Tonje Holte Stea

• Carvalho, Barbara Oliveira Vieira de; Stea, Tonje Holte; Coombes, Lindsey & Haugland, Siri Håvås (2026). Associations Between Parental Alcohol Use and Parenting Practices: A Systematic Review. Behavioral Sciences. 16(2). doi: 10.3390/bs16020236. Full text in Research Archive Show summary

  Parental practices strongly influence offspring development, and parental alcohol use may affect parenting behavior. However, most studies have focused on child-related outcomes. This review instead examined associations between parental drinking and parenting practices. Following PRISMA guidelines, a systematic search in MEDLINE, PsycINFO, Embase, and Scopus identified 9053 articles. Of these, 222 full texts were screened by two reviewers, and 77 were included for critical appraisal. After quality assessment, 68 studies published between 1991 and 2026 were reviewed. Studies were included if they (i) measured parental alcohol use as a predictor and parenting practices as an outcome, (ii) involved offspring under 20 years, (iii) had a quantitative design, (iv) were peer-reviewed and published in English, and (v) excluded pregnancy measures and alcohol/parenting treatment interventions. Parenting factors (e.g., parent–child relationship, monitoring, communication, discipline, conflict, abuse) were categorized and grouped into general and alcohol-specific practices. Parental drinking was categorized into alcohol use disorders (AUD) and non-dependent alcohol use. Sixty-four studies reported at least one significant association between parental drinking and poorer parenting practices. Mixed results were observed for non-dependent drinking and alcohol-specific parenting. Some associations varied with parental gender. Overall, different drinking patterns appear to be linked to impaired parenting quality. Despite being the most common pattern of alcohol use, non-dependent drinking remains understudied in parenting research. The present review highlights several critical gaps in the literature, particularly regarding the relationship between non-dependent drinking, maternal AUD, and parenting practices. Moreover, contextual factors, such as socioeconomic status and gender differences, are insufficiently explored, limiting the understanding of heterogeneity in risk and outcomes. Future research would benefit from employing robust longitudinal designs and expanding geographical representation, in order to capture variation across sociocultural contexts and enhance the generalizability of findings.

• An, Charis Rachel Ae Young; Dias, Stephanie Maria do Nascimento; Herkrath, Fernando José; Stea, Tonje Holte & Vettore, Mario Vianna (2026). The relationship between patterns of noncommunicable diseases and depressive symptoms in rural population: a latent class analysis. Psychiatry Research. ISSN 0165-1781. 366. doi: 10.1016/j.psychres.2026.117473. Full text in Research Archive Show summary

  Aim Noncommunicable diseases (NCDs) may exacerbate mental health problems in urban populations. However, the extent to which multimorbidity of NCDs influences depressive symptoms among rural populations is unclear. This study evaluated multimorbidity patterns of NCDs and examined their relationship with depressive symptoms in individuals aged 15 years and older living in rural areas. Method A cross-sectional study using data from a representative sample of the rural Brazilian population (N = 20,973) were analysed. Latent class analysis was used to identify multimorbidity patterns across eleven NCDs. Associations between multimorbidity patterns and depressive symptoms were tested using logistic regression models adjusted for demographics, socioeconomic factors and behaviours. Results The mean age of the sample was 43.4 years and 47.3% of the participants were female. Four multimorbidity clusters were depicted: class 1: low morbidity class, class 2: musculoskeletal-cardiometabolic cluster, class 3: complex multimorbidity cluster, and class 4: cardiometabolic-oral health cluster. Higher-prevalence patterns (classes 2-4) were associated with major depression (Class 2, OR = 8.9 [95%CI 5.3–15.1]; Class 3, OR = 8.5 [95%CI 5.3–13.6]; Class 4, OR = 2.3 [95%CI 1.3–4.1]) and other depression (Class 2, OR = 2.2 [95%CI 1.3–3.9]; Class 3, OR = 4.3 [95%CI 2.4–7.4]; Class 4, OR = 1.8 [95%CI 1.2–2.9]). Conclusion Distinct clusters of multimorbidity of NDCs play a significant role in depressive symptoms in rural people. The development of depression screening and early interventions in rural healthcare services for individuals with multimorbidity may mitigate the long-term mental health problems consequences.

• Opdal, Ida Marie; Bonsaksen, Tore; Kleppang, Annette Løvheim; Steigen, Anne Mari & Stea, Tonje Holte (2026). Screen socialising and depressive symptoms among Norwegian adolescents and the impact of the COVID-19 pandemic. Scandinavian Journal of Public Health. ISSN 1403-4948. p. 1–8. doi: 10.1177/14034948261459775. Full text in Research Archive Show summary

  Aims: This study aimed to assess associations between online gaming with others, online socialising and depressive symptoms among adolescents, and whether these associations changed before, during and after the COVID-19 pandemic (2018, 2021 and 2023). Methods: Cross-sectional data among Norwegian adolescents aged 13–19 years in 2018, 2021 and 2023, comprising a total sample of 83,453 adolescents (Oslo: n=69,164; Møre og Romsdal: n=14,289), were used in the analyses. Multivariable binary logistic regression models, stratified by sex, were used to examine associations between online gaming with others, online socialising and depressive symptoms separately for each study year. The models were adjusted for school level, having trusted friends and perceived family economy. Results: Among girls, the results showed slightly higher odds of depressive symptoms during the pandemic than before the pandemic (odds ratio (OR)=1.1; 95% confidence interval (CI): 1.1–1.2). Frequent online gaming with others and online socialising were associated with increased odds of depressive symptoms among boys (OR=1.2; 95% CI 1.1–1.4 and OR=1.5; 95% CI 1.3–1.6) and girls (OR=1.8; 95% CI 1.6–2.0 and OR=1.7; 95% CI 1.5–1.8). Among girls, weekly online gaming with others was associated with higher odds of depressive symptoms in 2021 (OR=1.4; 95% CI 1.2–1.6). Among boys with no online socialising, frequent online gaming with others was associated with increased odds of depressive symptoms (OR=1.8; 95% CI 1.3–2.3). Conclusions: Frequent online gaming with others and online socialising were associated with higher levels of depressive symptoms among both boys and girls, with stronger associations observed among girls, particularly during the pandemic.

• Steigen, Anne Mari; Stea, Tonje Holte; Granrud, Marie Dahlen; Dangmann, Cecilie Ruud & Bonsaksen, Tore (2026). Trends in sexual harassment exposure among adolescents in Norway between 2017 and 2023 and associations with depressive symptoms. Nordic Journal of Psychiatry. ISSN 0803-9488. 80(6), p. 366–374. doi: 10.1080/08039488.2026.2694659. Full text in Research Archive Show summary

  Purpose The aim of this study was to examine trends in sexual harassment victimization and possible changes in the association between sexual harassment victimization and depressive symptoms among adolescents (aged 16–19) in Norway between 2017 and 2023. Methods This study used cross-sectional data from the national Ungdata Survey conducted in upper secondary schools in Norway from 2017 to 2023 (total N = 229 417). Descriptive analyses and chi-square tests were used to examine changes in sexual harassment victimization across years by gender and age. Logistic regression analyses were used to study temporal trends and potential changes in the association between sexual harassment victimization and depressive symptoms. Results The prevalence of any sexual harassment victimization increased significantly among adolescents between 2017 and 2023. Girls reported a higher prevalence of all forms of sexual harassment victimization than boys. When studying the genders separately, the increase in exposure over time was statistically significant only among girls. Sexual harassment victimization was significantly associated with depressive symptoms in all years for both boys and girls. The strength of this association was generally higher among boys than among girls, and this gender difference became more pronounced between 2017 and 2023. Conclusions Our findings indicate a significant increase in sexual harassment victimization among girls between 2017 and 2023. Although girls are more frequently exposed to sexual harassment than boys, the association with depressive symptoms tends to be stronger among boys, and this difference appears to increase over time.

• Moen, Ellen Ånestad; Bonfils, Inge Storgaard; Sejersted, Ellen; Svendsen, Torhild & Stea, Tonje Holte (2026). Individual placement and support in the Scandinavian countries: a scoping review of providers’ perspectives on implementation and integration in cross-sectoral settings. European Journal of Social Work. ISSN 1369-1457. p. 14–14. doi: 10.1080/13691457.2026.2676560. Full text in Research Archive
• Grasaas, Erik; Ostojic, Sergej; Stea, Tonje Holte & Sandbakk, Øyvind Bucher (2026). Prior-night sleep duration and the relationship to quality of life and educational context in Norwegian pre-adolescents. BMC Pediatrics. 26. doi: 10.1186/s12887-026-06830-6. Full text in Research Archive Show summary

  Sufficient sleep is associated with improved development, health, and quality of life (QoL). The aim of this paper is twofold: (1) to describe prior-night sleep duration according to sleep recommendations across socioeconomic status (SES), age, gender and screen time use among Norwegian pre-adolescents and (2) to explore the association between reported prior-night sleep duration with QoL and school factors stratified by gender. Cross-sectional data was aggregated from the Norwegian Ungdata Junior Survey, collected in 2024. In total, 45,185 children aged between 10 and 12 years provided self-reported data anonymously by filling out an electronic/online questionnaire during school hours. About half of the study sample (53.1%) reported adherence to international sleep recommendations for children aged 10 to 12 years, with somewhat higher adherence among boys than girls(54.5% vs. 51.8%, p < 0.01). Results from binary regressions revealed positive associations related to QoL and school factors among children adhering to sleep recommendations compared to ones not adhering, with adjusted odds ratio ranging from 1.33 to 1.79 (all p < 0.01). In this population-based sample of Norwegian children aged 10 to 12 years, approximately half reported not achieving the recommended 9 to 12 h of sleep per night. Reporting prior-night sleep duration in accordance to the international sleep recommendations were strongly associated with higher QoL and positive school related factors among boys and girls, but particularly strong among girls. These findings emphasize the vital role of adequate sleep among pre-adolescents for QoL and optimizing school contexts, offering valuable insight for future practice and policy. 1. Why is this study needed? Children aged 10 to 12 years are recommended to obtain 9 to 12 h of sleep per day to support optimal health and development. However, global evidence indicates that between one-third to one-half of children report failing to meet these recommendations. 2. What is the key problem/issue/question this manuscript addresses? The aims of this paper were twofold: (1) to describe prior-night sleep duration according to the sleep recommendation across age, socioeconomic levels, gender and screen time use among Norwegian children aged 10 to 12 years and (2) to explore the association between reported prior-night sleep duration with quality of life and school factors stratified by gender. 3. What is the main point of your study? Research specifically examining sleep adherence and quality of life in Norwegian pre-adolescents is scarce. This study addresses that gap by providing novel data from a large population-based Norwegian sample, offering insight into potential cultural and age-specific differences. 4. What are your main results and what do they mean? This research identifies associations between children’s prior-night sleep duration and indicators of quality of life in an educational context, offering insights that may inform practice and policy development by highlighting the potential importance of sleep for daily functioning and well-being among children in Norway.

• Vettore, Mario Vianna; Lopes, Claudia de Souza; Miliauskas, Claudia Reis; Soares, Fernanda Cunha; Loureiro, Fabio Mascarenhas & Stea, Tonje Holte [Show all 7 contributors for this article] (2026). Exploring bidirectional links between body mass index and mental health: The role of intersectionality in the Pro-Saude cohort study. Psychiatry Research. ISSN 0165-1781. 360. doi: 10.1016/j.psychres.2026.117099. Full text in Research Archive Show summary

  Background The link between body mass index (BMI) and mental health has been investigated. However, longitudinal studies examining the bidirectional associations between BMI and psychological distress are scarce. Method The Pro-Saude study is a prospective cohort study involving non-faculty civil servants from university campuses in Rio de Janeiro, Brazil. Data from baseline (1999, N = 3,668), Wave 2 (2001–2002, N = 2,781), and Wave 3 (2006–2007, N = 2,372) were analysed. Baseline measures included age, sex, race/skin colour, educational attainment, BMI, and psychological distress (assessed using GHQ-12). BMI and psychological distress were reassessed at Waves 2 and 3. Data were collected through self-administered questionnaires and standardised anthropometric procedures conducted at participants’ workplaces. Changes in BMI and psychological distress were analysed using latent growth models. Intersectionality was assessed through interaction terms, complemented by age-adjusted linear regression models to examine intersectional effects. Bidirectionality between BMI and psychological distress was evaluated by cross-lagged models. Results BMI significantly increased over time. Psychological distress predicted BMI but BMI did not predict psychological distress across study waves. Psychological distress and female sex predicted a greater increase in BMI over time. Intersectionality between race/skin colour and educational attainment showed that all subgroups had higher mean BMI than white individuals with tertiary education. Male participants, those with higher BMI, white race/skin colour, and higher educational attainment had lower scores of psychological distress at baseline. Conclusion Prevent weight gain and mental health deterioration among employed adults should be aligned and integrated into workplace health strategies. Interventions targeting specific subgroups, including women, those with brown (pardo) and black skin colour, and lower educational attainment are necessary to reduce inequalities related to BMI.

• Øgård-Repål, Anita; Haugland, Siri Håvås; Vederhus, John-Kåre; Robstad, Anja Nastasja & Stea, Tonje Holte (2026). Exploring sleep-related problems among concerned others of individuals with mental health problems and/or problematic substance use: a cross-sectional study. Frontiers in Public Health. 14. doi: 10.3389/fpubh.2026.1703652. Full text in Research Archive Show summary

  Background: Mental health problems and/or problematic substance use (including alcohol) affect not only the individuals directly involved but also their close family members. Being a concerned other, a partner, parent, or child of someone with mental health problems or problematic substance use can be emotionally demanding and may negatively impact sleep health. This study aimed to examine whether concerned others are at increased risk of sleep-related symptoms compared with individuals without such family-related burdens.Materials and methods: A cross-sectional study was conducted among 18,517 Norwegian adults (>18 years) by completing an online self-report questionnaire. Multivariable logistic regression models adjusted for age, economic capability (SES) and gender were used to examine whether being a partner or parent of individuals struggling with substance use or mental health problems or having experienced a parent with problematic alcohol use or mental health problems during childhood was associated with sleep-related symptoms.Results: During childhood, 15.8% and 13.9% reported having parents with mental health problems or problematic alcohol use, respectively. In adulthood, 1 in 6 individuals reported being a partner or parent to someone with mental health problems, and 1 in 10 reported being a partner or parent to someone with problematic substance use. Childhood exposure to parental mental health problems or problematic alcohol use was significantly associated with increased odds of sleep initiation difficulties, sleep maintenance problems, daytime sleepiness, and chronic sleep issues in adulthood (ORs ranging from 1.43 to 1.73). Similarly, being a concerned other to someone with mental health problems or problematic substance use in adulthood was associated with increased odds of having the same sleep-related symptoms (ORs ranging from 1.56 to 1.95).Conclusion: Concerned others of individuals with mental health problems or problematic alcohol or substance use had higher prevalence of sleep-related symptoms. Both current caregiving and childhood exposure to such experiences are linked to poor sleep and potential long-term health consequences. These findings highlight the need for targeted support and early interventions to improve sleep and overall well-being among concerned others.

