Abstract: BACKGROUND: School and work participation in adolescence and young adulthood are important for future health and socioeconomic status. The authors studied the association between self-rated health in adolescents, high school dropout and long-term receipt of medical and non-medical social insurance benefits in young adulthood. METHODS: Self-rated health in adolescence was assessed in 8795 adolescents participating in the Norwegian Young-HUNT Study (1995-1997). Linkages to the National Education Database and the National Insurance Administration allowed identification of school dropout and receipt of long-term medical and non-medical benefits during a 10-year follow-up (1998-2007). The data were explored by descriptive statistics and by multinomial logistic regression. RESULTS: A total of 17% was registered as being high school dropouts at age 24. The predicted 5-year risk of receiving benefits between ages 24-28 was 21% (95% CI 20% to 23%). High school dropouts had a 5-year risk of receiving benefits of 44% (95% CI 41 to 48) compared with 16% (95% CI 15 to 17) in those who completed high school (adjusted for self-rated health, parental education and sex). There was a 27% school dropout rate in adolescents who reported poor health compared with 16% in those who reported good health. The predicted 5-year risk of receiving any long-term social insurance benefits in adolescents who reported poor health was 33% (95% CI 30 to 37) compared with 20% (95% CI 19 to 21) in those who reported good health. CONCLUSION: The strong association between poor self-rated health in adolescence, high school dropout and reduced work integration needs attention and suggests preventive measures on an individual as well as on a societal level.

Abstract: OBJECTIVES: To examine a possible association of parental chronic pain with chronic pain in the adolescent and young adult and to explore whether a relationship could be explained by socioeconomic and psychosocial factors or may be affected by differences in family structure. DESIGN: Unselected, population-based, cross-sectional study. SETTING: Nord-Trondelag County, Norway. PARTICIPANTS: All inhabitants of Nord-Trondelag County who were 13 years or older were invited to enroll in the study. In total, 8200 of 10 485 invitees (78.2%) participated in the investigation. Among 7913 participants in the target age group (age range, 13-18 years), 7373 (93.2%) completed the pain questions. The final study population consisted of 5370 adolescents or young adults for whom one or both parents participated in the adult survey. MAIN OUTCOME MEASURES: The primary outcome measure was chronic nonspecific pain in adolescents and young adults, defined as pain in at least 1 location, unrelated to any known disease or injury, experienced at least once a week during the past 3 months. Chronic multisite pain was defined as chronic pain in at least 3 locations. RESULTS: Maternal chronic pain was associated with chronic nonspecific pain and chronic multisite pain in adolescents and young adults (odds ratio, 1.5; 95% CI, 1.3-1.8). Paternal chronic pain was associated with increased odds of pain in adolescents and young adults. The odds of chronic nonspecific pain and chronic multisite pain in adolescents and young adults increased when both parents reported pain. Adjustments for socioeconomic and psychosocial factors did not change the results, although differences in family structure did. Among offspring living primarily with their mothers, clear associations were observed between maternal pain and pain in adolescents and young adults, but no association was found with paternal pain. CONCLUSIONS: Parental chronic pain is associated with chronic nonspecific pain and especially with chronic multisite pain in adolescents and young adults. Family structure influences the relationship, indicating that family pain models and shared environmental factors are important in the origin of chronic pain.

Abstract: BACKGROUND: The association between mental distress and divorce is well established in the literature. Explanations are commonly classified within two different frameworks; social selection (mentally distressed people are selected out of marriage) and social causation (divorce causes mental distress). Despite a relatively large body of literature on this subject, selection effects are somewhat less studied, and research based on data from both spouses is scarce. The purpose of the present study is to investigate selection effects both at the individual level and the couple level. METHODS: The current study is based on couple-level data from a Norwegian representative sample including 20,233 couples. Long-term selection effects were tested for by means of Cox proportional hazard models, using mental distress in both partners at baseline as predictors of divorce the next 16 years. Three identical sets of analyses were run. The first included the total sample, whereas the second and third excluded couples who divorced within the first 4 or 8 years after baseline, respectively. An interaction term between mental distress in husband and in wife was specified and tested. RESULTS: Hazard of divorce was significantly higher in couples with one mentally distressed partner than in couples with no mental distress in all analyses. There was also a significant interaction effect showing that the hazard of divorce for couples with two mentally distressed partners was higher than for couples with one mentally distressed partner, but lower than what could be expected from the combined main effects of two mentally distressed partners. CONCLUSIONS: Our results suggest that mentally distressed individuals are selected out of marriage. We also found support for a couple-level effect in which spouse similarity in mental distress to a certain degree seems to protect against divorce.

