Scandinavian Journal of Public Health最新文献

{"title":"A nation-wide study on snus and smoked tobacco: The Swedish Tobacco Cohort (SWETOC).","authors":"Magnus Olsson, Eva Nordendahl, Björn Klinge, Michael Fored, Johan Sundström, Anders Ekbom, Hanne Tønnesen, Stefan Gustafsson, Aron Naimi-Akbar","doi":"10.1177/14034948251350193","DOIUrl":"10.1177/14034948251350193","url":null,"abstract":"<p><strong>Aims: </strong>Smoking increases the risk of developing severe diseases. However, the effects of snus are less known. We aimed to create a cohort on tobacco exposure by collecting data from the Swedish Public Dental Service. The cohort will be used to study even rare health outcomes of both smoking and snus.</p><p><strong>Methods: </strong>In Sweden, 35% (2021) of the adult population and 85% (2021) of all children use the Public Dental Service. The dental practitioner asks about tobacco use and registers replies in patients' records. We have now assembled a database of all available such data in the country and linked them to other national health and social registers, forming the Swedish Tobacco Cohort (SWETOC). SWETOC is hence a cohort with prospectively designed data collection.ResultsOut of all 21 regions in Sweden, 19 participated, and approximately 5.5 million unique individuals provided tobacco data. Registrations dated from 1994 to 2023. All participating regions provided data from at least 2015 and forward. Overall prevalence for smoking was 12%, and 13% for snus. More men used snus than women, and there were regional differences in tobacco use patterns. Gender distribution was around equal at all age levels. Some regions provided additional tobacco information such as amount and type of product used, willingness for tobacco cessation, and notes in free text.</p><p><strong>Conclusions: </strong>\u0000 <b>SWETOC is a novel resource that can be used to close the current and future knowledge gaps regarding the health outcomes of smoked and smokeless tobacco.</b>\u0000 </p>","PeriodicalId":49568,"journal":{"name":"Scandinavian Journal of Public Health","volume":" ","pages":"672-679"},"PeriodicalIF":1.7,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13356259/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144486689","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Health literacy and screen use among 13-year-old students in Norway - A cross-sectional study.","authors":"Kristin Sofie Waldum-Grevbo, Solveig Holen, Åse Sagatun","doi":"10.1177/14034948251358570","DOIUrl":"10.1177/14034948251358570","url":null,"abstract":"<p><strong>Background: </strong>Adolescence is a life phase in which future life opportunities and patterns of adult health are established. There is growing concern about excessive screen use among adolescents. Health literacy is associated with various health behaviours, but the association with screen use is scarcely studied. The aim of this study was to investigate associations between health literacy and diverse types of screen use among students and to identify possible gender differences.</p><p><strong>Methods: </strong>Cross-sectional data was collected from a self-report survey distributed to 1425 (68.5% of those invited) 13-year-old students across 48 schools from 19 municipalities in Norway. Associations between self-reported health literacy (gathered using the Health Literacy in School Aged Children scale) and time spent on gaming, social media, TV, and total screen use were studied using linear mixed effect models.</p><p><strong>Results: </strong>Overall, a statistically significant association between health literacy and screen use was identified: an increase in health literacy tends to be associated with a decrease in screen time. This association was stronger for girls than boys and varied with different screen activities. The health literacy mean score was statistically significantly higher for boys (30.43) than girls (29.81), but the difference was small. About 25% of the students spend seven hours or more on screens on weekdays outside school hours. Girls are more likely to use social media and boys are more occupied with gaming.</p><p><strong>Conclusions: </strong>\u0000 <b>This study adds screen use to the list of health behaviours that are associated with health literacy among adolescents. Results indicate that increasing health literacy might help reduce screen time in conjunction with other targeted actions.