Epidemiology and Public Health Intervention Research (EPHIR) – Jette Möller's research group

Research areas

Research projects encompass descriptive, analytical as well as experimental studies in both community and institutional settings, with particular focus on social, behavioral and lifestyle factors of importance for human health during the whole life span. Also, studies rest on a variety of data sources, involving ad-hoc surveys, population-based registers, as well as biologic samples, particularly molecular genetics.

Collaborators

There are ongoing national collaborations within KI and external with Stockholm University,  the Public Health Agency of Sweden, Lund University, and many other international academic institutions. An important partner is the Centre for Epidemiology and Community Health of Stockholm County Health Care District (CES), where some of the group researchers have part-time commitments.

Internationally the group holds collaborations with Helsinki University, Oxford Brookes and Sheffield University (UK) and Avogadro University (IT) Within the group, a consortium between Norway (NIPH-FHI), Finland (THL) and Sweden (KI) has been promoted to conduct joint studies of the association between tobacco use and COVID-19.). 

The group is among the promoters of the European Society of Prevention Research (EUSPR).

Education

The group's members are actively involved in education at all levels as responsible for both programs and courses. Yearly we supervise several master students in their degree projects. For inquiries on degree projects, we refer to the PIs listed under current research projects.

Doctoral theses

• Bereavement and risks of cardiovascular diseases and mortality (ki.se) (2022), Hua Chen
• Bereavement in adulthood and risks of incident and recurrent cardiovascular diseases (ki.se) (2022), Dang Wei
• Social integration and immigrant mental health : the role of social capital and neighbourhood ethnic composition (ki.se)  (2021), Charisse Johnson-Singh
• The association between smoking behaviour and depressive symptoms in adolescence : the role of biology and of societal influences (2020), Elena Raffetti
• Adolescents’ future academic prospects : predictors and mental health outcomes (ki.se) (2019), Melody Almroth
• Depression among adolescents and young adults : social and gender differences (ki.se) (2018), Wirback, Therese
• Depression and cardiovascular diseases (ki.se) 2018), Aysha Almas
• Exercise as treatment for depression (ki.se) (2016), Björg Helgadottir
• Tobacco use and dependence : does it originate in utero? (ki.se) (2014), Mina Rydell
• Social environment and genetics as determinants of depression occurrence and its chronicity : a longitudinal survey (ki.se) (2013), Carlos Andrés Fandiño-Losada
• Triggers of sick leave : epidemiological studies of work-related factors (ki.se) (2011), Hanna Hultin

Currently, the group has received financial support from Forte, Swedish Research Council, NordForsk, the Public Health Agency, and Stockholm Region Health Care sector.

A national survey of physical activity and sedentary behaviour in Swedish children, Riksmaten young children

This study will generate new important knowledge about physical activity, sedentary time, and physical activity patterns among different ages, sex, and socioeconomic background in young children.

Approximately 2000 girls and boys aged 18 months and 4 years will be included in this study between 2021 and 2023. Physical activity and sedentary time will be measured objectively with hip worn accelerometers (Actigraph) for seven consecutive days. Data will be collected on physical activity behaviours, screen time, sleep, height, weight and parental socioeconomic background. This data collection will be part of a survey where also the dietary intake will be assessed with a validated web-based method using a repeated 24-h multiple pass recall method for three days.

PI: Gisela Nyberg

A school-based intervention to improve mental health, cognitive function, academic performance and decrease health inequalities in adolescents: A cluster randomised trial

The findings from this novel project will guide the development of evidence-based advice and tools for schools in order to design curricula and develop sustainable and effective strategies in schools to promote health and facilitate learning in students.

