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Vardavas C, Zisis K, Nikitara K, Lagou I, Marou V, Aslanoglou K, Athanasakis K, Phalkey R, Leonardi-Bee J, Fernandez E, Condell O, Lamb F, Sandmann F, Pharris A, Deogan C, Suk JE. Cost of the COVID-19 pandemic versus the cost-effectiveness of mitigation strategies in EU/UK/OECD: a systematic review. BMJ Open 2023; 13:e077602. [PMID: 37907290 PMCID: PMC10619092 DOI: 10.1136/bmjopen-2023-077602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 09/18/2023] [Indexed: 11/02/2023] Open
Abstract
OBJECTIVES The economic burden of COVID-19 pandemic is substantial, with both direct and indirect costs playing a significant role. DESIGN A systematic literature review was conducted to estimate the cost of the COVID-19 pandemic and the cost-effectiveness of pharmaceutical or non-pharmaceutical interventions. All cost data were adjusted to the 2021 Euro, and interventions compared with null. DATA SOURCES Ovid MEDLINE and EMBASE were searched from January 2020 through 22 April 2021. ELIGIBILITY CRITERIA Studies regarding COVID-19 outbreak or public health preparedness measures or interventions with outcome measures related to the direct and indirect costs for disease and preparedness and/or response in countries of the European Union (EU), the European Economic Area (EEA), the UK and the Organisation for Economic Co-operation and Development (OECD) of all relevant epidemiological designs which estimate cost within the selected time frame were considered eligible. DATA EXTRACTION AND SYNTHESIS Studies were searched, screened and coded independently by two reviewers with high measure of inter-rater agreement. Data were extracted to a predefined data extraction sheet. The risk of bias was assessed using the Consensus on Health Economic Criteria checklist. RESULTS We included data from 41 economic studies. Ten studies evaluated the cost of the COVID-19 pandemic, while 31 assessed the cost-benefit of public health surveillance, preparedness and response measures. Overall, the economic burden of the COVID-19 pandemic was found to be substantial. Community screening, bed provision policies, investing in personal-protective-equipment and vaccination strategies were cost-effective. Physical distancing measures were associated with health benefits; however, their cost-effectiveness was dependent on the duration, compliance and the phase of the epidemic in which it was implemented. CONCLUSIONS COVID-19 pandemic is associated with substantial short-term and long-term economic costs to healthcare systems, payers and societies, while interventions including testing and screening policies, vaccination and physical distancing policies were identified as those presenting cost-effective options to deal with the pandemic, dependent on population vaccination and the Re at the stage of the pandemic.
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Affiliation(s)
- Constantine Vardavas
- School of Medicine, University of Crete, Heraklion, Greece
- Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Harvard University, Boston, Massachusetts, USA
| | - Konstantinos Zisis
- School of Medicine, University of Crete, Heraklion, Greece
- Department of Public Health Policy, University of West Attica, Egaleo, Greece
| | | | - Ioanna Lagou
- School of Medicine, University of Crete, Heraklion, Greece
| | - Valia Marou
- School of Medicine, University of Crete, Heraklion, Greece
| | | | | | - Revati Phalkey
- Public Health England, London, UK
- University of Nottingham, Nottingham, UK
| | - Jo Leonardi-Bee
- Centre for Evidence-Based Healthcare, School of Medicine, University of Nottingham, Nottingham, UK
| | - Esteve Fernandez
- Tobacco Control Unit, Catalan Institute of Oncology, L'Hospitalet de Llobregat, Spain
| | - Orla Condell
- European Centre for Disease Prevention and Control, Solna, Sweden
| | - Favelle Lamb
- European Centre for Disease Prevention and Control, Solna, Sweden
| | - Frank Sandmann
- European Centre for Disease Prevention and Control, Solna, Sweden
| | | | - Charlotte Deogan
- European Centre for Disease Prevention and Control, Solna, Sweden
| | - Jonathan E Suk
- European Centre for Disease Prevention and Control, Solna, Sweden
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2
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Vardavas C, Nikitara K, Aslanoglou K, Lagou I, Marou V, Phalkey R, Leonardi-Bee J, Fernandez E, Vivilaki V, Kamekis A, Symvoulakis E, Noori T, Wuerz A, Suk JE, Deogan C. Social determinants of health and vaccine uptake during the first wave of the COVID-19 pandemic: A systematic review. Prev Med Rep 2023; 35:102319. [PMID: 37564118 PMCID: PMC10410576 DOI: 10.1016/j.pmedr.2023.102319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 07/07/2023] [Accepted: 07/10/2023] [Indexed: 08/12/2023] Open
Abstract
Social determinants of health significantly impact population health status. The aim of this systematic review was to examine which social vulnerability factors or determinants of health at the individual or county level affected vaccine uptake within the first phase of the vaccination program. We performed a systematic review of peer-reviewed literature published from January 2020 until September 2021 in Medline and Embase (Bagaria et al., 2022) and complemented the review with an assessment of pre-print literature within the same period. We restricted our criteria to studies performed in the EU/UK/EEA/US that report vaccine uptake in the general population as the primary outcome and included various social determinants of health as explanatory variables. This review provides evidence of significant associations between the early phases of vaccination uptake for SARS-CoV-2 and multiple socioeconomic factors including income, poverty, deprivation, race/ethnicity, education and health insurance. The identified associations should be taken into account to increase vaccine uptake in socially vulnerable groups, and to reduce disparities in uptake, in particular within the context of public health preparedness for future pandemics. While further corroboration is needed to explore the generalizability of these findings across the European setting, these results confirm the need to consider vulnerable groups and social determinants of health in the planning and roll-out of SARS-CoV-2 vaccination programs and within the context of future respiratory pandemics.