• Nedeljkovic, David; Todorovic, Nikola; Javorac, Dejan; Baltic, Sonja; Vranes, Milan & Panic, Jovana [Show all 14 contributors for this article] (2025). The effects of 8-week creatine supplementation with and without ubiquinol on sperm quality biomarkers in normospermic and oligospermic men: A randomized controlled pilot trial. Nutrition and Health. ISSN 0260-1060. doi: 10.1177/02601060251385000. Full text in Research Archive Show summary

  Background: No studies have investigated whether dietary creatine, administered alone or in the combination with other nutrients, can induce changes in the physical-chemical and microscopic characteristics of human semen. Objectives The primary objective of this randomized placebo-controlled exploratory pilot trial was to assess the effects of an 8-week supplementation regimen consisting of creatine, both with and without ubiquinol, on sperm quality in men classified as normospermic and oligospermic. Methods: A total of 15 volunteers (mean age 25.0 ± 6.1 years, body mass index 25.1 ± 2.0 kg/m²; including five oligospermic individuals) were randomly assigned, received the intended treatment, and were evaluated for spermiogram parameters, sperm biochemical markers, the World Health Organization (WHO-5) well-being index questionnaire, and the prevalence and severity of side effects. Results: There was a non-significant trend towards an increase in sperm concentration among participants receiving creatine-plus-ubiquinol, with an average rise of 7.4 million per milliliter ( P  = 0.22). Six out of ten participants receiving creatine (60%), both with and without ubiquinol, showed an improvement in sperm concentration at the 8-week follow-up, compared to only 20% of participants in the control group ( P  ≤ 0.05). In addition, all oligospermic men who received creatine and creatine-plus-ubiquinol demonstrated an improvement in sperm concentration at follow-up, whereas sperm concentration remained unchanged or further decreased among oligospermic men in the control group ( P  ≤ 0.05). Furthermore, there was a significant increase in sperm creatine concentration in the creatine-plus-ubiquinol group ( P = 0.03), demonstrating an average rise of 125.4 µmol/L (35.8%) at the 8-week follow-up. Conclusion: These preliminary findings are of considerable interest for male fertility health; however, they require validation through well-designed longitudinal trials with larger sample sizes. The study is registered at ClinicalTrials.gov (NCT06202469).

• Gonçalves, Bárbara Mulatinho Lopo; Armada, Luciana; Stea, Tonje Holte; Rebelo, Maria Augusta Bessa; Carvalho, Jefferson Calixto & Gonçalves, Lucio Souza [Show all 7 contributors for this article] (2025). Bidirectional association between dental caries and body mass index in socially vulnerable adolescents: a group-based trajectory analysis: Dental caries and body mass index in adolescents. Journal of Dentistry. ISSN 0300-5712. 162(2025). doi: 10.1016/j.jdent.2025.106087. Full text in Research Archive Show summary

  Objectives To examine bidirectional associations between dental caries and body mass index (BMI) among adolescents living in vulnerable communities in Brazil. Methods In a cohort study involving adolescents (n = 323), BMI, number of decayed teeth and odontogenic infections (PUFA/pufa index) were recorded at three time points between 12 and 15 years of age. Trajectories of dental caries, odontogenic infections, and BMI were developed using group-based trajectory modelling. Associations between dental caries and odontogenic infections trajectories with changes in BMI z-scores, and between BMI trajectories and dental caries and odontogenic infections incidence were adjusted for sugar intake and socioeconomic conditions using multiple Poisson regression. Results Three distinct trajectories of dental caries (stable low, moderate increasing, and high increase), odontogenic infections (stable low, stable moderate, and stable high), and BMI z-scores (stable low, stable moderate, and stable high) were identified. Compared with the stable moderate BMI z-score trajectory, the stable low was associated with increased risk of dental caries incidence (IRR 1.48, 95%CI 1.05–2.09). The high increase dental caries trajectory (IRR 1.38, 95%CI 1.02–1.88) and high stable odontogenic infections trajectory (IRR 1.50, 95%CI 1.12–2.00) were associated with positive changes in BMI z-scores. Conclusions Adolescents living in deprived communities with persistently low BMI were at higher risk of dental caries. Those with increasing dental caries and consistently high levels of odontogenic infections were at higher risk of BMI z-scores increases. Effective individual and public health strategies to reduce dental caries and malnutrition in adolescents should be aligned. Clinical significance Dental caries and body mass index are interrelated in underprivileged adolescents.

• Aarsland, Tonje Eiane; Aakre, Inger; Stea, Tonje Holte; Henjum, Sigrun; Markhus, Maria Wik & Strand, Tor Arne [Show all 10 contributors for this article] (2025). Association of Mild-to-Moderate Iodine Deficiency With Thyroid Function—A Systematic Review and Meta-analysis. Advances in Nutrition (AN/Adv Nutr). ISSN 2161-8313. 16(9). doi: 10.1016/j.advnut.2025.100471. Full text in Research Archive Show summary

  The only known function of iodine in the human body is as a component of thyroid hormones. Thus, all consequences of iodine deficiency should be mediated through altered thyroid hormone production. Although it is well established that severe iodine deficiency affects thyroid hormone production, the association between mild-to-moderate iodine deficiency and thyroid function remains unclear. This review aimed to review and summarize observational studies that examine the association between mild-to-moderate iodine deficiency and thyroid hormone function in the general population, including infants, children, adolescents, adults, pregnant and lactating women. Systematic searches of the literature were performed in November 2022 and repeated in February 2024 using the Medline Ovid, Embase Ovid, and Cochrane Central databases. Mild-to-moderate iodine deficiency was defined as a median urinary iodine concentration (UIC) of 20-100 μg/L in children, adolescents, and general adults, and 50-150 μg/L in pregnant women. Thyroid function outcomes included thyroid-stimulating hormone (TSH), free thyroxine (fT3), and free triiodothyronine (fT4) and clinical thyroid dysfunction entities. A total of 72 studies were included: 59 cross-sectional, 12 repeated cross-sectional (longitudinal), and 1 cohort study. Populations studied included infants, children, and adolescents (n = 7); women of reproductive age, including lactating women (n = 5); general adults (n = 20); and pregnant women (n = 43). For all population groups, most studies found no clear association between iodine status and thyroid function. Meta-analyses for 8 studies in pregnant women showed no difference in TSH, fT4, or fT3 for those with mild-to-moderate iodine deficiency compared with adequate status [mean difference (95% CI): TSH, 0.03 (-0.05, 0.12) mIU/L; fT4, -0.20 (-0.94, 0.53) pmol/L; fT3, 0.05 (-0.14, 0.03) pmol/L]. In conclusion, no clear association between mild-to-moderate iodine deficiency and thyroid function in the different population groups was found. This trial was registered at www.crd.york.ac.uk/PROSPERO as CRD42022360447.

• Kleppang, Annette Løvheim; Hagquist, Curt; Stea, Tonje Holte; Leonhardt, Marja; Bonsaksen, Tore & Lien, Lars [Show all 7 contributors for this article] (2025). Social media use, gaming and quality of life among adolescents in Norway: results from the Young-HUNT study. Health and Quality of Life Outcomes. 23(1). doi: 10.1186/s12955-025-02428-1. Full text in Research Archive Show summary

  Abstract Background The use of screens, especially mobile devices like tablets and smartphones has increased over the last years and have become an integral to daily life. Adolescents today spend a lot of time using screens both at school and outside school. Identifying possible associations between gaming, social media use and quality of life (QoL) may inform the development of public health guidelines targeting adolescent behaviour. The purpose of this study is to examine the association between gaming, social media use and quality of life (QoL) among adolescents, and whether sex, spending time with friends or psychological distress moderate these associations. Methods This study was based on cross-sectional data from the Trøndelag Health study (Young-Hunt4), collected in 2017–2019. The target group comprised 8066 adolescents (13–19 years). QoL was measured with the Norwegian version of the Inventory of Life Quality (ILC). Electronic media use was measured using the two variables social media use and gaming. Multiple linear regression was used to analyse the association between social media use, gaming, and QoL. Results Results showed a negative association between gaming (> 3 h per day) after school and quality of life (b = -0.26) and social media use (> 3 h per day) after school and quality of life (b = -0.20). Similar negative associations were observed between more time spent on gaming (> 3 h per day) during weekends and quality of life (b = -0.33) and more time spent on social media (> 3 h per day) during weekends and quality of life (b = -0.16). An interaction effect was observed between sex and social media use (after school), between sex and gaming (after school and during weekends), and between psychological distress and gaming during weekends. Conclusions More than three hours spent on gaming or social media per day, both during weekdays and weekends, was negatively associated with QoL. Sex moderated these associations; however, for social media use this was shown only after school. Additional research is needed to further explore these associations.

• Meland, Eivind; Abildsnes, Eirik; Samdal, Gro Beate; Stea, Tonje Holte; Haugen, Tommy & Berntsen, Sveinung [Show all 7 contributors for this article] (2025). Changes in physical activity among overweight and obese Norwegian children aged 6–12: A non-randomized cluster-controlled trial. Scandinavian Journal of Public Health. ISSN 1403-4948. 53(8), p. 872–880. doi: 10.1177/14034948251315350. Full text in Research Archive Show summary

  Aims: To explore whether a family-based intervention with playful activities among overweight and obese Norwegian children promoted moderate to vigorous and light physical activity compared with a waiting list control group, and to examine whether gross motor competence, isometric body mass index and motivational factors, as reported by the children and their parents, could explain changes observed during a six-month observation. Methods: A non-randomized cluster-controlled trial with 131 participants, 76 in the intervention group. Participants were aged 6–12 years, and 55 were boys. We performed linear regressions to compare the intervention and the control groups and adjusted linear models to examine predictors for outcomes with the groups merged into one cohort. Results: We could not demonstrate any intervention effect from the family-based activities. Moderate to vigorous physical activity levels were satisfactory at the start and were maintained during the observation period. None of the predictors could explain outcome status at six months, nor residual change of moderate to vigorous physical activity during the observation. We revealed that parental educational attainment, parental autonomous motivation and the participants’ experience of social support impacted light physical activity negatively after six months. Parental education also impacted the residual change of light physical activity negatively during the observation. Conclusions: The present family-based intervention to improve physical activity among overweight and obese children was ineffective. Baseline activity levels were already satisfactory. Paradoxically, factors such as parental socioeconomic status, autonomous motivation and self-reported support from parents and peers may be associated with diminished physical activity in such contexts. These unexpected findings need to be validated in further studies.

• Grasaas, Erik; Sandbakk, Øyvind Bucher; Ostojic, Sergej; Horverak, May Olaug & Stea, Tonje Holte (2025). Socioeconomic status, sport participation, and school-related outcomes among Norwegian adolescents: a cross-sectional analysis. Frontiers in Sports and Active Living. 7. doi: 10.3389/fspor.2025.1613391. Full text in Research Archive Show summary

  Background: Extensive research highlights the critical role of sport and physical activity (PA) engagement during adolescence, as it is strongly associated with enhanced subjective well-being, reduced risk of mental health problems, and prevention of chronic diseases in adulthood. Thus, it is highly important to identify key barriers of sport participation in adolescence. The present study aimed to; (1) describe socioeconomic status (SES) across different sport disciplines among current participants and sport dropouts, (2) examine possible associations between sport participation and sport dropouts on school-related outcomes. Methods: School-based cross-sectional data among 90,091 adolescents aged 16–19 years were collected across Norway between 2021 and 2023. A self-report questionnaire was used to assess information about sociodemographic background, current and previous sport participation, and school-related factors, including perceived school stress, teacher care, feeling tired at school and sense of belonging at school. Adjusted binary logistic regressions were conducted using IBM SPSS Statistics. Results: Adolescents currently participating in sport reported higher SES compared to sport dropouts (2.13 ± 0.51 vs. 1.97 ± 0.61, p < 0.01). Tennis participants demonstrated the highest SES of 2.39 ± 0.44, while motorsport participants revealed the lowest score (1.82 ± 0.49). The highest sport attrition rate (80.2%) was revealed among adolescents from the lowest SES level. Current sport participants reported favorable school-related outcomes and PA engagement compared to sport dropouts (all, p < 0.01). Adjusted logistic analyses showed that participation in sport activities was associated with lower odds of perceived school stress [OR = 0.83; 95% CI (0.81–0.86)] and being tired during school hours [OR = 0.74; 95% CI (0.71–0.77)], and higher odds for perceived teacher care [OR = 1.17; 95% CI (1.12–1.22)] and perceived sense of belonging [OR = 1.36; 95% CI (1.31–1.42)]. Conclusions: Higher SES was found among adolescents participating in sport compared to sport dropouts, underscoring the importance of promoting affordable sport opportunities during adolescence. Current sport participation was associated with favorable school-related outcomes compared to sport dropouts, such as lower odds for perceived school stress and tiredness in school, and higher odds of perceived sense of belonging in school and perceived teacher care.

• Mansoor, Mohammad Azam; Stea, Tonje Holte; Slettan, Audun; Perera, Erandie; Maddumage, Rimi & Kottahachi, Darshana [Show all 9 contributors for this article] (2025). Impact of single nucleotide polymorphisms (SNPs) in antioxidant-enzyme genes on the concentrations of folate, homocysteine and glutathione in plasma from healthy subjects after folic acid supplementation – a randomized controlled crossover trial. Genes & Nutrition. ISSN 1555-8932. 20. doi: 10.1186/s12263-024-00761-6. Full text in Research Archive Show summary

  Background One-carbon metabolism links folate and methionine metabolism and this is essential for nucleotide synthesis in the cells. Alterations in one-carbon metabolism are associated with cardiovascular disease (CVD), type 2 diabetes and cancer. Our aim was to investigate whether SNPs in antioxidant-enzyme genes impact the concentrations of folate in serum (s-folate), plasma total homocysteine (p-tHcy) and total glutathione in plasma (p-tGSH) in healthy subjects after supplementation with folic acid. Methods In a randomized, double blind, crossover study, healthy subjects received 0.8 mg folic acid per day or a placebo for two weeks. Twenty-four male, and sixty-seven female subjects participated in this study. Participants were aged 36.4 ± 14.8 years (mean ± SD). We studied SNPs in six genes by PCR methods. The concentrations of s-folate, p-tHcy and p-tGSH were measured in fasting samples with Cobas and an HPLC-fluorescence method. Student T-tests and ANOVA were used for the statistical calculations. Main findings The subjects with SNP (rs4880) in superoxide dismutase (SOD2) gene (CC) allele had higher concentrations of s-folate and lower concentrations of p-tHcy than subjects with (CT + TT) alleles, (p = 0.014 and p = 0.012). Contrary to SOD2 (CC) allele, the subjects with SNP (rs1001179) catalase (CAT) CC allele had lower concentrations of s-folate (p = 0.029), higher concentrations of p-tGSH (0.017) and higher concentrations of p-tHcy before and after folic acid supplementations (p = 0.015, p = 0.017) than the subjects with (CT + TT) allele. Glutathione transferase (theta)1 (GST-T1) genotype was associated with higher concentrations of s-folate than GST-T0 before (p = 0.025) and after folic acid supplementation (p = 0.047). SNP (rs1050450) in glutathione peroxidase (GPX1) had also impact on the concentrations of p-tGSH (p = 0.011) in healthy subjects. Conclusion SNPs in SOD2 (rs4880), CAT (rs1001179), and GST1 impact the concentrations of s-folate, and p-tHcy in healthy subjects before and after folic acid supplementation. Our findings suggest that SNPs in antioxidant-genes have a role in health and disease by impacting the concentrations of s-folate, p-tHcy and p-tGSH.

