of 32 EEA countries were extracted from Eurostat. Age-standardised YLL rates per 100,000 population were estimated from 2009 to 2019 based on methods from the Global Burden of Disease Study. Inequalities were assessed using the Gini coefficient (GC) and slope index of inequality (SII). The association between socioeconomic factors by YLLs were assessed using negative binomial mixed models in 2019.

Findings: Over the period 2009-2019, YLLs have decreased in almost all subnational regions. The GC of YLLs across EEA regions was 14% for females (95% CI = 135 to 146%) and 17% for males (CI = 161 to 175%). Greece (GC = 101%, CI = 78 to 25%) and Belgium (GC = 108%, CI = 95 to 120%) had the highest relative inequalities in YLLs for women and men, respectively. Subnational regions with the lowest income (incident rate ratio (IRR) = 139, CI = 123 to 158) and levels of educational attainment (IRRfemales = 119, CI = 113 to 126; IRRmales = 122, CI = 116 to 128), and highest poverty risk (IRR = 118, CI = 112 to 125) were associated with increased YLLs, with stronger associations observed in Central and Eastern Europe.

Interpretation: Differences in YLLs remain within and between EEA countries and are associated with socioeconomic factors. This evidence can assist stakeholders in addressing specific health inequities to improve overall disease burden within the EEA.

Key messages:

• The study highlights the need for public health policies targeted at the subnational level to reduce health inequalities in the EEA.
• The study describes the effect of existing public health policies targeting socioeconomic factors.

BACKGROUND: Parental substance abuse (SA) of alcohol and drugs is associated with offspring mortality, including sudden infant death syndrome (SIDS), in infancy, but research on cause-specific mortality and mortality in later childhood is scarce.

METHODS: Using population-based register data on all births in Sweden in 1973-2013 (N = 4.2 million) and Cox regressions, we examined the associations of mother's and father's SA registered between 2 years before and 12 years after the child birth with offspring all-cause and cause-specific mortality in infancy and childhood.

RESULTS: Parental SA was associated with increased offspring all-cause and natural-cause mortality in infancy, but not in the neonatal period, and with external-cause mortality in ages 1-9. Risk of SIDS was 130-280% higher in infants with parental SA compared to infants with no parental SA. Adjusting for parental socioeconomic and immigrant status and severe psychiatric disorders, paternal SA was associated with 66% higher mortality due to communicable diseases and infections in infancy, and both maternal and paternal SA were associated with 40-174% higher mortality due to accidents in infancy and in ages 1-9. The associations between parental SA and offspring mortality were similar for male and female offspring.

CONCLUSIONS: Child mortality is rare in contemporary Sweden, and parental SA has variable associations with elevated offspring mortality throughout the first 10 years of life, excluding the neonatal period, which is indicative of insufficient recognition of children at risk. Preventive measures should be long-term and targeted to both parental and offspring behaviour.

Background: Around 40% of the primary schools in Sweden have programs to prevent tobacco and alcohol use. One popular program is carried out by the Non-Governmental Organization SMART. The aim is to prevent or postpone alcohol, tobacco and other drug use among children through positive reinforcement and signing of contracts. The contract in this longitudinal study also contains items on good conduct behavior. Are there differences in youth problem behaviors between those who signed the contract all years versus those who signed the contract shorter time? What factors characterize those who signed the contract all the years compared to the others?                                                                         

Methods: Students in five schools in a middle-sized municipality in Sweden answered class-room questionnaires in three waves: 7^th (n=432), 8^th (n=458), and 9^th (n=422) grade. Response rates were 88%. Students are divided into three groups, based on response at T3 on many years of contract signing: long-attendees, short-attendees, sporadic- or non-attendees. A repeated measure ANOVA was conducted to analyze changes over time. Binge drinking was the outcome measure in this analysis. Identifying predictors for duration of the contract signing will be analyzed with multiple logistic regressions.                              

Results: Short-attendees, 40%, signed contract only two to four consecutive years starting in 4^th grade. Long-attendees, 22.5%, signed contract five to six years. Sporadic- or non-attendees, 20.5%, signed contract only in some non-consecutive, or none of the years. 17.2% missing-response. Long-attendees have significant lower levels of binge drinking in 9^th grade (M=1.72) compared to short-attendees (M=2.43) and sporadic- or non-attendees (M=2.41). F(2,408) = 9.52, p=<.001.                                             

Conclusion: Schools are an important setting for alcohol and tobacco prevention. Promising results were found regarding binge drinking for students that were long-attendees in the program. Further analysis of different outcomes and predictors, mediators and moderators is on-going.                                                                                                                  

Key messages:

Schools are an important setting for alcohol and tobacco prevention.

There is a need for longitudinal evaluations of preventive programs in national contexts.

Background: The use of clinical practice guidelines in clinical and organizational decision-making improves the care of patients and patient safety. Guidelines make healthcare consistent and efficient. In many low- and middle income countries healthcare workers depend on guidelines developed in higher income countries. For these to be useful and accepted they need to be adapted to the local setting. The aim of the study was to implement pre-hospital treatment guidelines into an organization that was not currently using guidelines. The study was partnership between a Swedish pre-hospital training organization and local ambulance service organizations in Kosovo.

Methods: An iterative process of implementing the guidelines was used:

• Identify guidelines appropriate for the local organization.
• In sets of five, have the guidelines translated into Albanian.
• Adapt the guidelines to the local conditions and context.
• Approval of guidelines by an expert group.
• Begin using the guidelines within the target organization.

Results: The first set of five guidelines was translated, approved, and implemented into the organizations. To improve acceptance, both practitioners and decision-makers were involved in the process. Seven workshops were held, with a total of 104 participants. In follow-up discussions participants said they accepted the guidelines and that they would be useful in their daily work.

Conclusions: It is important to evaluate to what extent the guidelines have been accepted, understood, and used. The success and acceptance is due to the flexible procedure managing the full implementation process. Adapting guidelines to fit with local needs and requirements using local experts made the guide-lines accessible and useful. The workshop discussions established justification and approval.

Key messages:

• Involve local experts in contextualising guidelines to increase acceptance from the start.
• Support building a robust local implementation organization to assist and administer change.

Sport and physical activity is important to address healthy aging. There are recommendations on how much physical activity people should do, but no recommendations for how organizations should organize activities to suit as many as possible.

The purpose of this study was to explore the characteristics of sport and physical activity initiatives that older adults participate in. Different ongoing sport and physical activity initiatives that involve older adults were investigated regarding their focus, organization, intensity and organizer, and in relation to their costs, booking opportunities and recruitment. The study was conducted with a cross-sectional design using the Salutogenic Physical Activity Health Resources Questionnaire (SPAHRQ). The study included 27 different initiatives with 372 participants (60% women) ranging from 60 to 96 years of age. A health-promoting, salutogenic, settings-based approach, and specifically the concepts drop-in, drop-through and drop-over (Geidne and Quennerstedt, 2021) were used in discussing recommendations for the organization of sport and physical activity for older adults.

The main findings were that who (sports clubs or senior associations) organizes the sport and physical activity initiative seems to affect the characteristics of how (for example intensity and characteristics of the activities) it is organized and what characterizes the participants in it. Despite the differing characters of sport and physical activity initiatives, the majority of older adults are recruited by internal contacts like friends and family. The lowest costs are found in senior associations, leisure-focused initiatives, individual initiatives, and low-intensity activities.

In senior associations, most activities were booked per semester 60%. In sport clubs the most common bookingsystem was per occasion, 40%.

In team sports (almost always in sport clubs), the most common way of booking was per semester (46%). Which older adults participate in which initiatives is explained mostly by the age and gender of the participants.

In conclusion, to attract as many older adults as possible, organizations should work with lowering the thresholds into, as well as within and between, organizations, and raise the threshold for dropping out of sports and physical activity.