The majority of adolescents do not meet the physical activity recommendation and there has been an increase in mental health problems. Adolescents report decreased time in reading and there is a large variation in reading comprehension depending on socio-economic background. There is inadequate evidence on what types of school-based interventions that improve mental health, cognitive function and academic performance and how to implement such interventions. This study will evaluate both outcome and process in 3 studies; (1) To explore barriers and facilitators related to an extension of the school day and identify feasible implementation strategies. Data will be collected through workshops and analyzed using content analysis, (2) To study the effects of a cluster randomized school-based intervention on mental health, cognitive function, and academic performance. Fifty schools with 2500 adolescents in grade 8 will be randomized to intervention or control groups. The intervention will be performed during an extended school day, 60 minutes three times/week, during one school year and include (a) physical activities, (b) homework support with activity breaks, and (c) walking and listening to a digital book. Physical activity will be measured by accelerometry, mental health with questionnaires, cognitive function by a computer-based test battery and academic performance by grades. Effectiveness regarding outcomes between groups will be analyzed by multi-level models, adjusting for relevant covariates, (3) To conduct a process evaluation including intervention dose, fidelity, feasibility, acceptability, and a description of the context to elucidate facilitating and hindering factors. Data will be analyzed with content analysis.

PI: Gisela Nyberg

This project is funded by grants from the Knowledge Foundation, Skandia Insurance and The Kamprad Family Foundation for Entrepreneurship, Research & Charity.

Bereavement and the risk of cardiovascular diseases: a lifecourse perspective

The death of a close relative is one of the most severe sources of stress and most individuals will experience it at least once in life. Increasing evidence suggests that death of a spouse in middle-aged and elderly individuals is associated with an increased risk of cardiovascular mortality. However, knowledge regarding the link between the loss of other type of relatives or of bereavement earlier in life and the risk of incident or of recurrent cardiovascular diseases is limited. The overall aim of this project is to investigate whether bereavement in different stages of life is associated with increased risks of incident and recurrent cardiovascular diseases. Several studies are being conducted by linking survey, clinical, conscription and/or Nordic register data. Better knowledge regarding the effect of bereavement across the lifespan on cardiovascular diseases may call for better support and attention from family and health care professionals to buffer its adverse health effects.

PI: Krisztina László

The project is funded by the Swedish Council for Working Life and Social Research.

Bamba

Intervention study aiming at improving microbiota in persons with ADHD. In cooperation with Center of Molecular Medicine.

PI: Yvonne Forsell

Cannabis use among young adults

The aim of this project is to study the hidden occurrence of cannabis use among young adults in Sweden, the health care response to cannabis-related problems and the potential modification in prevalence following different policy scenarios.

The project is part of a PhD track and encompasses four studies based on different data sources: health care visits in Stockholm region (VAL database); ad hoc survey with randomized response technique; international data collected at the European level by the EMCDDA.

PI: Rosaria Galanti

The project is partly funded by the Stockholm Region Health Care sector.

Fitforlife

Physical exercise in psychosis with the aim to increase function (social, cognitive and metabolic).

National project in cooperation with user organisations. So far 16 open care units involved. Education of persons affected by psychosis to be exercise trainers leading sessions for other patients at psychiatric open care units. Tests before and after 6 months. Cooperation with Swedish School of Health and Sports Medicine, Center of Molecular Medicine, User organisations and regions.

PI: Yvonne Forsell

Kupol

The aim of this project is to study determinants of mental ill health among adolescents, with particular emphasis on school and family related factors.

This is a longitudinal study of mental health in adolescence including about 4 thousands participants recruited in the 7th grade of the compulsory school (about 13 years old), with follow-up until the year after they left the compulsory grades, i.e. about 17 years old. The primary outcome (mental health) is assessed through the SDQ reported by the adolescents and by their parents. The data encompasses information on several predictors collected at different levels: the adolescents themselves, their parents, their schools. A subsample of about one thousand individuals also donated saliva samples that were used for analyses of biomarkers and for epigenetic analyses. Links with several registers were performed, both health care based (e.g., the Prescribed Drug Registers, in-and outpatient care registers) and socio-demographic or administrative (e.g., National Insurance Agency). This rich data repository is available for researchers after application to the project leader.

The project has yielded 19 scientific articles published in peer-reviewed journals and two PhD theses.

Galanti, MR Hultin H, Dalman C, Engström K, Ferrer-Wreder L, Forsell Y,  Karlberg M,  Lavebratt C, Magnusson C, Sundell K,  Zhou J,  Almroth M, Raffetti E. School environment and mental health in early adolescence - A longitudinal study in Sweden (KUPOL). BMC Psychiatry 2016;16:243 doi: 10.1186/s12888-016-0919-1

László KD, Andersson F, Galanti MR. School climate and mental health among Swedish adolescents: a multilevel longitudinal study. BMC Public Health. 2019 Dec 17;19(1):1695. doi: 10.1186/s12889-019-8018-0

Research project KUPOL – Knowledge of adolescents' mental health and learning | EPHIR

PI: Rosaria Galanti 

The project was funded with a grant from the Swedish Research Council, Vinnova, Formas and FORTE.