• Stea, Tonje Holte; Bonsaksen, Tore; Smith, Pierre; Kleppang, Annette Løvheim; Steigen, Anne Mari & Leonhardt, Marja [Show all 8 contributors for this article] (2024). Are social pressure, bullying and low social support associated with depressive symptoms, self-harm and self-directed violence among adolescents? A cross-sectional study using a structural equation modeling approach. BMC Psychiatry. 24(1). doi: 10.1186/s12888-024-05696-1. Full text in Research Archive Show summary

  Background: More in-depth evidence about the complex relationships between different risk factors and mental health among adolescents has been warranted. Thus, the aim of the study was to examine the direct and indirect effects of experiencing social pressure, bullying, and low social support on mental health problems in adolescence. Methods: A school-based cross-sectional study was conducted in 2022 among 15 823 Norwegian adolescents, aged 13–19 years. Structural Equation Modelling was used to assess the relationships between socioeconomic status, social pressure, bullying, social support, depressive symptoms, self-harm and suicide thoughts. Results: Poor family economy and low parental education were associated with high pressure, low parental support and depressive symptoms in males and females. Moreover, poor family economy was associated with bullying perpetration and bullying victimization among males and females, and cyberbullying victimization among females, but not males. Low parental education was associated with bullying victimization among males, but not females. Further, high social pressure was associated with depressive symptoms among males and females, whereas high social pressure was linked to self-harm and suicide thoughts among females, but not males. Bullying victimization and cyberbullying victimization were associated with depressive symptoms, self-harm, and suicide thoughts among males and females. Bullying victimization was associated with depressive symptoms among males, but not females, whereas bullying perpetration was linked to self-harm and suicide thoughts among females, but not males. Low parental support was associated with bullying perpetration, bullying victimization, depressive symptoms, self-harm and suicide thoughts among males and females, whereas low parental support was associated with high social pressure among females, but not males. Low teacher support was associated with high social pressure and depressive symptoms. Low support from friends was associated with bullying victimization, depressive symptoms and suicide thoughts among males and females, whereas low support from friends was linked to self-harm among males, but not females. Finally, results showed that depressive symptoms were associated with self-harm and suicide thoughts among males and females. Conclusion: Low socioeconomic status, social pressure, bullying and low social support were directly and indirectly associated with depressive symptoms and self-directed violence among Norwegian adolescents.

• Ostojic, Sergej; Stea, Tonje Holte; Ellery, Stacey & Smith-Ryan, Abbey (2024). Association between dietary intake of creatine and female reproductive health: Evidence from NHANES 2017–2020. Food Science & Nutrition. 12(7), p. 4893–4898. doi: 10.1002/fsn3.4135. Full text in Research Archive
• Kleppang, Annette Løvheim; Abildsnes, Eirik; Haraldstad, Kristin & Stea, Tonje Holte (2024). Changes in health‑related quality of life and sleep habits after a 6‑month non‑randomised cluster‑controlled trial among children with overweight or obesity. European Child and Adolescent Psychiatry. ISSN 1018-8827. 33, p. 1–9. doi: 10.1007/s00787-024-02375-0. Full text in Research Archive Show summary

  Being overweight or obese can have severe negative psychological impacts and reduce health-related functioning. To improve health-related quality of life (HRQoL) and sleep habits for children with overweight or obesity, it is important to design and implement effective interventions. The aim of this study was to evaluate the effects of a 6-month family-based lifestyle intervention on HRQoL and sleep habits in Norwegian children with overweight or obesity in a primary-care setting. This 6-month, non-randomised, cluster-controlled trial included Norwegian children aged 5–13 years with overweight or obesity and their parents. A questionnaire was filled out by the parents. A total of 33 and 52 children in the control group and 41 and 78 children in the intervention group answered the HRQoL and sleep habits questions, respectively, and were included. The intervention group received individual family counselling and participated in physical activity groups and nutrition courses. The Children’s Sleep Habits Questionnaire (CSHQ) and Kidscreen-10 index were used to assess sleep habits and HRQoL. At baseline, the mean average scores for HRQoL were 50.0 [standard deviation (SD) 8.1] for the intervention group and 49.0 (SD 10.1) for the control group. For sleep habits at baseline, the mean average scores were 45.2 (SD 11.8) for the intervention group and 46.0 (SD 11.9) for the control group. No significant changes in HRQoL and sleep habits after the intervention were revealed. Overall, the family-based lifestyle intervention targeting overweight and obese children in a primary-care setting showed no significant effect on HRQoL or sleep quality.

• Vettore, Mario V; Stea, Tonje Holte; Zahl-Olsen, Rune & Faerstein, Eduardo (2024). Longitudinal evidence of the influence of early life circumstances, family characteristics, social ties and psychological distress on healthy behaviours of Brazilian adults: The Pro-Saude cohort study. PLOS ONE. 19(8). doi: 10.1371/journal.pone.0306565. Full text in Research Archive
• Haugland, Siri Håvås; Carvalho, Barbara Oliveira Vieira de; Strandheim, Arve & Stea, Tonje Holte (2024). Parental Alcohol Intoxication, Adverse Childhood Experiences, and Negative Psychological Reactions to Childhood Adversities: Cross-Sectional and Prospective Data from the Population‑Based HUNT Study. Journal of Child and Adolescent Trauma. ISSN 1936-1521. doi: 10.1007/s40653-024-00651-4. Full text in Research Archive
• Stea, Tonje Holte; Bertelsen, Thomas Bjerregaard; Fegran, Liv; Sejersted, Ellen; Kleppang, Annette Løvheim & Fyhn, Tonje (2024). Interventions targeting young people not in employment, education or training (NEET) for increased likelihood of return to school or employment—A systematic review. PLOS ONE. 19(6). doi: 10.1371/journal.pone.0306285. Full text in Research Archive Show summary

  The present systematic review aims to identify, synthesize, and evaluate evidence of effects from interventions targeting youth not in education, employment, or training (NEET). We searched relevant multidisciplinary databases to identify randomized controlled trials (RCTs) and quasi-randomized re-engagement trials. Primary outcomes were participation in education and employment, and training status. Secondary outcomes included changes in financial status, quality of life and well-being, social functioning, and physical, psychological, and behavioral outcomes. The Joanna Briggs Institute methodology and PRISMA guidelines were applied. Eligible studies were screened, included, and extracted for data. Nine trials were included (eight RCTs and one quasi-experimental study), in which samples ranged from 96 to 7346 participants. Results on primary outcomes showed that five studies found an effect of interventions on employment outcomes, while three studies indicated an effect on education or training. Results on secondary outcomes included effects on mental health, subjective health complaints, drug use, self-esteem, and self-efficacy. Studies with other main outcomes than re-engagement showed an effect of interventions on pass rates for the driving test, independent housing, and increased job-seeking activities. Limitations and future directions are discussed, including the lack of rigorous studies, theoretical underpinnings, and standardized measures for re-engagement outcomes.

• Befus, Eva-Grethe; Mølland, Eirin; Helseth, Sølvi; Småstuen, Milada Cvancarova; Stea, Tonje Holte & Nolte, Sandra [Show all 7 contributors for this article] (2024). The use of youth healthcare services and its association with health-related quality of life, physical and mental health and over-the-counter analgesics use in 13–19-year-old adolescents: a cross-sectional study. BMC Public Health. 24. doi: 10.1186/s12889-023-17544-0. Full text in Research Archive Show summary

  Background Youth healthcare services in Norway include a public health nurse (PHN) at school and local youth health centres (YHCs). They provide health services for all adolescents free of charge, focusing on health promotion and disease prevention. The present study aimed to assess possible associations between health-related quality of life (HRQoL), physical and mental health, over-the-counter analgesics (OTCA) use and use of youth healthcare services among 13–19-year-old adolescents. Methods This study was based on national, cross-sectional data from the Ungdata Survey conducted in 2022. The sample was comprised of 16 482 adolescents. Multiple logistic regression was used to analyse the associations between HRQoL, headaches, selected physical symptoms, psychological distress, use of OTCA, PHN availability, sociodemographic variables, and use of the PHN at school or at a YHC. The KIDSCREEN-10 was used to measure HRQoL, and the Hopkins Symptoms Checklist 10 was used to measure symptoms of psychological distress. Results Girls used the youth healthcare services more frequently than boys. Better HRQoL was significantly associated with fewer visits to the PHN at school. Girls reported lower HRQoL and mental health, and more pain and frequent OTCA use than boys. When having symptoms of psychological distress, boys had greater odds of visiting the PHN at school than girls. For girls in senior high school, headaches and OTCA use were strongly associated with visiting the PHN at school and the YHC. In senior high school, boys with an immigration background had greater odds of visiting the YHC than native Norwegian boys, while girls with an immigration background were less likely to visit the YHC than native Norwegian girls. Conclusions Our results show that more girls than boys use youth healthcare services. When adolescents experience pain, have mental problems, use OTCA, or report low levels of HRQoL, they have greater odds of using youth healthcare services. Youth healthcare services offer excellent opportunities to support and follow up with adolescents. The findings provide important insights into youth healthcare services used by adolescents for various stakeholders, including PHNs and policy makers, with potential implications for future public health efforts.

• Bonsaksen, Tore; Steigen, Anne Mari; Granrud, Marie Dahlen; Dangmann, Cecilie Ruud & Stea, Tonje Holte (2024). Sexual harassment exposure among junior high school students in Norway: prevalence and associated factors. Frontiers in Public Health. 12. doi: 10.3389/fpubh.2024.1307605. Full text in Research Archive Show summary

  Background: Sexual harassment is common in most countries and cultures. Less is known about sexual harassment, its risk factors, and psychosocial outcomes among young adolescents. The aim of the study was to examine the 12-month prevalence of sexual harassment exposure, and sociodemographic and psychosocial factors associated with exposure among junior high school students in Norway. Methods: A comprehensive cross-sectional study was completed by 83,297 Norwegian adolescents in junior high school in 2021. Data on exposure to sexual harassment were used in combination with sociodemographic measures and psychosocial outcomes: depressive symptoms, loneliness, self-esteem, and well-being. Group differences were analyzed with Chi Square tests, and sociodemographic risk factors were analyzed with logistic regression. Psychosocial outcomes were assessed with multivariate and univariate ANOVAs, and dose–response relationships were assessed with linear regression. Results: Among the adolescents, 32.6% had experienced sexual harassment during the past year. Girls had higher odds of exposure (OR: 1.90, 95% CI: 1.84– 1.96), whereas adolescents whose parents had higher education had lower odds (OR: 0.95, 95% CI: 0.90–0.99). Exposure was associated with higher levels of depressive symptoms (partial η2 [ES]  =  0.11) and loneliness (ES  =  0.07), and with lower self-esteem (ES  =  0.06) and well-being (ES  =  0.06). Among exposed adolescents, more frequent exposure was associated with poorer outcomes. Conclusion: Exposure to sexual harassment affects one third of junior high school students in Norway. Those who are exposed have poorer psychosocial outcomes, and there is a dose–response relationship between exposure and outcomes. Awareness of sexual harassment among young adolescents, and interventions to prevent and reduce it, are needed.

• Øvrebø, Bente; Kjøllesdal, Marte Karoline Råberg; Stea, Tonje Holte; Wills, Andrew Keith; Bere, Elling Tufte & Magnus, Per Minor [Show all 8 contributors for this article] (2023). The influence of immigrant background and parental education on overweight and obesity in 8-year-old children in Norway. BMC Public Health. 23(1). doi: 10.1186/s12889-023-16571-1. Full text in Research Archive Show summary

  Background Little is known about the prevalence of overweight/obesity and socio-economic position (SEP) in children with immigrant background in Scandinavia. The purpose of this study is to examine the prevalence of overweight/obesity by immigrant background among children in Norway and to explore the role of SEP in explaining diferences in weight status. Methods Anthropometric data from 8,858 children (age 8.3 years) from the population-based Norwegian Childhood Growth Study were used. Information about immigrant background, country of origin, and parental education (used as an indicator of SEP) were provided by Statistics Norway. For children with immigrant background, regional background was determined based on country of origin. Prevalence ratios (PR) were estimated for overweight/obesity and weight-to-height-ratio (WHtR)≥0.5 by immigration and regional background, using generalized estimating equation log-binominal models adjusting for sex, age, survey year (model 1), residential area, population density (model 2) and parental education (model 3). Results Children with immigrant background had a higher prevalence of overweight/obesity and WHtR≥0.5 than non-immigrant background children. Adjusted for parental education, children with an immigrant background from Southern and Eastern Europe, Asia except South-Asia, and Africa had a higher prevalence of overweight/ obesity [PR: 1.37 (95% confdence interval (CI): 1.10–1.72), 1.28 (1.05–1.57), 1.47 (1.13–1.91), respectively] than children with a non-immigrant background. Children originating from Asia except South-Asia had a higher prevalence of WHtR≥0.5 (PR: 1.64, CI: 1.25–2.15) compared to non-immigrant background children. The adjustment for parental education did not substantially change the results. Conclusion Children with immigrant background had higher prevalence of overweight/obesity than non-immigrant background children. The diference varied according to region of origin but not substantially according to parental education. There is a need for culturally acceptable preventative measures targeting the parents of immigrant background children.