Background: People aged 60 years and over has doubled since 1980 and WHO predicts that this population will reach 2 billion by the year 2050. However, increases in life spans do not directly lead to increases in health. An aging population poses both challenges and opportunities for society and for individuals. In order to address this, scholars argue for the benefits of being physically active, especially in a group of peers. However, the relation between physical activity and health is often based on an understanding of what causes or prevents illness rather than what promotes health. The purpose of this study is thus to contribute to knowledge about which health resources older adults develop in their participation in organised physical activity initiatives. The study will consider to what extent older adults develop health resources, differences in demographic background and the relation between the health resources and Sense of coherence (SOC).

Methods: This is the first data collection in a longitudinal study. Participants were old adult men and women, 60 years and above. All participants were active in ongoing organised physical activity initiatives in different organisations on a voluntary basis. A survey included demographics, overall health, health resources (McCuaig & Quennerstedt, 2018) and SOC-13. The data collection is ongoing (preliminary n = 200) and ends spring 2020. Statistical analyses were descriptive and included bivariate analyses.

Results: Preliminary results show that the most frequent health resources are social relations, positive energy and embodied identity for both men and women. A positive related correlation of the health resource habit of exercising were observed with a high sense of coherence.

Conclusion: The Salutogenic idea of having access to various health resources linked to a high sense of coherence is in line with the result of a positively related correlation direction and also with the health resource habit of exercising. The results of the study can contribute to knowledge about which health resources older adults develop in their participation in organised physical activity initiatives.

Physical activity represents one of the most beneficial strategies for people of all ages to retain an overall health. Regardless of the numerous benefits of regular physical activity older adults represent one of the least active groups in society. Although there are groups of older adults that meet the PA recommendations, still there remains a great deal of room for improvement not the least within organised sports.

Current knowledge on sports for older adults often focus on matters of how to avoid physical inactivity and overcome barriers to participation and thus understanding what causes illness rather than what promotes health. Literature also exists on the reasons why older adults drop out of sports and organized physical activities, even though it is sparse. Hence, even if this research is important in terms of understanding inactivity and non-participation, less is known about why old people continue to be physically active. Against this backdrop, it is essential to investigate older adults who are physically active on a regular basis and what we can learn from them. A reason for targeting already physically active persons is that there is a lot to be learned from people who have the routines and habits needed to be active as an older adult.

The purpose of this project is to explore older adults' experiences of participation in organized sports. In the project we use a health-promoting perspective focusing on sports clubs as a setting. The research questions that this project address are: What is experienced as meaningful in older adults' sport participation? and What characterizes older adults' participation in organized sports?

In the study we will investigate sports for older adults from a health-promoting perspective using an extensive data material of 4 837 older adults over 60 years participating in Swedish sports clubs. The sample included more than 1000 sports clubs with a large variation.

Previous results where the same questionnaires were used concluded that there were differences between what men and women as well as different ages experienced as meaningful in relation to the physical initiatives.

Background

Alcohol and drug prevention is high on the public health agenda in many countries. In Sweden in 2002 an innovative project portfolio including an integrated research and competence-building strategy for non-governmental organizations (NGOs) was designed by the National Board of Health and Welfare (NBHW).

MethodsThe embedded case study includes 135 projects in 69 organizations and 14 in-depth process or effect studies. The data in the case study has been compiled using multiple methods - administrative data; interviews, questionnaires, focus group discussions and seminars; and documentation of implementation; consultations with the NBHW and the NGOs; and a literature review. Annual reports have been submitted each year and three bi-national conferences Reflections on preventions have been held.

Results

A broad range of organizations have been included in the NBHW project portfolio. A minority of the project were run by Alcohol or drug organizations, while a majority has children or adolescents as target groups. In order to develop a trustful partnership between practitioners, national agencies and researchers a series of measures were developed and implemented: meeting with project leaders, project dialogues and consultations, competence strengthening, support to documentation, in-depth studies and national conferences. A common element was that the projects were program-driven and not research-driven interventions. The role of researchers as technical advisors was suitable for the fostering of a trustful partnership for research and development. The independence of the NGOs was regarded as important for the momentum in the project implementation. The research strategy also includes elements of participatory research.

Conclusions

This research strategy case study shows that it is possible to integrate research into alcohol and drug prevention programs run by NGOs, and thereby contribute to a more evidencebased practice. A core element is developing a trustful partnership between the researchers and the organizations. Moreover, the funding agency must acknowledge the importance of knowledge development and allocating resources to a research group that is capable of cooperating with practitioners and NGOs.

BACKGROUND: Individuals of lower socioeconomic status generally have higher healthcare expenditures than individuals of higher socioeconomic status. However, little is known about how expenditures are distributed across socioeconomic groups over a lifetime, once accounting for differences in life expectancy. This study describes how lifetime healthcare expenditures are distributed across age, sex and socioeconomic groups in Sweden while adjusting for differences in life expectancy.

METHODS: Healthcare utilization from 2016 were linked to demographic and socioeconomic data for a random sample of individuals aged 20 and above in the four largest Swedish regions (n = 440 659). Mortality data were used to estimate income- and sex-specific survival rates. Expected lifetime healthcare expenditures were estimated by combining survival rates with mean healthcare expenditures over age, by sex, and income quintile.

RESULTS: We find that expected lifetime healthcare expenditures are highest among the first (lowest) income quintile despite their evident lower life expectancy. Expected lifetime expenditures were 17.9% (16.8%) higher in the first income quintile compared to the fifth (highest) quintile for women (men). Individuals in the first income quintile had higher expected lifetime expenditures for all care categories except for primary care.

CONCLUSION: We conclude that despite a lower life expectancy, the quintile of the lowest socioeconomic status still had higher lifetime healthcare expenditures.

Background:  In Sweden, there is a strong political belief that non-governmental organizations (NGOs) are important in health promotion and prevention, particularly in the areas of alcohol, drugs, doping and tobacco (ANDT). The Government therefore annually allocates about 2 million euros for this work. This study highlights the involved NGOs, added values and obstacles within NGOs ANDT prevention and conditions required for a successful preventive work.

Method:  The study is based on 375 project grants including 190 unique projects implemented by 60 NGOs between the years 2003–2012 (Figure 1). In surveys every two years, a total of 168 questionnaires were answered by 112 different project leaders. Both quantitative and qualitative methods were used for analysis.

Results:  There is a wide range and variety of different NGOs working with ANDT prevention. Added value of NGOs prevention work is that they counterbalance the public sector, have a familiarity and cultural competence that are important for the target groups and they possess a unique force in its voluntariness. Perceived barriers are shortterm project funds, time constraints, limited target group, lack of knowledge and trust from the surrounding society. Successful ANDT prevention requires a well-functioning organization with clear structures and support functions, a goal-oriented and knowledge-based work, support from the public sector and R & D as well as collaboration between different actors.

Conclusion:  With good organisational conditions and proper support NGOs can be an important complement to public ANDT prevention. They have an ability to reach and attract vulnerable target groups not reached by public interventions. There is a unique power and determination in NGOs.

Main messages:  NGOs play an important role and are an important complement within ANDT prevention. NGOs uniqueness creates an important added value in ANDT prevention.

 Background: Problematic gambling is a public health problem. Deaf and hearing-impaired young people are a high-risk group regarding health and lifestyles. There are indications that young people with disabilities gamble to a greater extent than adolescents without disabilities. Whether this applies specifically to the group deaf and hearing-impaired adolescents is a knowledge gap. This pilot study aims to investigate the prevalence and type of gambling problems in deaf students (16-19 years old) and to identify the group's risk and protective factors for problematic gambling.

Methods: Data from the study Life & Health -Young People conducted in Örebro County, Sweden 2014 was used. This is a total, cross-sectional survey of young people's living conditions, lifestyles and health.  Students in grade 2 (17-18 years old) in upper secondary school were included in this study (n=2468, 75% response rate). A systematic search has also been conducted.