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Affiliation(s)
- Constantine Vardavas
- School of Medicine, University of Crete, Heraklion, Crete, Greece
- Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Harvard University, Boston, MA, USA
| | | | | | - Ioanna Lagou
- School of Medicine, University of Crete, Heraklion, Crete, Greece
| | - Valia Marou
- School of Medicine, University of Crete, Heraklion, Crete, Greece
| | - Revati Phalkey
- Health Centre for Evidence Based Healthcare, School of Medicine, University of Nottingham, Nottingham, UK
| | - Jo Leonardi-Bee
- Health Centre for Evidence Based Healthcare, School of Medicine, University of Nottingham, Nottingham, UK
| | - Esteve Fernandez
- Tobacco Control Unit, WHO Collaborating Centre for Tobacco Control, Institut Català d'Oncologia-ICO, L’Hospitalet de Llobregat (Barcelona), Spain
- Tobacco Control Research Group, Institut d’Investigació Biomèdica de. Ellvitge-IDIBELL, L’Hospitalet de Llobregat (Barcelona), Spain
- School of Medicine and Health Sciences, Campus of Bellvitge, Universitat de Barcelona, Spain
- Centre of Biomedical Research Network on Respiratory Diseases (CIBERES de Enfermedaes Respiratorias), Insituto de Salud Carlos III, Madrid, Spain
| | | | | | | | - Teymur Noori
- Emergency Preparedness and Response Support, European Centre for Disease Prevention and Control, Solna, Sweden
| | - Andrea Wuerz
- Emergency Preparedness and Response Support, European Centre for Disease Prevention and Control, Solna, Sweden
| | - Jonathan E. Suk
- Emergency Preparedness and Response Support, European Centre for Disease Prevention and Control, Solna, Sweden
| | - Charlotte Deogan
- Emergency Preparedness and Response Support, European Centre for Disease Prevention and Control, Solna, Sweden
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3
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Vardavas CI, Nikitara K, Aslanoglou K, Kamekis A, Puttige Ramesh N, Symvoulakis E, Agaku I, Phalkey R, Leonardi-Bee J, Fernandez E, Condell O, Lamb F, Deogan C, Suk JE. Systematic review of outbreaks of COVID-19 within households in the European region when the child is the index case. BMJ Paediatr Open 2023; 7:10.1136/bmjpo-2022-001718. [PMID: 36649374 PMCID: PMC9835947 DOI: 10.1136/bmjpo-2022-001718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 12/07/2022] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVES This systematic review aims to identify the secondary attack rates (SAR) to adults and other children when children are the index cases within household settings. METHODS This literature review assessed European-based studies published in Medline and Embase between January 2020 and January 2022 that assessed the secondary transmission of SARS-CoV-2 within household settings. The inclusion criteria were based on the Population, Exposure, Outcome framework for systematic reviews. Thus, the study population was restricted to humans within the household setting in Europe (population), in contact with paediatric index cases 1-17 years old (exposure) that led to the transmission of SARS-CoV-2 reported as either an SAR or the probability of onward infection (outcome). RESULTS Of 1819 studies originally identified, 19 met the inclusion criteria. Overall, the SAR ranged from 13% to 75% in 15 studies, while there was no evidence of secondary transmission from children to other household members in one study. Evidence indicated that asymptomatic SARS-CoV-2 index cases also have a lower SAR than those with symptoms and that younger children may have a lower SAR than adolescents (>12 years old) within household settings. CONCLUSIONS SARS-CoV-2 secondary transmission from paediatric index cases ranged from 0% to 75%, within household settings between January 2020 and January 2022, with differences noted by age and by symptomatic/asymptomatic status of the index case. Given the anticipated endemic circulation of SARS-CoV-2, continued monitoring and assessment of household transmission is necessary.
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Affiliation(s)
- Constantine I Vardavas
- School of Medicine, University of Crete School of Medicine, Heraklion, Greece.,Department of Oral Health Policy and Epidemiology, Harvard University, Cambridge, Massachusetts, USA
| | - Katerina Nikitara
- School of Medicine, University of Crete School of Medicine, Heraklion, Greece
| | - Katerina Aslanoglou
- School of Medicine, University of Crete School of Medicine, Heraklion, Greece
| | - Apostolos Kamekis
- School of Medicine, University of Crete School of Medicine, Heraklion, Greece
| | - Nithya Puttige Ramesh
- Department of Oral Health Policy and Epidemiology, Harvard University, Cambridge, Massachusetts, USA
| | | | - Israel Agaku
- Department of Oral Health Policy and Epidemiology, Harvard University, Cambridge, Massachusetts, USA
| | - Revati Phalkey
- Centre for Evidence Based Healthcare, University of Nottingham, Nottingham, UK
| | - Jo Leonardi-Bee
- Centre for Evidence Based Healthcare, University of Nottingham, Nottingham, UK
| | - Esteve Fernandez
- Tobacco Control Unit, Catalan Institute of Oncology Institut Català d'Oncologia (ICO), L'Hospitalet de Llobregat, Barcelona, Spain.,Tobacco Control Research Group, Institut d'Investigació Biomèdica de Bellvithe (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain.,CIBER Respiratory Diseases (CIBERES), Madrid, Spain.,Department of Clinical Sciences, School of Medicine and Health Sciences, Universitat de Barcelona, Barcelona, Spain
| | - Orla Condell
- European Centre for Disease Prevention and Control (ECDC), Solna, Stockholm, Sweden
| | - Favelle Lamb
- European Centre for Disease Prevention and Control (ECDC), Solna, Stockholm, Sweden
| | - Charlotte Deogan
- European Centre for Disease Prevention and Control (ECDC), Solna, Stockholm, Sweden
| | - Jonathan E Suk
- European Centre for Disease Prevention and Control (ECDC), Solna, Stockholm, Sweden
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Vardavas CI, Mathioudakis AG, Nikitara K, Stamatelopoulos K, Georgiopoulos G, Phalkey R, Leonardi-Bee J, Fernandez E, Carnicer-Pont D, Vestbo J, Semenza JC, Deogan C, Suk JE, Kramarz P, Lamb F, Penttinen P. Prognostic factors for mortality, intensive care unit and hospital admission due to SARS-CoV-2: a systematic review and meta-analysis of cohort studies in Europe. Eur Respir Rev 2022; 31:220098. [PMID: 36323422 PMCID: PMC9724816 DOI: 10.1183/16000617.0098-2022] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 08/03/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND As mortality from coronavirus disease 2019 (COVID-19) is strongly age-dependent, we aimed to identify population subgroups at an elevated risk for adverse outcomes from COVID-19 using age-/gender-adjusted data from European cohort studies with the aim to identify populations that could potentially benefit from booster vaccinations. METHODS We performed a systematic literature review and meta-analysis to investigate the role of underlying medical conditions as prognostic factors for adverse outcomes due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), including death, hospitalisation, intensive care unit (ICU) admission and mechanical ventilation within three separate settings (community, hospital and ICU). Cohort studies that reported at least age and gender-adjusted data from Europe were identified through a search of peer-reviewed articles published until 11 June 2021 in Ovid Medline and Embase. Results are presented as odds ratios with 95% confidence intervals and absolute risk differences in deaths per 1000 COVID-19 patients. FINDINGS We included 88 cohort studies with age-/gender-adjusted data from 6 653 207 SARS-CoV-2 patients from Europe. Hospital-based mortality was associated with high and moderate certainty evidence for solid organ tumours, diabetes mellitus, renal disease, arrhythmia, ischemic heart disease, liver disease and obesity, while a higher risk, albeit with low certainty, was noted for chronic obstructive pulmonary disease and heart failure. Community-based mortality was associated with a history of heart failure, stroke, diabetes and end-stage renal disease. Evidence of high/moderate certainty revealed a strong association between hospitalisation for COVID-19 and solid organ transplant recipients, sleep apnoea, diabetes, stroke and liver disease. INTERPRETATION The results confirmed the strong association between specific prognostic factors and mortality and hospital admission. Prioritisation of booster vaccinations and the implementation of nonpharmaceutical protective measures for these populations may contribute to a reduction in COVID-19 mortality, ICU and hospital admissions.
