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  • 1.
    Brunnberg, Elinor
    et al.
    Örebro University, Department of Behavioural, Social and Legal Sciences.
    Linden Boström, Margareta
    Örebro University, School of Health and Medical Sciences.
    Berglund, Mats
    Tinnitus and hearing loss in 15-16-year-old students: mental health symptoms, substance use, and exposure in school2008In: International Journal of Audiology, ISSN 1499-2027, E-ISSN 1708-8186, Vol. 47, no 11, p. 688-694Article in journal (Refereed)
    Abstract [en]

    The current study assessed the responses from a survey titled ”Life and Health – Young People 2005”, completed by 2.878 15-16 year-old adolescents in mainstream schools in the county of Örebro, Sweden. Thirty-nine percent of students with hearing loss (slight, mild, or moderate) and 6% of students with normal hearing reported tinnitus often or always during the past three months. Almost no gender difference was observed among students with normal hearing reporting tinnitus (boys 6.3%, girls 5.6%); however, a gender difference was noticed among hard-of-hearing (HH) students (boys 50%, girls 28%). Adolescents with both hearing loss and tinnitus reported considerably higher scores for mental symptoms, substance use, and school problems than other students. Anxiety in the past three months, male gender, and alcohol consumption in the past year were associated with tinnitus in HH students; irritation and anxiety in the past three months, disability, use of illicit drugs, and truancy predicted tinnitus in the normal hearing group. Consequently, students with a hearing loss and tinnitus are at high risk and should be monitored for subsequent problems.

  • 2.
    Brunnberg, Elinor
    et al.
    Örebro University, Department of Behavioural, Social and Legal Sciences.
    Lindén Boström, Margareta
    Örebro University, Department of Health Sciences.
    Berglund, Mats
    Lunds Universitet.
    School adjustment, mental symptoms and substance use in 16 year old students with hearing impairment and other disabilities2007Conference paper (Refereed)
    Abstract [en]

    There are few studies on substance use, mental symptoms and school problems in adolescents with multi-disabilities. This survey, “Life and health-young 2005”, included all children in mainstream schools class 9 in the county of Örebro, Sweden. Children attending special schools for deaf/hard-of-hearing and multi-disabled children were not included. There were 56 (1.9%) hard-of-hearing students with some other disability, 93 (3.1%) ‘just hard-of-hearing’ students, 282 (9.7%) students with some other disability than hearing impairment and 2488 (85.2%) without a disability. Hard-of-hearing/other disability group of students reported considerably higher scores on mental symptoms, substance use and school problems than the others. A logistic regression analysis showed that mental symptoms explained 17% of the variance, alcohol and drugs 15% and school problems 9%. The final model explained 24% and included use of illegal drugs (OR 8.3), often irritated (OR 4.2), feeling bad (OR 3.2) and bullied (OR 2.2). In the hard-of-hearing/other disability group 43% reported at least 2 of these symptoms and in the other groups 17%, 18% and 8%, respectively. The combination of hearing impairment and other disabilities increases the risk for mental symptoms, substance use and school problems. This group of students in mainstream schools ought to be an important target for preventive efforts.

  • 3.
    Brunnberg, Elinor
    et al.
    Örebro University, Department of Behavioural, Social and Legal Sciences.
    Lindén Boström, Margareta
    Örebro University, Department of Health Sciences.
    Berglund, Mats
    Lund University.
    School adjustment, self-rated health and substance use in -16 year old hard-of-hearing students: a comparative study : life and health : young people 20052007Conference paper (Other academic)
  • 4.
    Brunnberg, Elinor
    et al.
    Örebro University, School of Law, Psychology and Social Work.
    Lindén Boström, Margareta
    Örebro University, School of Health and Medical Sciences.
    Berglund, Mats
    Lund university.
    Self-rated mental health, school adjustment, and substance use in hard-of-hearing adolescents2008In: Journal of Deaf Studies and Deaf Education, ISSN 1081-4159, E-ISSN 1465-7325, Vol. 13, no 3, p. 324-335Article in journal (Refereed)
    Abstract [en]