• Bonsaksen, Tore; Steigen, Anne Mari; Stea, Tonje Holte; Kleppang, Annette Løvheim; Lien, Lars & Leonhardt, Marja (2023). Negative social media-related experiences and lower general self-efficacy are associated with depressive symptoms in adolescents. Frontiers in Public Health. 10, p. 1–13. doi: 10.3389/fpubh.2022.1037375. Full text in Research Archive Show summary

  Social media are an integral part of adolescents' daily lives, and reviews have suggested an overall small association between more social media use and mental health problems. However, researchers have commonly investigated social media use in a time use perspective, rendering nuances in adolescents' social media experience less well explored. Thus, studies of relationships between social media use and mental health problems need also examine the nature of the events taking place on social media. This study aimed to examine depressive symptoms in adolescents in relationship to time spent on social media, negative social media-related experiences, and general self-efficacy. Data collected in a national survey, Ungdata 2021 (n = 139,841), was used. Multivariate linear regression analyses showed that time spent on social media was associated with depressive symptoms (β = 0.09, p < 0.001). However, negative social media-related experiences were more strongly associated with depressive symptoms (β ranging 0.09–0.22, all p < 0.001), and their inclusion weakened the initial association between time on social media and depressive symptoms. General self-efficacy was directly associated with lower symptom levels (β = −0.29, p < 0.001) but did not change the associations between social media use and depressive symptoms. The findings imply that not only time spent on social media, but in particular negative social media-related experiences, are related to depressive symptoms in Norwegian adolescents. General self-efficacy is an important resource for adolescents' mental health.

• Kleppang, Annette Løvheim; Vettore, Mario Vianna; Hartz, Ingeborg; Haugland, Siri Håvås & Stea, Tonje Holte (2023). Patterns of unhealthy behaviours during adolescence and subsequent anxiety and depression in adulthood: a prospective register linkage study of the HUNT survey and health registries. International Journal of Behavioral Nutrition and Physical Activity. 20(6). doi: 10.1186/s12966-023-01408-2. Full text in Research Archive Show summary

  Background There is increasing need for prospective investigations in the preventing role of health-related behaviours on mental health problems. The aim of this study is to identify patterns of health-related behaviours in adolescence, and the association between the behavioural patterns and the subsequent diagnoses and/or drug treatment for anxiety and/or depression in adulthood. Methods This prospective study consisted of 13–19-year-old participants in the Trøndelag Health Study (Young-HUNT3) in 2006–2008 (n = 2061, 1205 females and 856 males) in Norway, who also participated in HUNT4 (2017–2019). Survey data on health-related behaviours in adolescence, including low level of physical activity, low consumption of wholegrain bread, fish, fruit, vegetables and high consumption of sugar-sweetened beverages and insomnia were linked on an individual level to prospective information on drug use and diagnosis in national health registries. The different patterns of health-related behaviours were identified through latent class analysis. Subsequent anxiety or depression was defined as at least one recording in either of three registries covering recorded diagnosis in primary and specialist healthcare, or dispensed prescription drugs during 2008–2019. Additionally, self-reported psychological distress measured in young adulthood was applied as a supplemental outcome measure. Results Four patterns of health-related behaviours were identified: high risk behaviours (class 1), moderate to high risk behaviours (class 2), low to moderate risk behaviours (class 3) and low risk behaviours (class 4). Adolescents in class 3 showed higher odds of subsequent diagnoses for anxiety and/or depression in primary and specialist healthcare compared to class 4 participants. In addition, both class 1 and class 4 participants had higher odds for self-reported psychological distress than those class 4 (OR = 1.56 and OR = 1.86, respectively). Conclusions Our findings suggest that health-related behaviours are clustered among Norwegian adolescents. The patterns of unhealthy behaviours during adolescence only partly increased the risk of anxiety and depression in adulthood. Promoting healthy behaviours during adolescence may potentially reduce the burden of mental illness in adulthood, but further research is needed to clarify the nature of the relationships.

• Stea, Tonje Holte; Steigen, Anne Mari; Dangmann, Cecilie Ruud; Granrud, Marie Dahlen & Bonsaksen, Tore (2023). Associations between exposure to sexual abuse, substance use, adverse health outcomes, and use of youth health services among Norwegian adolescents. BMC Public Health. 23(1). doi: 10.1186/s12889-023-16261-y. Full text in Research Archive Show summary

  Background A strong association between sexual abuse and adverse health outcomes has been reported among adolescents. The present study aimed to provide more information about adverse health outcomes associated with sexual abuse and substance use, and to examine the use of youth health services among Norwegian adolescents. Methods National representative cross-sectional study among 16–19-year-old Norwegian adolescents (n = 9784). Multivariable regression analyses, adjusted for socioeconomic status and age, were used to examine the association between exposure to sexual abuse, substance use and health risk factors, and the use of youth health services. Results Adolescents exposed to sexual abuse had higher odds of depressive symptoms (males: OR:3.8; 95% CI:2.5–5.8, females: 2.9;2.4–3.5), daily headache (males: 5.3;2.8–10.1, females:1.9; 1.5–2.4), high medication use (males: 3.2;1.7-6.0, females: 2.0;1.6–2.6), self-harm (males: 3.8;2.4-6.0, females:3.2; 2.6–3.9), suicidal thoughts (males: 3.3; 2.2-5.0, females:3.0; 2.5–3.6) and suicide attempts (males: 9.5;5.6–16.0, females:3.6;2.7–4.9). Furthermore, exposure to sexual abuse was associated with higher odds of using school health services (males: 3.9;2.6–5.9, females: 1.6;1.3–1.9) and health services for youth (males: 4.8;3.1–7.6, females: 2.1;1.7–2.5). In general, substance use was associated with increased odds of adverse health related outcomes and use of youth health services, but the strength of the relationships varied according to sex. Finally, results indicated a significant interaction between sexual abuse and smoking that was associated with increased odds of having suicidal thoughts for males (2.6;1.1–6.5) but a decreased odds of having suicidal thoughts and have conducted suicide attempts once or more for females (0.6;0.4-1.0 and 0.5;0.3–0.9, respectively). Conclusions The present study confirmed a strong relationship between exposure to sexual abuse and health risks, especially among males. Moreover, males exposed to sexual abuse were much more likely to use youth health services compared to sexually abused females. Substance use was also associated with adverse health outcomes and use of youth health services, and interactions between sexual abuse and smoking seemed to influence risk of suicidal thoughts and attempts differently according to sex. Results from this study increase knowledge about possible health related effects of sexual abuse which should be used to identify victims and provide targeted treatment by youth health services.

• Lien, Lars; Bonsaksen, Tore; Stea, Tonje Holte; Kleppang, Annette Løvheim; Steigen, Anne Mari & Leonhardt, Marja (2023). Time trends in self-reported depressive symptoms, prescription of antidepressants, sedatives and hypnotics and the emergence of social media among Norwegian adolescents. PLOS ONE. 18(12). doi: 10.1371/journal.pone.0295384. Full text in Research Archive Show summary

  Background Research has shown increased mental health problems and use of prescription drugs among adolescents in recent years and social media use has been linked to poorer mental health. However, trend studies concerning these topics are scarce. The purpose of this study was to analyze gender-specific trends in a) symptoms of depression and loneliness, and b) prescription of antidepressants, hypnotics and sedatives, in relation to the emergence of social media among adolescents in Norway. Methods This is an ecological study using data from the ‘Young in Oslo’ surveys from 1996 to 2021. The surveys included approximately 110 000 students, 14–17 years of age, and yielded a response rate varying from 95% in 1996 to 64% in 2021. A self-report questionnaire was used to collect information on symptoms of depression and loneliness. Information on antidepressant and sleep medication prescription was retrieved from the Norwegian Prescription Database for the age group 15 to 19 years. A graphical approach and logistic regression models were used to examine gender-specific time-trends between 1996 to 2021. Results We found a doubling in self-reported symptoms of depression and loneliness among girls between 1996 and 2021, with the steepest increase in the period from 2006 to 2012, when Facebook and other social media were introduced. A similar trend was observed in the prescription of antidepressants among girls, with the steepest increase between 2011 and 2013. Among both boys and girls, ‘worried too much about things’ and ‘had sleep problems’ were the two symptoms with the greatest changes. Conclusion A significant upward trend in self-reported depressive symptoms and medication use was observed over the past 25 years, with variations in the rate of increase, including a steeper trajectory during certain periods immediately after the introduction of social media platforms in Norway.

• Korovljev, Darinka; Javorac, Dejan; Todorovic, Nikola; Ranisavljev, Marijana; Engeset, Dagrun & Stea, Tonje Holte [Show all 15 contributors for this article] (2023). The Effects of 12-Week Hydrogen-Rich Water Intake on Body Composition, Short-Chain Fatty Acids Turnover, and Brain Metabolism in Overweight Adults: A Randomized Controlled Trial. Current Topics in Nutraceuticals Research. ISSN 1540-7535. 21(3), p. 235–241. doi: 10.37290/235-241. Full text in Research Archive Show summary

  The aim of this randomized controlled trial was to analyze the effects of medium-term supplementation with hydrogen-rich water on brain metabolism, appetite-regulating hormones, body composition, and safety biomarkers in overweight adults. Twenty (n = 20, 10 females) apparently healthy adults with a body mass index >24.9 kg/m2 were assigned to receive 0.5 L per day of hydrogen-rich water (7.5 mg of hydrogen) or hydrogen-free water (tap water) for 12 weeks. Two-way analysis of variance with repeated measures revealed a significant difference between the two interventions in several body composition indices (P ≤ 0.05), with hydrogen-rich water superior to placebo to reduce waist circumference and mid-upper arm circumference by 1.31 cm (95% confidence interval, from –0.23 to 2.85) and 0.65 cm (95% confidence interval, from –0.10 to 1.40), respectively. Hydrogen-rich water outcompeted placebo to raise serum ghrelin levels, as the mean difference from the placebo group was 17.28 pmol/L (95% confidence interval, from 1.81 to 32.75) (P = 0.02). A non-significant strong positive trend (P = 0.10) was reported toward hydrogen-rich water being superior to placebo in augmenting total serum short-chain fatty acid levels, with a mean difference from the control group of 195.6 μmol/L (95% confidence interval, from –64.55 to 275.85). The mean fecal calprotectin levels were significantly reduced after hydrogen-rich water intervention for 19.7 μg/mg (95% confidence interval, from 0.31 to 39.09) (P = 0.03). Our findings advance hydrogen-rich water as a promising metabolic intervention in overweight adults, but further validation via multicentric longitudinal randomized controlled trials in metabolic and nutritional disorders is required.

• Stajer, Valdemar; Todorovic, Nikola; Conic, Branislava Srdenovic; Kladar, Nebojsa; Engeset, Dagrun & Stea, Tonje Holte [Show all 12 contributors for this article] (2023). The Effects of Medium-Term Intake of Hydrogen-Rich Water on Sperm Quality Biomarkers in Normospermic and Oligospermic Men: A Randomized Controlled Pilot Trial. Current Topics in Nutraceuticals Research. ISSN 1540-7535. 21(2), p. 182–186. doi: 10.37290/182-186. Full text in Research Archive
• Richardsen, Helene Kristin; Bere, Elling Tufte; Stea, Tonje Holte; Klepp, Knut Inge & Engeset, Dagrun (2023). Effect of Ending the Nationwide Free School Fruit Scheme on the Intake of Fruits, Vegetables, and Unhealthy Snacks in Norwegian School Children Aged 10–12 Years. International Journal of Environmental Research and Public Health (IJERPH). ISSN 1661-7827. 20(3). doi: 10.3390/ijerph20032489. Full text in Research Archive Show summary

  The Norwegian authorities started a nationwide free school fruit program in 2007, implemented in all secondary schools (grades 8–10) and combined schools (grades 1–10) in Norway. The program ended in 2014. This study evaluates the effect of ending the nationwide free school fruit program on the consumption of fruit, vegetables, and unhealthy snacks among Norwegian sixth and seventh graders. The study sample consists of pupils at 18 schools that participated in all data collections in the Fruits and Vegetables Make the Marks project (FVMM), initiated in 2001, with new data collections in 2008 and 2018. Four of the schools were combined schools, therefore children in sixth and seventh grade at these schools received free fruit in 2008 (intervention schools), and fourteen schools did not (control schools). Between 2008 and 2018, pupils at the intervention schools ate a lower proportion of fruits and vegetables per school week, and the consumption of unhealthy snacks increased compared to the control schools. Completion of the free fruit program was not significantly different for boys and girls, or low and high parental education. The results indicate that the end of the free school fruit program resulted in less healthy eating habits among children.

• Zahl-Olsen, Rune; Thuen, Frode & Stea, Tonje Holte (2023). Cohabitation, Marriage, and Union Dissolution in Norway: A Comparative Prospective Study. Journal of Divorce and Remarriage. ISSN 1050-2556. 64(5-6), p. 199–216. doi: 10.1080/10502556.2023.2277648. Full text in Research Archive Show summary

  Background: Few studies have examined dissolution rates among cohabitating and married couples, using prospective data. Objective: The main aim was to examine trends in living arrangements and dissolution rates among married and cohabiting couples in Norway. Method: Analysis of Norwegian longitudinal cohort data of 168,636 newly formed couples. Dissolution rates and relative risk were assessed at maximum 14 years of follow-up. Results: Most of the married couples with a child were still living together after 14 years (65%), this was not the case for cohabiting couples. The majority of cohabiting couples who stay together eventually marry, particularly those who have children. At 4-year follow-up, young cohabiting couples had split up three times more often than married young couples. Contribution: This study contributes by examining the effect of the living arrangement from a country where cohabitation has been the predominant living arrangement for many years.

• Tonheim, Live Edvardsen; Groufh-Jacobsen, Synne; Stea, Tonje Holte & Henjum, Sigrun (2023). Consumption of meat and dairy substitute products amongst vegans, vegetarians and pescatarians. Food & Nutrition Research (FNR). ISSN 1654-6628. 67. doi: 10.29219/fnr.v67.9081. Full text in Research Archive Show summary

  Background: An increasing number of people adhere to plant-based diets, and the market for plant-based meat and dairy substitute products has been expanding rapidly. Objective: To examine total intake of macronutrients and salt in a sample of Norwegian vegans, vegetarians and pescatarians; the consumption frequency of plant-based meat and dairy substitutes and raw ingredients used in these products; and the contribution to total macronutrient and salt intake from these products. Design: A cross-sectional design using single 24-h dietary recall to assess the intake of macronutrients, salt and substitute products that the participants (n = 158 Norway residents [age 18–60 years]: vegans [n = 83]; vegetarians [n = 47]; pescatarians [n = 28]) consumed. The chi-square test with pairwise comparisons and the Kruskal-Wallis test with post hoc test were used to compare differences between diet groups. Macronutrient and salt intake were assessed relative to the Nordic Nutrition Recommendations (NNR). Results: Dietary macronutrient intake fell within NNR recommendations, with a favourable distribution of fatty acids and high levels of dietary fibre. Most of the vegans (90%), vegetarians (68%) and pescatarians (64%) consumed meat or dairy substitutes. The main raw ingredient in the substitute products was soy, followed by oats and peas. Overall, substitute products contributed to 12% of total energy and 16% of total salt intake. The substitute products contributed to higher saturated fatty acid (SFA) intake amongst vegans (27% of total SFA intake) compared with vegetarians (10%) and pescatarians (8%). Moreover, substitute products contributed to higher protein intake in vegans (19%) compared with pescatarians (7%). Conclusion: Most participants consumed meat or dairy substitute products, suggesting that these products are included regularly in Norwegian plant-based diets. Furthermore, substitute products may contribute to dietary fat, SFA and protein intake amongst vegans.