Life-course study on cardiovascular diseases: interaction between birth markers and behavioral health patterns

The aim of this project is to assess the joint association between fetal growth and adult behaviors on the risk of cardiovascular diseases in young- and middle-aged adulthood.

The risk of cardiovascular diseases starts in early life and accumulates across life course. This project aims to answer the questions regarding whether and to what extent changes in health behaviors in adulthood can modify the risk of cardiovascular diseases that originates during early life. Findings are expected to help public health workers to facilitate individualized cardiovascular prevention programs to reduce the risk and burden of cardiovascular diseases from a life course perspective.

PI: Yajun Liang

The project is funded with a grant from the Swedish Research Council

Maternal diseases during pregnancy and the risk of severe cardiovascular diseases up to middle-age in the offspring: a Nordic collaborative study

The burden of cardiovascular diseases continues to rise despite considerable achievements in prevention and treatment. New insights into the development of the disease are needed. According to the theory of the foetal origins of health and disease, adverse conditions in utero may program the offspring’ s neuroendocrine and metabolic activity and may increase the risk of cardiovascular diseases. There is a growing body of evidence to suggest that children exposed to specific maternal disease during pregnancy have increased risks of preterm birth, fetal growth restriction and cardiovascular risk factors including high blood pressure, obesity, and diabetes. However, evidence for a direct link between these exposures and severe cardiovascular diseases is very limited. The overall aim of the project is to investigate whether specific maternal diseases during pregnancy are associated with increased risks of cardiovascular diseases in the offspring later in life. The study population consists of more than 8 million live births from the Danish (1978-2018), the Finnish (1987-2014) and the Swedish birth registries (1973-2021). Data on health and socioeconomic factors in children, parents and other relatives is obtained through linkage to national health and socioeconomic registers. Our findings may provide new opportunities for prevention very early in life to reduce the burden of cardiovascular diseases.

PI: Krisztina László

The project is funded by the Swedish Heart and Lung Foundation.

Newly initiated pharmacotherapy and unintentional poisoning in older adults -assessment of the short-term risks and identification of high-risk groups.

This project aim to add to the limited body of evidence in the field of acute risks of newly initiated pharmaceutical treatments in older adults. Specifically, it aim to determine the short-term risk of unintentional poisoning in relation to commonly prescribed medications affecting the cardiovascular and central nervous system. Further, to identify groups of individuals at risk (with regard to sociodemographic and health conditions) as well as critical time periods. The project is based on a register-based case-crossover design. It identifies all incident cases of unintentional poisoning among those aged 50 years and older in Sweden from 2006 to 2018 (approx. 15 000), based on hospitalisations and deaths according to the National Patient Register and the Cause of Death Register. Information on newly and chronic prescribed medications is linked using the Prescribed Drug Register. The results will inform about short-term adverse health effects of common pharmacotherapies and also identify effect modifiers to increase the knowledge of vulnerable groups, in order to assist clinicians in surveillance from a patient-safety perspective.

PI: Jette Möller

The project is funded by grant from Forte.

Part

A longitudinal population-based cohort study aiming to study mental health, work, and relationships, the interplay between these factors, and the consequences thereof. The baseline cohort consists of 10,441 adults aged 20-64 years residing in Stockholm County in 1998. The participants were followed up with questionnaires in 2003 (n=8613) and 2010 (n=5621). In 2010 and 2021 new random samples of 20-30 years participated. To the self-reported data, a range of health outcomes based on registers of inpatient and care at specialized hospital clinics), sick leave, mortality, and prescribed drugs has been linked and is to date available up to 2021.

A significant feature of the PART study is the inclusion of validated psychiatric scales combined with comprehensive information on psychosocial factors. In addition, saliva samples for DNA have been collected for 6000 persons and a cognitive test has been performed on a subsample.

Scientific publications based on the PART study are comprehensive.