Abstract: OBJECTIVE: Depression is strongly linked to increased mortality in individuals with type 2 diabetes. Despite high rates of co-occurring anxiety and depression, the risk of death associated with comorbid anxiety in individuals with type 2 diabetes is poorly understood. This study documented the excess mortality risk associated with symptoms of depression and/or anxiety comorbid with type 2 diabetes. RESEARCH DESIGN AND METHODS: Using data for 64,177 Norwegian adults from the second wave of the Nord-Trondelag Health Study (HUNT2), with linkage to the Norwegian Causes of Death Registry, we assessed all-cause mortality from survey participation in 1995 through to 2013. We used Cox proportional hazards models to examine mortality risk over 18 years associated with type 2 diabetes status and the presence of comorbid affective symptoms at baseline. RESULTS: Three clear patterns emerged from our findings. First, mortality risk in individuals with diabetes increased in the presence of depression or anxiety, or both. Second, mortality risk was lowest for symptoms of anxiety, higher for comorbid depression-anxiety, and highest for depression. Lastly, excess mortality risk associated with depression and anxiety was observed in men with diabetes but not in women. The highest risk of death was observed in men with diabetes and symptoms of depression only (hazard ratio 3.47, 95% CI 1.96, 6.14). CONCLUSIONS: This study provides evidence that symptoms of anxiety affect mortality risk in individuals with type 2 diabetes independently of symptoms of depression, in addition to attenuating the relationship between depressive symptoms and mortality in these individuals.

Abstract: AIMS: To investigate characteristics of families with adolescent children who have visited practitioners of complementary and alternative medicine (CAM). METHODS: The Nord-Trondelag Health Studies (HUNT) invited all inhabitants aged 13 years and older to a population-based study. The data of parents and adolescents were merged through the Norwegian family register. A family CAM visitor was a family where either the adolescent or the mother or father had visited a CAM practitioner in the previous year. The data were analyzed using multivariable logistic regression. RESULTS: A total of 7,888 adolescents with mother and/or fathers were included. The prevalence of families visiting CAM practitioners was 19.8%. The odds of a family visiting a CAM practitioner was significantly associated (p < 0.01) with a father with poor self-reported global health (adjusted odds ratio (adjOR) 3.0, 95% confidence interval (95% CI) 1.7-5.3), who exercised (adjOR 1.3, 1.1-1.5) or smoked daily (adjOR 0.7, 0.6-0.8). Family CAM visits were also associated with the mother having a recent health complaint (adjOR 1.4, 1.1-1.7) or having fair global health (adjOR 1.6, 1.2-2.0), or with the adolescent, mother or father having visited a general practitioner during the past year (adolescent adjOR 1.3, 1.2-1.5; mother 1.7, 1.5-2.0; father 1.4, 1.2-1.6). For family visits to a homeopath, the strongest association was the mother having visited a general practitioner (adjOR 1.9, 1.4-2.5). For visits to chiropractors the strongest association was whether the father was currently working (adjOR 2.1, 1.2-3.8). CONCLUSIONS: The factor most strongly associated with families' visits to CAM practitioners was a father who had poor self-reported health.

Abstract: AIMS: Norway is experiencing a rising life expectancy combined with an increasing dependency ratio – the ratio of those outside over those within the working force. To provide data relevant for future health policy we wanted to study trends in total and healthy life expectancy in a Norwegian population over three decades (1980s, 1990s and 2000s), both overall and across gender and educational groups. METHODS: Data were obtained from the HUNT Study, and the Norwegian Educational Database. We calculated total life expectancy and used the Sullivan method to calculate healthy life expectancies based on self-rated health and self-reported longstanding limiting illness. The change in health expectancies was decomposed into mortality and disability effects. RESULTS: During three consecutive decades we found an increase in life expectancy for 30-year-olds (~7 years) and expected lifetime in self-rated good health (~6 years), but time without longstanding limiting illness increased less (1.5 years). Women could expect to live longer than men, but the extra life years for females were spent in poor self-rated health and with longstanding limiting illness. Differences in total life expectancy between educational groups decreased, whereas differences in expected lifetime in self-rated good health and lifetime without longstanding limiting illness increased. CONCLUSIONS: The increase in total life expectancy was accompanied by an increasing number of years spent in good self-rated health but more years with longstanding limiting illness. This suggests increasing health care needs for people with chronic diseases, given an increasing number of elderly. Socioeconomic health inequalities remain a challenge for increasing pensioning age.

Abstract: Agriculture has undergone profound changes, and farmers face a wide variety of stressors. Our aim was to study the levels of anxiety and depression symptoms among Norwegian farmers compared with other occupational groups. Working participants in the HUNT3 Survey (The Nord-Trondelag Health Study, 2006-2008), aged 19-66.9 years, were included in this cross-sectional study. We compared farmers (women, n = 317; men, n = 1,100) with HUNT3 participants working in other occupational groups (women, n = 13,429; men, n = 10,026), classified according to socioeconomic status. We used the Hospital Anxiety and Depression Scale (HADS) to measure anxiety and depression symptoms. Both male and female farmers had higher levels of depression symptoms than the general working population, but the levels of anxiety symptoms did not differ. The differences in depression symptom levels between farmers and the general working population increased with age. In an age-adjusted logistic regression analysis, the odds ratio (OR) for depression caseness (HADS-D >/=8) when compared with the general working population was 1.49 (95% confidence interval [CI]: 1.22-1.83) in men and 1.29 (95% CI: 0.85-1.95) in women. Male farmers had a higher OR of depression caseness than any other occupational group (OR = 1.94, 95% CI: 1.52-2.49, using higher-grade professionals as reference). Female farmers had an OR similar to men (2.00, 95% CI: 1.26-3.17), but lower than other manual occupations. We found that farmers had high levels of depression symptoms and average levels of anxiety symptoms compared with other occupational groups.