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Affiliation(s)
- Constantine I Vardavas
- School of Medicine, University of Crete, Heraklion, Crete, Greece
- Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Harvard University, Boston, MA, USA
| | - Alexander G Mathioudakis
- Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, The University of Manchester, Manchester, UK
- North West Lung Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | | | - Kimon Stamatelopoulos
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens, Greece
| | - Georgios Georgiopoulos
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens, Greece
| | - Revati Phalkey
- Centre for Evidence Based Healthcare, Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, UK
- Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany
| | - Jo Leonardi-Bee
- Centre for Evidence Based Healthcare, Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, UK
| | | | - Dolors Carnicer-Pont
- Catalan Institute of Oncology, Barcelona, Spain
- Institut d'Investigació Biomèdica de Bellvithe (IDIBELL), Barcelona, Spain
| | - Jørgen Vestbo
- Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, The University of Manchester, Manchester, UK
- North West Lung Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Jan C Semenza
- European Centre for Disease Prevention and Control (ECDC), Solna, Sweden
| | - Charlotte Deogan
- European Centre for Disease Prevention and Control (ECDC), Solna, Sweden
| | - Jonathan E Suk
- European Centre for Disease Prevention and Control (ECDC), Solna, Sweden
| | - Piotr Kramarz
- European Centre for Disease Prevention and Control (ECDC), Solna, Sweden
| | - Favelle Lamb
- European Centre for Disease Prevention and Control (ECDC), Solna, Sweden
| | - Pasi Penttinen
- European Centre for Disease Prevention and Control (ECDC), Solna, Sweden
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Abstract
OBJECTIVES School closures have been used as a core non-pharmaceutical intervention (NPI) during the COVID-19 pandemic. This review aims at identifying SARS-CoV-2 transmission in educational settings during the first waves of the pandemic. METHODS This literature review assessed studies published between December 2019 and 1 April 2021 in Medline and Embase, which included studies that assessed educational settings from approximately January 2020 to January 2021. The inclusion criteria were based on the PCC framework (P-Population, C-Concept, C-Context). The study Population was restricted to people 1-17 years old (excluding neonatal transmission), the Concept was to assess child-to-child and child-to-adult transmission, while the Context was to assess specifically educational setting transmission. RESULTS Fifteen studies met inclusion criteria, ranging from daycare centres to high schools and summer camps, while eight studies assessed the re-opening of schools in the 2020-2021 school year. In principle, although there is sufficient evidence that children can both be infected by and transmit SARS-CoV-2 in school settings, the SAR remain relatively low-when NPI measures are implemented in parallel. Moreover, although the evidence was limited, there was an indication that younger children may have a lower SAR than adolescents. CONCLUSIONS Transmission in educational settings in 2020 was minimal-when NPI measures were implemented in parallel. However, with an upsurge of cases related to variants of concern, continuous surveillance and assessment of the evidence is warranted to ensure the maximum protection of the health of students and the educational workforce, while also minimising the numerous negative impacts that school closures may have on children.
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Affiliation(s)
- Constantine Vardavas
- School of Medicine, University of Crete, Heraklion, Greece
- Department of Oral Health Policy and Epidemiology, Harvard University, Cambridge, Massachusetts, USA
| | | | - Alexander G Mathioudakis
- Immunity and Respiratory Medicine, The University of Manchester, Manchester, UK
- Manchester Academic Health Science Centre, Manchester, UK
| | - Michele Hilton Boon
- WISE Centre for Economic Justice, Glasgow Caledonian University, Glasgow, UK
| | - Revati Phalkey
- Division of Epidemiology and Public Health, University of Nottingham School of Medicine, Nottingham, UK
| | - Jo Leonardi-Bee
- Division of Epidemiology and Public Health, University of Nottingham School of Medicine, Nottingham, UK
| | - Anastasia Pharris
- Epidemic Prone Diseases, Coronavirus and Influenza, Disease Programmes Unit, European Centre for Disease Prevention and Control, Solna, Sweden
| | - Charlotte Deogan
- Epidemic Prone Diseases, Coronavirus and Influenza, Disease Programmes Unit, European Centre for Disease Prevention and Control, Solna, Sweden
| | - Jonathan E Suk
- Emergency Preparedness and Response Support, Public Health Functions Unit, European Centre for Disease Prevention and Control, Solna, Sweden
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Deogan C, Bergström J, Heimer G, Mannheimer L, Björkenstam C. Socioeconomic inequalities in sexual victimisation in a nationally representative sample of the Swedish population. Scand J Public Health 2022:14034948221079064. [PMID: 35319297 DOI: 10.1177/14034948221079064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AIMS Sexual victimisation is a key public health concern because of its physical, psychological and social consequences. Nationally representative studies exploring sexual victimisation and re-victimisation are still scarce. The aim of the current study was to explore associations of sexual victimisation with sociodemographic factors including sexual orientation in Sweden. METHODS We used Swedish data from a national population survey linked to nationwide registers. The sample consisted of 3349 individuals aged 30-44 years, (2021 women and 1328 men). With a latent class analysis we identified groups of individuals with distinctly different experiences of sexual victimisation. Multinomial logistic regression was used to explore how common characteristics could explain latent class membership classes. RESULTS Experiences of sexual victimisation were common: 48% of women and 13% of men had experienced sexual harassment, 47% of women and 12% of women sexual assault, 11% of women and 1% of men attempted intercourse and 8% of women and 1% of men rape. Among women four groups were identified who had distinctly different experiences of exposure to sexual victimisation such as low victimisation, sexually harassed and assaulted several times, highly sexually victimised with low re-victimisation and finally high victimisation. Both women and men who were highly sexually victimised had to a higher extent a non-heterosexual sexual identity. CONCLUSIONS Non-heterosexual orientation is a robust indicator of a high level of sexual victimisation as well as re-victimisation among both male and female adults.
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Affiliation(s)
- Charlotte Deogan
- The Public Health Agency of Sweden, Sweden.,Department of Global Public Health Sciences, Karolinska Institutet, Sweden
| | | | - Gun Heimer
- Department of Women's and Children's Health, Uppsala University, Sweden
| | - Louise Mannheimer
- The Public Health Agency of Sweden, Sweden.,Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Sweden
| | - Charlotte Björkenstam
- The Public Health Agency of Sweden, Sweden.,Department of Neuroscience, Psychiatry, Uppsala University, Sweden
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7
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Bundle N, Dave N, Pharris A, Spiteri G, Deogan C, Suk JE. COVID-19 trends and severity among symptomatic children aged 0-17 years in 10 European Union countries, 3 August 2020 to 3 October 2021. Euro Surveill 2021; 26. [PMID: 34915968 PMCID: PMC8728490 DOI: 10.2807/1560-7917.es.2021.26.50.2101098] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
We estimated risks of severe outcomes in 820,404 symptomatic paediatric COVID-19 cases reported by 10 European Union countries between August 2020 and October 2021. Case and hospitalisation rates rose as transmission increased but severe outcomes were rare: 9,611 (1.2%) were hospitalised, 640 (0.08%) required intensive care and 84 (0.01%) died. Despite increased individual risk (adjusted odds ratio hospitalisation: 7.3; 95% confidence interval: 3.3–16.2; intensive care: 8.7; 6.2–12.3) in cases with comorbidities, most (83.7%) hospitalised children had no comorbidity.