Results: A systematic search of the literature of problem gambling in the hard-of-hearing group reveals that this is an un-researched area. This could be one of the first studies researching gambling problems in this particular target group. Around 17 % of the total sample has gambled for money several times a month. Almost 8 % of this sample has some type of hard-of-hearing. The first results indicate that the hard-of-hearing group is gambling for money to a higher extent than normal hearing students.

Conclusions: There is a need to increase knowledge about gambling and problematic gambling in deaf and hearing-impaired adolescents. Knowledge about gambling in this target group will lay the foundation for the development of methods to counteract gambling problems which could improve the health within this high-risk group.

Main messages: There is a lack of research on problem gambling in the hard-of-hearing group.

There are indications that the hard-of-hearing group gambles for money to a higher extent than others young people.

Background: In many European countries, about two-thirds of young people participate in sports clubs. However, these numbers peaks in early adolescence and then decrease. In addition, participation in sports clubs looks different in different groups. Participation in sports have the possibility to contribute to young peoplés health in a broad sense, both increasing their physical activity, but also their mental and social health. Sports clubs have also been acknowledged as health promoting settings by researchers and policymakers. Young people participate in sports for different reasons, most common are that it is fun, social, developing and healthy. On the other hand, young people drop out of sports because of coach and teammate relations, but also for organizational reasons like facilities or lack of coaches. A reason can also be too much focus on performance, although this can also be a motivating reason. A major task for sports clubs is to develop sports to maintain the participation of young people. Different perspectives can be used to develop sports clubs activities, among them the novel health-promoting sports clubs approach. Few studies have however explored young people's perspectives on health-promoting sports clubs. The aim of this study is therefore to explore young peoplés perspectives on what makes a sports club health-promoting.

Methods: This cross-sectional study conducted a brief survey in two schools in central Sweden with grade 9 pupils (15-16 years old). The sample consisted of 123 participants (54 % girls, 52 % sport clubs participants, 37 % former sports clubs participants). The questionnaire contained three open-ended questions about what characteristic of a sports clubs makes them feel well, not well and makes them want to stay in sports clubs. The data was analysed with content analysis in combination with statistical analyses.

Results: Early results shows that fun, social dimensions, coaches, but also organizing aspects like amount and ambition of practice are factors that young people think makes a sports club health-promoting.

Conclusions: Health-promoting perspective on sports clubs can from young peoplés perspective include many dimensions and develop sports clubs in this direction could lead to young people staying longer.

Purpose: The concepts of public health, health and health promotion have been used for decades in relation to sport in policy, research and practice. That sport has some kind of significance for and connection to public health is clear. But how can we understand the relationships between sport and public health?

The aim of this presentation is to argue that what is regarded as knowledge about the relationship between sport and public health largely depends on how the concepts of public health, health, health promotion and sport are framed.

Methods: In this presentation, we theorize the relationship between sport and public health as different patterns and give examples of how sports clubs can thus act as a health-promoting setting for different target groups.

Results: A first attempt to categorize the patterns in the four categories (i) health promotion as an outcome of sport, (ii) health promotion through sport, (iii) health promotion in sport, and (iv) health promoting sport. In these four categories we reveal research, that because of how they define health promotion and sport, are quite different. The different categories also use the concept of sport differently, as something that will always be healthy because it contains physical activity, as a mean, as an arena where you reach people or in a more integrated way.

Conclusions: We argue that it is not enough to recognize that physical activity and sport are good for people's physical health. By using a more inclusive conceptualization of how health can be promoted in, through and as health-promoting sport, health promotion studies can feed into the conclusions of other studies, i.e. what can be done about the how-question. What we propose and provide empirical examples of in this presentation can be seen as a theoretical basis for discussing the relationship or relationships between sport and public health that can be used in policy, research and practice. It is therefore possible to broaden the issue, to make it more complex, to go beyond compartmentalized thinking and to contribute to sustainable change in sport. Because, sustainable sport can be a question of how!

Background: Leisure-time is an important part of young people’s lives. Despite this, leisure-time settings have hitherto had a minor role in setting-based health-promotion initiatives. Improving adolescents’ quality of leisure-time activities can reduce social differences in health. Youth centers can therefore be good settings for promoting health. However, young people with immigrant backgrounds participate less in organized leisure-time activities. The aim of the study is to increase awareness of the importance of young people's leisure-time activities in a health promotion perspective. Further questions like who participate and why, what they gain, and what particular strategies the different youth-centers use in their everyday work will be presented.                                                                           

Methods: In this practice-based longitudinal study data were collected 2012-2014 at two youth-centers in multicultural, socially deprived suburbs using surveys with 12-16 year old adolescents (n=207). Individual interviews with staff (n=7) and focus-groups interviews with adolescents (6 groups, 50 % girls). Moreover individual interviews (n=3) were made with cooperation partners in the neighborhoods. Quantitative, qualitative and mixed methods were used for analysis.                                                                                           

Results: Most of the participants are second generation immigrants. They feel healthy, enjoy school, and feel quite safe in their neighborhoods. They participate in youth-centers to do fun and interesting activities, to see friends as well as to have leaders that care about them. If factors like support from youth-center leaders, influence, gender equality or alcohol and drug rules are important for making adolescents use less alcohol or feel better will also be revealed. Strategies for recruiting youth to youth-centers are central to succeeding.    

Conclusions: Youth centers can be health-promoting settings when their strategies include some important factors, both in theory and in daily practice.                                           Main messages: Leisure-time activities are underestimated health promoting settings. Youth-centers can be a health-promoting setting.

Background: Mental health problems among adolescents account for a large portion of the global burden of disease and affect 10 - 20 % of children and adolescent worldwide. The public health nurse in the school health services is in the forefront for adolescents and play an important role in providing mental health. In order to identitfy and help the adolescents in secondary school with mental health problems the public health nurses are dependent on collaboration with other professionals. The aim of this study was to describe the variation in public health nurses perceptions of interprofessional collaboration related to mental health problems among adolescents in secondary school.

Methods: This study has a qualitative design and individual interviews were analyzed with a phenomenographic approach. Eighteen public health nurses working in school health services, strategically selected from different counties, both urban and rural areas, were included to ensure variation in the phenomena.

Findings: The analysis resulted in three descriptive categories: ’The formal structure has an impact on the interprofessional collaboration’, ’The public health nurse is an important but not always self-evident partner in interprofessional collaboration’ and ’The primary players are the teachers in collaboration ́.

Conclusions: The findings demonstrated that public health nurses are important but not always included in interprofessional collaboration and they were dependent especially of teachers to achieve good collaboration. There were variations in how public health nurses perceived interprofessional collaboration from school to school, which may give the adolescents with mental health different services. The knowledge from this study may be essential to strengthen public health nurses positions and presence in the school health service, which will benefit the adolescents with mental health problems.

Key messages:

• The public health nurse need to work actively to be included in interprofessional collaboration.
• The public health nurse are dependent on teachers and principals to achieve good collaboration.

Solution-focused brief coaching departs from the idea that a focus on the clients’ strengths and hopes for the future, rather than on past or present problems, will lead them to do more of what works well and move them toward a desired future. Compared to a problem-oriented approach, the solution-focused is systemic and interactive; the client is viewed as a resourceful individual in a context and as an expert on his or her own life. From this foundation, the Solution-focused Intervention for mental health (SIM) was developed for students in upper secondary school. SIM builds upon four fundamental assumptions. First, an understanding of the cause of a personal problem does not necessarily bring the student closer to a solution of it, or to a desired future. Second, what we focus our attention on and the language we use to describe and discuss our health will grow on us. Third, all students “want to and can do something” that can lead them towards their desired future. Fourth, all students are resourceful and can act in a self-desired direction. During the coaching process in SIM, what the students “hope will start to happen and resources and abilities that can make this possible” are explored and reinforced with a solution-focused dialogue. With support from a group coach and their classmates, students are encouraged to explore what could help towards a desired future and what efforts need to be taken to move in this direction. This is followed up in future sessions by focusing on what works well and efforts made towards what is wanted. The solutions-focused coaching approach, and its associated techniques, aim to engage the students in a process that enhances the awareness and motivation to explore their own strengths and resources so as to engender self-efficacy and self-confidence and strengthen their desire to further develop their abilities and skills. The objective of the process is to establish a mental health promotion that is positively self-reinforcing.