    This survey, "Life and Health—Young People 2005," included all 15/16-year-old adolescents in mainstream schools in the county of Örebro, Sweden. Just students with a slight/mild or moderate hearing loss were included. There were 56 (1.9%) "hard-of-hearing (HH) students with multiple disabilities," 93 (3.1%) students who were "just HH," 282 (9.7%) students with some "other disability than HH," and 2,488 (85.2%) students with "no disability." "HH with multiple disabilities" reported considerably higher scores for mental symptoms, substance use, and school problems than the "no disability" group. Those with "just HH" and those with "other disability than HH" had more mental symptoms and school problems than the "no disability" group but no significant differences in substance use. In conclusion, the combination of a hearing loss and some other disability strongly increases the risk for mental symptoms, school problems, and substance use. This group, thus, is an important target for preventive measures.

  • 5.
    Brunnberg, Elinor
    et al.
    Örebro University, School of Law, Psychology and Social Work.
    Lindén Boström, Margareta
    Örebro County Council, Department of Community.
    Berglund, Mats
    Departement of Health Sciences, Lund University.
    Sexuality of 15/16-year-old girls and boys with and without modest disabilities2009In: Sexuality and disability, ISSN 0146-1044, E-ISSN 1573-6717, Vol. 27, no 3, p. 139-153Article in journal (Refereed)
    Abstract [en]

    Girls and boys with disabilities, 15-16 years of age, report a significantly higher rate of sexual debut than adolescents with no disabilities. In a society where a young person with a disability often is considered to have an essentially asexual status, there can be several fronts for adolescents to fight. The survey Life and Health - Young People 2005 was completed by  3,084 adolescents attending mainstream schools in Sweden. In this study the sexual debut in girls and boys with and without disabilities is related to mental health, school exposure and substance use. Our findings might be explained by a mechanism of identity construction from the adolescents' ideas of normality and by a battle for acceptance and confirmation of life. The ideas of normality can be erroneous but still influence the adolescents' sexual activity. Multivariate analyses also showed that the relationship between sex and substance use is strong among all adolescents.

  • 6.
    Brunnberg, Elinor
    et al.
    Örebro University, School of Law, Psychology and Social Work.
    Lindén Boström, Margareta
    Persson, Carina
    Att höra eller nästan inte höra: Liv & hälsa ung 2005 och 2007 i Örebro län2009Report (Other academic)
    Abstract [en]

    I linje med FN:s barnkonvention och Konventionen om rättigheter förpersoner med funktionshinder ska ungdomars röst göras hörd. Den härrapporten bygger helt på ungdomars uppgifter om sin verklighet.Studierna Liv & hälsa ung 2005 och 2007 visar att i den reguljära skolanupplever drygt fem procent av eleverna att de har ett funktionshinder närdet gäller hörseln och de rapporterar ofta en utsatt situation. Det finns även hörselskadade ungdomar på specialskolan/riksgymnasiet för döva och hörselskadade. De hörselskadade ungdomarna är en grupp som rapporterar en mängd hälsorelaterade problem, många känner sig mobbade av kamrater eller kränkta av vuxna i skolan. Det är också en grupp som förhållandevis ofta rapporterar bruk av alkohol, tobak och narkotika. De kan även ha andra funktionsnedsättningar eller tinnitus. De hörselskadade ungdomarna är en högriskgrupp som behöver uppmärksammas och få ett bättre anpassat stöd. Det behövs fördjupade studier hur stödet kan utformas på ett relevant sätt, speciellt gäller det dem med flera funktionshinder. För att göra detta är det viktigt att ungdomarna själva involveras i arbetet. Fördjupade studier behövs också om hur hörselskadade ungdomars delaktighet i den reguljära skolan kan förbättras samt om vad som skapar exempelvis stress, trötthet och olyckor. Det behövs åtgärder för att minska den mobbning som sker och inte minst minska det ungdomar rapporterar om kränkning från vuxna. Det behövs riktade insatser för att öka de hörselskadade ungdomarnas simkunnighet och fysiska aktivitet. Det är också av stor betydelse för de hörselskadade och döva ungdomarna att det finns kompetent tvåspråkig (svenska och teckenspråk) personal på ungdomsmottagningar och barnahus.