• Stea, Tonje Holte; Vettore, Mario Vianna; Øvrebø, Bente & Abildsnes, Eirik (2023). Changes in dietary habits and BMI z-score after a 6-month non-randomized cluster-controlled trial among 6–12 years old overweight and obese Norwegian children. Food & Nutrition Research (FNR). ISSN 1654-6628. 67, p. 1–15. doi: 10.29219/fnr.v67.9617. Full text in Research Archive Show summary

  Background: Effective prevention programs to address the high prevalence of childhood overweight and obesity and the concomitant health consequences have been warranted. Objective: To improve dietary habits and weight status among Norwegian children with overweight/obesity in the primary care setting. Design: A 6-month non-randomized cluster-controlled intervention among 137 children, aged 6–12 years, with overweight/obesity and their parents. Intervention and control groups were recruited by public health nurses and followed-up by 12 Healthy Life Centers across Norway. The intervention group received individual family counseling and participated in nutrition courses and physical activity groups. A frequency questionnaire assessing sociodemographic characteristics and dietary habits was completed by the parents. Trained public health nurses measured height and weight using standardized methods to calculate body mass index (BMI) and BMI z-scores. Results: The intervention resulted in an increased odds of consuming evening meals (OR: 3.42), a decreased availability of salty snacks (β = –0.17), a decreased intake of salty snacks (−0.18), an increased consumption of water (β = 0.20), and a decreased estimated total intake of energy (β = –0.17), carbohydrates (β = –0.17), mono- and disaccharides (β = –0.21), sucrose (β = –0.24), and saturated fatty acids (β = –0.17). The intervention directly predicted lower BMI z-score (β = –0.17), and post-treatment levels of energy (β = –0.65), saturated fat (β = 0.43), and total carbohydrates (β = 0.41) were directly linked to BMI z-score after intervention. Age and sex were indirectly associated with BMI after intervention through energy and saturated fat intake. Conclusions: The intervention had a beneficial impact on nutrient intake and weight status among children with overweight/obesity. These findings provide support for implementing complex intervention programs tailored to local primary care settings.

• Stea, Tonje Holte; Shatri, Herolinda; Haugland, Siri Håvås & Kleppang, Annette Løvheim (2022). Association between self-repoted childhood difficulties and obesity and health related behaviors in adulthood- a cross sectional study among 28,047 adults from the general population. International Journal of Environmental Research and Public Health (IJERPH). ISSN 1661-7827. 19(3). doi: 10.3390/ijerph19031395. Full text in Research Archive Show summary

  The aim of the present study was to examine the associations between self-reported childhood difficulties, weight status, and lifestyle behaviors among a representative sample of Norwegian adults. This cross-sectional study included 28,047 adults (>18 years old) living in southern Norway. A self-report questionnaire was used to assess information about the overall quality of the respondents’ childhood retrospectively in addition to current weight status and current lifestyle behaviors. Multivariable logistic regression models adjusted for gender, age, and educational level showed that evaluating childhood as difficult was associated with increased odds of obesity (OR: 1.29; 95% CI; 1.16–1.44) in adulthood. Moreover, a difficult childhood was associated with increased odds of unhealthy lifestyle behaviors in adulthood, including low consumption of fruit and berries (1.21; 1.09–1.34) and fish (1.43; 1.30–1.57), high consumption of sugar-sweetened beverages (1.30; 1.14–1.48), low level of physical activity (1.10; 1.01–1.21), smoking cigarettes (1.78; 1.61–1.97), and using smokeless tobacco (1.20; 1.07–1.36). Overall, results from the present study suggest that experiencing childhood as difficult is associated with an increased risk of obesity and a range of unhealthy lifestyle behaviors in adulthood. Thus, our findings highlight the importance of identifying and providing support to children in difficult life circumstances in addition to customized and targeted public health efforts in adulthood.

• Haugland, Siri Håvås & Stea, Tonje Holte (2022). Risky Lives? Self-Directed Violence and Violence From Others Among Young People Not in Education, Employment, or Training (NEET). Frontiers in Public Health. 10. doi: 10.3389/fpubh.2022.904458. Full text in Research Archive
• Øvrebø, Bente; Stea, Tonje Holte; Bergh, Ingunn Holden; Bere, Elling Tufte; Suren, Pål & Magnus, Per Minor [Show all 8 contributors for this article] (2022). A nationwide school fruit and vegetable policy and childhood and adolescent overweight: A quasi-natural experimental study. PLoS Medicine. ISSN 1549-1277. 19(1). doi: 10.1371/journal.pmed.1003881. Full text in Research Archive Show summary

  Background School free fruit and vegetable (FFV) policies are used to promote healthy dietary habits and tackle obesity; however, our understanding of their effects on weight outcomes is limited. We assess the effect of a nationwide FFV policy on childhood and adolescent weight status and explore heterogeneity by sex and socioeconomic position. Methods and findings This study used a quasi-natural experimental design. Between 2007 and 2014, Norwegian combined schools (grades 1–10, age 6 to 16 years) were obligated to provide FFVs while elementary schools (grades 1–7) were not. We used 4 nationwide studies (n = 11,215 children) from the Norwegian Growth Cohort with longitudinal or cross-sectional anthropometric data up to age 8.5 and 13 years to capture variation in FFV exposure. Outcomes were body mass index standard deviation score (BMISDS), overweight and obesity (OW/OB), waist circumference (WC), and weight to height ratio (WtHR) at age 8.5 years, and BMISDS and OW/OB at age 13 years. Analyses included longitudinal models of the pre- and post-exposure trajectories to estimate the policy effect. The participation rate in each cohort was >80%, and in most analyses <4% were excluded due to missing data. Estimates were adjusted for region, population density, and parental education. In pooled models additionally adjusted for pre-exposure BMISDS, there was little evidence of any benefit or unintended consequence from 1–2.5 years of exposure to the FFV policy on BMISDS, OW/OB, WC, or WtHR in either sex. For example, boys exposed to the FFV policy had a 0.05 higher BMISDS (95% CI: −0.04, 0.14), a 1.20-fold higher odds of OW/OB (95% CI: 0.86, 1.66) and a 0.3 cm bigger WC (95% CI: −0.3, 0.8); while exposed girls had a 0.04 higher BMISDS (95% CI: −0.04, 0.13), a 1.03 fold higher odds of OW/OB (95% CI: 0.75, 1.39), and a 0-cm difference in WC (95% CI: −0.6, 0.6). There was evidence of heterogeneity in the policy effect estimates at 8.5 years across cohorts and socioeconomic position; however, these results were inconsistent with other comparisons. Analysis at age 13 years, after 4 years of policy exposure, also showed little evidence of an effect on BMISDS or OW/OB. The main limitations of this study are the potential for residual confounding and exposure misclassification, despite efforts to minimize their impact on conclusions. Conclusions In this study we observed little evidence that the Norwegian nationwide FFV policy had any notable beneficial effect or unintended consequence on weight status among Norwegian children and adolescents.

• Ostojic, Sergej; Stea, Tonje Holte & Engeset, Dagrun (2022). Creatine as a Promising Component of Paternal Preconception Diet. Nutrients. 14(3). doi: 10.3390/nu14030586. Full text in Research Archive Show summary

  Abstract: Male fertility has been declining globally over the past several decades, advancing from a personal issue to a public health problem. Beyond any doubt, a reduction in fertility (often characterized by low sperm count or motility) can severely threaten reproductive health and lifecourse framework in a long-term fashion. Aside from uncovering the currently unknown etiology of modern-day male infertility, the scientific and medical community faces a double burden: finding an efficient biomarker of impaired fertility and exploring any intervention that can act to enhance fertility. A plethora of nutritional compounds have been recognized as possible modulators of semen quality, and specific dietary patterns and nutrients appear to be accompanied by a lower risk of male infertility. Creatine, a conditionally essential nutrient, has caught attention as a male fertilitypromoting candidate due to its role in sperm energy metabolism. This mini-review describes the creatine-related bioenergetics of spermatozoa, explores a connection between creatine levels and sperm quality in men, and critically examines available evidence for interventional studies with creatine to affect sperm viability.

• Stea, Tonje Holte; Solaas, Susanne Aune & Kleppang, Annette Løvheim (2022). Association between physical activity, sedentary time, participation in organized activities, social support, sleep problems and mental distress among adults in Southern Norway: a cross-sectional study among 28,047 adults from the general population. BMC Public Health. 22. doi: 10.1186/s12889-022-12769-x. Full text in Research Archive Show summary

  Abstract: Background: Identifcation of modifable factors associated with poor mental health is crucial to develop targeted and efective intervention strategies for prevention of mental distress and illness in the general population. Thus, the aim of the present study was to examine the association between low level of leisure-time physical activity, high sedentary time, low participation in organized activities, low social support, sleep problems, and mental distress in a large sample of Norwegian adults. Methods: A cross-sectional study was completed by 28,047 adults (≥18 years old) in southern Norway by flling out an online self-report questionnaire. Multivariable binary logistic regression models, stratifed according to gender and adjusted for age and perceived fnancial situation, were used to examine possible associations between unhealthy lifestyle behaviors, participation in organized activities, social support, and mental distress. Results: Our results showed an increased odds of having mental distress among men reporting low leisure-time physical activity (OR: 1.18; 95%CI: 1.03–1.37), high sedentary time (1.32; 1.16–1.51), low involvement in organized activities (1.43; 1.25–1.64), low social support (2.55; 2.18–2.99), and sleep problems (7.29; 6.35–8.37) compared to the rest of the male population. For women, the results showed increased odds of mental distress among those reporting high sedentary time (1.25; 1.11–1.39), low involvement in organized activities (1.60; 1.42–1.80), low social support (2.71; 2.39–3.06), and sleep problems (5.78; 5.15–6.50) compared to the rest of the female population. For both men and women, results also indicated that mental distress was increased among younger adults and among those reporting fnancial difculties compared to the rest of the population. Conclusion: Our results showed an association between unhealthy lifestyle behaviors, low participation in organized activities, low social support and mental distress, and that the strength of the association varied substantially. These fndings provide increased knowledge about the relationship between modifable lifestyle factors and mental health which should have implications for future public health eforts.

• Stea, Tonje Holte; Jong, Miek C.; Fegran, Liv; Sejersted, Ellen; Jong, M. & Wahlgren, Sophia Louise Hjorth [Show all 7 contributors for this article] (2022). Mapping the Concept, Content, and Outcome of Family-Based Outdoor Therapy for Children and Adolescents with Mental Health Problems: A Scoping Review. International Journal of Environmental Research and Public Health (IJERPH). ISSN 1661-7827. 19(10). doi: 10.3390/ijerph19105825. Full text in Research Archive Show summary

  Outdoor therapy and family-based therapy are suggested to be promising interventions for the treatment of mental health problems. The aim of the present scoping review was to systematically map the concept, content, and outcome of combining family- and outdoor-based therapy for children and adolescents with mental health problems. The Joanna Briggs Institute methodology and PRISMA guidelines were applied. Eligible qualitative and quantitative studies were screened, included, and extracted for data. Seven studies were included. Findings from these studies indicated that family-based outdoor therapy programs have a positive impact on family- and peer relationships, adolescent behavior, mental health, self-perceptions (self-concept), school success, social engagement, and delinquency rates. However, participant characteristics, study design, and content and mode of delivery of the interventions varied substantially, hence preventing detailed comparison of outcomes across studies. In addition, most of the studies included few participants and lacked population diversity and comparable control groups. Although important ethical concerns were raised, such as non-voluntary participation in some of the programs, there was a lack of reporting on safety. This review indicates that a combination of family- and outdoor-based therapy may benefit mental health among children and adolescents, but due to the limited number of studies eligible for inclusion and high levels of heterogeneity, it was difficult to draw firm conclusions. Thus, future theory-based studies using robust designs are warranted.

• Stea, Tonje Holte; Holvik, Kristin; Bryntesen, Caroline Marlen Solie & Myhre, Jannicke Borch (2021). Changes in food habits amongst Norwegian adolescents in 2016 and 2019 according to gender and socioeconomic status. Food & Nutrition Research (FNR). ISSN 1654-6628. 65, p. 1–10. doi: 10.29219/fnr.v65.6262. Full text in Research Archive Show summary

  Background: Monitoring dietary habits is important in order to identify risk groups and as a basis for targeted public health initiatives. Objective: To study trends in consumption of selected foods and beverages from 2016 to 2019 amongst Norwegian adolescents according to gender and parental education. Design: Repeated cross-sectional study amongst 25,996 adolescents, aged 14–17 years old. Consumption of selected food and beverages was measured by an online food frequency questionnaire and general linear models were applied to estimate changes in dietary habits. Results: Between 2016 and 2019, we observed a reduced frequency of consumption of vegetables (from 4.7 to 4.4 times/week), fruit and berries (from 4.4 to 4.2 times/week), whole-grain bread (from 5.1 to 4.2 times/week), and fish (from 2.3 to 1.6 times/week). During this time period, we also observed a reduced frequency of consumption of salty snacks (from 2.1 to 1.9 times/week), sweets (from 2.3 to 2.0 times/week), sugar-sweetened beverages (from 2.8 to 2.6 times/week), and artificially sweetened beverages (from 2.2 to 1.5 times/week). In girls, there was a decrease in the reported frequency of consumption of fruit and berries (−4%, vs. no change in boys). The decrease in consumption frequency of whole-grain bread was larger in girls than in boys (−19% vs. −14%). Further, a 17% decrease in consumption of sweets was observed amongst adolescents with no or only one parent having college/university education compared to a 13% decrease in adolescents whose both parents had college/university education. Conclusion: Our results showed a decrease in frequency of consumption of selected healthy and unhealthy food and beverages amongst adolescents between 2016 and 2019. The gender gap in consumption of fruit and berries and whole-grain bread seemed to decrease during this time period, and the socio-economic gap in consumption of sweets seemed to disappear.

