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  • 1.
    Elinder, Liselotte S.
    et al.
    Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
    Heinemans, Nelleke
    Centre for Epidemiology and Community Medicine, Stockholm County Council, Solna, Sweden.
    Zeebari, Zangin
    Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
    Patterson, Emma
    Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
    Longitudinal changes in health behaviours and body weight among Swedish school children - Associations with age, gender and parental education - The SCIP school cohort2014In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 14, no 1, article id 640Article in journal (Refereed)
    Abstract [en]

    In order to develop health promotion initiatives it is important to identify at what age gender and socioeconomic inequalities in health-related behaviours emerge. The aim of this longitudinal study was to analyse how health-related behaviours and weight status differed by age-group, gender, family socio-economic status and over time in three cohorts of school children. Methods. All children in grades 2, 4 and 7 in a Swedish semi-urban municipality were invited to participate (n = 1,359) of which 813 (60%) consented. At baseline and after 2 years a health questionnaire was answered by all children. Height and weight was measured. Fourteen outcomes were analysed. The main and interaction effects of time, gender and parental educational level on the health-related behaviours, weight status and body mass index standard deviation score (BMIsds) were analysed by the Weighted Least Squares method for categorical repeated measures and Analysis of Variance. Results: Nine of 12 health behaviours deteriorated over the two years: consumption of breakfast and lunch, vegetables and fruit, intake of sweetened drinks, TV viewing, club membership, being outdoors, and school recess activity; two behaviours were unchanged: intake of sweets, and active transport. Only sports participation increased with time. Girls consumed more vegetables, less sweetened drinks, performed less sports, were less physically active during recess, and had lower BMIsds, compared to boys. Those with more highly educated parents had more favourable or similar behaviours compared to those with less educated parents in 10 out of 12 health behaviours, the only exception being intake of sweets and being outdoors, and had lower BMIsds. Conclusions: This study adds to our knowledge regarding the temporal development of health behaviours and weight status in school children. Differences with regard to gender and socioeconomic status were seen already at a young age. These results contribute to our understanding of several important determinants of obesity and chronic diseases and may inform future interventions regarding how to decrease gender and social inequalities in health.

  • 2.
    Elinder, Liselotte S.
    et al.
    Department of Public Health Sciences, Karolinska Institutet, Solna, Sweden.
    Sundblom, Elinor
    Department of Public Health Sciences, Karolinska Institutet, Solna, Sweden.
    Zeebari, Zangin
    Jönköping University, Jönköping International Business School, JIBS, Statistics. Department of Public Health Sciences, Karolinska Institutet, Solna, Sweden.
    Bergström, Helena
    Department of Public Health Sciences, Karolinska Institutet, Solna, Sweden.
    Effect and process evaluation of a structural health intervention in community residences for adults with intellectual disabilities2018In: Journal of Policy and Practice in Intellectual Disabilities, ISSN 1741-1122, E-ISSN 1741-1130, Vol. 15, no 4, p. 319-328Article in journal (Refereed)
    Abstract [en]

    Interventions to improve health among adults with intellectual disabilities (ID) living in community residences are needed as unhealthy behaviors, obesity, and chronic diseases are more common in this group than in the general population. This study evaluated effectiveness of a structural health intervention, a study circle for paid carers aiming to improve health promotion work routines for residents, and explored barriers and facilitators in the implementation process. A quasi-experimental design was used. Eight municipalities with 84 community residences agreed to participate with 70 of these completing the study. A 26-item questionnaire was used regarding staff work routines in three domains (general health promotion, food and meals, physical activity) and a total score to evaluate effectiveness. An inductive qualitative method was used to explore barriers and facilitators in the implementation process. The intervention group (n = 42 residences) improved their health promoting work routines significantly more than the comparison group (n = 28 residences) in the domains of general health promotion (p =.05), physical activity (p =.02), and for the total score (p =.002), but no significant change was found in the food and meal domain (p =.11). Regarding barriers and facilitators in the implementation process, a “Need for a supportive structure and key persons with a mandate to act,” was identified as an overarching theme. Barriers and facilitators were identified within four categories: (1) characteristics of the study circle, (2) staff capacity, (3) organizational capacity, and (4) external support. This study provides evidence that a structural intervention targeting staff in community residences for people with ID can improve health promoting work routines and that the results might be generalizable. If disseminated on a wider scale, this intervention has the potential of improving health and preventing obesity and other chronic diseases in adults with ID. 