BACKGROUND: The Örebro Musculoskeletal Pain Screening Questionnaire (ÖMPSQ) was developed to identify psychological and functioning-related risk factors among individuals with musculoskeletal pain at risk of work disability. This study aimed to examine whether the short version of the ÖMPSQ (ÖMPSQ-SF) can be used for this purpose, using registry-based outcomes.

METHODS: The ÖMPSQ-SF was completed by the members of the Northern Finland Birth Cohort 1966 at the age of 46 years (baseline). These data were enriched with national registers, including information on sick leaves and disability pensions (indicators of work disability). The associations between the ÖMPSQ-SF categories (low-, medium- and high risk) and work disability over a 2-year follow-up were analysed using negative binomial regression and binary logistic regression models. We made adjustments for sex, baseline education level, weight status and smoking.

RESULTS: Overall, 4063 participants provided full data. Of these, 90% belonged to the low-risk, 7% to the medium-risk and 3% to the high-risk group. Compared to the low-risk group, the high-risk group had a 7.5 [Wald 95% confidence interval (CI) 6.2-9.0] times higher number of sick leave days and 16.1 (95% CI 7.1-36.8) times higher odds of disability pension after adjustments in the 2-year follow-up.

CONCLUSIONS: Our study suggests that the ÖMPSQ-SF could be used for predicting registry-based work disability at midlife. Those allocated to the high-risk group seemed to have a particularly great need of early interventions to support their work ability.

About 3% of children in Sweden, 4-5% in the UK, and 5% in the US experience the death of a parent during childhood. The event is highly unexpected and stressful and could have long-term social and health consequences across the life course. To alleviate grief, bereaved children may engage in health-damaging behaviours such as smoking, alcohol or druga buse, violence, delinquency and risky sexual behaviour. Few studies have been able to study health consequences by childhood parental loss and mechanisms explaining associations across the life course. Using the Stockholm Birth Cohort Study (SBC), including all children born in 1953 in the metropolitan Stockholm area, we examined whether childhood bereavement is associated with all-cause mortality until age 63 and whether various pathways (e.g. economic, behavioral and social circumstances) account for the association. 15,117 individuals were followed between 1953 and 2018 using survey data and national registry data. We used Cox proportional hazard regression and mediation analysis forsurvival analysis to decompose direct and indirect effects. Thedeath of a parent was associated with 40 to 50% elevated risk of mortality in offspring, and the association was mediated through delinquent behaviour in adolescence and income in adulthood especially for male offspring. Our findings suggest that parental loss has a life long impact on the mortality risk of bereaved children and that interventions targeting delinquency and socio-economic circumstances in bereaved children could be successful in reducing their excess mortality risk.

Key messages:

• Bereavement in childhood has a life-long impact on health.
• Interventions targeting delinquency and socio-economic circumstances could be successful in reducing the excess mortality risk.

This presentation extends the public health theme in relation to Sustainable Development Goal #8, focusing on the health inequality trend in Japan. It is important to understand whether low economic growth is compatible with a low level of health inequalities. Unlike the UK and USA, life expectancy in Japan continued to improve despite a stagnant economy.

Ten triennial waves of a nationally representative survey in Japan, 1986-2013 (n = 731,647) were used. Slope and Relative Indices of Inequality (SII and RII respectively) in relation to net household income and self-rated good health were calculated. Analyses were stratified by sex and age, for children, working-age adults, younger old and older old, given age differences in relation to labour market. Time trends of SII and RII were tested during the period of economic stagnation 1992-2013.

In all age groups, prevalence of good health declined slightly from its peak in 1995 but increased after 2007. In 1992 among children, working-age adults and younger old, health in equal-ity based on SII was small, about 10% lower prevalence of good health in those with lowest compared to highest income. Among working-age adults, time trends of health inequalities based on SII narrowed from 1992 and then widened after 2002 (quadratic trends in men and women p < 0.05), resulting in the magnitude of health inequality returning to its level at the beginning of economic stagnation in 1992 but not exceeding it. Time trends in relative inequality (RII) were qualitatively similar to those in absolute inequality (SII).

The long-term low-growth Japanese economy appears compatible with maintaining and improving population health and holding health inequalities at current levels. This evidence is of great significance for sustainable development and the health of current and future generations.

Background: Healthcare in post-war Balkans is still under development. Healthcare changes towards more complex clinical scenarios that need different competencies around patients. This study reports on survey based learning to increasing professional awareness for developing sustainable healthcare settings using an experiential learning approach.

Methods: In this study, researchers and educators identified non-technical skills concepts on individual, team, and organizational levels. These concepts were contextualized into the local setting through interactive workshops. Two pediatric surgery clinics in Kosovo and Bosnia and Herzegovina participated who were part of an international clinical skills training project. The tools and surveys were: Johari window, Kolb’s learning style questionnaire, team members exchange quality scale, the IPEC framework for interprofessional competence, Team STEPPS observation tool and organizational models.

Results: A model is developed for contextualizing core concepts on professional awareness into a local developing healthcare setting. It entails three steps conducted in consecutive workshops: Identifying research-based concepts on professional compe-tence on individual, team and organizational levels. Facilitating local contextualization of these concepts by using surveys in interactive workshops. Agreeing on indicators to maintain high professional awareness.

Conclusions: Capacity-building in public health can be conducted through increasing professional awareness. Professional awareness can be approached in individual, team and organizational dimensions. Established core concepts of non-technical skills can be contextualized in other cultures through a survey-based experiential learning approach.

Key messages:

• Professional individual, team and organizational awareness is a vital part of conducting efficient healthcare.
• The professional awareness can be enhanced through processing core concepts in a local context through facilitated workshops.

Background: The aim of this project is to create understanding on the determinant factors enhancing adherence to treatment guidelines for the emergency medical services in Kosovo (EMSK). Focus is on barriers, and enablers while introducing the guidelines. It is aiming to create clearance and understanding of how and why the implementation outcomes are achieved. The factors influencing implementation will be mapped in three main domains. The domains are part of the determinant framework Promoting Action on Research Implementation in Health Services (PARIHS). Each of the domains is further divided into sub-constructs.

Methods: The process of implementing treatment guidelines into the emergency medical services in Kosovo was observed and documented by 4 researchers, using a participatory research design. The PARIHS framework that consists of three core components: evidence, context, and facilitation was applied to make clarity on what works better and why, in order to achieve the outcomes of the implemented guidelines.

Results: The preliminary results have shown that the three constructs have an important role in the process of implementation. The domain evidence determined the way the evidence based practice is conceived in this particular setting. The domain context concerns the organization and teamwork shaped challenges and possibilities for adherence to the guidelines. The role of an external facilitator was of specific importance.

Conclusions: The PARIHS framework serves in both practical and theoretical planning of an intervention. In the present project it provides clarity on planning of the process, while also offer understanding of the elements that contribute to the sustainability of the intervention. Finally the lessons from the approach can be replicated in similar context.

Key messages:

• Implementation projects can be more successful suing a framework to direct the effort.
• Such interventions should be premised with clarity on the evidence, the local context, and facilitation factors.

Background: The settings-based approach has become an increasing focus in health promotion since the World Health Organization’s 1986 Ottawa Charter. Schools and cities have implemented this approach, but development within sports clubs is limited. Thus, an internationally validated measurement of health promotion within this setting is lacking.

Methods: A modified Delphi study was completed to develop an international evaluation tool grounded in the settings-based approach. Expert panelists from academia, sports and health sectors were invited to participate in 3 online rounds. Items were generated or selected based on 3 prior Delphi-based studies and 2 nationally validated scales. Round one created a collaborative list of items, round two validated items based on relevance, importance and feasibility and the final round classified items into one of four determinants: cultural, social, environmental or economic.