• Øvrebø, Bente; Bergh, Ingunn Holden; Stea, Tonje Holte; Bere, Elling; Surén, Pål & Magnus, Per Minor [Show all 8 contributors for this article] (2021). Overweight, obesity, and thinness among a nationally representative sample of Norwegian adolescents and changes from childhood: Associations with sex, region, and population density. PLOS ONE. 16(8). doi: 10.1371/journal.pone.0255699. Full text in Research Archive
• Kleppang, Annette Løvheim; Haugland, Siri Håvås; Bakken, Anders & Stea, Tonje Holte (2021). Lifestyle habits and depressive symptoms in Norwegian adolescents: a national cross-sectional study. BMC Public Health. 21. doi: 10.1186/s12889-021-10846-1. Full text in Research Archive Show summary

  Background: This study’s purpose was to examine the association between a broad range of lifestyle habits and depressive symptoms in Norwegian adolescents. Methods: This study was based on national, self-reported, cross-sectional data from the Ungdata Surveys, conducted in 2017–2019. The target group comprised 244,250 adolescents (ages 13–19). Binominal logistic regression was used to analyse the association between lifestyle habits (physical activity, social media use, gaming, dietary habits, smoking, smokeless tobacco, alcohol intoxication) and depressive symptoms. The outcome measure was defined as a high level of depressive symptoms (≥80th percentile). Separate analyses were performed for boys and girls, and all models were adjusted for perceived family economy, parental higher education and age. Results: The odds of having depressive symptoms were significantly lower among those who reported being physically active at least 3 times per week (OR; boys: 0.81, girls: 0.83), used social media ≤3 h per day (OR; boys: 0.65, girls: 0.70), engaged in gaming ≤3 h per day (OR; boys: 0.72, girls: 0.77), were non-smokers (OR; boys: 0.74, girls: 0.72) and had not experienced alcohol intoxication during the previous 12 months (OR; boys: 0.66, girls: 0.67). Furthermore, the results indicated a significant inverse association between depressive symptoms and high consumption of a range of healthy food items and low consumption of unhealthy food and beverages among girls. Similar tendencies were found among boys (OR; 0.77–0.91). Finally, higher adherence to healthy lifestyle habits was associated significantly with lower odds of having depressive symptoms among both genders (OR; boys: 0.40, girls: 0.52). Conclusions: A healthier lifestyle was associated with lower odds of having depressive symptoms. Additional research is needed to confirm a possible causal relationship.

• Henjum, Sigrun; Groufh-Jacobsen, Synne; Stea, Tonje Holte; Tonheim, Live Edvardsen & Almendingen, Kari (2021). Iron Status of Vegans, Vegetarians and Pescatarians in Norway. Biomolecules. 11(3). doi: 10.3390/biom11030454. Full text in Research Archive Show summary

  Abstract: Although plant-based diets provide well-established physical and environmental health benefits, omitting meat or meat products has also been associated with a risk of being deficient in specific nutrients, such as iron. As data on the iron status among Norwegian vegans, vegetarians and pescatarians are lacking, the present study aimed to assess iron status in these groups of healthy adults. Blood markers for iron status were measured in 191 participants (18–60 years old) comprising 106 vegans, 54 vegetarians and 31 pescatarians: serum-ferritin (S-Fe), serum-iron (S-Iron) and serum-total iron binding capacity (S-TIBC). Serum-transferrin-saturation (S-TSAT) was estimated (S-Iron/S-TIBC × 100). The median concentration of blood markers for iron status were within the normal range with no difference between the different dietary practices. In total, 9% reported iron supplement use the last 24 h. S-Fe concentrations below reference (<15 μg/L) were found in 8% of the participating women, of which one participant reported iron supplement use. In multiple regression analysis, duration of adherence to dietary practices and the female gender were found to be the strongest predictors for decreased S-Fe concentration. In conclusion, although the participants were eating a plant-based diet, the majority had sufficient iron status. Female vegans and vegetarians of reproductive age are at risk of low iron status and should have their iron status monitored.

• Haugland, Siri Håvås; Carvalho, Barbara Olivieira Vieira de; Stea, Tonje Holte; Strandheim, Arve & Vederhus, John-Kåre (2021). Associations between parental alcohol problems in childhood and adversities during childhood and later adulthood: a cross-sectional study of 28047 adults from the general population. Substance Abuse Treatment, Prevention, and Policy. 16. doi: 10.1186/s13011-021-00384-9. Full text in Research Archive Show summary

  Background Adverse childhood experiences (ACE) are related to adverse physical and mental health outcomes. However, few larger studies based on a general population sample with age groups ranging from young adults to elderly have investigated whether parental alcohol problems increase the risk of offspring subjective reports of ACE both during childhood and current adult adversities. The purpose of this study was to examine the associations between parental alcohol problems and adversities during childhood and later in adulthood. Methods The 28,047 respondents were adults (> 18 years old) from the general population who participated in the Norwegian Counties Public Health Survey. The study had a cross-sectional design and included respondents’ evaluations of childhood experiences and current adult adversities. The short version of the Children of Alcoholics Screening Test (CAST-6, cut-off ≥3) measured parental alcohol problems. Multivariable logistic regression was adjusted for gender, age, and education. Results Growing up with parental alcohol problems strongly increased the risk of experiencing a dysfunctional family environment during childhood (odds ratio [OR] 6.84; 95% confidence interval [CI] 6.36–7.36), perceiving childhood as difficult (OR 5.01; 95% CI 4.58–5.49), and reporting a lack of support from a trusted adult (OR 3.07; 95% CI 2.86–3.29). Parental alcohol problems were associated with a modestly increased risk of harmful alcohol use (OR 1.38; 95% CI 1.29–1.48), but the association with struggling with bad memories was strong (OR 4.56; 95% CI 4.17–4.98). Conclusions Parental alcohol problems increased the risk of offspring experiencing adversities during both childhood and adulthood. Providing supportive services to these children and their families and addressing this issue as part of treatment is important to prevent alcohol related harm.

• Kleppang, Annette Løvheim; Ridder, Karin de; Haugland, Siri Håvås & Stea, Tonje Holte (2021). Physical activity, sugar‑sweetened beverages, whole grain bread and insomnia among adolescents and psychological distress in adulthood: prospective data from the population‑based HUNT study. International Journal of Behavioral Nutrition and Physical Activity. 18, p. 1–11. doi: 10.1186/s12966-021-01215-7. Full text in Research Archive
• Stea, Tonje Holte; Alvsvåg, Linn & Kleppang, Annette Løvheim (2021). The Association between Dietary Habits, Substance Use, and Mental Distress among Adults in Southern Norway: A Cross-Sectional Study among 28,047 Adults from the General Population. International Journal of Environmental Research and Public Health (IJERPH). ISSN 1661-7827. 18(18). doi: 10.3390/ijerph18189731. Full text in Research Archive
• Haraldstad, Kristin & Stea, Tonje Holte (2021). Associations between pain, self-efficacy, sleep duration and symptoms of depression in adolescents: a cross-sectional survey. BMC Public Health. 21(1617). doi: 10.1186/s12889-021-11680-1. Full text in Research Archive
• Stea, Tonje Holte; Nordheim, Oda; Bere, Elling Tufte; Stornes, Per Gunnar & Eikemo, Terje Andreas (2020). Fruit and vegetable consumption in Europe according to gender, educational attainment and regional affiliation — A cross-sectional study in 21 European countries. PLOS ONE. 15(5). doi: 10.1371/journal.pone.0232521. Full text in Research Archive Show summary

  Objective The purpose of the present study was to examine fruit and vegetable consumption according to gender, educational attainment and regional affiliation in Europe. Design Cross-sectional study. Setting 21 European countries. Participants 37 672 adults participating in the 7th round of the European Social Survey. Main outcome measures Fruit and vegetable consumption was measured using two single frequency questions. Responses were dichotomized into low (<once a day) and high (≥once a day) consumption. The association between consumption of fruit and vegetables and gender, educational level, regional affiliation was examined using logistic regression analyses. Results Overall, females showed increased odds of consuming fruit (OR 1.71 (95%CI:1.62, 1.79) and vegetable (1.59 (1.51, 1.67)) compared to males and high educated participants showed increased odds of consuming fruit (1.53 (1.43, 1.63)) and vegetables (1.86 (1.74, 2.00)) compared to low educated participants. Our results also showed that participants living in Eastern Europe had the lowest odds of consuming fruit and vegetables, whereas participants from Southern- and Northern Europe had the highest odds of consuming fruit and vegetables, respectively. Results from interaction analyses confirmed the positive association between fruit and vegetable consumption and educational level, although for some European regions, decreased odds of fruit and vegetables was observed among medium educated participants compared to those with low education. Conclusions Overall, the present study showed that being female and having a high education were associated with increased consumption of fruit and vegetables. However, the direction and strength of these relationships depends on regional affiliations.

• Henjum, Sigrun; Brantsæter, Anne Lise; Holvik, Kristin; Lillegaard, Inger Therese Laugsand; Mangschou, Bente & Parr, Christine Louise [Show all 14 contributors for this article] (2020). Benefit and risk assessment of iodization of household salt and salt used in bread and bakery products. Scientific opinion of the Panel on Nutrition, Dietetic Products, Novel Food and Allergy of the Norwegian Scientific Committee for Food and Environment. VKM Report. 2020(5), p. 1–312. Full text in Research Archive
• Stea, Tonje Holte; Ridder, Karin de & Haugland, Siri Håvås (2019). Comparison of risk-behaviors among young people who are not in education, employment or training (NEET) versus high school students. A cross-sectional study. Norsk Epidemiologi. ISSN 0803-2491. 28(1/2), p. 39–47. doi: 10.5324/nje.v28i1-2.3049. Full text in Research Archive
• Øvrebø, Bente; Stea, Tonje Holte; Velde, Saskia J. te; Bjelland, Mona; Klepp, Knut Inge & Bere, Elling Tufte (2019). A comprehensive multicomponent school-based educational intervention did not affect fruit and vegetable intake at the 14-year follow-up. Preventive Medicine. ISSN 0091-7435. 121, p. 79–85. doi: 10.1016/j.ypmed.2019.02.015. Full text in Research Archive Show summary

  The intake of fruit and vegetables is associated with beneficial health outcomes, and studies aimed at increasing fruit and vegetable intake lack long-term follow-up. The primary objective of this study was to evaluate the long-term (14-year) effects of a multicomponent school-based educational intervention targeted to increase fruit and vegetable intake in children. The secondary objective was to evaluate the potential synergistic effect between free school fruit and the educational program. A cluster randomized school-based intervention was initiated in 2001 in Norway, known as the Fruit and Vegetable Make the Marks study. In total, 38 schools were randomized; for the intervention (n = 18) and as control schools (n = 20). A subsample of the intervention schools (n = 9) were additionally given free school fruit, resulting in two intervention groups - one with and one without free fruit. Participants completed questionnaires in September 2001 (baseline, mean age 11.8), May 2002 (at the end of the intervention), May 2003, May 2005, September 2009 and throughout 2016 (mean age 26.5). Of 1950 participants, 982 (50.4%) completed the 14-year follow-up and were considered as the current study sample. Analysis yielded no 14-year effects of the educational program on fruit and vegetable intake. A synergistic effect between the educational program and free fruit was not observed either. Future studies might benefit from increased focus on more extensive parental involvement, increased home availability, and a longer intervention period. However, more long-term studies are needed to evaluate the effects of school-based interventions into adulthood.

• Haugland, Siri Håvås; Coombes, Lindsey & Stea, Tonje Holte (2019). Associations between parenting and substance use, meal pattern and food choices: A cross-sectional survey of 13,269 Norwegian adolescents. Preventive Medicine Reports. 14. doi: 10.1016/j.pmedr.2019.100862. Full text in Research Archive
• Stea, Tonje Holte; Abildsnes, Eirik; Strandheim, Arve & Haugland, Siri Håvås (2019). Do young people who are not in education, employment or training (NEET) have more health problems than their peers? A cross-sectional study among Norwegian adolescents. Norsk Epidemiologi. ISSN 0803-2491. 28(1-2), p. 89–95. doi: 10.5324/nje.v28i1-2.3055. Full text in Research Archive Show summary

  Objectives: An increasing proportion of young Norwegians are categorised as too ill to attend upper secondary education, and poor physical and mental health may reduce their opportunities to return to school or find paid employment. This study examined the differences in self-perceived health, mental health, and prevalence of pain between Norwegian adolescents, who are not in education, employment or training (NEET) compared to adolescents who attend upper secondary school (age 16-21 years). Design: Cross-sectional study. Participants and setting: A total of 96 NEET youth and 384 age and gender matched adolescents attending upper secondary school in the south of Norway participated in the study. Main outcome measures: Self-perceived health, mental health and pain. Results: Multivariable analyses, adjusted for parental education, showed that more NEET girls reported poor self-perceived health (odds ratio 3.2; 95% CI 1.4–7.5) and poor mental health (2.4;1.0–5.2) when compared to girls who were attending school. The results showed no difference in the prevalence of various types of pain between girls who were attending or not attending school, and among boys the results showed no differences in health problems assessed in this study. Conclusion: The study indicates that NEET girls have poorer self-perceived health and poorer mental health when compared to girls who are attending upper secondary school. It will be essential to identify the causes of these health problems. This may provide a basis for specially adapted measures that could help more people in the target group return to school or paid employment.

• Hovdenak, Ingrid Marie; Stea, Tonje Holte; Twisk, Jos; Velde, Saskia J. te; Klepp, Knut Inge & Bere, Elling Tufte (2019). Tracking of fruit, vegetables and unhealthy snacks consumption from childhood to adulthood (15 year period): does exposure to a free school fruit programme modify the observed tracking? International Journal of Behavioral Nutrition and Physical Activity. 16(22). doi: 10.1186/s12966-019-0783-8. Full text in Research Archive Show summary

  Background The rationale for promoting increased consumption of fruit and vegetables (FV) at an early age is based on results from previous tracking-studies, indicating that dietary habits learned in childhood sustain into adulthood. Previous tracking studies have several limitations (e.g. low study sample, few repeated measurements and/or short a follow-up period). In addition, to our knowledge, no study has shown that a dietary intervention initiated in childhood affects tracking of dietary behaviour. The main objectives in this study were therefore to assess tracking of FV and unhealthy snacks in a large sample with multiple follow-up surveys over 15-years, and whether exposure to free school fruit for one school year modified tracking. Method The longitudinal cohort-study, Fruit and Vegetables Make the Marks, included 38 randomly drawn schools in Norway; nine intervention schools received free fruit (or vegetable) in the school year 2001/2002 and 29 schools severed as control. The baseline sample included 1950 subjects, and 16–92% participated at five follow-up surveys (2002–2016). FV consumption and unhealthy snacks were measured by FFQ. Mixed models were applied to estimate overall tracking coefficients, and to assess whether the intervention modified tracking ((from baseline, from follow-up one (while intervention was running) and from follow-up two (after end of intervention)). Results Overall tracking coefficients were 0.33 for fruit, 0.36 for vegetables and differed by sex for unhealthy snacks: 0.46 males and 0.39 for females (interaction p = 0.065). Most analyses showed no significant difference in tracking between the intervention group and control group. However, from follow-up one, tracking coefficients were different for unhealthy snacks, 0.46 vs. 0.38 (interaction p = 0.036), and from follow-up two for vegetables, 0.35 vs 0.48 (p = 0.036), in the intervention group and control group, respectively. Conclusion Our results indicate low to moderate tracking of FV and unhealthy snacks from childhood to adulthood. We found little evidence that the free fruit intervention modified tracking of fruit, vegetables or unhealthy snacks. More research is needed on if or how we can influence the tracking of fruit, vegetables and unhealthy snacks consumption to improve public health.