  • 3.
    Falkstedt, D.
    et al.
    Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
    Möller, J.
    Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
    Zeebari, Zangin
    Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
    Engström, K.
    Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
    Multiple health-risk behaviors in women and men with different socio-economic trajectories2016In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 26, p. 97-97Article in journal (Refereed)
  • 4.
    Falkstedt, Daniel
    et al.
    Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
    Möller, Jette
    Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
    Zeebari, Zangin
    Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
    Engström, Karin
    Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
    Prevalence, co-occurrence, and clustering of health-risk behaviors among people with different socio-economic trajectories: A population-based study2016In: Preventive Medicine, ISSN 0091-7435, E-ISSN 1096-0260, Vol. 93, p. 64-69Article in journal (Refereed)
    Abstract [en]

    Only a few previously published studies have investigated the co-occurrence and clustering of health-risk behaviors in people with different socio-economic trajectories from childhood to adulthood. This study was based on data collected through the Stockholm County Council's public health surveys. We selected the 24,241 participants aged 30 to 65 years, who responded to a postal questionnaire in 2010. Information on parents' and participants' educational levels was used for classification of four socio-economic trajectories, from childhood to adulthood: the ‘stable high’, the ‘upwardly mobile’, the ‘downwardly mobile’, and the ‘stable low’. Information on daily smoking, risky drinking, physical inactivity, and poor diet was used for assessment of health-risk behaviors: their prevalence, co-occurrence, and clustering. We found all health-risk behaviors to be more prevalent among women and men with a downwardly mobile or stable low socio-economic trajectory. Accordingly, having three or four co-occurring health-risk behaviors were much more likely (up to 4 times, in terms of odds ratios) in these groups as compared to the women and men with an upwardly mobile or a stable high socio-economic trajectory. However, clustering of the health-risk behaviors was not found to be stronger in those with a downwardly mobile or stable low socio-economic trajectory. Thus, the fact that women and men with a disadvantageous socio-economic career were found to have co-occurring health-risk behaviors more often than people with an advantageous socio-economic career seemed to be generated by differences in prevalence of the health-risk behaviors, not by differences in clustering of the behaviors.

  • 5.
    Galanti, Maria R.
    et al.
    Department of Public Health Sciences, Karolinska Institutet, Solna, Stockholm, Sweden.
    Virtanen, Suvi E.
    Department of Public Health Sciences, Karolinska Institutet, Solna, Stockholm, Sweden.
    Zeebari, Zangin
    Centre for Epidemiology and Community Medicine, Stockholm Health Care District, Solna, Sweden.
    Rohyo, Izla
    Dentistry Clinic Solvändan, Sörmland Health Care Region, Folktandvården Sörmland AB, Folktandvården, Mariefred, Sweden.
    Reply to Ms. PM-14-1161: Brief counseling for tobacco cessation in dental clinics: A toothless intervention?2015In: Preventive Medicine, ISSN 0091-7435, E-ISSN 1096-0260, Vol. 76, p. 124-125Article in journal (Other (popular science, discussion, etc.))
  • 6.
    Hallgren, Mats
    et al.
    Division of Epidemiology and Public Health Intervention Research (EPHIR), Department of Public Health Sciences, Karolinska Institute, Solna, Sweden.
    Helgadóttir, Björg
    Division of Epidemiology and Public Health Intervention Research (EPHIR), Department of Public Health Sciences, Karolinska Institute, Solna, Sweden.
    Herring, Matthew P.
    Department of Physical Education and Sport Sciences, Health Research Institute, University of Limerick, Ireland.
    Zeebari, Zangin
    Division of Epidemiology and Public Health Intervention Research (EPHIR), Department of Public Health Sciences, Karolinska Institute, Solna, Sweden.
    Lindefors, Nils
    Department of Clinical Neuroscience, Karolinska Institute, Huddinge, Sweden.
    Kaldo, Viktor
    Öjehagen, Agneta
    Department of Clinical Sciences, Psychiatry, Lund University, Lund, Sweden.
    Forsell, Yvonne
    Division of Epidemiology and Public Health Intervention Research (EPHIR), Department of Public Health Sciences, Karolinska Institute, Solna, Sweden.
    Exercise and internet-based cognitive-behavioural therapy for depression: Multicentre randomized controlled trial with 12-month follow-up2016In: British Journal of Psychiatry, ISSN 0007-1250, E-ISSN 1472-1465, Vol. 209, no 5, p. 414-420Article in journal (Refereed)
    Abstract [en]

    Background

    Evidence-based treatment of depression continues to grow, but successful treatment and maintenance of treatment response remains limited.

    Aims

    To compare the effectiveness of exercise, internet-based cognitive-behavioural therapy (ICBT) and usual care for depression.

    Method

    A multicentre, three-group parallel, randomised controlled trial was conducted with assessment at 3 months (posttreatment) and 12 months (primary end-point). Outcome assessors were masked to group allocation. Computer-generated allocation was performed externally in blocks of 36 and the ratio of participants per group was 1:1:1. In total, 945 adults with mild to moderate depression aged 18-71 years were recruited from primary healthcare centres located throughout Sweden. Participants were randomly assigned to one of three 12-week interventions: supervised group exercise, clinician-supported ICBT or usual care by a physician. The primary outcome was depression severity assessed by the Montgomery-Åsberg Depression Rating Scale (MADRS).

    Results

    The response rate at 12-month follow-up was 84%. Depression severity reduced significantly in all three treatment groups in a quadratic trend over time. Mean differences in MADRS score at 12 months were 12.1 (ICBT), 11.4 (exercise) and 9.7 (usual care). At the primary end-point the group x time interaction was significant for both exercise and ICBT. Effect sizes for both interventions were small to moderate.

