Inequality and COVID-19 in Sweden: relative risks of nine bad life events, by four social gradients, in pandemic vs. prepandemic years

The COVID-19 pandemic struck societies directly and indirectly, not just challenging population health but disrupting many aspects of life. Different effects of the spreading virus—and the measures to fight it—are reported and discussed in different scientific fora, with hard-to-compare methods and metrics from different traditions. While the pandemic struck some groups more than others, it is difficult to assess the comprehensive impact on social inequalities. This paper gauges social inequalities using individual-level administrative data for Sweden’s entire population. We describe and analyze the relative risks for different social groups in four dimensions—gender, education, income, and world region of birth—to experience three types of COVID-19 incidence, as well as six additional negative life outcomes that reflect general health, access to medical care, and economic strain. During the pandemic, the overall population faced severe morbidity and mortality from COVID-19 and saw higher all-cause mortality, income losses and unemployment risks, as well as reduced access to medical care. These burdens fell more heavily on individuals with low income or education and on immigrants. Although these vulnerable groups experienced larger absolute risks of suffering the direct and indirect consequences of the pandemic, the relative risks in pandemic years (2020 and 2021) were conspicuously similar to those in prepandemic years (2016 to 2019)

Pathways from Childhood Economic Conditions to Adult Mortality in a 1953 Stockholm Cohort: The Intermediate Role of Personal Attributes and Socioeconomic Career

Although both childhood and adult economic conditions have been found to be associated with mortality, independently or in combination with each other, less is known about the role of intermediate factors between these two life stages. This study explores the pathways between childhood economic conditions and adult mortality by taking personal attributes as well as adult socioeconomic career into consideration. Further, we investigate the role of intergenerational income mobility for adult mortality. We used data from a prospective cohort study of individuals that were born in 1953 and residing in Stockholm, Sweden, in 1963 who were followed for mortality between 2002 and 2021 (n = 11,325). We fit Cox proportional hazards models to assess the association of parental income, cognitive ability, social skills, educational attainment, occupational status, and adult income with mortality. The income mobility is operationalized as the interaction between parental and adult income. Our results show that the association between parental income and adult mortality is modest and largely operates through cognitive ability and adult educational attainment. However, our results do not provide support for there being an effect of intergenerational income mobility on adult mortality. In a Swedish cohort who grew up in a comparatively egalitarian society during the 1950s and 1960s, childhood economic conditions were found to play a distinct but relatively small role for later mortality

Youth, Sexual Risk-Taking Behavior, and Mental Health: a Study of University Students in Uganda

BACKGROUND: Little focus has been paid to the role of mental health among young people with regard to risky sexual behavior and HIV prevention in sub-Saharan Africa. The aim of this study was to investigate the relationship between poor mental health and risky sexual behavior (HIV/AIDS) among a population of university students in Uganda. METHODS: In 2005, 980 Ugandan university students completed a self-administered questionnaire (response rate 80%) assessing sociodemographic and religious background factors, mental health, alcohol use, and sexual behavior. Mental health was assessed using items from the Hopkins Symptoms Checklist-25 and the Symptom Checklist-90. RESULTS: High scores on depression and high numbers of sexual partners among both males (odds ratio (OR) 2.0, 95% confidence interval (CI) 1.2-3.3) and females (OR 3.3, 95% CI 1.3-8.6) were significantly associated. Elevated anxiety scores among men were associated with high numbers of sexual partners (OR 1.9, 95% CI 1.1-3.3) and inconsistent condom use (OR 1.9, 95% CI 1.1-3.6). Psychoticism was also significantly associated with high numbers of sexual partners among men. The associations remained statistically significant after controlling for sociodemographic factors and level of alcohol consumption. CONCLUSION: These findings indicate that previous conclusions on the association between sexual behavior and mental health from high- and middle-income countries also are valid in a low-income setting, such as in Uganda. This knowledge has implications for policy formation and HIV/AIDS preventive strategies. Coordinated youth-friendly mental health and sexual and reproductive health services to meet the needs of young people would be desirable

Patterns of alcohol consumption and risky sexual behavior: a cross-sectional study among Ugandan university students.

As reflected in elevated rates of sexually transmitted infections, there is a high prevalence of risky sexual behavior among Ugandan university students. It has been assumed that alcohol contributes to risky sexual behavior. However, perhaps owing to methodological issues, this relationship has found only mixed support in empirical research. The present study analyzes the association between alcohol use and risky sexual behavior at the global, situational, and event level among Uganda university students with sexual experience

Associations Between Being ‘Locked-In’ and Health – An Epidemiological Study

Objective. The aim of this study was to investigate associations between an individual’s level of perceived control over labor market position (locked-in and not locked-in) and self-rated health and psychological well-being.Methods. A representative sample (n = 11,675) of the working population in southern Sweden responded to a questionnaire.Results. Sixty-seven percent of the respondents worked in their preferred workplace and occupation. Nineteen percent reported being in a nonpreferred workplace and nonpreferred occupation (double locked-in). Twenty-three percent reported suboptimal health compared with 31% among the double locked-in. The risk of suboptimal health was elevated in all locked-in groups also after adjustment for background variables and job strain. In the double locked-in group, the fully adjusted odds ratio for suboptimal health was 1.72 (95% confidence interval 1.49–1.99) and for suboptimal psychological well-being 2.17 (95% confidence inter val 1.84–2.56). Odds ratio for the other locked-in groups was lower but still statistically significant.Conclusions. Being at a nonpreferred work-place or occupation was associated with impaired health

Association between Self-Reported Academic Performance and Risky Sexual Behavior among Ugandan University Students- A Cross Sectional Study.