</b>\u0000 </p>","PeriodicalId":49568,"journal":{"name":"Scandinavian Journal of Public Health","volume":" ","pages":"598-606"},"PeriodicalIF":1.7,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13356265/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144734937","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Childhood socioeconomic position and later-life mortality, morbidity and self-rated health: a linked study from the Historical Population Register of Norway and the Tromsø Study 1950-2022.","authors":"Petja L Langholz, Hilde L Sommerseth, Doris T Kristoffersen, Laila A Hopstock","doi":"10.1177/14034948251365024","DOIUrl":"10.1177/14034948251365024","url":null,"abstract":"<p><strong>Aims: </strong>Previous studies on childhood socioeconomic position (CSEP) and health have mostly focused on outcomes in early to mid-life or relied on recalled CSEP in adulthood. The objective of this study was to investigate the association of prospectively measured CSEP with a variety of health outcomes in mid to old age among residents in Northern Norway.</p><p><strong>Methods: </strong>This study linked health data from the population-based Tromsø Study to the Historical Population Register of Norway. Using Cox proportional hazards models, logistic and ordinal logistic regression, we investigated sex-specific associations between fathers' occupation in 1950 and all-cause mortality (<i>n</i>=7056), as well as chronic disease prevalence and self-rated health (<i>n</i>=4576) at age 50 years and older among Tromsø Study participants born in 1930-1955.</p><p><strong>Results: </strong>Self-rated health showed the strongest association with CSEP and a clear social gradient that was more pronounced among women. We found only minor differences in all-cause mortality and varying patterns for prevalence of chronic diseases by CSEP. High CSEP was associated with lower prevalence of chronic respiratory diseases for both women and men, and higher odds for cancer among women. Associations were attenuated when educational level was included in the models.</p><p><strong>Conclusions: </strong>\u0000 <b>Prospectively measured CSEP was associated with later-life health, although to a varying degree depending on the health indicator under study. This study highlights that, beyond binary disease endpoints, a broad indicator such as self-rated health can be an important tool to uncover health inequalities by CSEP in later life, as it summarises a multitude of possible dimensions of health and wellbeing throughout the life course.</b>\u0000 </p>","PeriodicalId":49568,"journal":{"name":"Scandinavian Journal of Public Health","volume":" ","pages":"663-671"},"PeriodicalIF":1.7,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13356268/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144976504","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Time trends and predictors of difficulties in getting to sleep among adolescents from six Nordic countries 2002-2018.","authors":"Einar Baldvin Thorsteinsson, Anne-Siri Fismen, Ársæll Már Arnarsson, Katrine Rich Madsen, Charli Eriksson, Curt Hagquist, Birgit Niclasen","doi":"10.1177/14034948251320808","DOIUrl":"10.1177/14034948251320808","url":null,"abstract":"<p><strong>Aims: </strong>Sleep difficulties among adolescents are of a significant concern given its associations with adverse health outcomes. The aims of the present study were to examine trends and predictors of self-perceived difficulties in getting to sleep among adolescents in the Nordic countries.</p><p><strong>Methods: </strong>The study was based on cross-sectional data from 10- to 17- year-olds (<i>N</i> = 139,799) from six Nordic countries (Sweden, Iceland, Norway, Denmark, Greenland, and Finland) participating in the international Health Behaviour in School-aged Children (HBSC) study, collected via six survey rounds in the period 2002-2018.</p><p><strong>Results: </strong>Since 2002, the prevalence of self-perceived difficulties in getting to sleep has risen in all Nordic countries. However, from 2014 to 2018, the trend of adolescents reporting difficulty more than weekly increased in Denmark, Finland, Greenland, and Norway, whereas it was mostly stable in Sweden, and Iceland showed a reduction. Predictors of difficulties in getting to sleep varied across countries, but younger age, reduced life satisfaction, decreased physical activity, feeling low, and feeling nervous were common predictors across the six countries. Gender and perceived family wealth had different effects on difficulties getting to sleep in different countries.</p><p><strong>Conclusions: </strong>Prevalence of and trends in difficulties getting to sleep varied by country, with a concerning rise identified in Greenland, 2006-2018. Predictors such as feeling low, feeling nervous, age, gender, life satisfaction, physical activity, and perceived family wealth varied by country and thus emphasize the need for tailored interventions to address diverse challenges in adolescent sleep health.