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Affiliation(s)
- Nick Bundle
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - Nishi Dave
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - Anastasia Pharris
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - Gianfranco Spiteri
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - Charlotte Deogan
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - Jonathan E Suk
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
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- The Study group members are listed under Investigators
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8
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Deogan C, Jacobsson E, Mannheimer L, Björkenstam C. Are Men Who Buy Sex Different from Men Who Do Not?: Exploring Sex Life Characteristics Based on a Randomized Population Survey in Sweden. Arch Sex Behav 2021; 50:2049-2055. [PMID: 33354757 PMCID: PMC8275502 DOI: 10.1007/s10508-020-01843-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 09/09/2020] [Accepted: 09/16/2020] [Indexed: 06/12/2023]
Abstract
The buying and selling of sex is a topic of frequent discussion and a relevant public health issue. Studies of sex workers are available, while studies addressing the demand side of sex are scarce, especially based on robust population data. The current study provides national estimates of the prevalence of and factors associated with having paid for sex among men in Sweden. We used a randomized population-based survey on sexual and reproductive health and rights among ages 16-84 years, linked to nationwide registers. The sample consisted of 6048 men. With a logistic regression, we analyzed what sex life factors were associated with ever having paid for or given other types of compensation for sex. A total of 9.5% of male respondents reported ever having paid for sex. An increased probability of having paid for sex was identified in men who were dissatisfied with their sex life (aOR: 1.72; 95% CI: 1.34-2.22), men reporting having had less sex than they would have liked to (aOR: 2.78; 95% CI: 2.12-3.66), men who had ever looked for or met sex partners online (aOR: 5.07; 95% CI: 3.97-6.46), as well as frequent pornography users (aOR: 3.02; 95% CI: 2.28-3.98) Associations remained statistically significant after adjustment for age, income, and educational attainment. Sex life characteristics such as poor sex life satisfaction, high online sex activity, and frequent pornography use are strongly associated with sex purchase. These findings can help guide and support counselling and prevention activities targeting sex buyers.
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Affiliation(s)
- Charlotte Deogan
- The Public Health Agency of Sweden, SE-171 82, Solna, Stockholm, Sweden.
- Karolinska Institutet, Department of Global Public Health Sciences, Social Medicine, Infectious Diseases and Migration Research, Stockholm, Sweden.
| | - Elin Jacobsson
- The Public Health Agency of Sweden, SE-171 82, Solna, Stockholm, Sweden
| | - Louise Mannheimer
- The Public Health Agency of Sweden, SE-171 82, Solna, Stockholm, Sweden
- Karolinska Institutet, Department of Learning, Informatics, Management and Ethics, Stockholm, Sweden
| | - Charlotte Björkenstam
- The Public Health Agency of Sweden, SE-171 82, Solna, Stockholm, Sweden
- Department of Neuroscience, Psychiatry, Uppsala University, Uppsala, Sweden
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9
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Crawshaw AF, Deal A, Rustage K, Forster AS, Campos-Matos I, Vandrevala T, Würz A, Pharris A, Suk JE, Kinsman J, Deogan C, Miller A, Declich S, Greenaway C, Noori T, Hargreaves S. What must be done to tackle vaccine hesitancy and barriers to COVID-19 vaccination in migrants? J Travel Med 2021; 28:6189154. [PMID: 33772312 PMCID: PMC8083646 DOI: 10.1093/jtm/taab048] [Citation(s) in RCA: 71] [Impact Index Per Article: 23.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 03/16/2021] [Accepted: 03/23/2021] [Indexed: 01/21/2023]
Abstract
Migrants have been disproportionately impacted by COVID-19 and emerging evidence suggests they may face barriers to COVID-19 vaccination. Participatory approaches and engagement strategies are urgently needed to strengthen uptake, alongside innovative delivery mechanisms and sharing of best practice, to ensure migrants are better consider within countries’ existing vaccine priority structures.
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Affiliation(s)
- Alison F Crawshaw
- Migrant Health Research Group, Institute for Infection and Immunity, St George's, University of London, SW17 0RE London, UK
| | - Anna Deal
- Migrant Health Research Group, Institute for Infection and Immunity, St George's, University of London, SW17 0RE London, UK.,Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, WC1E 7HT London, UK
| | - Kieran Rustage
- Migrant Health Research Group, Institute for Infection and Immunity, St George's, University of London, SW17 0RE London, UK
| | - Alice S Forster
- Department of Behavioural Science and Health, University College London, WC1E 6BT London, UK
| | - Ines Campos-Matos
- Health Improvement Division, Public Health England, SE1 8UG London, UK and UCL Collaborative Centre for Inclusion Health, University College London, WC1E 6BT London, UK
| | - Tushna Vandrevala
- Department of Psychology, Kingston University London, Kingston KT2 7LB, UK
| | - Andrea Würz
- Disease Programmes (AW, AP, JK, CD, TN); Public Health Functions (JES), European Centre for Disease Prevention and Control, Stockholm SE-Solna, Sweden
| | - Anastasia Pharris
- Disease Programmes (AW, AP, JK, CD, TN); Public Health Functions (JES), European Centre for Disease Prevention and Control, Stockholm SE-Solna, Sweden
| | - Jonathan E Suk
- Disease Programmes (AW, AP, JK, CD, TN); Public Health Functions (JES), European Centre for Disease Prevention and Control, Stockholm SE-Solna, Sweden
| | - John Kinsman
- Disease Programmes (AW, AP, JK, CD, TN); Public Health Functions (JES), European Centre for Disease Prevention and Control, Stockholm SE-Solna, Sweden
| | - Charlotte Deogan
- Disease Programmes (AW, AP, JK, CD, TN); Public Health Functions (JES), European Centre for Disease Prevention and Control, Stockholm SE-Solna, Sweden
| | - Anna Miller
- Policy & Advocacy Division, Doctors of the World UK, part of the Médicins du Monde network, E14 5AA London, UK
| | - Silvia Declich
- National Centre for Global Health, Istituto Superiore di Sanità, 00161 Roma RM, Italy
| | - Chris Greenaway
- Department of Medicine, McGill University Montreal, H3A 1A1 Quebec, Canada
| | - Teymur Noori
- Disease Programmes (AW, AP, JK, CD, TN); Public Health Functions (JES), European Centre for Disease Prevention and Control, Stockholm SE-Solna, Sweden
| | - Sally Hargreaves
- Migrant Health Research Group, Institute for Infection and Immunity, St George's, University of London, SW17 0RE London, UK
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10
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Shedrawy J, Deogan C, Öhd JN, Hergens MP, Bruchfeld J, Jonsson J, Siroka A, Lönnroth K. Cost-effectiveness of the latent tuberculosis screening program for migrants in Stockholm Region. Eur J Health Econ 2021; 22:445-454. [PMID: 33559787 PMCID: PMC7954754 DOI: 10.1007/s10198-021-01265-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 01/13/2021] [Indexed: 06/07/2023]
Abstract
INTRODUCTION The majority of tuberculosis (TB) cases in Sweden occur among migrants from endemic countries through activation of latent tuberculosis infection (LTBI). Sweden has LTBI-screening policies for migrants that have not been previously evaluated. This study aimed to assess the cost-effectiveness of the current screening strategy in Stockholm. METHODS A Markov model was developed to predict the costs and effects of the current LTBI-screening program compared to a scenario of no LTBI screening over a 50-year time horizon. Epidemiological and cost data were obtained from local sources when available. The primary outcomes were incremental cost-effectiveness ratio (ICER) in terms of societal cost per quality-adjusted life year (QALY). RESULTS Screening migrants in the age group 13-19 years had the lowest ICER, 300,082 Swedish Kronor (SEK)/QALY, which is considered cost-effective in Sweden. In the age group 20-34, ICER was 714,527 SEK/QALY (moderately cost-effectives) and in all age groups above 34 ICERs were above 1,000,000 SEK/QALY (not cost-effective). ICER decreased with increasing TB incidence in country of origin. CONCLUSION Screening is cost-effective for young cohorts, mainly between 13 and 19, while cost-effectiveness in age group 20-34 years could be enhanced by focusing on migrants from highest incidence countries and/or by increasing the LTBI treatment initiation rate. Screening is not cost-effective in older cohorts regardless of the country of origin.