    Conclusions

    The long-term treatment effects reported here suggest that prescribed exercise and clinician-supported ICBT should be considered for the treatment of mild to moderate depression in adults. 

  • 7.
    Hallgren, Mats
    et al.
    Department of Public Health Sciences, Section for Epidemiology and Public Health Intervention Research (EPHIR), Karolinska Institutet, Stockholm, Sweden.
    Kraepelien, Martin
    Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Stockholm, Sweden.
    Öjehagen, Agneta
    Department of Clinical Science, Lund, Division of Psychiatry, Lund University, Lund, Sweden.
    Lindefors, Nils
    Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Stockholm, Sweden.
    Zeebari, Zangin
    Department of Public Health Sciences, Section for Epidemiology and Public Health Intervention Research (EPHIR), Karolinska Institutet, Stockholm, Sweden.
    Kaldo, Viktor
    Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Stockholm, Sweden.
    Forsell, Yvonne
    Department of Public Health Sciences, Section for Epidemiology and Public Health Intervention Research (EPHIR), Karolinska Institutet, Stockholm, Sweden.
    Physical exercise and internet-based cognitive-behavioural therapy in the treatment of depression: Randomised controlled trial2015In: British Journal of Psychiatry, ISSN 0007-1250, E-ISSN 1472-1465, Vol. 207, no 3, p. 227-234Article in journal (Refereed)
    Abstract [en]

    Background

    Depression is common and tends to be recurrent. Alternative treatments are needed that are non-stigmatising, accessible and can be prescribed by general medical practitioners.

    Aims

    To compare the effectiveness of three interventions for depression: physical exercise, internet-based cognitive-behavioural therapy (ICBT) and treatment as usual (TAU). A secondary aim was to assess changes in self-rated work capacity.

    Method

    A total of 946 patients diagnosed with mild to moderate depression were recruited through primary healthcare centres across Sweden and randomly assigned to one of three 12-week interventions (trail registry: KCTR study ID: KT20110063). Patients were reassessed at 3 months (response rate 78%).

    Results

    Patients in the exercise and ICBT groups reported larger improvements in depressive symptoms compared with TAU. Work capacity improved over time in all three groups (no significant differences).

    Conclusions

    Exercise and ICBT were more effective than TAU by a general medical practitioner, and both represent promising non-stigmatising treatment alternatives for patients with mild to moderate depression. 

  • 8.
    Hallgren, Mats
    et al.
    Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
    Lundin, Andreas
    Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
    Zeebari, Zangin
    Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
    Rehm, J.
    Institute for Mental Health Policy Research, Center for Addiction and Mental Health, Toronto, Canada.
    Collectivity of drinking or collective thinking?: Policy implications of polarised alcohol consumption trends2018In: Drug and Alcohol Review, ISSN 0959-5236, E-ISSN 1465-3362, Vol. 37, p. S470-S471Article in journal (Other (popular science, discussion, etc.))
  • 9.
    Hallgren, Mats
    et al.
    Epidemiology of Psychiatric Conditions, Substance use and Social Environment (EPiCSS), Department of Public Health Sciences, Karolinska Institutet, Sweden.
    Owen, Neville
    Behavioral Epidemiology Laboratory, Baker Heart and Diabetes Institute, Melbourne, Australia.
    Stubbs, Brendon
    Physiotherapy Department, South London and Maudsley NHS Foundation Trust, London, United Kingdom.
    Zeebari, Zangin
    Jönköping University, Jönköping International Business School, JIBS, Statistics. Department of Public Health Sciences, Karolinska Institutet, Solna, Sweden.
    Vancampfort, Davy
    KU Leuven, Department of Rehabilitation Sciences, Leuven, Belgium.
    Schuch, Felipe
    Centro Universitário La Salle (Unilasalle) Canoas, Brazil.
    Bellocco, Rino
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Sweden.
    Dunstan, David
    Physical Activity Laboratory, Baker Heart and Diabetes Institute, Melbourne, Australia.
    Trolle Lagerros, Ylva
    Department of Medicine, Clinic of Endocrinology, Metabolism and Diabetes, Karolinska University, Hospital Huddinge, Stockholm, Sweden.
    Passive and mentally-active sedentary behaviors and incident major depressive disorder: A 13-year cohort study2018In: Journal of Affective Disorders, ISSN 0165-0327, E-ISSN 1573-2517, Vol. 241, p. 579-585Article in journal (Refereed)
    Abstract [en]

    Background: Regular physical activity reduces the risk of depression onset and is an effective treatment for mood disorders. Recent studies have reported that sedentary behavior (SB) increases the risk of depression in adults, but relationships of different types of SBs with depression have not been examined systematically. We explored longitudinal relationships of passive (e.g. watching TV) and mentally-active (e.g. office-work) SBs with incident major depressive disorder (MDD).