</p>","PeriodicalId":49568,"journal":{"name":"Scandinavian Journal of Public Health","volume":" ","pages":"641-651"},"PeriodicalIF":1.7,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13356263/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143617825","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The challenge of assessing the needs of vulnerable populations in public health: Promoting an approach grounded in proportionate universalism principles.","authors":"Kenji Leta, Maïté Verloigne, Lieve Bradt, Shana Sabbe, Babette Demeester, Emelien Lauwerier, Sara Willems","doi":"10.1177/14034948251352643","DOIUrl":"10.1177/14034948251352643","url":null,"abstract":"<p><strong>Aim: </strong>Health inequities persist as a pressing public health challenge, often rooted in unequal access to resources, opportunities and privileges that disproportionately affect vulnerable populations. Proportionate universalism offers a promising approach by advocating for universal health interventions that adjust in scale and intensity to meet varying levels of needs. Despite its potential, implementing proportionate universalism in health promotion remains challenging, particularly when narrowly assessing vulnerability using socioeconomic indicators alone, which can misclassify or stigmatise vulnerable groups and perpetuate inequities. This commentary reflects on these challenges in the context of developing a smoking prevention intervention for adolescents facing societal vulnerability and proposes more nuanced strategies for assessing needs within a proportionate universalism framework.</p><p><strong>Conclusions: </strong><b>This article highlights the complexity of defining and assessing vulnerability in public health research and practice. By sharing insights from our research process, we advocate for a broader understanding of adolescent vulnerability that moves beyond traditional socioeconomic measures. We hope to inspire more inclusive and equitable health promotion interventions that are responsive to the diverse and intersecting forms of</b> <b>disadvantage individuals may experience.</b></p>","PeriodicalId":49568,"journal":{"name":"Scandinavian Journal of Public Health","volume":" ","pages":"561-567"},"PeriodicalIF":1.7,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144555543","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Non-response bias in the Norwegian Counties Public Health Survey: Insights from linkage to register data.","authors":"Thomas S Nilsen, Marit Knapstad, Jens C Skogen, Leif E Aarø, Øystein Vedaa","doi":"10.1177/14034948251360674","DOIUrl":"10.1177/14034948251360674","url":null,"abstract":"<p><strong>Aims: </strong>The Norwegian Counties Public Health Surveys (NCPHS) aim to capture critical aspects of the population's health and well-being. However, selective non-response can introduce bias, potentially compromising survey representativeness. This study assesses non-response patterns in NCPHS using registry data on health-related benefits.</p><p><strong>Methods: </strong>NCPHS comprises cross-sectional web-based surveys assessing various health metrics in Norway's adult population. This study uses data from NCPHS conducted in Hordaland County (April 10 to May 17 2018). Health data, including sickness benefits, disability pension and work assessment allowance (WAA), were linked from national registries.</p><p><strong>Results: </strong>From 34,925 invited residents, the response rate was 45.3%, with higher rates among females (50.0%), older individuals (61.0% for ages 60-69 years) and those with higher education (55.9%). Sickness benefit was not associated with participation rates (adjusted risk ratio (RR) 0.96 I, 95% confidence interval (CI): 0.90-1.02). Disability pension, particularly for mental and behavioural disorders, was associated with lower response rates (adjusted RR 0.81, 95% CI: 0.72-0.92). WAA had no overall significant effect, but WWA due to psychological conditions was related to lower response propensity (adjusted RR 0.85, 95% CI: 0.73-0.99).</p><p><strong>Conclusions: </strong>\u0000 <b>These findings suggest that health-related non-response associated with these benefits has a limited impact on overall population estimates but may introduce bias in specific subgroups, depending on the research question. Though the degree selection into a survey creates bias depend on the research question, knowing that there is relatively little selection by factors such as sickness benefit, WAA and disability pension is important as 22-23% of the population aged 18-67 receive one of these benefits at any time.