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Affiliation(s)
- Jad Shedrawy
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.
| | - Charlotte Deogan
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- The Public Health Agency of Sweden, Stockholm, Sweden
| | - Joanna Nederby Öhd
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Department of Communicable Disease Control and Prevention, Stockholm County Council, Stockholm, Sweden
| | - Maria-Pia Hergens
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Department of Communicable Disease Control and Prevention, Stockholm County Council, Stockholm, Sweden
| | - Judith Bruchfeld
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
- Division of Infectious Diseases, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | | | | | - Knut Lönnroth
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
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11
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Nkulu-Kalengayi FK, Jonzon R, Deogan C, Hurtig AK. Evidence and gaps in the literature on HIV/STI prevention interventions targeting migrants in receiving countries: a scoping review. Glob Health Action 2021; 14:1962039. [PMID: 34404337 PMCID: PMC8381899 DOI: 10.1080/16549716.2021.1962039] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 07/21/2021] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Evidence suggests that migration increases vulnerability to human immunodeficiency virus (HIV) and other sexually transmitted infections (STI). However, there is limited knowledge about what has been done or needs to be done to address migrants' vulnerability in receiving countries. OBJECTIVES A scoping review was carried out to map the existing literature in this field, describe its characteristics, identify gaps in knowledge and determine whether a Sexual and Reproductive Health and Rights (SRHR)-perspective was applied. METHODS We used the Arksey and O'Malley framework and the Joanna Briggs Institute guidelines for scoping reviews and subsequent enhancements proposed by other authors. We searched three databases and grey literature to identify relevant publications. RESULTS A total of 1,147 records were found across the three electronic databases and compiled. Of these, only 29 papers that met the inclusion criteria were included. The review shows that research in this field is dominated by studies from the USA that mostly include behavioural interventions for HIV and HBV prevention among migrants from Latin America and Asian countries, respectively. None of the interventions integrated an SRHR perspective. The intervention effects varied across studies and measured outcomes. The observed effects on knowledge, attitudes, perceptions, behavioural intentions and skills were largely positive, but reported effects on testing and sexual risk behaviours were inconsistent. CONCLUSIONS There is a need for good quality research, particularly in parts of the world other than the USA that will address all STIs and specifically target the most vulnerable subgroups of migrants. Further research requires greater scope and depth, including the need to apply an SRHR perspective and incorporate biomedical and structural interventions to address the interacting causes of migrants' vulnerability to HIV/STIs.
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Affiliation(s)
| | - Robert Jonzon
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
- Department of Sexual Health and HIV Prevention, The Public Health Agency of Sweden, Stockholm, Sweden
| | - Charlotte Deogan
- Department of Sexual Health and HIV Prevention, The Public Health Agency of Sweden, Stockholm, Sweden
| | - Anna-Karin Hurtig
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
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12
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Deogan C, Abrahamsson K, Mannheimer L, Björkenstam C. Having a child without wanting to? Estimates and contributing factors from a population-based survey in Sweden. Scand J Public Health 2020; 50:215-222. [PMID: 33158406 PMCID: PMC8873963 DOI: 10.1177/1403494820965762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Aims: The aims of the current study were to identify the prevalence of unwanted childbirth (UC), to explore the association with sociodemographic factors and to identify possible contributing factors such as psychosomatic health, contraceptive use, experiences of induced abortion and sexual violence. Methods: We used Swedish data from the randomised population-based study SRHR2017 on sexual and reproductive health and rights (SRHR), based on self-administered surveys, linked to nationwide registers. The national sample consisted of 14,537 women and men aged between 16 and 84 years. With logistic regression, we examined differences in self-reported experience of UC, stratified by sex, in relation to socio-economic factors, as well as several possible contributing factors. Results: Despite advances in SRHR and fertility control, 6% of women and men in Sweden reported UC. This experience tends to be unevenly distributed in the population according to age, country of birth and, to some extent, income and educational attainment. Previous experience of induced abortion, sexual violence and threat from a partner were significantly associated with UC, whereas self-reported good health was protective. Conclusions: Mechanisms behind unintended, unplanned, unwanted or mistimed pregnancies are complex. Current results focus on the role of individual factors and personal experiences. In addition, in line with previous understanding, there is a need for adopting a broader socio-ecological perspective on fertility intentions.