  • 7.
    Brunnberg, Elinor
    et al.
    Örebro University, School of Law, Psychology and Social Work.
    Lindén Boström, Margareta
    Örebro County Council, Department of Community Medicine and Public Health, Örebro.
    Persson, Carina
    Örebro County Council, Department of Community Medicine and Public Health, Örebro.
    Berglund, Mats
    Departement of Health Sciences, Lund University, Malmö University Hospital, Sweden.
    Hard-of-hearing adolescents reporting some other disability or tinnitus: a replication study including an age-related analysis2009Conference paper (Other academic)
    Abstract [en]

    In two previous studies based on the survey, Life & Health Young 2005 in Örebro county 15-16 years old Hard-of-hearing (HH) students with some other disability (HHDIS) and HH with tinnitus (HHTINN) reported considerably higher scores for mental symptoms and substance use than adolescents ‘just‘ HH or hearing adolescents.

     

    In order to replicate these findings we analysed the 2007 survey and included adolescents in grade 7, 9 and 2 in secondary school concerning substance use and depression. We also used reference data from the corresponding adult survey Life & Health 2008. In grade 9 HHDIS (2.0%) and HHTINN (2.0 %) both reported strongly increased rates of risky alcohol consumption (55/51% versus 13%), daily tobacco use (57/54% versus 10%) and depression (43/43% versus 14%) than hearing or ´just´ HH adolescents. Similar but less pronounced changes were present in grade 7 and grade 2. In HHDIS increased risk drinking was found until age 35, increased daily tobacco use until age 50 and increased depression until age 65. In HHTINN only rate of depression was increased in adult life.

     

    HHDIS and HHTINN thus are important targets for preventive measures. In addition tinnitus in young people can be a marker like disability of vulnerability.

  • 8.
    Ekbäck, Gunnar
    et al.
    Department of Dentistry, Örebro County Council, Örebro, Sweden.
    Persson, Carina
    Örebro University, School of Health Sciences. Department of Community Medicine and Public Health, Örebro County Council, Örebro, Sweden.
    Lindén-Boström, Margareta
    Örebro University, School of Health Sciences. Department of Community Medicine and Public Health, Örebro County Council, Örebro, Sweden.
    What factors can be protective for both self-rated oral health and general health?2015In: Swedish Dental Journal, ISSN 0347-9994, Vol. 39, no 2, p. 99-107Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to analyze if the same protective factors are significant for both self-rated health and oral health. It was hypothesized that these factors should be the same.

    The material is based on a population sample of 17 113 women and men aged 18-84years in one county in central Sweden.The response rate was 61%.The data were collected through a postal questionnaire "Life and Health" in 2008.The questionnaire comprised of 149 questions and was divided into a number of areas, e.g. socioeconomic conditions, quality of life, social relations, lifestyle, and health. To analyze the strength of the protective factors whilst taking into account the relationships between the various independent variables, multivariate analyses were conducted using binary multiple logistic regression. The outcome measures with the strongest association to general health is belonging to the age group 18-34 years, positive faith in the future, good sleeping pattern and to be employed/ self-employed/retired.

    The outcomes with the strongest association to oral health are good finances, belonging to the age group 18-34years, to be born in Sweden and positive faith in the future.

    Conclusions.This study shows that, in.general, the same protective factors are significant for both self-rated health and self-rated oral health, making it possible to use the same approach to strengthen both general health and oral health. One important outcome, not often considered, is having positive faith in the future. It is a task for the health care system to strengthen people's faith in the future, partly through a very high quality care when needed, but also through active health promotion that increases the chances of a healthy life, both from a public health perspective as from an oral health perspective.