</b>\u0000 </p>","PeriodicalId":49568,"journal":{"name":"Scandinavian Journal of Public Health","volume":" ","pages":"607-614"},"PeriodicalIF":1.7,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13356266/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144795982","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Identification of ongoing pregnancies using routine ultrasound procedure codes for timely surveillance of maternal vaccine uptake: A Norwegian registry study.","authors":"Melanie Stecher, Margrethe Greve-Isdahl, Jesper Dahl, Evy Dvergsdal, Suzanne Campbell, Fredrik Skår, Inger J Bakken, Hilde M Engjom, Hinta Meijerink","doi":"10.1177/14034948261457718","DOIUrl":"https://doi.org/10.1177/14034948261457718","url":null,"abstract":"<p><strong>Aim: </strong>Timely monitoring of maternal vaccination is essential for guiding immunization strategies, but ongoing pregnancies are usually not identified in health registries, resulting in delayed surveillance. We evaluated a registry-based method using routinely collected pregnancy-specific ultrasound procedure codes introduced in 2022 to identify ongoing pregnancies and demonstrate feasibility of timely vaccination surveillance, using influenza vaccination as an example.</p><p><strong>Methods: </strong>We linked population-based registry data from the Medical Birth Registry of Norway (MBRN), the Norwegian Patient Register (NPR), and the Immunisation Registry. Ongoing pregnancies in the NPR were identified using either second-trimester ultrasound procedure codes (Scenario 1) or a combination of first- and second-trimester codes with adjustments for pregnancy loss and non-attendance (Scenario 2). Estimates of vaccination uptake using ongoing pregnancies identified in the NPR as denominator were compared with estimates using birth data from the MBRN data as denominator (gold standard). Monthly and cumulative seasonal influenza vaccination uptake was assessed from October 2022 to February 2023.</p><p><strong>Results: </strong>A total of 26,996 and 27,940 pregnant women were identified using Scenarios 1 and 2, respectively, compared with 27,513 using MBRN data. Monthly vaccination uptake estimates deviated by less than 1.5% from the gold standard. Cumulative vaccination uptake was 27.1% (7328/26,996) and 26.9% (7503/27,940) for Scenarios 1 and 2, compared with 27.8% (7656/27,513) using MBRN data.</p><p><strong>Conclusions: </strong>\u0000 <b>Ongoing pregnancies can be identified through ultrasound procedure codes from administrative healthcare data, enabling robust and timely vaccination surveillance during pregnancy. The approach supports near real-time vaccination monitoring and might be applicable to broader antenatal care surveillance in general.</b>\u0000 </p>","PeriodicalId":49568,"journal":{"name":"Scandinavian Journal of Public Health","volume":" ","pages":"14034948261457718"},"PeriodicalIF":1.7,"publicationDate":"2026-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148632402","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Changes in mental health across gender and resilience among Norwegian adolescents into the COVID-19 pandemic: the Young-HUNT study.","authors":"Bodil Ev Aasan, Erik R Sund, Kirsti Kvaløy","doi":"10.1177/14034948261463421","DOIUrl":"https://doi.org/10.1177/14034948261463421","url":null,"abstract":"<p><strong>Aims: </strong>The objective of this follow-up study was to investigate whether changes in mental health from before and into the COVID-19 pandemic varied between girls and boys, as well as between adolescents with high and low levels of resilience.</p><p><strong>Methods: </strong>We included data from Norwegian adolescents (<i>n</i> = 1565, 64% girls) who participated in the Young-HUNT4 (2017-2019) and the Young-HUNT COVID (2021) surveys. We measured six dimensions of mental health using the Strength and Difficulties Questionnaire. The resilience factors-family cohesion, personal competence and social competence-were measured using the Resilience Scale for Adolescents. Linear mixed models were used to investigate whether change in the mental health dimensions depended on sex or level of resilience.</p><p><strong>Results: </strong>Change in mental health appeared to differ by sex and resilience level. Specifically, girls showed greater increases in hyperactivity, emotional symptoms and total difficulties, whereas boys displayed greater increases in peer problems along with greater decreases in prosocial behaviour. Compared with adolescents with low resilience, those with high resilience demonstrated a stronger increase in emotional symptoms, peer problems and total difficulties. Adolescents with low resilience displayed a greater decrease in prosocial behaviour. A decrease in conduct problems was observed among adolescents with low resilience, which was not evident among those with high resilience.</p><p><strong>Conclusions: </strong>\u0000 <b>The present findings suggest that girls and boys, as well as adolescents with high and low levels of resilience, may have experienced the pandemic situation somewhat differently.