Results: Panelists (69) from 13 countries participated in creating a final list of 62 items at 3 organizational levels. The sports club level included; 5 cultural, 6 social, 6 environmental and 5 economic items. The management level included; 5 cultural, 5 social, 5 environmental and 3 economic items. The coaching level included; 5 cultural, 5 social, 4 environmental and 4 economic items.

Conclusions: This study provides three important innovations; 1- it is rooted in theory through the settings-based approach, 2- the measurement tool includes three levels within sports clubs, capturing a whole club dynamic and 3- all items included in the tool have been validated by an international panel of experts.

Key messages:

• This 62-item measurement tool allows the comparison of perceptions from participants, coaches and management regarding how health is promoted within their sports club.
• This information offers insight on the capacity of sports clubs to implement and monitor policies and practices on the promotion of health beyond sports performance within their organization.

BACKGROUND: Sports clubs have requested support from national governing authorities to invest in health promotion (HP), by developing policies, guidelines and dedicated funding. This article outlines the development of a national audit tool to review policies development and implementation to support HP in sports clubs.

METHODS: A five-step process was undertaken by an international project team: (i) a rapid literature review to identify items assessing policies in physical activity, HP and sports, (ii) a thematic analysis to categorize items, (iii) a Delphi method to analyze item relevance, country specificity, reformulation, validation and organization, (iv) face validity through an online survey and in-depth interviews with expert representatives on physical activity and sports and (v) audit tool finalization though project team consensus.

RESULTS: Eight sources were reviewed with 269 items identified. Items were coded into 25 categories with 3 broad themes: policies, actors and settings-based approach. The Delphi study extracted and refined 50 items and categorized them into 10 sections. After revisions from 22 surveys and 8 interviews, consensus was reached by the international project team on 41 items categorized into 11 sections: Role of ministry or department; Policies; Communication; Implementation and Dissemination; Evaluation and Measurement methods; Sub-national-level policies; Funding and Coordination; Participative approach; Actors and Stakeholders; National sporting events; Case studies and Implicated stakeholders.

CONCLUSION: To progress HP in the sports club context it is necessary to understand existing national-level policies. This national audit tool will aid in monitoring and assessing national policies for health promoting sports clubs.

Background: A growing aging population demands new welfare public health activities in nursing homes. Involving residents in meal activity through a co-creational approach as part of a rehabilitation strategy has been suggested as a solution, but knowledge is limited. This project explore how co-creational meal practices in a breakfast club might improve residents’ food related functionality and quality of life.

Methods: The project is designed as a three-year complex intervention study in a Danish nursing home. A breakfast club is held with 4-5 residents (16 all together) and 2-6 staff members on a weekly basis during a period of 10 month. Residents are on shift hosting the club and all members are preparing the meal together. The degree of food related functionality is assessed after each club and is analyzed through paired t-test on mean values. Semi-structured interviews in combination with Research Driven Photo-Elicitation is conducted with 16 residents and 8-10 staff members before, during and after holding the clubs in order to evaluate quality of life and potentials for implementing meal practices to everyday practices. A hermeneutic analysis strategy is applied.

Results: Preliminary results from 12 breakfast clubs finds an increase in residents food related functionality. Data will be presented in November 2019. All residents express impact on quality of life independent of physical or mental state. Improved functionality is not the main value for participation in the breakfast club. Staff became aware of utilizing residents food related functionality.

Conclusions: The study will contribute with new knowledge about whether co-creational meal activities could have a positive effect on functional abilities and improve health-related quality of life in residents in nursing homes. A meal practice based on co-creation has potential to become implemented as a public health activity in nursing homes and increase residents’ quality of life and food related functionality.

BACKGROUND: Alcohol use has decreased among Swedish adolescents in the past few decades. We examined peer and parent factors (i.e. time spent with peers, time spent with parents and parental monitoring) that could contribute to explaining this trend by investigating their main effects and interaction effects with investigation years on alcohol use. We furthermore examined whether municipality-level socioeconomic conditions could contribute to explaining the trend.

METHODS: We used data from a repeated cross-sectional study that took place eight times between 1988 and 2011. The study targeted all ninth grade students (15-16 years old) in Värmland County, Sweden. Adolescents (N = 22 257) reported their monthly alcohol use, time spent with peers and parents and parental monitoring. Municipality-level socioeconomic conditions were based on parent education levels.

RESULTS: Logistic multilevel regression analyses showed that peer and parent factors and municipality-level socioeconomic conditions were associated with alcohol use among adolescents. The interaction effects between peer and parent factors and investigation years were not significant. The decreased trend in time spent with peers was associated with the decreased trend in frequency of alcohol use over time.

CONCLUSIONS: The findings of the current study provide an indication that the decreased trend in alcohol use that has been observed in Swedish adolescents over the past few decades may be related to changes in adolescents' social interactions with peers.

Background: Falls and fall injuries among the elderly population is an important public health issue today since ageing is an independent risk factor of falling and because of an increasing elderly population. Falls and fall injuries are associated with high healthcare costs but also considerable suffering for the individual. According to the Swedish National Health Institute the costs of deterioration in quality of life caused by accidental falls are calculated to be twice as high as the direct costs such as medical treatment, healthcare and rehabilitation. There are various predictive factors of falling and visual impairment isone of them. It is well known that visual impairment occurs increasingly as people age. Usually, only visual acuity is considered when measuring visual impairment, but nothing regarding a person’s functional visual ability is taken into account.

Methods: Therefore, the aim of our study was to assess the perceived vision-targeted health status among non-institutionalized elderly living in the community using the 25-item National Eye Institute Visual Function Questionnaire (NEI VFQ-25) and to investigate whether there was any association between the vision-targeted health status and falls. There were 212 randomly selected elderly participants in the study.

Results: The results showed that general health was the only variable significantly associated with falls both among men (p = 0.011) and women (p = 0.029). However, among men, distance activities (p = 0.033), such as going down steps, or curbs in dim light, and peripheral vision (p = 0.048) such as difficulties in noticing objects off to the side while walking along, were significantly associated with falling. Near activities (p = 0.005), color vision (p = 0.002) and dependency (p = 0.022) as well as social functioning (p = 0.014) and role difficulties (p = 0.000) were also significantly associated with falling among men.

Conclusions: To meet the demands from an increasing elderly population, a more holistic approach of the visual function is needed when identifying elderly individuals at risk of falling.

Background: Despite high prevalence and severe consequences for health and wellbeing, emotional neglect (EN) in childhood is a neglected topic in epidemiological research. To enable prevention of neglect knowledge is important about conditions related to EN such as parental individual characteristics and social/economic situation. Aim to investigate the relationship between parental socioeconomic position (SEP), psychological problems, and EN in childhood.

Methods: The sample comprised Swedish women, N = 976, mean age 22. EN was assessed by five indicators: maternal/paternal rejection, maternal/paternal lack of time, and occurrence of domestic violence. The associations between parental SEP/psychological problems and EN were examined by logistic regressions.

Results: The odds of experiencing domestic violence in childhood was higher among women with parents with low (OR 3.1 95% CI 1.1-8.5) or medium SEP (OR 3.4 95% CI 1.7-6.9). Women who reported maternal psychological problems had higher odds of maternal rejection (OR 6.8 95% CI 3.5-13.0), maternal lack of time (OR 2.4 95% CI 1.2-5.0) and paternal rejection (OR 1.9 95% CI 1.1-3.5). Women who reported paternal psychological problems had higher odds of perceiving their father as rejecting (OR 4.0 95% CI 2.1-7.7), not having enough time for them (OR 4.9 95% CI 2.3-10.6), and experiencing domestic violence (OR 4.9 95% CI 2.1-11.6).

