Kyriaki Kosidou

Research problem and specific questionsMore than half of Swedish schoolchildren do not meet the physical activity guidelines, which will have long-lasting effects on their health in adulthood. The school environment plays a crucial role in establishing healthy physical activity behaviors for a population. By reconstructing physical activity promoting schoolyards with greenery, physical activity levels among children can be increased at the population level and also mitigate health and environmental risks resulting from rising climate changes in urban areas. Research questions:How does schoolyard reconstruction affect physical activity levels, blood pressure, BMI, mental health and sleep in schoolchildren?Which components of schoolyard reconstruction are associated with changes (if any) in physical activity levels, blood pressure, BMI, mental health and sleep in schoolchildren?Are there components in the schoolyard reconstruction that affect the health outcomes of girls and boys differently?What would be the cost-effectiveness of schoolyard reconstruction on the physical activity and health outcomes of school children, and its impact on the microclimate and CO2-emissions in urban areas, if the project would be extended to other schools in Stockholm, and possibly Sweden as a whole? Data and MethodThe project will be designed as a quasi-experimental stepped-wedge trial, with schools serving as both intervention and control schools. Over the course of four years (2024-2027), a total of 20 schoolyard reconstructions will be evaluated, with five reconstructions per year. This project will include second and fifth grade children, totaling 3 600 children. Societal Relevance and UtilizationThe majority of schoolyards in Stockholm lack appealing play areas and are instead dominated by concrete and asphalt surfaces. As school participation is not segregated by socioeconomic factors, schoolyard reconstructions that promote physical activity can benefit children from all socioeconomic groups. Additionally, reconstructing schoolyards with greenery can mitigate health and environmental risks associated with increasing climate changes in urban areas. Plan for Project RealizationA formal decision has been made by the City of Stockholm to reconstruct 20 Stockholm public schoolyards from 2024 to 2027. The proposed project is a co-creation effort between the City of Stockholm, Cancerfonden, Arwidssonstiftelsen and Karolinska Institutet evaluating the effects of this decision.

The use of smokeless nicotine products (SNP) is increasing fast among young people in high-income countries, especially among women. While the adverse perinatal effects of smoking in pregnancy are well established, and the marketing and sales of smoked tobacco products thus strictly regulated, less is known about such effects of SNP. Young women’s attitudes towards, and risk perception of, SNP use in pregnancy have never been surveyed in Sweden. We therefore propose a project to fill these knowledge gaps, taking a multidisciplinary approach. The work will rest on a recent register-based cohort study, involving all pregnancies in Sweden since 1999 (N=2.4 million) with data from health data registers. We will use “snus use”, as recorded at various points of gestation in the Medical Birth Register (MBR), as our main exposure and proxy for SNP use. In addition to perinatal outcomes (e.g., gestational diabetes and preterm birth) assessed from health registers, we will explore associations between snus use and foetal growth and growth velocity identified from ultrasounds measures. We will also validate the MBR data on snus using biomarkers analysed from maternal sera. Lastly, we will conduct semi-structured interviews with young women to improve the understanding of risk perceptions. We believe that the expected research findings are important to guide the development of interventions that can mitigate any negative public health consequences of the current surge in SNP use.

This is a co-creation project between the City of Stockholm, Cancerfonden, Arwidssonstiftelsen and Karolinska Institutet with the aim to establish an evidence-based approach for schoolyard reconstruction and investigate how schoolyard reconstructions influences physical activity levels and wellbeing among school children.The following research questions will be addressed:What is the causal effect of schoolyard reconstruction on the physical activity, wellbeing and sick leave of school children?What components in the schoolyard reconstruction interventions are associated with school children’s changes (if any) in physical activity, wellbeing and sick leave?The project will be designed as a non-randomized intervention with two conditions: intervention schools (schoolyard reconstruction) and control schools (no schoolyard reconstruction). Units of observation will be 2ndand 5th grade children (in total 3,600 children.The schoolyard reconstruction intervention components will all include greening but vary by the school (e.g., increase schoolyard size etc.), reflecting the local needs. In total, five schoolyard reconstructions per year in Stockholm public schools, will be included in the project during the years 2022-2025 (in total 20 schools).This project has the potential to improve physical activity and markers of health in children, across all socioeconomic groups, and perhaps population health in the long run, by physical activity promoting schoolyard reconstructions.

Research problem and specific questionsYoung LGBTQ+ people i.e. Lesbians, Gays, Bisexuals, Transgender and Queer or Questioning persons have high risks for mental health problems but the reasons are unclear. This project will, therefore, focus on mental health of young LGBTQ+ people aged 16-29 years and vulnerable subgroups. Our research questions are:  Have the mental health outcomes of young LGBTQ+ people changed over time (2006-2021)? How has the COVID-19 pandemic impacted on the mental health of young LGBTQ people?How does the mental health of young LGBTQ+ people evolve as they transition into adulthood and what are the risk and protective factors?Why do bisexuals, transgender persons and persons with gender dysphoria have worse mental health than other LGBTQ+ subgroups i.e. gays and lesbians?What do young LGBTQ+ people think are the causes of mental ill-health among their peers and what support do they need? What works and is lacking in existing support to young LGBTQ+ people within first line health services and in society?Data and methodThe project has two parts. Part 1 is quantitative and based on the Stockholm Public Health Cohort (SPHC), a longitudinal (2002-2021) and population-based cohort (N≈140,000) with linked self-reported and registry data. The SPHC includes information on LGBTQ+ status and health, lifestyle and social factors, making it a world-unique dataset to study mental health of young LGBTQ+ people. Part 2 is qualitative and based on focus group discussions and in-depth interviews with young LGBTQ+ people.Plan for project realisationRegion Stockholm´s Centre for epidemiology and community medicine will host the project and has funded the SPHC. We ask for funds to cover costs for salaries for the project staff, data management and research- and conference travel.RelevanceAbout 15% of young people 16-29 years in Sweden (N=211,000) are LGBTQ+ persons, and young LGBTQ+ people have poorer mental health than their non-LGBTQ+ peers. It is, therefore, of great societal interest to address mental health inequities in this population. Our studies will span a very broad spectrum of young LGBTQ+ people, including gays, lesbians, bisexuals, transgender and queer persons and persons with gender dysphoria, making up a substantial share of young people in Sweden. The project will add new knowledge on the mental health of young LGBTQ+ people and help optimize the societal support and reduce inequality.

Mental and alcohol use disorders in Africa are seriously understudied and underfinanced but have a huge impact on the burden of disease, human suffering and progress towards goals of leaving no-one behind and Agenda 2030. During COVID-related lockdowns, mental distress has increased in high-income settings but primary data from Africa and appropriate interventions are lacking. However mental health is closely interlinked with school closures, lost life opportunities, poverty, food insecurity. This large population-based study in Uganda aims to analyse the occurrence of the most common mental disorders (depression, anxiety) and alcohol abuse, and interactions with poverty, age, gender, reproductive health (HIV), urbanicity, food insecurity and partner violence. We will validate tools on stigma against mental illness and care seeking, and, assess the influence of the pandemic on access to care and prevention for mental and alcohol use disorders. This 3-year project will use longitudinal data from a cohort of 11,000 individuals aged 13-80 years before, during and after the pandemic. Based on our results we will suggest new policy guidelines for health care and community interventions to mitigate the impact of mental disorders and change prevailing discriminatory views of mental health in general. We build on a strong collaboration between Karolinska and AMBSO research organisation in Uganda overall aiming to optimize capacity for operational research in low-income contexts.