1. Empowerment is related to health among Swedish adolescents 1 Epidemiology and Public Health Sciences, Umeå University, Sweden 2 Center for Clinical Research Falun, Sweden 3 Research Department, National Institute of Public Health – Sweden 4 Department of Public Health and Caring Sciences, Uppsala University, Sweden 5 Pediatrics, Department of Clinical Sciences, Umeå University, Sweden Lars Jerden 1,2,3 Gunilla Burell 4 Hans Stenlund 1 Lars Weinehall 1,3 Erik Bergström 1,5

3. Empowerment “Empowerment is defined as a process wherein people assert control over factors which affect their lives” Ref: Connelly LM, Keele BS, Kleinbeck SV, Schneider JK, Cobb AK. A place to be yourself: empowerment from the client's perspective. Image J Nurs Sch. 1993 Winter;25(4):297-303.

4. Empowerment  Personal control, perceived power is central  Broad concept, including self-efficacy, competence and social interaction  Different levels: Individual, group and community level of analysis In our study we have focused on the individual level

5. Study population All students in 7th grade (n = 1 046) in seven schools, representing varying number of inhabitants, geographical areas, and levels of education among parents.

6. Aim To examine if empowerment is associated with self-rated health and health behaviour (among Swedish adolescents)

7. Sweden Västerbotten Province (2 schools) Dalarna Province (5 schools)

8. Construction of the instrument A questionnaire was constructed with questions about empowerment, socio- demographic characteristics, self-rated health and health behavior. Half of the empowerment questions were selected from the Swedish part of the Health Behavior in School-Aged Children survey (HBSC), and from other established Swedish surveys. The rest were constructed for the study.

9. Test-retest (204 student) 4 items with Kappa < 0.4 were dropped The final 17 “empowerment items” 21 preliminary“empowerment items”combining HBSC and new questions Development of the instrument

10. The final 17 “empowerment items” Health-related competence Social interaction Self-efficacy 3 dimensions From items to dimensions

11. To what degree can you yourself influence your well-being? Very much Rather much Not very much + Not at all Do you know what to do in order to feel well? Yes, most often Yes, sometimes No, seldom How often do you feel helpless? Never Seldom Sometimes + Often + Always Self-efficacy related items Self-efficacy Item scores for reply alternatives 321

12. Health related competence items Item scores for reply alternatives 321 When you feel bad: do you know the reason? Do you know how your body functions? Do you know what to do if you get a headache? Do you know what to do in order to avoid stress? Do you know what to do if you become stressed? Do you know what to do if you feel bad mentally? Do you usually feel that things that happen in your daily life are difficult to understand? Yes, most often Yes No Yes, sometimes Uncertain Yes, sometimes No, seldom No Yes, most often Health-related competence

13. Social interaction items Item scores for reply alternatives 321 Never No, seldom Yes, most often No No, seldom Yes, most often Seldom Yes, sometimes Once or twice + A few times Yes, sometimes Sometimes + Often + Alvays Yes, often No, seldom About once a week + Several times a week Yes, most often No, seldom How often do you feel left aside? Does it happen that you are alone, although you don´t want it? Do you have as many mates as you want? Have you been mobbed during the last year? Do you find it embarrassing to speak in front of your class? Do your teachers usually care about your opinion? Are you taking part in decisions in your family? Social interaction

14. Empowerment dimensions and total empowerment vs parents education levels Self-efficacy Health Related Competence Social Interaction Empowerment University/college Lower 0,02,55,07,5 6,86 * 6,99 2,28 2,29 2,32 2,37 2,24 * 2,33

15. Empowerment dimensions and total empowerment vs gender Self-efficacy Health Related Competence Social Interaction Empowerment Boys Girls 0,02,55,07,5 6,85 6,98 2,30 * 2,26 2,34 2,35 2,21 *** 2,36

16. Empowerment dimensions and total empowerment vs self rated health Self-efficacy Health Related Competence Social Interaction Empowerment High Low 0,02,55,07,5 5,82 *** 7,00 2,08 *** 2,29 2,03 *** 2,37 1,72 *** 2,33

17. Empowerment dimensions and total empowerment vs smoking habits Self-efficacy Health Related Competence Social Interaction Empowerment No smoking Smoking 0,02,55,07,5 6,26*** 6,95 2,21 2,28 2,12*** 2,36 1,94*** 2,30

18. Conclusions  Empowerment is closely related to self- rated health and health behaviour (among Swedish adolescents).  Empowerment dimensions are influenced by gender and by educational level of parents

19. e-mail: lars.jerden@Ltdalarna.se www.Ltdalarna.se/VIP