Conclusions: Lower SES was not related to EN in form of parental rejection or lack of time but to the occurrence of domestic violence. Parental psychological problems were related to all indicators of EN but differently among mothers and fathers. Public health initiatives aiming at supporting parents should also embrace parental psychological wellbeing.

Key messages:

• Emotional neglect was clearly related to parental psychological problems but not parental socioeconomic status.
• Gendered structures need to be considered in studies of emotional neglect.

Background: Exposure to psychological stress can elicit a physiological response that may influence characteristics of the gastrointestinal mucosa, including increased intestinal permeability, in turn possibly increasing susceptibility to gastrointestinal infections. We investigated whether low stress resilience in adolescence is associated with an 'increased' risk of gastrointestinal infections in subsequent adulthood.

Methods: Data were provided by Swedish registers for a cohort of 237 577 men who underwent military conscription assessment in late adolescence (1969-76). As part of the assessment procedure, certified psychologists evaluated stress resilience through semi-structured interviews. The cohort was followed from conscription assessment until 31 December 2009 (up to age 57 years). Cox regression assessed the association of stress resilience with gastrointestinal infections (n = 5532), with adjustment for family background measures in childhood and characteristics in adolescence. Peptic ulcer disease (PUD) in adulthood was modelled as a time-dependent covariate.

Results: Compared with high stress resilience, lower stress resilience was associated with a 'reduced' risk of gastrointestinal infections after adjustment for family background in childhood, characteristics in adolescence and PUD in adulthood, with hazard ratios (and 95% confidence intervals) of 0.88 (0.81-0.97) and 0.83 (0.77-0.88) for low and moderate stress resilience, respectively.

Conclusion: Lower stress resilience in adolescence is associated with reduced risk of gastrointestinal infections in adulthood, rather than the hypothesized increased risk.

Background: Socioeconomic conditions and lifestyle factors have been found to be related to self-rated health, which is an established predictor of morbidity and mortality. Few studies, however, have investigated the independent effect of material and psychosocial conditions as well as lifestyle factors on self-rated health. Methods: The association between socioeconomic conditions, lifestyle factors, and self-rated health was investigated using a postal survey questionnaire sent to a random population sample of men and women aged 18-79 years during March-May 2000. The overall response rate was 65%. The area investigated covers 58 municipalities in the central part of Sweden. Multivariate odds ratios for poor self-rated health were calculated for a range of variables. A total of 36 048 subjects with full data were included in the analysis. Similar analyses of the influence of working conditions were conducted among those employed aged 18-64 years (17 820 subjects). Results: The overall prevalence of poor self-rated health was 7% among men and 9% among women. Poor self-rated health was most common among persons who had been belittled, who had experienced economic hardship, who lacked social support, or who had retired early. A low educational level was independently associated with poor self-rated health among men, but not among women. Physically inactive as well as underweight and obese subjects were more likely to have poor self-rated health than other subjects. Working conditions associated with poor self-rated health were dissatisfaction with work, low job control and worry about losing one's job. Conclusion: While a cross-sectional study does not allow definite conclusions as to which factors are determinants and which are consequences of poor self-rated, the present findings support the notion that both psychosocial and material conditions as well as lifestyle factors are independently related with poor self-rated health.

Background: The aim was to investigate trends in the prevalence of obesity by age and level of education in the general population in mid-Sweden from year 2000 to 2012.

Methods: A postal questionnaire was sent to a random population sample aged 25-74 years in years 2000, 2004, 2008 and 2012. The overall response rates were 67%, 65%, 60% and 53%, respectively, and the study included 29 017, 27 385, 25 910 and 24 152 respondents, respectively. Obesity (BMI ≥ 30 kg/m(2)) was based on self-reported weight and height.

Results: The age-standardized prevalence of obesity increased from 13% to 17% in women and from 12% to 17% in men between 2000 and 2012. Obesity increased in all age groups from 2000 to 2008 and continued to increase among the middle aged (45-64 years) between 2008 and 2012. The socioeconomic gradient in obesity changed during the study period since the absolute increase in obesity was steepest at the middle educational level. In 2012, the prevalence of obesity was almost twice as high at both middle and low educational levels compared with high educational level. The 'true' prevalence of adult obesity, corrected for self-reported weight and height, was around 20% in 2012 for both men and women.

Conclusion: In the majority, among the middle-aged and those with secondary education, the prevalence of obesity continued to increase even between 2008 and 2012.

Background: The importance of public health capacity development with a focus on public health emergencies and humanitarian assistance is continuously increasing at the global scale. In the time of Public Health Emergencies of International Concern is crucial to provide basic training in core public health competences to all health professionals, including students. Faculty of Medicine & Dentistry, Palacký University Olomouc, Czech Republic (full ASPHER member), implemented in medical as well as public health curricula new topics focused on core competences of health professionals in the area of public health emergencies and humanitarian assistance.

Objectives: To strengthen competences and skills of medical as well as public health students to prepare them better for public health emergencies and humanitarian assistance in the time of increasing risk of global public health emergencies. New modules were proposed and tested in all education programmes at our Faculty of Medicine & Dentistry, Palacký University Olomouc (CZ): General Medicine (Czech and English programmes), Dentistry (Czech and English programmes) and Public Health (Czech programme).

Results: New modules on Public Health Emergencies, including preparedness, responses, risk management and risk communication were successfully tested in all education programmes during the academic year 2018/19 and fully implemented for the academic year 2019/20. New module has blended learning structure based on combination of face-to-face seminars and exercises with e-learning parts, including self-assessment. New module is presented in details.

Conclusions: This new education module fully supports international recommendations to strengthen public health competences and skills of medical as well as public health students to be ready for any unexpected public health emergencies at all levels, in particular at the local community level. COVID-19 pandemic confirmed.

Background: Studies have found that the death of a sibling is associated with adverse health in bereaved siblings. Anniversaries may trigger grief reactions and contribute to an acute deterioration of health and are exogenous to shared intergenerational characteristics and may provide an indication of a causal effect of bereavement. Previous studies have found anniversary effects following the loss of a child and parent. We examined whether mortality increases among adult siblings around the anniversary following sibling death.

Methods: This case-crossover study used Swedish register-based longitudinal data from 1990 to 2016, based on the entire population. Participants included all adults aged 18 to 65 years who experienced sibling death and subsequently died. Conditional logistic regression was used to quantify the association between the anniversary (or preanniversary and postanniversary periods) and mortality, controlling for time-invariant confounding. All analyses were stratified by sex of the bereaved. Further analyses will also be stratified by socio-demographic characteristics such as the sex of the deceased sibling, time since sibling death, age, marital status and cause of sibling death.

Results: The results show that the anniversary of a siblings’ death is not associated with an increased mortality risk in bereaved siblings. We rather found somewhat reduced mortality risks around the anniversary dates in men (OR 0.78 95% CI 0.55-1.10 for the period ranging from 2 days before up to the anniversary) and women (OR 0.44 95% CI 0.20-0.97 for the anniversary). Further analysis will scrutinize whether anniversary effects are found when the analysis are stratified by socio-demographic characteristics and cause of sibling death.

Conclusions: Anniversaries following sibling death might not trigger grief to the same extent as anniversaries following the death of a parent or child. Sibling bereavement may still have health consequences although not during anniversaries.

Key messages:

• Anniversaries following sibling death might not trigger grief to the same extent as child and parental bereavement.

• Sibling bereavement may still have health consequences although not around anniversaries.

Objective: Fall-related injuries among the elderly, specifically hip fractures, cause significant morbidity and mortality as well as imposing a substantial financial cost on the health care system. Impact-absorbing flooring has been advocated as an effective method for preventing hip fractures resulting from falls. This study identifies the cost-effectiveness of impact-absorbing flooring compared to standard flooring in residential care facilities for the elderly in a Swedish setting.