</b>\u0000 </p>","PeriodicalId":49568,"journal":{"name":"Scandinavian Journal of Public Health","volume":" ","pages":"14034948261463421"},"PeriodicalIF":1.7,"publicationDate":"2026-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148473414","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How are non-optimal air temperatures related to health care use among older populations in Europe? A systematic scoping review 2000-2024.","authors":"Linda Enroth, Laura Kananen, Ella Tapola, Jutta Pulkki","doi":"10.1177/14034948261460380","DOIUrl":"https://doi.org/10.1177/14034948261460380","url":null,"abstract":"<p><strong>Aims: </strong>The climate in Europe is warming, and the population is ageing faster than on other continents. These concurrent trends present significant challenges for social, economic and ecological sustainability of health care systems. This systematic scoping review examines how non-optimal air temperatures are associated with health care utilization among older populations in Europe.</p><p><strong>Methods: </strong>We screened peer-reviewed articles from six databases (MEDLINE, Science Direct, Web of Science, Scopus, ProQuest and GreenFILE) published in English during 2000-2024. The key search terms were air temperature, older people, health care services and Europe. We screened 1794 articles, reviewed 144 full-texts and extracted data from 52 articles. Of the included articles, 29 (56%) focused on heat exposure, 10 (19%) on cold exposure and 13 (25%) on both.</p><p><strong>Results: </strong>A positive association between non-optimal air temperature and health care use was found in 43 (38%) of heat-related and 30 (48%) of cold-related analyses. Emergency hospital admissions were the most frequently examined type of health care service, with cardiovascular and respiratory conditions being the primary causes. The strongest evidence of positive associations was observed for respiratory conditions in emergency hospitalisations and for cardiovascular hospitalisations associated with cold exposure. The evidence regarding modifying effects of social vulnerabilities remains limited.</p><p><strong>Conclusions: </strong><b>Our findings highlight the need for future research using large datasets to explore a wider range of health conditions, to identify individual and area-based risk factors and to explore different types of health care services, transitions between them, and mortality as a competing event</b>.</p>","PeriodicalId":49568,"journal":{"name":"Scandinavian Journal of Public Health","volume":" ","pages":"14034948261460380"},"PeriodicalIF":1.7,"publicationDate":"2026-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148399870","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence and characteristics of concerned significant others of individuals with gambling problems in Sweden: A population-based study.","authors":"Johan Svensson, David Forsström, Erica Sundin","doi":"10.1177/14034948261459770","DOIUrl":"https://doi.org/10.1177/14034948261459770","url":null,"abstract":"<p><strong>Background and aims: </strong>Gambling problems impact not only individuals who gamble but also those closely associated with them, referred to as concerned significant others (CSOs). Many of the harms experienced by individuals who gamble also affect CSOs. These include negative economic consequences and physical and mental health problems (e.g. depression and anxiety). This study aimed to estimate the prevalence of CSOs affected by gambling at the population level in Sweden and to describe the characteristics of CSOs.</p><p><strong>Methods: </strong>The data were derived from a survey conducted on a nationally representative sample of the Swedish population. The initial sample comprised 27,000 individuals aged 17-84 years living in Sweden. The response rate was 36.8%, resulting in an analytical sample of 9819 respondents. The study had a cross-sectional design, and Poisson regression models with robust error variance were applied to assess associations.</p><p><strong>Results: </strong>A total of 5.5% of the sample reported being a CSO of an individual who gambled during the past 12 months. No significant sex differences were found. An age gradient was observed, with older adults (aged 50-84 years) being less likely to report being a CSO. CSOs had higher scores on the Problem Gambling Severity Index and were more likely to report heavy episodic drinking, daily smoking and drug use during the past year. They also reported poorer health than non-CSOs. When comparing all CSOs with those who reported negative consequences of being a CSO, we found higher risks of problem gambling, daily smoking and poor health among those reporting negative consequences.</p><p><strong>Conclusions: </strong>\u0000 <b>The findings suggest that gambling prevention and treatment efforts should also target CSOs due to the negative consequences they experience.</b>\u0000 </p>","PeriodicalId":49568,"journal":{"name":"Scandinavian Journal of Public Health","volume":" ","pages":"14034948261459770"},"PeriodicalIF":1.7,"publicationDate":"2026-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148383053","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}