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Affiliation(s)
- Charlotte Deogan
- The Public Health Agency of Sweden, Sweden.,Department of Global Public Health Sciences, Social Medicine, Infectious Diseases and Migration, Karolinska Institutet, Sweden
| | | | - Louise Mannheimer
- The Public Health Agency of Sweden, Sweden.,Department of Public Health Sciences, Division of Learning, Informatics, Management and Ethics, Karolinska Institutet, Sweden
| | - Charlotte Björkenstam
- The Public Health Agency of Sweden, Sweden.,Department of Neuroscience, Uppsala University, Psychiatry, Sweden
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13
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Deogan C, Jacobsson E, Mannheimer L, Björkenstam C. Meeting Sexual Partners Online and Associations With Sexual Risk Behaviors in the Swedish Population. J Sex Med 2020; 17:2141-2147. [PMID: 32873533 DOI: 10.1016/j.jsxm.2020.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 07/13/2020] [Accepted: 08/03/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Online arenas may facilitate sexual encounters. However, to what extent finding sexual partners online is associated with sexual risk behavior and sexual health outcomes is still not fully explored. METHODS A stratified randomized population based study on sexual and reproductive health and rights of 50,000 Swedes was conducted in 2017. The final sample consisted of 14,537 women and men aged 16-84 years. We identified sexual health factors associated with finding sexual partners online and estimated prevalences thereof. RESULTS Having used the internet to meet sexual partners was reported by 11% (95% confidence interval: 10.1-12.3) of men and 7% (95% confidence interval: 6.0-7.4) of women and was most common among men aged 30-44 years (13.7%). After adjustment, those reporting a non-heterosexual identity were most likely to meet sexual partners online. Meeting sexual partners online was also associated with reporting several sexual risk behaviors: condomless sex with temporary partner during the past 12 months, adjusted odds ratio (AOR): 5.1 (3.8-6.8) for women and AOR: 6.0 (4.5-7.9) for men, and having had a test for sexually transmitted infections (STIs) generated a 4-fold AOR for both sexes, STI diagnosis showed a 2-fold AOR, ever having paid or given other compensation for sex AOR: 4.8 (2.7-8.8) for women and AOR: 4.2 (2.9-6.1) for men as well as ever having received money or other compensation for sex AOR: 4.0 (1.3-11.9) for women and AOR: 6.0 (2.4-15.1) for men. CLINICAL TRANSLATION Meeting sexual partners online was associated with sexual risk behaviors, which is of importance in tailoring sexual health interventions and STI/HIV-control activities. STRENGTHS AND LIMITATIONS Few studies of online sexual behaviors are based on population-based surveys of the general population with results stratified by sexual identity. However, the use of lifetime prevalence of ever having used the internet, smartphone, or app to meet sexual partners has limitations. CONCLUSION Meeting sexual partners online was associated with sexual risk behaviors in a randomized sample of the Swedish population, which is of importance to tailoring sexual health interventions. Deogan C, Jacobsson E, Mannheimer L, et al. Meeting Sexual Partners Online and Associations With Sexual Risk Behaviors in the Swedish Population. J Sex Med 2020;17:2141-2147.
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Affiliation(s)
- Charlotte Deogan
- The Public Health Agency of Sweden, Solna, Sweden; Department of Public Health Sciences, Division Global Health, Karolinska Institutet, Stockholm, Sweden.
| | | | - Louise Mannheimer
- The Public Health Agency of Sweden, Solna, Sweden; Department of Public Health Sciences, Division of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
| | - Charlotte Björkenstam
- The Public Health Agency of Sweden, Solna, Sweden; Uppsala University, Department of Neuroscience, Psychiatry, Uppsala, Sweden
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14
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Björkenstam C, Mannheimer L, Löfström M, Deogan C. Sexual Orientation-Related Differences in Sexual Satisfaction and Sexual Problems-A Population-Based Study in Sweden. J Sex Med 2020; 17:2362-2369. [PMID: 32873532 DOI: 10.1016/j.jsxm.2020.07.084] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 07/21/2020] [Accepted: 07/31/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Human sexuality is a natural and important part of peoples' life and well-being. The underlying interactions affecting sexual satisfaction are complex, and sexual orientation differences partly remain to be identified as well as explained. AIM Our aim was to investigate sexual orientation-related differences in sexual satisfaction and sexual dissatisfaction and differences in sexual function and sexual-related problems. METHODS We used Swedish data from SRHR2017 (sexual and reproductive health and rights), based on self-administered surveys, linked to nationwide registers. The national sample consisted of 14,537 women and men aged 16-84 years. With logistic regression, we examined sexual orientation-related differences in self-reported sexual satisfaction and sexual dissatisfaction, stratified by sex. MAIN OUTCOME MEASURES The main outcome measures of this study are odds ratios (ORs) with 95% confidence intervals (CIs). RESULTS Bisexual women were more dissatisfied with their sex life, as compared with heterosexual women (OR: 1.8; 95% CI: 1.3-2.6), as were bisexual men compared with heterosexual men (OR: 2.7; 95% CI: 1.7-4.4). A bisexual or lesbian identity was a robust risk factor for premature orgasm (OR: 2.1; 95% CI: 1.1-3.9 and OR: 8.0; 95% CI: 3.2-20.0, respectively). Lesbian women seemed to have lower risk for many sexual-related problems (however not significant). Gay men lacked arousal (OR: 3.3; 95% CI: 1.6-6.9), had no orgasm (OR: 2.6; 95% CI: 1.4-4.7), and were at lower risk of experiencing premature ejaculation (OR: 0.4; 95% CI: 0.2-0.9), as compared with heterosexual men. CONCLUSION Our findings contribute to the sparse evidence of some sexual orientation differences in sexual satisfaction and sexual dysfunctions. Especially bisexual women and men appear to experience less sexual satisfaction in relation to heterosexual and homosexual women and men. Björkenstam C, Mannheimer L, Löfström M, et al. Sexual Orientation-Related Differences in Sexual Satisfaction and Sexual Problems-A Population-Based Study in Sweden. J Sex Med 2020;17:2362-2369.
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Affiliation(s)
- Charlotte Björkenstam
- Department of Communicable Disease Control and Health Protection, The Public Health Agency of Sweden, Stockholm, Sweden; Division Public Health Epidemiology, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden; Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
| | - Louise Mannheimer
- Department of Communicable Disease Control and Health Protection, The Public Health Agency of Sweden, Stockholm, Sweden; Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
| | - Matilda Löfström
- Department of Communicable Disease Control and Health Protection, The Public Health Agency of Sweden, Stockholm, Sweden
| | - Charlotte Deogan
- Department of Communicable Disease Control and Health Protection, The Public Health Agency of Sweden, Stockholm, Sweden; Division of Global Health, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
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15
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Deogan C, Mannheimer L, Kaartinen K, Jacobsson E, Winzer R. Effective methods to promote health among sexual and gender minorities – a scoping review. Eur J Public Health 2018. [DOI: 10.1093/eurpub/cky212.713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- C Deogan
- The Public Health Agency of Sweden, Solna, Sweden
| | - L Mannheimer
- The Public Health Agency of Sweden, Solna, Sweden
| | - K Kaartinen
- The Public Health Agency of Sweden, Solna, Sweden
| | - E Jacobsson
- The Public Health Agency of Sweden, Solna, Sweden
| | - R Winzer
- The Public Health Agency of Sweden, Solna, Sweden
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16
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Johansson K, Persson KI, Deogan C, El-Khatib Z. Factors associated with condom use and HIV testing among young men who have sex with men: a cross-sectional survey in a random online sample in Sweden. Sex Transm Infect 2018; 94:427-433. [PMID: 29773663 DOI: 10.1136/sextrans-2017-053369] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Revised: 04/10/2018] [Accepted: 04/28/2018] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVES The objectives are to analyse social determinants of sexual health behaviour (condom use and HIV testing) among young, internet-active, cis men who have sex with men (MSM) in a high-income country. The aspects of sexual health behaviour analysed here are condomless anal intercourse with one or more new or casual partner(s), condomless anal intercourse during the most recent sex with a man and HIV testing. METHODS A randomised sample of men active on Sweden's main online community for Lesbian, Gay, Bisexual and Trans people responded to an online survey (response rate 19%). A subsample of young people, aged 15-29, was analysed (effective sample 597-669) using multivariable logistic regression with respect to factors associated with condomless anal intercourse with one or more new or casual partner(s), condomless anal intercourse at most recent sex and not having had a test for HIV. RESULTS Low education, being single and living in a metropolitan area were found to be independently associated with condomless anal intercourse with new or casual partner(s). Sex with a steady partner was associated with condomless anal intercourse during the most recent sex. Knowledge of where to get tested, high education, being born outside Sweden and condomless anal intercourse with new or casual sex partner(s) were independently associated with having been tested for HIV. CONCLUSIONS The factors associated with sexual health behaviour among young MSM are complex, and preventive messages need to be tailored accordingly.