• Hovdenak, Ingrid Marie; Stea, Tonje Holte; Magnus, Per; Krokstad, Steinar; Samdal, Oddrun & Bere, Elling Tufte (2019). How to evaluate the effect of seven years of The Norwegian School Fruit Scheme (2007-14) on fruit, vegetables, snacks consumption and weight status- A natural experiment. Scandinavian Journal of Public Health. ISSN 1403-4948. 49, p. 347–357. doi: 10.1177/1403494819875923. Full text in Research Archive Show summary

  Aim: From August 2007 to June 2014, the Norwegian School Fruit Scheme (NSFS) legally established that all pupils in junior high and combined schools (275,000 pupils every year), but not those in primary schools (343,000 pupils every year), were entitled to a free piece of fruit or vegetable every school day. The NSFS is a natural experiment, unique in terms of scope and lengthiness. Such governmental efforts to improve the diet of the public are rarely evaluated. Thus, an evaluation of the comprehensive, well-designed NSFS is warranted. The aim was to describe how the NSFS can be evaluated using existing data sets. Methods: Four data sets have been identified for the evaluation of the NSFS: (a) the Nord-Trøndelag Health Study, (b) the Norwegian Mother and Child Cohort Study, (c) the Norwegian Child Growth Study/Growth in Teenagers and (d) Health Behaviour in School Aged Children. These comprehensive studies have collected cross-sectional or longitudinal data providing information about children’s dietary consumption and/or weight status, which can be utilised in the evaluation of the NSFS. Both short- and long-term effects of the NSFS related to dietary habits and weight status and the potential effect of moderators such as socio-economic status, sex, ethnicity and the age of children and adolescents can be studied. Conclusions: Worldwide, there is a lack of well-designed, long-term studies evaluating the impact of governmental efforts to improve public diet. The present study describes how the NSFS can be evaluated using data from four large data sets on eating habits and weight status.

• Hovdenak, Ingrid Marie; Bere, Elling Tufte & Stea, Tonje Holte (2019). Time trends (1995-2008) in dietary habits among adolescents in relation to The Norwegian School Fruit Scheme: The HUNT study. Nutrition Journal. 18(77). doi: 10.1186/s12937-019-0501-z. Full text in Research Archive
• Samdal, Gro Beate; Meland, Eivind; Eide, Geir Egil; Berntsen, Sveinung; Abildsnes, Eirik & Stea, Tonje Holte [Show all 7 contributors for this article] (2018). Participants at Norwegian Healthy Life Centres: Who are they, why do they attend and how are they motivated? A cross-sectional study. Scandinavian Journal of Public Health. ISSN 1403-4948. 46(7), p. 774–781. doi: 10.1177/1403494818756081. Full text in Research Archive
• Torstveit, Monica Klungland; Johansen, Bjørn Tore; Haugland, Siri Håvås & Stea, Tonje Holte (2018). Participation in organized sports is associated with decreased likelihood of unhealthy lifestyle habits in adolescents. Scandinavian Journal of Medicine & Science in Sports. ISSN 0905-7188. 28(11), p. 2384–2396. doi: 10.1111/sms.13250. Full text in Research Archive
• Samdal, Gro Beate; Meland, Eivind; Eide, Geir Egil; Berntsen, Sveinung; Abildsnes, Eirik & Stea, Tonje Holte [Show all 7 contributors for this article] (2018). The Norwegian Healthy Life Centre Study: A pragmatic RCT of physical activity in primary care. Scandinavian Journal of Public Health. ISSN 1403-4948. p. 1–10. doi: 10.1177/1403494818785260. Full text in Research Archive
• Stea, Tonje Holte; Tveter, Eline Tønnesson; Velde, Saskia J. te; Vik, Frøydis Nordgård; Klepp, Knut Inge & Bere, Elling Tufte (2018). The effect of an extra piece of fruit or vegetables at school on weight status in two generations - 14 years follow-up of the Fruit and Vegetables Makes the Marks study. PLOS ONE. 13:e0205498(10). doi: 10.1371/journal.pone.0205498. Full text in Research Archive Show summary

  Background: The obesity epidemic presents a major public health challenge, and a poor diet quality has been identified as one of the most important contributing factors. Whereas a sufficient fruit and vegetable consumption has been associated with several positive health outcomes, the long-term effect on overweight and obesity is unclear. Thus, the aims of this study were to investigate if one year with free school fruit had any effect on weight status 14 years later, and if it affected the birth weight of the participants’ children. Methods: In 2001, 10 -12-year old Norwegian children, received one year of free school fruit in the intervention study “Fruits and Vegetables Make the Marks” (FVMM) and in 2016, a total of 1081 participants of 2049 eligible responded to a follow-up survey. Multilevel logistic regression was used to investigate if one year of free school fruit was associated with weight status and with birthweight status of the offspring. The analyses were adjusted for gender, educational level, and the offspring analysis also for parents’ weight status, and the nested design (child/parent). Results: The odds ratios of being overweight (OR: 0.93, 95% CI: 0.70, 1.24) or having a child with high or low birth weight (OR: 0.52, 95% CI: 0.21, 1.30) in the intervention group compared to the control group were not statistically significant, 14 years after the intervention period. Conclusions: One year of free school fruit did not have an effect on weight status on the participants or birth weight of their offspring, 14 years after the intervention period. Although, results from the present study contribute to fill the knowledge gaps concerning long-term effects of public health efforts on weight status, more follow-up studies with larger samples are warranted.

• Stea, Tonje Holte; Hovdenak, Ingrid Marie; Rønnestad, Jannike Berggren; Rennestraum, Kjersti Hovland; Vik, Frøydis Nordgård & Klepp, Knut Inge [Show all 7 contributors for this article] (2018). Effects of 1 y of free school fruit on intake of fruits, vegetables, and unhealthy snacks: 14 y later. American Journal of Clinical Nutrition. ISSN 0002-9165. 108. doi: 10.1093/ajcn/nqy243. Full text in Research Archive
• Bolt-Evensen, Kathrine; Vik, Frøydis Nordgård; Stea, Tonje Holte; Klepp, Knut Inge & Bere, Elling (2018). Consumption of sugar-sweetened beverages and artificially sweetened beverages from childhood to adulthood in relation to socioeconomic status - 15 years follow-up in Norway. International Journal of Behavioral Nutrition and Physical Activity. 15:8, p. 1–9. doi: 10.1186/s12966-018-0646-8. Full text in Research Archive Show summary

  BACKGROUND: In Norway, social inequalities in health and health-related behaviors have been reported despite the well-developed welfare state. The objective of the present study was to analyze; (i) the development in frequency of consumption of sugar-sweetened beverages (SSB) and artificially sweetened beverages (ASB) from childhood to adulthood; (ii) socioeconomic inequalities in the consumption of SSB and ASB using different indicators of socioeconomic status (SES); (iii) time trends in potential disparities in SSB and ASB consumption among different socioeconomic groups to assess the development in socioeconomic inequality from childhood to adulthood. METHODS: This study uses data from the Fruits and Vegetables Make the Marks (FVMM) longitudinal cohort, including participants (n = 437) from 20 random schools from two Norwegian counties. Data from the first survey in 2001 (mean age 11.8) and follow-up surveys in 2005 (mean age 15.5) and 2016 (mean age 26.5) were used. Consumption of SSB and ASB were measured using a food frequency questionnaire, which the participants completed at school in 2001 and 2005, and online in 2016. Various indicators of SES were included; in 2001, parental education and income were measured, in 2005, participants' educational intentions in adolescence were measured, and in 2016, participants' own education and income were measured. The main analyses conducted were linear mixed effects analysis of the repeated measures. RESULTS: Between 2001 and 2016, a decrease in frequency of consumption of SSB (2.8 v 1.3 times/week; p = < 0.001) and an increase in frequency of consumption of ASB (1.1 v 1.6 times/week; p = 0.002) were observed. Participants with a higher educational level in adulthood and higher educational intentions in adolescence had a significantly lower frequency of consumption of SSB at all time points (2001, 2005 and 2016). No significant widening (or narrowing) of inequalities were observed from childhood to adulthood. CONCLUSIONS: A decrease in consumption of SSB and an increase in consumption of ASB from childhood to adulthood were found. Participants with high SES consumed in general less SSB (but not ASB), however, results varied depending on SES indicator used. The established inequalities persisted from childhood to adulthood.

• Haraldstad, Kristin; Rohde, Gudrun E.; Stea, Tonje Holte; Lohne-Seiler, Hilde; Hetlelid, Ken Joar & Paulsen, Gøran [Show all 7 contributors for this article] (2017). Changes in health-related quality of life in elderly men after 12 weeks of strength training. European Review of Aging and Physical Activity. ISSN 1813-7253. 14(1). doi: 10.1186/s11556-017-0177-3. Full text in Research Archive Show summary

  Background: Muscular strength is associated with functional ability in elderly, and older adults are recommended to perform muscle-strengthening exercise. Understanding how improved muscle strength and -mass influence general and specific domains of quality of life is important when planning health promotion efforts targeting older adults. The aims of the present study were to describe changes in health-related quality of life (HRQOL) in older men participating in 12 weeks of systematic strength training, and to investigate whether improvements in muscle strength and muscle mass are associated with enhancements in HRQOL. Methods: We recruited 49 men aged 60–81 years to participate in an intervention study with pre-post assessment. The participants completed a 12-week strength training program consisting of three sessions per week. Tests and measurements aimed at assessing change in HRQOL, and changes in physical performance (maximal strength) and physiological characteristics. HRQOL was measured using the 12-item short-form survey (SF-12). Muscle mass was assessed based on changes in lean mass (leg, trunk, arm, and total), and strength was measured as one-repetition maximum in leg extension, leg press, and biceps curl. Results: Two of the eight HRQOL SF-12 scores, role physical and general health, and the physical component summary scores, increased significantly during the intervention period. Small significant positive correlations were identified between improvements in muscle strength, and better physical and social function. Moreover, a significant increase in total muscle mass was seen during the intervention period. Conclusions: The positive, findings from this study would suggest that systematic strength training seems to be a beneficial intervention to improve HRQOL, muscle strength and muscle mass in older men.

View all works in NVA

• Nedeljkovic, David; Todorovic, Nikola; Stea, Tonje Holte; Engeset, Dagrun & Ostojic, Sergej (2025). Association between dietary creatine intake and serum biomarkers of spermatogenesis in males aged 12 years and older. doi: 10.1530/raf-25-0009. Full text in Research Archive Show summary

  Creatine is a nutrient that helps provide energy to different parts of the body, including the testes. Since making sperm takes a lot of energy, creatine might play a role in supporting sperm health. Some studies suggest it could help, while others raise concerns. However, it is still unclear what effect, if any, creatine from food has on sperm. To learn more, we looked at data from over 1,300 males in the US, aged 12 and older. We compared how much creatine they got from their diet with levels of two hormones in the blood that are related to sperm production. We found no strong link between dietary creatine and these hormone levels. This suggests that creatine from food probably does not have a major effect – good or bad – on male reproductive health. Since this study used existing data and did not test creatine directly in an experiment, we cannot say for sure if creatine causes any changes. More research, especially studies that look directly at sperm, is needed to better understand how creatine might affect fertility.

• Steigen, Anne Mari; Kleppang, Annette Løvheim; Stea, Tonje Holte; Opdal, Ida Marie & Bonsaksen, Tore (2025). In-person and online socialization among Norwegian adolescents in relation to the COVID-19 pandemic. Full text in Research Archive
• Øgård-Repål, Anita; Haugland, Siri Håvås; Vederhus, John-Kåre; Robstad, Anja Nastasja & Stea, Tonje Holte (2024). What about the family? Sleep problems among close family members of people with mental health- or substance use problems. Full text in Research Archive
• Befus, Eva-Grethe; Mølland, Eirin; Helseth, Sølvi; Småstuen, Milada Cvancarova; Stea, Tonje Holte & Nolte, Sandra [Show all 7 contributors for this article] (2024). Livskvalitet og psykisk helse hos ungdom. Full text in Research Archive
• Befus, Eva-Grethe; Mølland, Eirin; Helseth, Sølvi; Hagen, Milada; Stea, Tonje Holte & Nolte, Sandra [Show all 7 contributors for this article] (2024). Lørdagsuniversitetet i Kristiansand: Hva kan vi gjøre for ungdoms psykiske helse? Full text in Research Archive
• Kleppang, Annette Løvheim; Abildsnes, Eirik; Haraldstad, Kristin & Stea, Tonje Holte (2023). Changes in Health-Related Quality of Life and Sleep Habits after a 6-Month Non-Randomised Cluster-Controlled Trial among Children with Overweight or Obesity. Full text in Research Archive
• Steigen, Anne Mari; Bonsaksen, Tore; Granrud, Marie Dahlen; Dangmann, Cecilie Ruud & Stea, Tonje Holte (2023). Time trends in sexual harassment exposure among adolescents in Norway between 2017 and 2021. Full text in Research Archive
• Bonsaksen, Tore; Steigen, Anne Mari; Stea, Tonje Holte; Kleppang, Annette Løvheim; Lien, Lars & Leonhardt, Marja (2023). Negative social media experiences and lower self-efficacy are associated with depressive symptoms. Full text in Research Archive
• Stea, Tonje Holte (2023). Ungdata - Risikofaktorer forbundet med helseproblemer, selvskading og selvmordsfare blant norske ungdommer. Full text in Research Archive Show summary

  Professor Tonje Holte Stea (UiA) vil presentere ny forskning basert på Ungdata som identifiserer ulike risikofaktorer og beskyttende faktorer for fysisk og psykisk helse blant norske ungdommer. Resultatene beskriver komplekse sammenhenger mellom en rekke ulike faktorer som sosioøkonomisk bakgrunn, sosial støtte, opplevd press, mobbing og symptomer på depresjon, selvskading og selvmordstanker blant ungdom i Agder. Nasjonale tall viser også en sterk sammenheng mellom seksuelle overgrep, bruk av rusmidler og helserelaterte konsekvenser. Samtidig har vi undersøkt i hvilken grad ungdom som er utsatt for seksuelle overgrep oppsøker helsetjenester for ungdom. Noen av resultatene overrasket oss forskere også. Vi mener at slike studier bidrar med økt kunnskap slik at foreldre, skole og helsevesen kan drive god forebygging og tilby tilpasset oppfølging og behandling for sårbare grupper.