  • 9.
    Linden-Bostrom, Margareta
    et al.
    Dept Community Med & Publ Hlth, Örebro Cty Council, Örebro, Sweden.
    Persson, Carina
    Dept Community Med & Publ Hlth, Örebro Cty Council, Örebro, Sweden.
    Eriksson, Charli
    Örebro University, School of Health and Medical Sciences.
    Neighbourhood characteristics, social capital and self-rated health - A population-based survey in Sweden2010In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 10, p. 628-Article in journal (Refereed)
    Abstract [en]

    Background: In previous public health surveys large differences in health have been shown between citizens living in different neighbourhoods in the Orebro municipality, which has about 125000 inhabitants. The aim of this study was to investigate the determinants of health with an emphasis on the importance of neighbourhood characteristics such as the influence of neighbourhood social cohesion and social capital. The point of departure in this study was a conceptual model inspired by the work of Carpiano, where different factors related to the neighbourhood have been used to find associations to individual self-rated health. Methods: We used data from the survey 'Life & Health 2004' sent to inhabitants aged 18-84 years in Orebro municipality, Sweden. The respondents (n = 2346) answered a postal questionnaire about living conditions, housing conditions, health risk factors and individual health. The outcome variable was self-rated health. In the analysis we applied logistic regression modelling in various model steps following a conceptual model. Results: The results show that poor self-rated health was associated with social capital, such as lack of personal support and no experience of being made proud even after controlling for strong factors related to health, such as age, disability pension, ethnicity and economic stress. Also the neighbourhood factors, housing area and residential stability were associated with self-rated health. Poor self-rated health was more common among people living in areas with predominately large blocks of flats or areas outside the city centre. Moreover, people who had lived in the same area 1-5 years reported poor health more frequently than those who had lived there longer. Conclusions: The importance of the neighbourhood and social capital for individual health is confirmed in this study. The neighbourhoods could be emphasized as settings for health promotion. They can be constructed to promote social interaction which in turn supports the development of social networks, social support and social capital - all important determinants of health.

  • 10.
    Lindén-Boström, Margareta
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital.
    Persson, Carina
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Region Örebro County, Örebro, Sweden.
    Disparities in mental health among adolescents with and without impairments2015In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 43, no 7, p. 728-735Article in journal (Refereed)
    Abstract [en]

    Aim: To analyse whether there are differences in mental health among adolescents with and without various kinds of impairments, taking into account the number of impairments and gender.

    Methods: Data from the study Life & Health - Young People conducted in a Swedish county in 2011 was used. The survey included all students in grades 7 (13-14 years) and 9 (15-16 years) in compulsory school and grade 2 (17-18 years) in upper secondary school; there were 7793 respondents (81.0%). The students answered a questionnaire anonymously during school hours. Various measures of mental health were assessed in the groups: hard of hearing, visual impairment, motor impairment, difficulties in reading/writing/dyslexia, attention deficit hyperactive disorder/attention deficit disorder, other impairment, no impairment.

    Results: Of the studied impairments, difficulties in reading/writing/dyslexia are the most common (6.3%), followed by hard of hearing (5.4%). To have at least one impairment is more common among boys (18.2%) than girls (15.4%). In the impairment group, 21.5% have multiple impairments. Adolescents with impairments have worse mental health than those without, and those with multiple impairments have particularly higher odds ratio to have worse mental health. There are also differences in mental health between number and various kinds of impairments and between girls and boys.

    Conclusion: Adolescents with impairments, particularly girls and those with multiple impairments, have considerably worse mental health than others. These inequalities in health are an immense challenge, not only for those directly involved with the impaired: they affect everyone involved with the goal health equity for the whole population.

  • 11. Lindén-Boström, Margareta
    et al.
    Persson, Carina
    Eriksson, Charli
    Örebro University, School of Health and Medical Sciences.
    Bostadsområdets karaktäristika, socialt kapital och självskattad hälsa2010In: Partnerskap för hållbar välfärdsutveckling: utveckling och forskning under sex år i fyra städer / [ed] Charli Eriksson, Eva Järliden, Annika Larsson, Solveig Sandberg, Örebro: Örebro universitet , 2010, p. 199-217Chapter in book (Other academic)
  • 12. Molarius, Anu
    et al.
    Berglund, Kenneth
    Eriksson, Charli
    Örebro University, School of Health and Medical Sciences.
    Eriksson, Hans G.
    Linden-Bostrom, Margareta
    Nordstrom, Eva
    Persson, Carina
    Sahlqvist, Lotta
    Starrin, Bengt
    Ydreborg, Berit
    Mental health symptoms in relation to socio-economic conditions and lifestyle factors: a population-based study in Sweden2009In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 9, p. 302-Article in journal (Refereed)
    Abstract [en]