Method: An incremental cost-effectiveness analysis was performed comparing impact-absorbing flooring to standard flooring using a Markov decision model. A societal perspective was adopted and incremental costs were compared to incremental gains in quality-adjusted life years (QALYs). Data on costs, probability transitions and health-related quality of life measures were retrieved from the published literature and from Swedish register data. Probabilistic sensitivity analysis was performed through a Monte Carlo simulation.

Results: The base-case analysis indicates that the impact-absorbing flooring reduces costs and increases QALYs. When allowing for uncertainty we find that 60% of the simulations indicate that impact-absorbing flooring is cost-saving compared to standard flooring and an additional 20% that it has a cost per QALY below a commonly used threshold value

Conclusions: Using a modelling approach, we find that impact-absorbing flooring is a dominant strategy at the societal level considering that it can save resources and improve health in a vulnerable population.

Purpose: Assess changes in health-promoting physical activity (HPPA), according to the WHO guidelines, among Swedish adults during the COVID-19 pandemic. HPPA has been ignored as an outcome in the physical activity (PA) studies during the pandemic.

Methods: A population-based repeated cross-sectional study was conducted among 18-79-year-old Swedes (n ¼ 1035 in December 2020 [response rate 52%], n ¼ 1095 in January 2022 [55%], n ¼ 1027 in December 2022 [55%]). Data was collected via online questionnaires, including sex, age, civil status, education, employment, and country of birth. PA was measured using the International Physical Activity Questionnaire-Short Form (IPAQ-SF). In 2020, recall questions about PA one year earlier were included. The WHO guidelines for moderate, vigorous, or combined HPPA were applied, and the proportions of respondents completing the guidelines for these three HPPA categories were calculated.

Differences in proportions of moderate, vigorous, and combined HPPA across the survey timepoints were tested by chi-square tests, and by McNemar tests concerning differences between the recall in 2019 and December 2020. Binary logistic regression analyses were performed for women and men to assess whether the survey time-points or the sociodemographic variables were independently associated with HPPA. Interaction terms between each sociodemographic factor and survey timepoint were added to the models to assess differences in changes in HPPA in different sociodemographic subgroups.

Results: While the proportions of moderate, vigorous, and combined HPPA decreased substantially from 2019 (recall) to 2020 in both sexes, the changes seen between 2020 and 2022 were statistically non-significant. No significant interactions between sociodemographic factors and survey timepoint were observed, and survey timepoint was not associated with HPPA in the logistic regression models. Factors most consistently associated with the different HPPA categories were education in women and employment in men. In women, compulsory and/or high school indicated less HPPA than university education. Among men, white-collar and/or retired had less HPPA than the blue-collar employment category.

Conclusions: No clear changes in HPPA were observed between December 2020 and December 2022. Differences in HPPA according to education and employment indicate need for research on targeted PA promotion measures.

Background: Qualitative studies have aimed to understand why some women continue to drink during pregnancy; however, there is a lack of comparative cross-cultural research. We aimed to explore perceptions and practices of alcohol use during pregnancy in England and Sweden.

Methods: Semi-structured interviews were conducted with 21 parents in Merseyside, England and 22 parents in Örebro County, Sweden. Interviews were audio recorded, transcribed verbatim and translated. Data were analyzed using thematic analysis.

Results: The majority of women in both countries abstained from alcohol when they found out they were pregnant, despite alcohol being part of many social contexts before pregnancy. Nine of the seventeen English women drank at some point during pregnancy, typically on special occasions. Most parents felt women should modify their alcohol intake when they become mothers, though several English parents argued that responsible motherhood did not necessarily equate to abstinence. Swedish parents held strong opinions against drinking during pregnancy and argued that any amount of alcohol could harm the foetus. English parents' opinions were divided; some were skeptical of whether low to moderate drinking was associated with risks.

Conclusions: Practices and attitudes towards alcohol use during pregnancy and views on foetal rights and responsibilities of pregnant women differed in England and Sweden. Shared social norms around drinking may be shaped within the policy context of pregnancy drinking guidelines, determining whether women consume alcohol or not.

Background: Adolescent depression has negative health and economic outcomes in the short- and long-term. Indicated preventive interventions, in particular group based cognitive behavioural therapy (GB-CBT), are effective in preventing depression in adolescents with subsyndromal depression. However, little is known about the cost-effectiveness of these interventions.

Methods: A Markov cohort model was used to conduct cost-effectiveness analyses comparing a GB-CBT indicated preventive intervention for depression, to a no-intervention option. Taking a time horizon of 5- and 10 years, incremental differences in societal costs and health benefits expressed as cases of depression prevented, and as quality adjusted life years (QALYs) gained were estimated. Through univariate and probabilistic sensitivity analyses, the robustness of the results was explored. Costs, presented in 2018 USD, and effects were discounted at a yearly rate of 3%.

Results: The base-case analysis showed that GB-CBT indicated preventive intervention incurred lower costs, prevented more cases of depression and generated higher QALYs compared to the no-intervention option for both time horizons. Offering the intervention was even a cost saving strategy and demonstrated a probability of being cost-effective of over 95%. In the sensitivity analyses, these results were robust to the modelling assumptions.

Limitations: The study considered a homogeneous cohort and assumed a constant annual decay rate of the relative treatment effect.

Conclusions: GB-CBT indicated preventive interventions for depression in adolescence can generate good value for money compared to leaving adolescents with subsyndromal depression untreated.

Key messages:

• Indicated preventive interventions for depression are cost-saving and can generate substantial health benefits.
• Indicated preventive interventions can be adopted as cost-effective preventive strategies for depression.

With its compensatory mandate, the school is essential for health-promoting interventions. There are evaluated programs available that prevent mental problems, mental illnesses and various risk behaviours. However, there is a dearth of evaluated interventions designed to promote mental well-being in adolescents, which are adapted for upper secondary school. It was against this background that the development and evaluation of the Solution-focused Intervention for Mental health (SIM) began in 2018. This presentation will briefly overview the intervention, its components, design and results from feasibility studies. As an intervention programme, SIM consists of group-based coaching that starts from the core components and indicators of mental well-being and enjoying school. Thus, the intervention is based on a normative model of mental well-being; however, the dialogue conducted during the nine two-hour weekly group sessions is based on the solution-focused approach and its techniques. Specially trained teachers facilitating the content and process during group sessions lead SIM. The SIM programme is manual-based and designed to help students discover, explore, practice and develop existing personal resources in order to strengthen hedonic and eudemonic well-being. The teacher uses solution-focused coaching techniques to encourage the students to practise and discover how to utilise their existing resources. By focusing on what works small steps can be taken towards a desired future using indicators of well-being and solution-focused techniques. SIM has so far been tested in feasibility studies in 2019 (n∼140), 2021 (n∼200) and 2023 (n∼50). Results from focus group interviews, session scales ratings and pairwise testing of changes in well-being after compared to before interventions show promising results with increased well-being and total effect sizes ranging from Coheńs d of 0.19 to 0.59. SIM is now ready to be properly evaluated in a randomised controlled trial.

The latest World mental health report states that mental health is an integral component of health and well-being and is more than the absence of pathology. Indeed, the view of mental health is slowly shifting to an emphasis on positive health indicators as national authorities around the world are increasingly adopting the two continua model of mental health (TCM). Adopting the TCM has several important implications for public health practice. One is that the epidemiological surveillance will have to include measures of both mental illness and mental well-being. The purpose of this presentation is to illuminate the conceptual and practical use of the TCM in the analysis of adolescent mental health. The presentation will be limited to a focus on the theoretical underpinnings and methodological considerations made to operationalize and categorize mental health according to the TCM. It will consider the added value of the TCM to epidemiological surveillance as well as its implications for public health practice when it comes to meeting population needs with appropriate interventions. To construct the model, data from population-based regional public health surveys among adolescents including validated measures of both mental ill health and mental well-being was used. The Kessler 6 scale was used to estimate the proportion of adolescents with or without probable serious mental illness (SMI, >13) and the Mental Health Continuum - Short Form was used to estimate the proportion of adolescents with flourishing (FMH), moderate (MMH) or languishing (LMH) mental health according to the original categorization developed by Keyes. Combining these two dimensions of mental health and their respective categories will yield six mental health status groups: Complete mental health = FMH without SMI, Vulnerable = MMH without SMI, Most vulnerable = LMH without SMI, Symptomatic but content = SMI with FMH, Troubled = SMI with MMH, and Most troubled = SMI with LMH.