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Affiliation(s)
- Klara Johansson
- Unit of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | | | - Charlotte Deogan
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Ziad El-Khatib
- Unit of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.,Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.,World Health Program, Université du Québec en Abitibi-Témiscamingue (UQAT), Québec, Ottawa, Canada
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17
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Nkulu Kalengayi F, Hurtig A, Jonzon R, Deogan C. 5.5-O7HIV/STI prevention targeting migrants in host countries: a scoping review. Eur J Public Health 2018. [DOI: 10.1093/eurpub/cky047.190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | | | - R Jonzon
- The Public Health Agency of Sweden, Stockholm, Sweden
| | - C Deogan
- The Public Health Agency of Sweden, Stockholm, Sweden
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18
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Zeluf G, Dhejne C, Orre C, Mannheimer LN, Deogan C, Höijer J, Winzer R, Thorson AE. Targeted Victimization and Suicidality Among Trans People: A Web-Based Survey. LGBT Health 2018; 5:180-190. [PMID: 29641313 PMCID: PMC5905855 DOI: 10.1089/lgbt.2017.0011] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Purpose: The aim of this study was to investigate the associations between a series of empirically known risk and protective factors and suicidality among trans people in Sweden. Methods: Participants were self-selected anonymously to a web-based survey conducted in 2014. Univariable and multivariable logistic regression analyses were performed to assess associations between contributing factors and suicide ideation in the past 12 months and lifetime suicide attempts. Results: The analysis included 796 trans individuals, between 15 and 94 years of age, who live in Sweden. A total of 37% of respondents reported that they have seriously considered suicide during the past 12 months and 32% had ever attempted a suicide. Offensive treatment during the past three months and lifetime exposure to trans-related violence were significantly associated with suicidality. Less satisfaction with contacts with friends and acquaintances and with one's own psychological wellbeing were associated with suicide ideation in the past 12 months. Lack of practical support was associated with lifetime suicide attempts. Conclusions: Our findings show that suicidality is directly correlated with trans-related victimization. Preventing targeted victimization is, therefore, a key preventive intervention against this elevated suicidality.
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Affiliation(s)
- Galit Zeluf
- 1 Department of Public Health Sciences, Karolinska Institutet , Stockholm, Sweden
| | - Cecilia Dhejne
- 2 Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet , Stockholm, Sweden .,3 ANOVA, Andrology, Sexual Medicine, and Transgender Medicine, Karolinska University Hospital , Stockholm, Sweden
| | - Carolina Orre
- 4 Department of Health and HIV-Prevention, the Swedish Federation for LGBTQ Rights (RFSL) , Stockholm, Sweden
| | - Louise Nilunger Mannheimer
- 5 Department of Learning, Informatics, Management and Ethics, Karolinska Institutet , Stockholm, Sweden .,6 Department of Communicable Disease Control and Health Protection, the Public Health Agency of Sweden , Stockholm, Sweden
| | - Charlotte Deogan
- 1 Department of Public Health Sciences, Karolinska Institutet , Stockholm, Sweden .,6 Department of Communicable Disease Control and Health Protection, the Public Health Agency of Sweden , Stockholm, Sweden
| | - Jonas Höijer
- 7 Unit of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet , Stockholm, Sweden
| | - Regina Winzer
- 1 Department of Public Health Sciences, Karolinska Institutet , Stockholm, Sweden .,8 Department of Living Conditions and Lifestyles, the Public Health Agency of Sweden, Stockholm, Sweden
| | - Anna Ekéus Thorson
- 1 Department of Public Health Sciences, Karolinska Institutet , Stockholm, Sweden
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Affiliation(s)
- Malin Lindroth
- Department of Nursing Sciences, School of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Galit Zeluf
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | | | - Charlotte Deogan
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
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20
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Zeluf G, Dhejne C, Orre C, Mannheimer LN, Deogan C, Höijer J, Thorson AE. Erratum to: Health, disability and quality of life among trans people in Sweden-a web-based survey. BMC Public Health 2016; 16:1085. [PMID: 27741944 PMCID: PMC5065080 DOI: 10.1186/s12889-016-3735-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Galit Zeluf
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
| | - Cecilia Dhejne
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Gender Team, Centre for Andrology and Sexual Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Carolina Orre
- Department of Health and HIV-prevention, The Swedish Federation for LGBTQ Rights (RFSL), Stockholm, Sweden
| | - Louise Nilunger Mannheimer
- Department of Learning Information Management and Ethics, Karolinska Institutet, Stockholm, Sweden.,The Public Health Agency of Sweden, Stockholm, Sweden
| | - Charlotte Deogan
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.,The Public Health Agency of Sweden, Stockholm, Sweden
| | - Jonas Höijer
- Unit of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Anna Ekéus Thorson
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
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21
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Zeluf G, Dhejne C, Orre C, Nilunger Mannheimer L, Deogan C, Höijer J, Ekéus Thorson A. Health, disability and quality of life among trans people in Sweden-a web-based survey. BMC Public Health 2016; 16:903. [PMID: 27576455 PMCID: PMC5006581 DOI: 10.1186/s12889-016-3560-5] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2016] [Accepted: 08/19/2016] [Indexed: 11/30/2022] Open
Abstract
Background Swedish research concerning the general health of trans people is scarce. Despite the diversity of the group, most Swedish research has focused on gender dysphoric people seeking medical help for their gender incongruence, or on outcomes after medical gender-confirming interventions. This paper examines self-rated health, self-reported disability and quality of life among a diverse group of trans people including trans feminine, trans masculine, and gender nonbinary people (identifying with a gender in between male of female, or identify with neither of these genders) as well as people self-identifying as transvestites. Methods Participants were self-selected anonymously to a web-based survey conducted in 2014. Univariable and multivariable regression analyses were performed. Three backward selection regression models were conducted in order to identify significant variables for the outcomes self-rated health, self-reported disability and quality of life. Results Study participants included 796 individuals, between 15 and 94 years of age who live in Sweden. Respondents represented a heterogeneous group with regards to trans experience, with the majority being gender nonbinary (44 %), followed by trans masculine (24 %), trans feminine (19 %) and transvestites (14 %). A fifth of the respondents reported poor self-rated health, 53 % reported a disability and 44 % reported quality of life scores below the median cut-off value of 6 (out of 10). Nonbinary gender identity (adjusted Odds Ratio (aOR) = 2.19; 95 % CI: 1.24, 3.84), negative health care experiences (aOR = 1.92; 95 % CI: 1.26, 2.91) and not accessing legal gender recognition (aOR = 3.06; 95 % CI: 1.64, 5.72) were significant predictors for self-rated health. Being gender nonbinary (aOR = 2.18; 95 % CI: 1.35, 3.54) and history of negative health care experiences (aOR = 2.33; 95 % CI: 1.54, 3.52) were, in addition, associated with self-reported disability. Lastly, not accessing legal gender recognition (aOR = 0.32; 95 % CI: 0.17, 0.61) and history of negative health care experiences (aOR = 0.56; 95 % CI: 0.36, 0.88) were associated with lower quality of life. Conclusions The results of this study demonstrate that the general health of trans respondents is related to vulnerabilities that are unique for trans people in addition to other well-known health determinants.