PI: Jette Möller

The most recent data collection was funded by Forte/FORMAS.

Physical activity for healthy brain functions in school children

The aim of this project is to investigate the cross-sectional relationships and acute effects between detailed physical activity patterns, sedentary time, and healthy brain functions in adolescents.

Cross sectional data were collected in the autumn 2019. In total, 1142 boys (49%) and girls (51%), aged 13-14 years, were included in the study with a participation rate of 73% in the 64 school classes. The participants came from 34 schools that varied in size, geographical region and parental socio-economic background from 22 municipalities around Stockholm. Physical activity and sedentary time were measured for seven days by accelerometry. Working memory and episodic memory were used as measures of cognitive functions using a computer-based test battery. The mental health outcomes; health-related quality of life, anxiety, psychosomatic health, stress and hyperactivity were measured with questionnaires; KIDSCREEN-10, SCAS-S, PSP, SISQ and SDQ. Cardiovascular fitness was estimated with a cycle ergometer test. Dietary intake was self-reported with a web-based method using a repeated 24-h multiple pass recall method for three days. Body weight and height were measured using standardised procedures. The teachers reported about the physical environment of the participating schools.

Publications:

• Kjellenberg K, Ekblom O, Ahlen J, Helgadottir B, Nyberg G. Cross-sectional associations between physical activity pattern, sports participation, screen time and mental health in Swedish adolescents. BMJ Open. 2022;12(8):e061929.
• Regan C, Walltott H, Kjellenberg K, Nyberg G, Helgadottir B. Investigation of the Associations between Diet Quality and Health-Related Quality of Life in a Sample of Swedish Adolescents. Nutrients. 2022;14(12).
• Helgadottir B, Bauren H, Kjellenberg K, Ekblom O, Nyberg G. Breakfast Habits and Associations with Fruit and Vegetable Intake, Physical Activity, Sedentary Time, and Screen Time among Swedish 13-14-Year-Old Girls and Boys. Nutrients. 2021;13(12).
• Nyberg G, Ekblom O, Kjellenberg K, Wang R, Larsson H, Thedin Jakobsson B, et al. Associations between the School Environment and Physical Activity Pattern during School Time in Swedish Adolescents. Int J Environ Res Public Health. 2021;18(19).
• Kjellenberg K, Ekblom Ö, Stålman C, Helgadóttir B, Nyberg G. Associations between Physical Activity Patterns, Screen Time and Cardiovascular Fitness Levels in Swedish Adolescents. Children. 2021;8(11):998.
• Yman J, Helgadottir B, Kjellenberg K, Nyberg G. Associations between organised sports participation, general health, stress, screen-time and sleep duration in adolescents. Acta Paediatr. 2022.

PI: Gisela Nyberg

This project is funded by a grant from the Knowledge Foundation

Regassa

A randomized controlled trial of internet-based cognitive behavioral therapy, physical activity and treatment as usual in mild to moderate depression. National RCT in 6 regions. Diagnosed depression in primary care.

PI: Yvonne Forsell

Saga Sagor

A project focusing on a new method to support children at age of 4 and 5 and their families at BVC.

Saga Sagor project will evaluate whether the new conversation method, Saga Sagar, benefit the children and their families. It includes two phases. In phase I, qualitative research has been conducted. In phase II, a cluster randomized intervention will be conducted, collecting information on self-efficacy of parents after Saga Sagor is implemented. Project leader for phase II is Marie Löf.

PI: Susanne Andermo

The project is funded with a grant from Cancerfonden.

The COVID-19 pandemic and changes in physical activity patterns, mental health and academic performance in Swedish adolescents

The aim of this study is to investigate changes in mental health, academic performance and lifestyle factors among Swedish adolescents before and during the COVID-19 pandemic.

Adolescents aged 14-15 (grade 8) (n=1139) who participated in the baseline measurements in 2019 before the COVID-19 pandemic (autumn 2019). Participants have been invited to follow-up measurements during the pandemic (spring 2021). During the baseline measurements, the participants filled in a 3-day dietary recall and participated in a fitness test and cognitive function tests. Their body weight, height and body fat were measured and they were equipped with an accelerometer for 7 days to assess physical activity patterns. Furthermore, a questionnaire with items covering mental health, dietary intake, stress, sleep, physical activity habits and screen-time was answered.