    Methods: Self-report questionnaires were completed by 40,569 Swedish adults in 1997; responses were linked to clinician-diagnosed MDD obtained from medical registers until 2010. Relationships between passive, mentally-active and total SBs with incident MDD were explored using survival analysis with Cox proportional hazards regression. Models controlled for leisure time moderate-vigorous physical activity and occupational physical activity. Moderating effects of gender were examined.

    Results: In fully-adjusted models, including only non-depressed adults at baseline, those reporting ≥ 3 h of mentally-active SBs on a typical day (versus < 3 h) had significant lower hazards of incident MDD at follow-up (HR = 0.74, 95% CI = 0.58–0.94, p = 0.018). There was a non-significant positive relationship of passive SBs with incident MDD (HR = 1.20, 95% CI = 0.96–1.52, p = 0.106). The association between total SBs (passive and mentally-active combined) was not significant (HR = 0.91, 95% CI = 0.75–1.10, p = 0.36). Gender did not moderate these associations.

    Limitations: Physical activity and SBs were self-reported.

    Conclusion: Mentally-active SBs may have beneficial effects on adults’ mental well-being. These effects are largely independent of habitual physical activity levels. 

  • 10.
    Norman, Åsa
    et al.
    Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
    Zeebari, Zangin
    Jönköping University, Jönköping International Business School, JIBS, Statistics. Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
    Nyberg, Gisela
    Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
    Elinder, Liselotte Schäfer
    Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
    Parental support in promoting children's health behaviours and preventing overweight and obesity - a long-term follow-up of the cluster-randomised healthy school start study II trial.2019In: BMC Pediatrics, ISSN 1471-2431, E-ISSN 1471-2431, Vol. 19, no 1, article id 104Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Effects of obesity prevention interventions in early childhood are only meaningful if they are sustained over time, but long-term follow-up studies are rare. The school-based cluster-randomised Healthy School Start (HSS) trial aimed at child health promotion and obesity prevention through parental support was carried out in 31 pre-school classes (378 families) in disadvantaged areas in Sweden during 2012-2013. Post-intervention results showed intervention effects on intake of unhealthy foods and drinks, and lower BMI-sds in children with obesity at baseline. This study aimed to evaluate the long-term effectiveness 4 years post-intervention.

    METHODS: Data were collected from 215 children in March-June 2017. Child dietary intake, screen time, and physical activity were measured through parental-proxy questionnaires. Child height and weight were measured by the research group. Group effects were examined using Poisson, linear, logistic, and quantile regression for data on different levels. Analyses were done by intention to treat, per protocol, and sensitivity analyses using multiple imputation.

    RESULTS: No between-group effects on dietary intake, screen time, physical activity, or BMI-sds were found for the entire group at the four-year follow-up. In girls, a significant subgroup-effect was found favouring intervention compared to controls with a lower intake of unhealthy foods, but this was not sustained in the sensitivity analysis. In boys, a significant sub-group effect was found where the boys in the intervention group beyond the 95th percentile had significantly higher BMI-sds compared to boys in the control group. This effect was sustained in the sensitivity analysis. Analyses per protocol showed significant intervention effects regarding a lower intake of unhealthy foods and drinks in the children with a high intervention dose compared to controls.

    CONCLUSIONS: Four years after the intervention, only sub-group effects were found, and it is unlikely that the HSS intervention had clinically meaningful effects on the children. These results suggest that school-based prevention programmes need to be extended for greater long-term effectiveness by e.g. integration into school routine practice. In addition, results showed that children with a high intervention dose had better long-term outcomes compared to controls, which emphasises the need for further work to increase family engagement in interventions.

    TRIAL REGISTRATION: ISRCTN, ISRCTN39690370, retrospectively registered March 1, 2013, http://www.isrctn.com/ISRCTN39690370 .

  • 11.
    Nyberg, Gisela
    et al.
    Karolinska Institutet, Department of Public Health Sciences, Stockholm, Sweden.
    Norman, Åsa
    Karolinska Institutet, Department of Public Health Sciences, Stockholm, Sweden.
    Sundblom, Elinor
    Karolinska Institutet, Department of Public Health Sciences, Stockholm, Sweden.
    Zeebari, Zangin
    Karolinska Institutet, Department of Public Health Sciences, Stockholm, Sweden.
    Elinder, Liselotte S.
    Karolinska Institutet, Department of Public Health Sciences, Stockholm, Sweden.
    Effectiveness of a universal parental support programme to promote health behaviours and prevent overweight and obesity in 6-year-old children in disadvantaged areas, the Healthy School Start Study II, a cluster-randomised controlled trial2016In: International Journal of Behavioral Nutrition and Physical Activity, ISSN 1479-5868, E-ISSN 1479-5868, Vol. 13, no 1, article id 4Article in journal (Refereed)
    Abstract [en]

    Background: There is increasing evidence for the effectiveness of parental support programmes to promote healthy behaviours and prevent obesity in children, but only few studies have been conducted among groups with low socio-economic status. The aim of this study was to develop and evaluate the effectiveness of a parental support programme to promote healthy dietary and physical activity habits and to prevent overweight and obesity in six-year-old children in disadvantaged areas.