Viewing mental health from a two continua perspective, this presentation focuses on results of pooled data from a recurrent cross-sectional survey, carried out in ninth and eleventh grade in lower and upper secondary school of Västmanland county, Sweden, 2020 - weeks prior to the Covid-19 outbreak - and 2023. In total, 7908 students participated of which 50% were girls (2020 N = 3880; 2023 N = 4028; response rate≈72%). A compilation of the results according to the two continua model and the six mental health status groups described in the previous presentation shows that 39.0% are categorized as having Complete Mental Health (CMH), 1.6% as Symptomatic But Content (SBC), 36.7% as Vulnerable (V), and 2.9% as being the Most Vulnerable (MV). Further, 12.8% are categorized as being Troubled (T) and 6.9% as Most Troubled (MT). Statistically significant differences are seen between boys and girls in the categories CMH (boys=47.4%, girls=30.8%), SBC (boys 1.0%, girls 2.1%), T (boys 7.2%, girls 18.3%) and MT (boys 3.7%, girls 10.1%). Significant changes over time, between 2020 and 2023, are seen in SBC (0.9% statistically significant increase) and MV (1.9% statistically significant increase). When divided by sex, significant changes over time are only seen among girls: in CMH (5.3% statistically significant decrease), MV (1.9% statistically significant increase) and SBC (1.3% statistically significant increase). No statistically significant changes are seen over time for boys. The result indicates that only four out of ten adolescents have a CMH. The differences between boys and girls are substantial; almost five out of ten boys and three out of ten girls has CMH. This emphasizes the importance of promoting mental well-being, especially among girls. The result also implies the importance of strengthening well-being in the large group without flourishing mental health since the latter can also provide a buffer against mental illness.

The potential for organised sports to promote health has been underexploited so far, according to researchers and policy-makers. Sports clubs have limited capacity to promote health due to their voluntary nature and have called for support from their national sports federations. The present article provides guidelines based on health promoting sports clubs theoretical foundations, and an analysis of practical tools and proven strategies to support national sports federations’ investment in health promotion (HP). A qualitative iterative study was undertaken, based on five two-hour meetings of a group of 15 international researchers in health promotion in sports clubs. Notes and minutes from meetings, as well as shared outputs were analyzed based on the health promoting sports club framework. Guidelines for national sports federations to promote health includes a definition of a health promoting sports federation, a description of the settings-based approach stages adapted to national sports federations, as well as practical applications of the health promoting sports club's intervention strategies. The analysis of existing tools demonstrated that most tools are centered on a single dimension of health (social, mental, physical, spiritual or community), and often on a specific health topic. Furthermore, they do not cover HP as a continuous process or support of sports clubs’ members health, but are generally short-term programs. The HPSF clarifies theoretical concepts, their practical implementation via case studies and outlines intervention components and tools useful for sports federations in their implementation of HP. The guidelines are meant to facilitate national sports federations to acknowledge, reinforce and foster their further investment in HP.

Background: Researchers and policymakers have acknowledged sports clubs (SCs) as health promoting settings. Limited research links the health promoting sports club (HPSC) concept with evidence-driven strategies to offer SCs guidance to develop health promotion interventions. As implementation science insists on theoretically grounded interventions, this work’s objective was to provide SCs an evidence-driven intervention framework for planning health promotions.

Methods: A 4-step process was undertaken: 1) investigate indicators for SCs to be considered health promoting, 2) adapt the theoretical HPSC concept to create a HPSC model, 3) reformulate published evidence-driven guidelines into imple-mentable intervention components (ICs) and 4) merge the model with the ICs to provide an intervention planning framework for SCs. During 3 workshops, researchers defined the model elements and ICs. Workshop participants classified ICs into the HSPC model. Each IC could be classified multiple times within the model.

Results:Researchers drafted 5 HPSC indicators: 1) an approach embracing all SC actions, 2) involve all SC levels in actions and decisions, 3) involve external partners, 4) promoting health is continuous and iterative and 5) base actions on needs. To create the HPSC model, elements were defined: 3 SC levels (club, management, coaches) and 4 health determinants (organizational, social, environmental, economic) per level based on the indicators. Published guidelines from literature reviews aided in developing 14 strategies with 55 ICs. Workshop classification of ICs into the model included: club (n = 79), management (n = 67) and coaches (n = 48).

Conclusions: The theoretical HPSC model and intervention planningframework act as starting points to develop and implementinterventions to increase HP efforts by stakeholders in severalways: 1) SCs can apply strategies based on goals, 2) SCs cantarget specific levels with corresponding ICs or 3) ICs cantarget specific health determinants.

Key messages:

• A Health Promoting Sports Club model defines 4 health determinants at 3 levels (coach, management operational) of sports clubs to plan, develop and implement targeted health promotion activities.
• This HPSC intervention planning framework has 14 strategies with 55 intervention components targeting multiple sports club levels giving stakeholders a path to become a health promoting sports club.

Background: Sports clubs have requested support from national governing authorities to invest in health promotion (HP), by developing policies, guidelines and dedicated funding. This manuscript outlines the development of a national audit tool to review policies development and implementation to support HP insports clubs.

Methods: A 5-step process was undertaken by an international project team: (1) a rapid literature review to identify items assessing policies in physical activity, HP and sports, (2) a thematic analysis to categorize items, (3) a Delphi method to analyze item relevance, country specificity, reformulation, validation and organization, (4) face validity through an online survey and in-depth interviews with expert representatives on physical activity and sports and (5) audit tool finalization though project team consensus.

Results: Eight sources were reviewed with 269 items identified. Items were coded into 25 categories with three broad themes: policies, actors and settings-based approach. The Delphi study extracted and refined 50 items and categorized them into 10 sections. After revisions from 22 surveys and 8 interviews, consensus was reached by the international project team on 41 items categorized into 11 sections: Role of ministry or department; Policies; Communication; Implementation & Dissemination; Evaluation & Measurement methods; Sub-national level policies; Funding & Coordination; Participative approach; Actors & Stakeholders; National sporting events; Case studies and Implicated stakeholders.

Conclusions: To progress HP in the sports club context it is necessary to understand existing national level policies. This national audit tool will aid in monitoring and assessing national policies for health promoting sports clubs.

Purpose: Beyond promoting their sports and contributing to elite success, sports federation have a broader health and sport for all promoting role, to include everyone in sport. The symposium has as objective to showcase theoretical grounds, case studies and tools to support health and physical activity promotion among international and national sports federation.

Methods: The symposium will entail four presentation reflecting on different aspects of health and physical activity promotion. The first presentation will focus on theoretical grounds and guidelines created by 15 researchers and in collaboration with the World Health Organisation. The second presentation describes a case study among 51 national sports federation in France, to explain how they promote health and showcase the use of the indicators of health promoting sports federation indicators created by authors of the first presentation. The third presentation will describe a World Athletics project on the promotion of physical activity through competitions organisation and its stakes, as a practice-oriented example. The fourth presentation offer insights on the development and use of the “International and European Sport Organisations Activate Citizens” Capacity Building Framework, created through an Erasmus+ project, which entails a set of tools to empower international sports federation to promote sport for all.

Results: After the four presentation, an open discussion will be engaged with the audience on the success and challenges, as well as a small interactive session on future directions for international and national sports federation to consider their health enhancing physical activity potential and fully exploit it.

Conclusions: The symposium will equip the audience with theory, tools and example of practice, as well as reflect on how to move the research and practice agenda for health promoting sport federation.