    Background: Poor mental health has large social and economic consequences both for the individual and society. In Sweden, the prevalence of mental health symptoms has increased since the beginning of the 1990s. There is a need for a better understanding of the area for planning preventive activities and health care. Methods: The study is based on a postal survey questionnaire sent to a random sample of men and women aged 18-84 years in 2004. The overall response rate was 64%. The area investigated covers 55 municipalities with about one million inhabitants in central part of Sweden. The study population includes 42,448 respondents. Mental health was measured with self-reported symptoms of anxiety/depression (EQ-5D, 5th question). The association between socio-economic conditions, lifestyle factors and mental health symptoms was investigated using multivariate multinomial logistic regression models. Results: About 40% of women and 30% of men reported that they were moderately or extremely anxious or depressed. Younger subjects reported poorer mental health than older subjects, the best mental health was found at ages 65-74 years. Factors that were strongly and independently related to mental health symptoms were poor social support, experiences of being belittled, employment status (receiving a disability pension and unemployment), economic hardship, critical life events, and functional disability. A strong association was also found between how burdensome domestic work was experienced and anxiety/depression. This was true for both men and women. Educational level was not associated with mental health symptoms. Of lifestyle factors, physical inactivity, underweight and risk consumption of alcohol were independently associated with mental health symptoms. Conclusion: Our results support the notion that a ground for good mental health includes balance in social relations, in domestic work and in employment as well as in personal economy both among men and women. In addition, physical inactivity, underweight and risk consumption of alcohol are associated with mental health symptoms independent of socio-economic factors.

  • 13.
    Molarius, Anu
    et al.
    Competence Centre for Health, Västmanland County Council, Karlstad University, Västerås, Sweden.
    Granström, Fredrik
    R&D Centre, Sörmland County Council, Eskilstuna, Sweden.
    Lindén-Boström, Margareta
    Örebro University Hospital. Department of Community Medicine and Public Health, Örebro County Council, Örebro, Sweden.
    Elo, Sirkka
    Department of Community Medicine and Public Health, Örebro County Council, Örebro, Sweden.
    Domestic work and self-rated health among women and men aged 25-64 years: Results from a population-based survey in Sweden2014In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 42, no 1, p. 52-59Article in journal (Refereed)
    Abstract [en]

    Aims: This study investigated the association between domestic work and self-rated health among women and men in the general population.

    Methods: The study is based on women (N = 12,910) and men (N = 9784) aged 25-64 years, who responded to a survey questionnaire in 2008 (response rate 56%). Logistic regression models were used to assess the association adjusting for age, educational level, employment status, family status and longstanding illness. Population attributable risks (PAR) were calculated to assess the contribution of domestic work to the prevalence of suboptimal self-rated health.

    Results: More women (29%) than men (12%) spent more than 20 hours per week in domestic work. Women also experienced domestic work more often as burdensome. Disability pensioners and single mothers reported highest levels of burdensome domestic work. There was a strong independent association between burdensome domestic work and suboptimal self-rated health both in women and men. The PAR for burdensome domestic work was 21% in women and 12% in men and comparable to other major risk factors.

    Conclusions: The results suggest that domestic work should not be omitted when considering factors that affect self-rated health in the general population.

  • 14.
    Molarius, Anu
    et al.
    Competence Centre for Health, Västmanland County Council, Västerås, Sweden; Department of Public Health, Karlstad University, Karlstad, Sweden.
    Lindén-Boström, Margareta
    Örebro University, School of Health Sciences. Department for Sustainable Development, Örebro University, Örebro, Sweden.
    Granström, Fredrik
    Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden.
    Karlsson, Jan
    University Health Care Research Center, Region Örebro County, Örebro, Sweden.
    Obesity continues to increase in the majority of the population in mid-Sweden: a 12-year follow-up2016In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 26, no 4, p. 622-627Article in journal (Refereed)
    Abstract [en]

    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.