In the follow-up study (spring 2021) participants have answered a shorter version of the questionnaire and used an accelerometer for 7 days. The questionnaires and accelerometers were distributed by the schools or sent out by post. Physical activity patterns were measured by accelerometry, mental health (health-related quality of life and anxiety) was assessed with questionnaires, and academic performance was assessed with school grades (Swedish and mathematics). The questionnaire also included items on psychosomatic health, stress, sleep, physical activity habits and screen-time. Additional questions have been added in the follow-up questionnaire regarding the students’ current school situation, i.e., the amount of distance learning and resources at home, and changes in behavior during the pandemic. Register data on parental education will also be collected and used as an indicator of socioeconomic position.

Publications:

• Nyberg G, Helgadóttir B, Kjellenberg K, Ekblom Ö. COVID-19 and unfavorable changes in mental health unrelated to changes in physical activity, sedentary time, and health behaviors among Swedish adolescents: A longitudinal study. Front Public Health. 2023 Mar 10;11:1115789. 
• Helgadóttir B, Fröberg A, Kjellenberg K, Ekblom Ö, Nyberg G. COVID-19 induced changes in physical activity patterns, screen time and sleep among Swedish adolescents - a cohort study. BMC Public Health. 2023 Feb 23;23(1):380.

PI: Gisela Nyberg

This project is funded by a grants from Skandia Insurance and the Public Health Agency.

Tobrisk-Cov

The aim of the project is to study the potential causal association between tobacco use (snus and cigarettes) and the risk of COVID-19.

This collaborative project among Nordic Countries encompasses several register-based studies from Sweden, Norway and Finland as well as a pooled analysis including data from all three countries. From Sweden two cohort-base analyses are being conducted, one based on a cohort of clients of the Public Dentistry clinics the other on data from the Stockholm Public Health Cohort. In all studies, smoking histories from participants are collected prospectively with reference to the outcome (COVID-19 disease).

PI: Rosaria Galanti

The project is funded with a grant from NordForsk

Topas

The aim of this project is to evaluate the effectiveness and cost-effectiveness of a school-based preventive program (Rökfri Duo) on adolescents’ tobacco use initiation.

This was a cluster-randomized school-based pragmatic trial complemented by a repeated cross-sectional study. The cluster-randomized trial involved 34 schools and about 1800 students. Schools were randomized to either a comprehensive multi-component tobacco prevention program or to a brief structured educational program on tobacco. The primary outcome was the onset of smoking, snus use or e-cigarette use. The intervention was administered in 7th, 8th and 9th grades of the compulsory school. One baseline assessment prior to the intervention and three follow-up surveys were conducted. Data was collected on the program’s costs to allow for a cost-effectiveness analysis.

This rich data repository is available for researchers after application to the project leader. 

The project's data collection has been finalized and the report to the funder (Swedish with English abstract) can be read on Topas - tobakspreventivt arbete i skolan. Slutrapport : en utvärdering av det ANDT-förebyggande programmet Tobaksfri duo (diva-portal.org)

Study protocols:

• Galanti MR, Pulkki-Brännström AM, Nilsson M. Tobacco-Free Duo Adult-Child Contract for Prevention of Tobacco Use Among Adolescents and Parents: Protocol for a Mixed-Design Evaluation. JMIR Res Protoc. 2020 Oct 29;9(10):e21100. doi: 10.2196/2110
• Pulkki-Brännström A-M, Galanti MR, Nilsson M. Protocol for the evaluation of cost-effectiveness and health equity impact of a school-based tobacco prevention programme in a cluster randomised controlled trial (the TOPAS study). BMJ Open 2021;11:e045476. doi:10.1136/ bmjopen-2020-045476

Early results:
Beeres D, Arnö E, Pulkki-Brännström AM, Nilsson M, Galanti MR. Evaluation of the Swedish school-based program "tobacco-free DUO" in a cluster randomized controlled trial (TOPAS study). Results at 2-year follow-up. Prev Med. 2022 Feb;155:106944. doi: 10.1016/j.ypmed.2021.106944

PI: Rosaria Galanti 

The project was funded with a grant from the Swedish National Agency for Public Health.