Little is known about the association between self-reported academic performance and risky sexual behaviors and if this differs by gender, among university students. Academic performance can create psychological pressure in young students. Poor academic performance might thus potentially contribute to risky sexual behavior among university students. The aim of this study was to investigate the association between self-reported academic performance and risky sexual behaviors, and whether gender affects this relationship among Ugandan university students. In 2010, 1,954 students participated in a cross-sectional survey, conducted at Mbarara University of Science and Technology in southwestern Uganda (72% response rate). Multivariate logistic regression analysis was used for the analysis. 1,179 (60.3%) students in our study sample reported having debuted sexually. Of these 440 (42.2%) used condoms inconsistently with new sexual partners, and 344 (33.6%) had had multiple sexual partners. We found a statistically significant association between poor academic performance and inconsistent condom use with a new sex partner and this association remained significant even after adjusting for all the potential confounders. There was no such association detected regarding multiple sexual partners. We also found that gender modified the effect of poor academic performance on inconsistent condom use. Females, who were poor academic performers, were found to be at a higher risk of inconsistent condom use than their male counterparts. Interventions should be designed to provide extra support to poor academic performers, which may improve their performance and self-esteem, which in turn might reduce their risky sexual behaviors

Exploring the longevity advantage of doctorates in Finland and Sweden : The role of smoking- and alcohol-related causes of death

Aims: Tobacco smoking and alcohol use contribute to differences in life expectancy between individuals with primary, secondary and tertiary education. Less is known about the contribution of these risk factors to differences at higher levels of education. We estimate the contribution of smoking and alcohol use to the life-expectancy differences between the doctorates and the other tertiary-educated groups in Finland and in Sweden. Methods: We used total population data from Finland and Sweden from 2011 to 2015 to calculate period life expectancies at 40 years of age. We present the results by sex and educational attainment, the latter categorised as doctorate or licentiate degrees, or other tertiary. We also present an age and cause of death decomposition to assess the contribution of deaths related to smoking and alcohol. Results: In Finland, deaths related to smoking and alcohol constituted 48.6% of the 2.1-year difference in life expectancy between men with doctorate degrees and the other tertiary-educated men, and 22.9% of the 2.1-year difference between women, respectively. In Sweden, these causes account for 22.2% of the 1.9-year difference among men, and 55.7% of the 1.6-year difference among women, which in the latter case is mainly due to smoking. Conclusions: Individuals with doctorates tend to live longer than other tertiary-educated individuals. This difference can be partly attributed to alcohol consumption and smoking.Peer reviewe

Relationship between commuting and health outcomes in a cross-sectional population survey in southern Sweden

<p>Abstract</p> <p>Background</p> <p>The need for a mobile workforce inevitably means that the length of the total work day (working and traveling time) will increase, but the health effects of commuting have been surprisingly little studied apart from perceived stress and the benefits of physically active commuting.</p> <p>Methods</p> <p>We used data from two cross-sectional population-based public health surveys performed in 2004 and 2008 in Scania, Sweden (56% response rate). The final study population was 21, 088 persons aged 18-65, working > 30 h/week. Duration (one-way) and mode of commuting were reported. The outcomes studied were perceived poor sleep quality, everyday stress, low vitality, mental health, self-reported health, and absence from work due to sickness during the past 12 months. Covariates indicating socioeconomic status and family situation, overtime, job strain and urban/rural residency were included in multivariate analyses. Subjects walking or cycling to work < 30 min were used as a reference category.</p> <p>Results</p> <p>Monotonous relations were found between duration of public transport commuting and the health outcomes. For the category commuting > 60 min odds ratios (ORs) ranged from 1.2 - 1.6 for the different outcomes. For car commuting, the relationships were concave downward or flat, with increasing subjective health complaints up to 30-60 min (ORs ranging from 1.2 - 1.4), and lower ORs in the > 60 min category. A similar concave downward relationship was observed for sickness absence, regardless of mode of transport.</p> <p>Conclusions</p> <p>The results of this study are concordant with the few earlier studies in the field, in that associations were found between commutation and negative health outcomes. This further demonstrates the need to consider the negative side-effects of commuting when discussing policies aimed at increasing the mobility of the workforce. Studies identifying population groups with increased susceptibility are warranted.</p

Willingness and acceptability of cervical cancer screening among HIV positive Nigerian women

Background: The proven benefit of integrating cervical cancer screening programme into HIV care has led to its adoption as a standard of care. However this is not operational in most HIV clinics in Nigeria. Of the various reasons given for non-implementation, none is backed by scientific evidence. This study was conducted to assess the willingness and acceptability of cervical cancer screening among HIV positive Nigerian women. Methods: A cross sectional study of HIV positive women attending a large HIV treatment centre in Lagos, Nigeria. Respondents were identified using stratified sampling method. A pretested questionnaire was used to obtain information by trained research assistants. Obtained information were coded and managed using SPSS for windows version 19. Multivariate logistic regression model was used to determine independent predictor for acceptance of cervical cancer screening. Results: Of the 1517 respondents that returned completed questionnaires, 853 (56.2%) were aware of cervical cancer. Though previous cervical cancer screening was low at 9.4%, 79.8% (1210) accepted to take the test. Cost of the test (35.2%) and religious denial (14.0%) were the most common reasons given for refusal to take the test. After controlling for confounding variables in a multivariate logistic regression model, having a tertiary education (OR = 1.4; 95% CI: 1.03-1.84), no living child (OR: 1.5; 95% CI: 1.1-2.0), recent HIV diagnosis (OR: 1.5; 95% CI: 1.1-2.0) and being aware of cervical cancer (OR: 1.5; 95% CI: 1.2-2.0) retained independent association with acceptance to screen for cervical cancer. Conclusions: The study shows that HIV positive women in our environment are willing to screen for cervical cancer and that the integration of reproductive health service into existing HIV programmes will strengthen rather than disrupt the services