    Methods: A cluster-randomised controlled trial was carried out in disadvantaged areas in Stockholm. Participants were six-year-old children (n = 378) and their parents. Thirty-one school classes from 13 schools were randomly assigned to intervention (n = 16) and control groups (n = 15). The intervention lasted for 6 months and included: 1) Health information for parents, 2) Motivational Interviewing with parents and 3) Teacher-led classroom activities with children. Physical activity was measured by accelerometry, dietary intake and screen time with a questionnaire, body weight and height were measured and BMI standard deviation score was calculated. Measurements were conducted at baseline, post-intervention and at 5months follow-up. Group effects were examined using Mixed-effect Regression analyses adjusted for sex, parental education and baseline values.

    Results: Fidelity to all three intervention components was satisfactory. Significant intervention effects were found regarding consumption of unhealthy foods (p = 0.01) and unhealthy drinks (p = 0.01). At follow-up, the effect on intake of unhealthy foods was sustained for boys (p = 0.03). There was no intervention effect on physical activity. Further, the intervention had no apparent effect on BMI sds for the whole sample, but a significant difference between groups was detected among children who were obese at baseline (p = 0.03) which was not sustained at follow-up.

    Conclusions: The Healthy School Start study shows that it is possible to influence intake of unhealthy foods and drinks and weight development in obese children by providing individual parental support in a school context. However, the effects were short-lived. Therefore, the programme needs to be prolonged and/or intensified in order to obtain stronger and sustainable effects. This study is an important contribution to the further development of evidence-based parental support programmes to prevent overweight and obesity in children in disadvantaged areas.

  • 12.
    Rahman, Md S.
    et al.
    Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
    Millischer, Vincent
    Neurogenetics Unit, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
    Zeebari, Zangin
    Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
    Forsell, Yvonne
    Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
    Lavebratt, Catharina
    Neurogenetics Unit, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
    BDNF Val66Met and childhood adversity on response to physical exercise and internet-based cognitive behavioural therapy in depressed Swedish adults2017In: Journal of Psychiatric Research, ISSN 0022-3956, E-ISSN 1879-1379, Vol. 93, p. 50-58Article in journal (Refereed)
    Abstract [en]

    The genetic effect of Brain-derived neurotrophic factor (BDNF) on treatment response in depression is not consistent in the literature. Childhood adversity is a known risk factor for depression which has been reported to increase depression susceptibility by interacting with BDNF genetic variation. We aimed to explore whether the BDNF variation Val66Met and childhood adversity (CA) predicted the treatment response to a 12-week intervention with physical exercise (PE) or internet-based cognitive behavioural therapy (ICBT) when compared with treatment as usual (TAU). A prospective cohort study nested within a randomised control trial was conducted using data from 547 participants with mild to moderate depression. Depression severity at baseline and follow-up was measured using the Montgomery-Åsberg Depression Rating Scale. Met allele carriers without exposure to CA and current antidepressant use showed higher treatment response to PE than Val homozygotes. There was no evidence to support that BDNF Val66Met or CA alone predicted treatment response to PE and ICBT. The Met carriers had higher serum mature BDNF level. These data suggest that Met allele carriers benefit more from PE treatment but only if they are not exposed to early adversity. 

  • 13.
    Shukur, Ghazi
    et al.
    Jönköping University, Jönköping International Business School, JIBS, Economics, Finance and Statistics.
    Zeebari, Zangin
    Jönköping University, Jönköping International Business School, JIBS, Economics, Finance and Statistics.
    Median regression for SUR models with the same explanatory variables in each equation2012In: Journal of Applied Statistics, ISSN 0266-4763, E-ISSN 1360-0532, Vol. 39, no 8, p. 1765-1779Article in journal (Refereed)
    Abstract [en]

    In this paper we introduce an interesting feature of the generalized least absolute deviations method for seemingly unrelated regression equations (SURE) models. Contrary to the collapse of generalized leasts-quares parameter estimations of SURE models to the ordinary least-squares estimations of the individual equations when the same regressors are common between all equations, the estimations of the proposed methodology are not identical to the least absolute deviations estimations of the individual equations. This is important since contrary to the least-squares methods, one can take advantage of efficiency gain due to cross-equation correlations even if the system includes the same regressors in each equation.