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Affiliation(s)
- Galit Zeluf
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
| | - Cecilia Dhejne
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Gender Team, Centre for Andrology and Sexual Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Carolina Orre
- Department of Health and HIV-prevention, The Swedish Federation for LGBTQ Rights (RFSL), Stockholm, Sweden
| | - Louise Nilunger Mannheimer
- Department of Learning Information Management and Ethics, Karolinska Institutet, Stockholm, Sweden.,The Public Health Agency of Sweden, Stockholm, Sweden
| | - Charlotte Deogan
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.,The Public Health Agency of Sweden, Stockholm, Sweden
| | - Jonas Höijer
- Unit of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Anna Ekéus Thorson
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
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22
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Zeluf G, Thorson A, Deogan C, Mannheimer L. Transgender health in Sweden - results from a self-selected web survey on health and health determinants. Eur J Public Health 2015. [DOI: 10.1093/eurpub/ckv173.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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23
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Deogan C, Zarabi N, Stenström N, Högberg P, Skärstrand E, Manrique-Garcia E, Neovius K, Månsdotter A. Cost-Effectiveness of School-Based Prevention of Cannabis Use. Appl Health Econ Health Policy 2015; 13:525-542. [PMID: 25972235 DOI: 10.1007/s40258-015-0175-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND Cannabis is the most frequently used illicit drug globally. Despite increasing evidence that cannabis use is associated with adverse health effects, the knowledge on preventative strategies is still limited. This study stemmed from a systematic review of effective prevention in which school-based programmes were identified as promising. The primary objective was to evaluate the cost effectiveness of Project ALERT (Adolescent, Learning, Experiences, Resistance, and Training), compared with ordinary ATOD (Alcohol, Tobacco, and Other Drug) education, among Swedish students in the eighth grade of compulsory school. METHODS The cost-effectiveness analysis was performed from the societal perspective with quality-adjusted life-years (QALYs) as an outcome (willingness-to-pay threshold €50,000) and follow-up periods from 1 year to a lifetime, considering a discounting rate of 3%, and with costs inflated to 2013 levels. A Markov model was constructed on the basis of the 'states' of single use, regular use, daily use and use of other illicit drugs, which were associated with 'complications' of psychosis, schizophrenia, traffic accidents, depression and amotivational syndrome. Health and cost consequences were linked to both states and complications. RESULTS The programme was cost saving on the basis of evidence from the USA (ratio 1:1.1), and was cost effective (incremental cost-effectiveness ratio €22,384 per QALY) after reasonable adjustment for the Swedish context and with 20 years of follow-up. When the target group was restricted to boys who were neither studying nor working/doing work experience, the programme was cost effective after 9 years and cost saving (ratio 1:3.2) after 20 years. CONCLUSION School-based prevention such as Project ALERT has the potential to be cost effective and to be cost saving if implemented in deprived areas. In the light of the shifting landscape regarding legalization of cannabis, it seems rational to continue the health economic analysis of prevention initiated here.
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Affiliation(s)
- Charlotte Deogan
- Karolinska Institutet, Public Health Sciences, 177 77, Stockholm, Sweden
| | - Natalie Zarabi
- Dental and Pharmaceutical Benefits Agency, Stockholm, Sweden
| | | | - Pi Högberg
- Public Health Agency of Sweden, Stockholm, Sweden
| | - Eva Skärstrand
- Karolinska Institutet, Public Health Sciences, 177 77, Stockholm, Sweden
| | | | | | - Anna Månsdotter
- Karolinska Institutet, Public Health Sciences, 177 77, Stockholm, Sweden.
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Zeluf G, Thorson A, Deogan C, Mannheimer L. Transgender health and health determinants in Sweden – results from a self-selected web survey. Eur J Public Health 2015. [DOI: 10.1093/eurpub/ckv171.085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Deogan C, Moberg C, Lindberg L, Månsdotter A. Chlamydia prevention in Sweden—A case study of potential key factors in successful response. ACTA ACUST UNITED AC 2013. [DOI: 10.4236/ojpm.2013.31009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Deogan C, Ferguson J, Stenberg K. Resource needs for adolescent friendly health services: estimates for 74 low- and middle-income countries. PLoS One 2012; 7:e51420. [PMID: 23300548 PMCID: PMC3531400 DOI: 10.1371/journal.pone.0051420] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2012] [Accepted: 11/01/2012] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND In order to achieve Millennium Development Goals 4, 5 and 6, it is essential to address adolescents' health. OBJECTIVE To estimate the additional resources required to scale up adolescent friendly health service interventions with the objective to reduce mortality and morbidity among individuals aged 10 to 19 years in 74 low- and middle- income countries. METHODS A costing model was developed to estimate the financial resources needed to scale-up delivery of a set of interventions including contraception, maternity care, management of sexually transmitted infections, HIV testing and counseling, safe abortion services, HIV harm reduction, HIV care and treatment and care of injuries due to intimate partner physical and sexual violence. Financial costs were estimated for each intervention, country and year using a bottom-up ingredients approach, defining costs at different levels of delivery (i.e., community, health centre, and hospital level). Programme activity costs to improve quality of care were also estimated, including activities undertaken at national-, district- and facility level in order to improve adolescents' use of health services (i.e., to render health services adolescent friendly). RESULTS Costs of achieving universal coverage are estimated at an additional US$ 15.41 billion for the period 2011-2015, increasing from US$ 1.86 billion in 2011 to US$ 4,31 billion in 2015. This corresponds to approximately US$ 1.02 per adolescent in 2011, increasing to 4.70 in 2015. On average, for all 74 countries, an annual additional expenditure per capita ranging from of US$ 0.38 in 2011 to US$ 0.82 in 2015, would be required to support the scale-up of key adolescent friendly health services. CONCLUSION The estimated costs show a substantial investment gap and are indicative of the additional investments required to scale up health service delivery to adolescents towards universal coverage by 2015.
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Affiliation(s)
- Charlotte Deogan
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
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Deogan C, Cnattingius S, Månsdotter A. Risk of self-reportedChlamydia trachomatisinfection by social and lifestyle factors – A study based on survey data from young adults in Stockholm, Sweden. EUR J CONTRACEP REPR 2012; 17:458-67. [DOI: 10.3109/13625187.2012.729624] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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