  • 15.
    Pettersson, Camilla
    et al.
    Örebro University, School of Health and Medical Sciences.
    Lindén-Boström, Margareta
    Department of Community Medicine, Örebro County Council .
    Eriksson, Charli
    Örebro University, School of Health and Medical Sciences.
    Parental attitudes and behaviour concerning adolescent alcohol consumption: do sociodemographic factors matter?2009In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 37, no 5, p. 509-517Article in journal (Refereed)
    Abstract [en]

    Aims: Parental attitudes and behaviour with regard to young people and alcohol are associated with teenagers' drinking behaviour. This study examined the association between sociodemographic factors among parents and parental attitudes and behaviour with regard to alcohol and adolescents. Methods: Postal questionnaires were sent to parents of children aged 12—16 years in six Swedish municipalities. Seven hundred and ninety-five parents were included in the study. Seven sociodemographic factors and four questions identifying parental attitudes and behaviour were examined. Logistic regression was used to compute odds ratios and confidence intervals. Results: The study showed that fathers were more likely than mothers to report that children had been drinking or tasting alcohol at home. Parents who answered the questionnaire together also stated that their children had been served alcohol at home to a larger extent than mothers. Fathers, single parents and parents with older children were more likely to have non-restrictive attitudes towards adolescents and alcohol than mothers, parents living in a household with more than one adult, and parents with younger children. Factors such as age of the parents, employment status and numbers of children in the household were not associated with either parental attitudes or behaviour. Conclusions: The sex of the responding parent was the only sociodemographic factor that was associated with both parental attitudes and behaviour. Fathers were more likely than mothers to have a non-restrictive attitude. The fathers also reported to a greater extent than mothers that children had been drinking or tasting alcohol at home.

  • 16.
    Pettersson, Camilla
    et al.
    Örebro University, School of Health and Medical Sciences.
    Lindén-Boström, Margareta
    Department of Community Medicine, Örebro County Council .
    Eriksson, Charli
    Örebro University, School of Health and Medical Sciences.
    Reasons for non-participation in a parental program concerning underage drinking: a mixed-method study2009In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 9, article id 478Article in journal (Refereed)
    Abstract [en]

    Background: Alcohol consumption among adolescents is a serious public health concern. Research has shown that prevention programs targeting parents can help prevent underage drinking. The problem is that parental participation in these kinds of interventions is generally low. Therefore, the aim of the present study is to examine non-participation in a parental support program aiming to prevent underage alcohol drinking. The Health Belief Model has been used as a tool for the analysis.

    Methods: To understand non-participation in a parental program a quasi-experimental mixed-method design was used. The participants in the study were invited to participate in a parental program targeting parents with children in school years 7-9. A questionnaire was sent home to the parents before the program started. Two follow-up surveys were also carried out. The inclusion criteria for the study were that the parents had answered the questionnaire in school year 7 and either of the questionnaires in the two subsequent school years (n = 455). Multinomial logistic regression analysis was used to examine reasons for non-participation. The final follow-up questionnaire included an opened-ended question about reasons for non-participation. A qualitative content analysis was carried out and the two largest categories were included in the third model of the multinomial logistic regression analysis.

    Results: Educational level was the most important socio-demographic factor for predicting non-participation. Parents with a lower level of education were less likely to participate than those who were more educated. Factors associated with adolescents and alcohol did not seem to be of significant importance. Instead, program-related factors predicted non-participation, e.g. parents who did not perceive any need for the intervention and who did not attend the information meeting were more likely to be non-participants. Practical issues, like time demands, also seemed to be important.

    Conclusion: To design a parental program that attracts parents independently of educational level seems to be an important challenge for the future as well as program marketing. This is something that must be considered when implementing prevention programs.

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