  • 14.
    Shukur, Ghazi
    et al.
    Jönköping University, Jönköping International Business School, JIBS, Economics, Finance and Statistics.
    Zeebari, Zangin
    Jönköping University, Jönköping International Business School, JIBS, Economics, Finance and Statistics.
    On the median regression for SURE models with applications to 3-generation immigrants data in Sweden2011In: Economic Modelling, ISSN 0264-9993, E-ISSN 1873-6122, Vol. 28, no 6, p. 2566-2578Article in journal (Refereed)
    Abstract [en]

    In this paper we generalize the median regression method to be applicable to system of regression equations, in particular SURE models. Giving the existence of proper system wise medians of the residuals from different equations, we apply the weighted median regression with the weights obtained from the covariance matrix of the equations obtained from ordinary SURE method. The benefit of this model in our case is that the SURE estimators utilise the information present in the cross regression (or equations) error correlation and hence more efficient than other estimation methods like the OLS method. The Seemingly Unrelated Median Regression Equations (SUMRE) models produce results that are more robust than the usual SURE or single equations OLS estimation when the distributions of the dependent variables are not normally distributed or the data are associated with outliers. Moreover, the results are also more efficient than is the cases of single equations median regressions when the residuals from the different equations are correlated. A theorem is derived and indicates that even if there is no statistically significant correlation between the equations, using SUMRE model instead of SURE models will not damage the estimation of parameters.

  • 15.
    Shukur, Ghazi
    et al.
    Jönköping University, Jönköping International Business School, JIBS, Economics, Finance and Statistics.
    Zeebari, Zangin
    Jönköping University, Jönköping International Business School, JIBS, Economics, Finance and Statistics.
    Kibria, B. M. G.
    Department of Mathematics and Statistics, Florida International University, Miami, USA.
    Modified Ridge Parameters for Seemingly Unrelated Regression Model2012In: Communications in Statistics - Theory and Methods, ISSN 0361-0926, E-ISSN 1532-415X, Vol. 41, no 9, p. 1675-1691Article in journal (Refereed)
    Abstract [en]

    In this article, we modify a number of new biased estimators of seemingly unrelated regression (SUR) parameters which are developed by Alkhamisi and Shukur (2008), AS, when the explanatory variables are affected by multicollinearity. Nine estimators of the ridge parameters have been modified and compared in terms of the trace mean squared error (TMSE) and (PR) criterion. The results from this extended study are the also compared with those founded by AS. A simulation study has been conducted to compare the performance of the modified estimators of the ridge parameters. The results showed that under certain conditions the performance of the multivariate ridge regression estimators based on SUR ridge R MSmax is superior to other estimators in terms of TMSE and PR criterion. In large samples and when the collinearity between the explanatory variables is not high, the unbiased SUR, estimator produces a smaller TMSEs.

  • 16.
    Sörberg Wallin, Alma
    et al.
    Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
    Zeebari, Zangin
    Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
    Lager, Anton
    Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
    Gunnell, David
    Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom.
    Allebeck, Peter
    Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
    Falkstedt, Daniel
    Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
    Suicide attempt predicted by academic performance and childhood IQ: a cohort study of 26 000 children2018In: Acta Psychiatrica Scandinavica, ISSN 0001-690X, E-ISSN 1600-0447, Vol. 137, no 4, p. 277-286Article in journal (Refereed)
    Abstract [en]

    Objective: Academic performance in youth, measured by grade point average (GPA), predicts suicide attempt, but the mechanisms are not known. It has been suggested that general intelligence might underlie the association.

    Methods: We followed 26 315 Swedish girls and boys in population-representative cohorts, up to maximum 46 years of age, for the first suicide attempt in hospital records. Associations between GPA at age 16, IQ measured in school at age 13 and suicide attempt were investigated in Cox regressions and mediation analyses.

    Results: There was a clear graded association between lower GPA and subsequent suicide attempt. With control for potential confounders, those in the lowest GPA quartile had a near five-fold risk (HR 4.9, 95% CI 3.7–6.7) compared to those in the highest quartile. In a mediation analysis, the association between GPA and suicide attempt was robust, while the association between IQ and suicide attempt was fully mediated by GPA.

    Conclusions: Poor academic performance in compulsory school, at age 16, was a robust predictor of suicide attempt past young adulthood and seemed to account for the association between lower childhood IQ and suicide attempt. 

  • 17.
    Virtanen, Suvi E.
    et al.
    Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
    Zeebari, Zangin
    Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
    Rohyo, Izla
    Dentistry Clinic Solvändan, Sörmland Health Care Region, Mariefred, Sweden.
    Galanti, Maria R.
    Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
    Evaluation of a brief counseling for tobacco cessation in dental clinics among Swedish smokers and snus users: A cluster randomized controlled trial (the FRITT study)2015In: Preventive Medicine, ISSN 0091-7435, E-ISSN 1096-0260, Vol. 70, p. 26-32Article in journal (Refereed)
    Abstract [en]

    Objective: The aim of this study is to assess the effectiveness of a very brief structured counseling for tobacco cessation in dentistry clinics.

    Method: A cluster randomized trial was conducted in Sweden in 2012-2013.

    Twenty-seven dentistry clinics in two Swedish counties were randomized to provide either a structured brief advice based on the 5 A's model or usual care. Participants were 467 patients currently using tobacco daily (225 in the intervention group and 242 in usual care), of which 97% were retained at follow-up, six months after enrolment. Study outcomes were: 7-day abstinence (primary outcome); 3-month sustained abstinence; 50% reduction of the amount tobacco used; quit attempts lasting at least 24 h.