• Stea, Tonje Holte (2023). Verdensdagen for selvmordsforebygging. Full text in Research Archive
• Øvrebø, Bente; Kjøllesdal, Marte Karoline Råberg; Stea, Tonje Holte; Wills, Andrew Keith; Bere, Elling Tufte & Suren, Pål [Show all 9 contributors for this article] (2022). Prevalence of overweight, obesity and central adiposity among children with immigrant background in Norway. Full text in Research Archive
• Stea, Tonje Holte (2022). Skolefrukt hadde ingen effekt på overvekt: – Synd at det ble avsluttet. [TV]. NRK TV Dagsrevyen + NRK TV Sørlandssendinga. Full text in Research Archive
• Kleppang, Annette Løvheim; Vettore, Mario Vianna; Hartz, Ingeborg; Haugland, Siri Håvås & Stea, Tonje Holte (2022). Patterns of unhealthy behaviours during adolescence and subsequent anxiety and depression in adulthood. A prospective register linkage study of the HUNT survey and health registries. Full text in Research Archive
• Stea, Tonje Holte; Vettore, Mario Vianna; Øvrebø, Bente & Abildsnes, Eirik (2022). Changes in dietary habits after a six-months intervention study among overweight and obese children. Full text in Research Archive
• Haugland, Siri Håvås & Stea, Tonje Holte (2022). Commentary on Welford, Danielsson & Manhica: The complexity of life conditions among offspring exposed to parental SUD. Addiction. ISSN 0965-2140. 117(7), p. 2057–2058. doi: 10.1111/add.15870. Full text in Research Archive
• Stea, Tonje Holte (2020). Aronia-bær skal halvere bruken av antibiotika og styrke immunforsvaret hos eldre. Full text in Research Archive
• Stea, Tonje Holte (2020). Vil halvere antibiotikabruken med aronia-juice. [Radio]. NRK Sørlandet. Full text in Research Archive
• Stea, Tonje Holte (2020). Nordmenn er blant de ivrigste fruktspiserne i Europa. Men kampanjene som skal få oss til å spise mer frukt og grønt, virker bare på kvinner. [Internet]. Forskning.no. Full text in Research Archive
• Stea, Tonje Holte (2020). Las mujeres de alto nivel educativo son las que comen más fruta y verdura en Europa. [Journal]. El Pais. Full text in Research Archive
• Stea, Tonje Holte (2020). Tror bruk av antibiotika kan halveres med aronia-juice. [Internet]. Forskning.no. Full text in Research Archive
• Stea, Tonje Holte (2020). Disse spiser mest frukt og grønt. [Internet]. Uia.no. Full text in Research Archive
• Stea, Tonje Holte (2020). Vil halvere antibiotikabruken med aronia-juice. [Journal]. Fædrelandsvennen. Full text in Research Archive
• Asbjørnsen, Rikke Aune; Smedsrød, Mirjam Lien; Hjelmesæth, Jøran; Hertel, Jens Kristoffer; Gemert-Pijnen, Lisette Van & Varsi, Cecilie [Show all 21 contributors for this article] (2019). Building an eHealth intervention for weight maintenance after weight loss: Identifying behavioral design elements & user needs. Full text in Research Archive
• Stea, Tonje Holte (2019). Sosial ulikhet i kosthold og helse. In Engeset, Dagrun; Torheim, Liv Elin & Øverby, Nina Cecilie (Ed.), Samfunnsernæring. Universitetsforlaget. ISSN 9788215030630. Full text in Research Archive
• Hovdenak, Ingrid Marie; Bere, Elling Tufte & Stea, Tonje Holte (2019). Time trends (1995-2006) in dietary habits among Among adolescents in relation to the Norwegian School Fruit Scheme: The HUNT study. Full text in Research Archive
• Stea, Tonje Holte & Ridder, Karin De (2019). Clustering of lifestyle behaviors among Norwegian adolescents. Full text in Research Archive
• Haugland, Siri Håvås; Stea, Tonje Holte & Ridder, Karin De (2018). Health risk-behaviors among young people not in employment, education or training (NEET). Full text in Research Archive
• Stea, Tonje Holte (2018). Hva er sammenhengen mellom skolemat og læring. [Radio]. Her og Nå. NRK. Full text in Research Archive
• Øvrebø, Bente; Bere, Elling Tufte & Stea, Tonje Holte (2022). Evaluations of school-based and fiscal efforts on diet-related behaviors and weight, emphasizing fruit, vegetables, candy, and soda. Universitetet i Agder. ISSN 9788284270647. Full text in Research Archive
• Løvik, Martinus; Dahl, Lisbeth; Mangschou, Bente; Ulven, Stine Marie; Andersen, Lene Frost & Dalen, Knut Tomas [Show all 10 contributors for this article] (2019). Assessment of dietary intake of fluoride and maximum limits of fluoride in food supplements. Opinion of the Panel on Nutrition, Dietetic Products, Novel Food and Allergy of the Norwegian Scientific Committee for Food and Environment. Norwegian Scientific Committee for Food and Environment (VKM). ISSN 9788282593281. Full text in Research Archive Show summary

  The Norwegian Scientific Committee for Food and Environment (Vitenskapskomiteen for mat og miljø, VKM) has, at the request of the Norwegian Food Safety Authority (Mattilsynet, NFSA), evaluated the intake of fluoride in the diet, together with intake of fluoride from dental hygiene and caries prevention products. VKM has also evaluated suggested maximum limits for fluoride in food supplements at 0.5, 1, 5 and 7 mg/day in relation to established tolerable upper intake levels (ULs). The former maximum limit for fluoride of 0.5 mg/day in food supplements was repealed 30 May 2017. Fluorine is a gaseous halogen which occurs naturally only in anionic form as fluoride (F-). Fluorides are ubiquitous in air, water and the lithosphere. Fluoride is found naturally in all water sources. The highest levels are found in groundwater. Surface water usually has lower concentrations of fluoride than groundwater, most often under 0.5 mg/L. Major dietary fluoride sources are water and tea. An important non-dietary source is dental hygiene products such as toothpaste and tablets for caries prevention. There is no fluoridation of drinking water or salt in Norway. Fluoride is not an essential nutrient. Caries is not a fluoride deficiency disease. However, because of the beneficial effects for caries prevention, an adequate intake (AI) of 0.05 mg per kg body weight per day has been set for fluoride by the European Food Safety Authority (EFSA). Readily soluble fluorides (sodium- and potassium fluoride) are rapidly and almost completely absorbed by passive diffusion in the stomach and the small intestine. Absorption is influenced by acidity and concomitant food intake. Absorbed fluoride is rapidly distributed in blood plasma, but is retained only in calcified tissues, that are bones and teeth. Consequently, 99% of the total fluoride content of the body is found in bone and teeth. Absorbed fluoride which is not deposited in calcified tissues is excreted almost exclusively via the kidneys. Whereas skeletal bone and dentine accumulate fluoride throughout life, enamel of teeth incorporate fluoride only at the time of tooth formation. Fluoride substitutes for hydroxyl groups in the apatite, increasing the resistance to caries. In permanent teeth enamel maturation is completed at the age of seven to eight years, except in the third molars. Posteruptive fluoride uptake by enamel occurs only in the outer layer and depends on local oral fluoride levels. A linear relationship between fluoride exposure and caries resistance has been demonstrated. Over the years, the view has shifted from systemic fluoride being most effective for caries prevention to local oral exposure being most important. Acute toxic effects may be provoked by fluoride, and deaths have been reported after intake of very large doses from fluoride tablets. The main adverse outcomes from intake of excess doses of fluoride over time, are enamel fluorosis in children up to eight years of age, and bone fluorosis in older children and adults. Dental fluorosis causing mottled teeth is largely a cosmetic effect, whereas bone fluorosis causes stiff joints and a greater tendency to fractures. Tolerable upper intake levels (UL) for fluoride have been set by the American Institute of Medicine (IOM) and by the European Food Safety Authority (EFSA). In this report, we relate estimated fluoride intakes to the upper level set by EFSA. Intakes of the main dietary fluoride sources, water and tea, in different age groups were obtained from Norwegian dietary surveys. High fluoride intakes were estimated by applying the 95 percentile of fluoride concentrations in water obtained from 2001 fluoride analyses from Norwegian waterworks in the period between 2010 and 2018 and in tea obtained from a Polish study to the daily volume consumed. Fluoride intakes from recommended use of dental hygiene and caries prevention products were then added, plus a small fixed value for undescribed sources. The estimated 95 percentile fluoride exposure calculated this way was compared to the upper level, and scenarios with additional fluoride supplementation of 0.5, 1, 5 or 7 mg/day were developed. The estimated 95-percentile of fluoride exposure from water, tea and dental hygiene products alone (before fluoride from the suggested food supplement doses at 0.5, 1, and 7 mg/day were added) was found to exceed the upper level for 2-year old children and for adults. VKM concludes that all the suggested food supplement doses considered will cause the tolerable upper intake level to be exceeded in all age groups, except for the supplement doses of 0.5 in 9- and 13-year olds and 1 mg/day in 9 year olds. VKM emphasises that the current assessment of maximum limits for fluoride in food supplements is merely based on published reports concerning upper levels from the IOM (USA, 2001), Scientific Committee on Food (EU, 2003), Expert Group on Vitamins and Minerals (UK, 2003) and Nordic Nutrition Recommendations (Nordic Countries, 2012). VKM has not conducted any review of the literature for the current opinion, as this was outside the scope of the terms of reference from the NFSA.

• Holvik, Kristin; Frøyland, Livar; Haugen, Margaretha; Henjum, Sigrun; Løvik, Martinus & Stea, Tonje Holte [Show all 8 contributors for this article] (2018). Assessment of dietary intake of vitamin K and maximum limits for vitamin K in food supplements. Opinion of the Panel on Nutrition, Dietetic Products, Novel Food and Allergy of the Norwegian Scientific Committee for Food and Environment. Norwegian Scientific Committee for Food Safetyand Enviroment (VKM). ISSN 9788282593007. Full text in Research Archive
• Strand, Tor A; Frøyland, Livar; Haugen, Margaretha; Henjum, Sigrun; Løvik, Martinus & Stea, Tonje Holte [Show all 8 contributors for this article] (2018). Assessment of dietary intake of molybdenum in relation to tolerable upper intake level. Opinion of the Panel on Nutrition, Dietetic Products, Novel Food and Allergy of the Norwegian Scientific Committee for Food and Environment. Norwegian Scientific Committee for Food and Environment (VKM). ISSN 9788282593021. Full text in Research Archive Show summary

  The Norwegian Scientific Committee for Food and Environment (Vitenskapskomiteen for mat og miljø, VKM) has, at the request of the Norwegian Food Safety Authority (Mattilsynet; NFSA), evaluated the intake of molybdenum. VKM has also conducted scenario calculations to illustrate the consequences of amending maximum limits for molybdenum to 100, 250, 500 or 1000 µg/day in food supplements. The previous maximum limit was 250 µg/day. Molybdenum is as a cofactor for some important enzymes in humans. These enzymes are involved in the catabolism of sulfur amino acids and heterocyclic compounds, including purines and pyridines. A distinct molybdenum deficiency has not been described in animals when subjected to molybdenum restriction, despite considerable reduction in the activity of molybdoenzymes. Molybdenum deficiency is not observed in healthy humans. The estimated Adequate Intake (AI) proposed by the European Food Safety Authority (EFSA) is 65 µg per day for men and women. Legumes, grains, and nuts are major contributors of molybdenum in the diet. Molybdenum is a potential antagonist to copper absorption, but symptoms of copper deficiencies due to excess molybdenum intake have only been observed in ruminants. Based on the effect on reproduction and growth in animals, tolerable upper intake levels (ULs) have been estimated to be 2 mg/day by the U.S. Institute of Medicine (IOM) in 2001 and 0.6 mg/day by the Scientific Committee on Food (SCF) in 2000. These ULs were based on the same scientific evidence, but IOM used an uncertainty factor (UF) of 30 and SCF used a UF of 100 because the evidence base was considered to be weak. Because of the limited safety data on molybdenum, VKM support the use of the default uncertainty factors at 100 for extrapolation of data from animal studies to humans. Additionally, molybdenum deficiency is very rare and no studies have indicated a nutritional need for additional molybdenum from dietary supplements. The ULs for children were derived by adjusting the adult UL according to default body weights. According to the scenario estimations, only the highest suggested maximum limit of 1000 µg molybdenum from food supplements will lead to exceedance of the UL for adults. For 1-3 year old children, all the suggested maximum limits for molybdenum will lead to exceedance of the UL. In children 4-10 years, supplements with 250, 500 or 1000 µg molybdenum will lead to exceedance of the ULs, whereas for adolescents 11-17 years, the UL will be exceeded with supplemental doses at 500 or 1000 µg per day. VKM emphasises that the current assessment of maximum limits for molybdenum in food supplements is merely based on published reports concerning upper levels from the SCF (2000, EU), IOM (2001, USA), EVM (2003, UK) and NNR (2012, Nordic countries). VKM has not conducted any systematic review of the literature for the current opinion, as this was outside the scope of the terms of reference from NFSA.

• Haugen, Margaretha; Frøyland, Livar; Henjum, Sigrun; Løvik, Martinus; Stea, Tonje Holte & Strand, Tor A [Show all 8 contributors for this article] (2018). Assessment of dietary intake of manganese in relation to tolerable upper intake level. Opinion of the Panel on Nutrition, Dietetic Products, Novel Food and Allergy of the Norwegian Scientific Committee for Food and Environment. Norwegian Scientific Committee for Food and Environment (VKM). ISSN 9788282592994. Full text in Research Archive
• Løvik, Martinus; Frøyland, Livar; Haugen, Margaretha; Henjum, Sigrun; Stea, Tonje Holte & Strand, Tor A [Show all 8 contributors for this article] (2018). Assessment of dietary intake of chromium (III) in relation to tolerable upper intake Level. Opinion of the Panel on Nutrition, Dietetic Products, Novel Food and Allergy of the Norwegian Scientific Committee for Food and Environment. Norwegian Scientific Committee for Food and Enviroment (VKM). ISSN 9788282593038. Full text in Research Archive
• Haugen, Margaretha; Lillegaard, Inger Therese L.; Frøyland, Livar; Henjum, Sigrun; Løvik, Martinus & Stea, Tonje Holte [Show all 8 contributors for this article] (2017). Assessment of Dietary Intake of Phosphorus in Relation to Tolerable Upper Intake Levels. Opinion of the Panel on Nutrition, Dietetic Products, Novel Food and Allergy of the Norwegian Scientific Committee for Food Safety. Norwegian Scientific Committee for Food Safety (VKM). ISSN 9788282592758. Full text in Research Archive
• Haugen, Margaretha; Lillegaard, Inger Therese L.; Frøyland, Livar; Henjum, Sigrun; Løvik, Martinus & Stea, Tonje Holte [Show all 8 contributors for this article] (2017). Assessment of dietary intake of potassium in relation to upper guidance Level. Opinion of the Panel on Nutrition, Dietetic Products, Novel Food and Allergy of the Norwegian Scientific Committee for Food Safety. Norwegian Scientific Committee for Food Safety (VKM). ISSN 9788282592741. Full text in Research Archive

View all works in NVA