    Results: Compared to usual care, brief counseling was not associated to statistically significant increase in the proportion abstinent from tobacco use after 6. months. However, there was a statistically significant association with reduction of tobacco consumption (OR = 2.07 95% CI 1.28-3.35). Changes in the expected direction for all outcomes were more frequent in the intervention than in the usual care group, and larger among exclusive snus users than among smokers.

    Conclusions: Very brief and structured counseling in dentistry may achieve positive behavioral modifications among tobacco users, with significant reduction of tobacco consumption, particularly among smokeless tobacco users.

  • 18.
    Winters, Maike
    et al.
    Karolinska Institutet, Stockholm, Sweden.
    Jalloh, Mohamed F.
    Karolinska Institutet, Stockholm, Sweden.
    Sengeh, Paul
    FOCUS1000, Freetown, Sierra Leone.
    Jalloh, Mohammad B.
    FOCUS1000, Freetown, Sierra Leone.
    Conteh, Lansana
    Ministry of Health and Sanitation Sierra Leone, Freetown, Sierra Leone.
    Bunnell, Rebecca
    Centers for Disease Control and Prevention, Atlanta, GA, United States.
    Li, Wenshu
    Centers for Disease Control and Prevention, Atlanta, GA, United States.
    Zeebari, Zangin
    Karolinska Institutet, Stockholm, Sweden.
    Nordenstedt, Helena
    Karolinska Institutet, Stockholm, Sweden.
    Risk communication and Ebola-Specific knowledge and behavior during 2014-2015 outbreak, Sierra Leone2018In: Emerging Infectious Diseases, ISSN 1080-6040, E-ISSN 1080-6059, Vol. 24, no 2, p. 336-344Article in journal (Refereed)
    Abstract [en]

    We assessed the effect of information sources on Ebola-specific knowledge and behavior during the 2014-2015 Ebola virus disease outbreak in Sierra Leone. We pooled data from 4 population-based knowledge, attitude, and practice surveys (August, October, and December 2014 and July 2015), with a total of 10,604 respondents. We created composite variables for exposures (information sources: electronic, print, new media, government, community) and outcomes (knowledge and misconceptions, protective and risk behavior) and tested associations by using logistic regression within multilevel modeling. Exposure to information sources was associated with higher knowledge and protective behaviors. However, apart from print media, exposure to information sources was also linked to misconceptions and risk behavior, but with weaker associations observed. Knowledge and protective behavior were associated with the outbreak level, most strongly after the peak, whereas risk behavior was seen at all levels of the outbreak. In future outbreaks, close attention should be paid to dissemination of information.

  • 19.
    Zeebari, Zangin
    Jönköping University, Jönköping International Business School, JIBS, Economics, Finance and Statistics.
    A Simulation Study on the Least Absolute Deviations Method for Ridge Regression2012In: Communications in Statistics - Theory and Methods, ISSN 0361-0926, E-ISSN 1532-415XArticle in journal (Refereed)
    Abstract [en]

    Though the Least Absolute Deviations (LAD) method of estimation is robust, there is still the possibility of having strong multicollinearity of the predictors in a linear regression analysis. The paper consists of the application of the LAD estimation instead of the Ordinary Least Squares (OLS) estimation for the ridge regression and a simulation study to assess the performance of some biasing parameters used in the literature with their new LAD versions. The aim is to deal with the cases when the predictors are highly collinear  and the error terms are asymmetric or heavy-tailed, by giving more room to the bias in order to reduce the Mean Squared Error (MSE) of the LAD estimators.

  • 20.
    Zeebari, Zangin
    Jönköping University, Jönköping International Business School, JIBS, Economics, Finance and Statistics.
    Developing ridge estimation method for median regression2012In: Journal of Applied Statistics, ISSN 0266-4763, E-ISSN 1360-0532, Vol. 39, no 12, p. 2627-2638Article in journal (Refereed)
    Abstract [en]

    In this paper, the ridge estimation method is generalized to the median regression. Though the least absolute deviation (LAD) estimation method is robust in the presence of non-Gaussian or asymmetric error terms, it can still deteriorate into a severe multicollinearity problem when non-orthogonal explanatory variables are involved. The proposed method increases the efficiency of the LAD estimators by reducing the variance inflation and giving more room for the bias to get a smaller mean squared error of the LAD estimators. This paper includes an application of the new methodology and a simulation study as well.

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  • 21.
    Zeebari, Zangin
    Jönköping University, Jönköping International Business School, JIBS, Economics, Finance and Statistics.
    On Median and Ridge Estimation of SURE Models2012Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    This doctoral dissertation is a progressive generalization of some of the robust estimation methods in order to make those methods applicable to the estimation of the Seemingly Unrelated Regression Equations (SURE) models. The robust methods are each of the Least Absolute Deviations (LAD) estimation method, also known as the median regression, and the ridge estimation method. The first part of the dissertation consists of a brief explanation of the LAD and the ridge methods. The contribution of this investigation to the statistical methodology is focused on in the second part of the dissertation, which consists of 5 articles.

    The first article is a generalization of the median regression to the estimation of the SURE models. The proposed methodology is compared with each of the Generalized Least Squares (GLS) method and the median regression of individual regression equations.

    The second article generalizes the median regression on the conventional multivariate regression analysis, i.e., the SURE models with the same design matrices of the equations. The results are compared with the median regression of individual regression equations and the conventionally used OLS estimation method for such models (which is equivalent to the GLS estimation, as well).

    In the third article, the author develops ridge estimation for the median regression. Some properties and the asymptotic distribution of the estimator presented are investigated, as well. An empirical example is used to assess the performance of the new methodology.

    In the fourth article, the properties of some biasing parameters used in the literature for ridge regression are investigated when they are used for the new methodology proposed in the third article.

    In the last article, the methodologies of the four preceding articles are assembled in a more generalized methodology to develop the ridge-type estimation of the LAD method for the SURE models. This article has also provided an opportunity to investigate the behavior of some biasing parameters for the SURE models, which were previously used by some researchers in a non-SURE context.

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    fulltext
  • 22.
    Zeebari, Zangin
    et al.
    Department of Public Health Sciences, Karolinska Institute, Stockholm, Sweden.
    Kibria, B. M. G.
    Department of Mathematics and Statistics, Florida International University, Miami, USA.
    Shukur, Ghazi
    Jönköping University, Jönköping International Business School, JIBS, Statistics. Department of Economics and Statistics, Linnaeus University, Växjö, Sweden.
    Seemingly unrelated regressions with covariance matrix of cross-equation ridge regression residuals2018In: Communications in Statistics - Theory and Methods, ISSN 0361-0926, E-ISSN 1532-415X, Vol. 47, no 20, p. 5029-5053Article in journal (Refereed)
    Abstract [en]

    Generalized least squares estimation of a system of seemingly unrelated regressions is usually a two-stage method: (1) estimation of cross-equation covariance matrix from ordinary least squares residuals for transforming data, and (2) application of least squares on transformed data. In presence of multicollinearity problem, conventionally ridge regression is applied at stage 2. We investigate the usage of ridge residuals at stage 1, and show analytically that the covariance matrix based on the least squares residuals does not always result in more efficient estimator. A simulation study and an application to a system of firms' gross investment support our finding.

  • 23.
    Zeebari, Zangin
    et al.
    Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
    Lundin, Andreas
    Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
    Dickman, Paul W.
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Hallgren, Mats
    Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
    Are changes in alcohol consumption among swedish youth really occurring 'in concert'?: A new perspective using quantile regression2017In: Alcohol and Alcoholism, ISSN 0735-0414, E-ISSN 1464-3502, Vol. 52, no 4, p. 487-495Article in journal (Refereed)
    Abstract [en]

    Aims: Recent studies of youth alcohol consumption indicate a collective downward drinking trend at all levels of consumption, i.e. reductions occurring 'in concert'. We re-examine the collectivity of drinking theory by applying quantile regression methods to the analysis and interpretation of Swedish youth alcohol consumption.

    Method: Changes in youth alcohol consumption between 2000 and 2014 were assessed using a school-based survey conducted in Stockholm (n = 86,402). Participants were Swedish youth aged 15-18 years. The rate of change in consumption was examined using quantile regression, and compared to Ordinary Least Squares modelling. The hypothesis of parallelism or 'in concert' changes in consumption was assessed using the test of the equality of linear regression slopes corresponding to different quantiles of log consumption.

    Results: In both models, changes in consumption over time did not occur in parallel, contrary to the collectivity of drinking theory. Instead, a clear divergence in the rate of drinking was observed, with most adolescent quantiles reducing consumption, while heavy consuming remained stable.

    Conclusions: Contrary to previous studies, our findings do not support a collectivity of drinking behaviour among Swedish youth. Quantile regression is a robust and appropriate method for analysing temporal changes in alcohol consumption data.

  • 24.
    Zeebari, Zangin
    et al.
    Jönköping University, Jönköping International Business School, JIBS, Economics, Finance and Statistics.
    Shukur, Ghazi
    Jönköping University, Jönköping International Business School, JIBS, Economics, Finance and Statistics.
    On the least absolute deviations method for ridge estimation of SURE models2014In: Communications in Statistics - Theory and Methods, ISSN 0361-0926, E-ISSN 1532-415XArticle in journal (Other academic)
    Abstract [en]

    In this paper we examine the application of the Least Absolute Deviations (LAD) method for ridge-type parameter estimation of Seemingly Unrelated Regression Equations (SURE) models. The methodology is aimed to deal with the SURE models with non-Gaussian error terms and highly collinear predictors in each equation. Some biasing parameters used in the literature are taken and the efficiency of both Least Squares (LS) ridge estimation and the LAD ridge estimation of the SURE models, through the Mean Squared Error (MSE) of parameter estimators, is evaluated.

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