Course manager

• Global health in a changing world, 7.5 ECTS, graduate level (MSc), Stockholm University
• Technological development, digitalisation and public health, 7.5 ECTS, undergraduate level (BSc), Stockholm University (course given in Swedish)
• Epidemiological development, infectious diseases and public health, 7.5 ECTS, undergraduate level (BSc), Stockholm University (course given in Swedish)
• Conflicting goals and public health, 7.5 ECTS, undergraduate level (BSc), Stockholm University (course given in Swedish) 

Educational planning

• Coordinator for development of Bachelor's programme in public health sciences  (programme given in Swedish)

Guest lecturer on graduate level courses in public health sciences and psychology at Karolinska institutet and Stockholm University

• Infectious diseases and public health
• Theory in public health research and explanatory models of health inequality
• Gender and health inequalities
• A life course perspective on alcohol related disorders

The unequal pandemic: investigating the relationship between health equity and political responses to covid-19, principal investigator (2023-2025)

The project aims to investigate the broad connection between the political response to covid-19 and social inequality in health. Countries' political responses to covid-19 share a common goal of protecting public health, yet are highly diverse in both design and outcome. In a set of three integrated studies, the purpose of this project is to investigate how social inequalities in health have been affected by political determinants during the covid-19 pandemic. In the first study, we aim to analyse how the reciprocal relationship between political responses and global burden of covid-19 has developed over time. In the second study, we will generate a typology of political responses in European countries, taking into consideration how they explicitly address, discursively frame and implicitly affect health equity. In the third study, we will use Nordic registers to decompose inequalities in mortality and hospitalisations by their underlying causes and compare trends before and during the pandemic, using the results of the two first studies as an interpretative framework.

The project is funded by the Swedish Research Council for Health, Working Life and Welfare (Forte).

Pathways to health among individuals with experience of childhood adversity: A risk and resilience framework (RISE), researcher and PhD co-supervisor, department of public health sciences, Stockholm University (2020 - 2022)

This project aims to investigate the connection between childhood adversity and health later in life, while considering the mitigating role of resilience. The project is based on the newly updated Stockholm Birth Cohort Multigenerational Study, which includes 14,562 individuals born in 1953 in Stockholm. The cohort is followed from birth to retirement age in 2008.

The project is funded by the Swedish Research Council for Health, Working Life and Welfare (Forte).

Self-employment, precarious work and health inequalities, postdoc project at the department for public health sciences, Stockholm University (2018-2019)

This project aims to investigate precarious employment as a social determinant of health. Precarious work has been described as "non-standard employment that is poorly paid, insecure, unprotected, and cannot support a household" and is highly interlinked with more traditional classifications of social class. 

By using a large Swedish register data material on all native- and foreign-born residents in Sweden who were born between 1972 and 1997, the project will investigate how precarious work is associated with all-cause and cause-specific mortality and morbidity in different population groups. Particular attention will be paid to different types of self-employment, as this form of employment often strips the worker of rights that regular employees are entitled to. In addition, the project will focus on the growing immigrant population in Sweden, which is over-represented in precarious work.

A methodological aim of the project is to develop a register-based measure of precarious employment. In combination with survey-based measures, such a tool will increase the opportunity to better understand the phenomenon of precarious work in Sweden. 

The project is funded by the Swedish Research Council for Health, Working Life and Welfare (Forte).

Coming of Age in Exile (CAGE), researcher, study coordinator and deputy team leader for Sweden, University of Copenhagen (2015-2020)

This large Nordic research project aims to study health and socioeconomic development among young refugees in Denmark, Finland, Norway and Sweden. Researchers in the project conduct quantitative register studies, policy analyses and qualitiative interview studies to investigate education, health and labour market integration among young refugees arriving to the Nordic countries in the late decades of the 20th Century. 

In December 2017 the a report by Karl Gauffin and Eveliina Lyytinen was published: Working for integration: A comparative analysis of policies impacting labour market access among young immigrants and refugees in the Nordic countries

The final report of the CAGE project was published in December 2020.

The project is funded by NordForsk.

Social inequality in childhood and alcohol related disorders later in life, PhD student, Karolinska institutet (2011-2015).

This PhD project aimed to investigate the interrelation between different forms of childhood social inequality and alcohol related disorder later in life. The project utilised a register-based data material including the entire Swedish population born between 1973 and 1984. The results of the project are presented in the thesis Embodiment of inequality - The translation of childhood social inequality to alcohol related health disparities later in life

A selection from Stockholm University publication database

• Waves of inequality: income differences in intensive care due to Covid-19 in Sweden

  2023. Karl Gauffin, Olof Östergren, Agneta Cederström. European Journal of Public Health 33 (4), 574-579

  Article

  Background: Socioeconomically vulnerable groups were overall more likely to develop severe Covid-19, but specific conditions in terms of preparedness, knowledge and the properties of the virus itself changed during the course of the pandemic. Inequalities in Covid-19 may therefore shift over time. This study examines the relationship between income and intensive care (ICU) episodes due to Covid-19 in Sweden during three distinct waves.

  Methods: This study uses Swedish register data on the total adult population and estimates the relative risk (RR) of ICU episodes due to Covid-19 by income quartile for each month between March 2020 and May 2022, and for each wave, using Poisson regression analyses.

  Results: The first wave had modest income-related inequalities, while the second wave had a clear income gradient, with the lowest income quartile having an increased risk compared to the high-income group [RR: 1.55 (1.36–1.77)]. In the third wave, the overall need for ICU decreased, but RRs increased, particularly in the lowest income quartile [RR: 3.72 (3.50–3.96)]. Inequalities in the third wave were partly explained by differential vaccination coverage by income quartile, although substantial inequalities remained after adjustment for vaccination status [RR: 2.39 (2.20–2.59)].

  Conclusions: The study highlights the importance of considering the changing mechanisms that connect income and health during a novel pandemic. The finding that health inequalities increased as the aetiology of Covid-19 became better understood could be interpreted through the lens of adapted fundamental cause theory.

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• Att ta framtiden i anspråk

  2022. Karl Gauffin. Tidskrift för politisk filosofi 3

  Article

  Beslutet att inrätta ett slutförvar för använt kärnbränsle i Forsmark öppnar upp för frågor kring vår relation till den mycket avlägsna framtiden. Utifrån idéhistoriska och filosofiska texter resonerar denna artikel kring hur samtidens historiskt specifika förhållande till tid kan bidra till att vi tar framtiden i anspråk på det exempellösa sätt som kärnkraften och förvaret av dess restprodukter innebär. Artikelns huvudsakliga poäng är att vi, genom att få syn på vår specifika förståelse av framtiden och dess människor, kan skärpa blicken inför rimligheten i valet mellan korttids- och slutförvar.

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• Precariousness on the Swedish labour market

  2020. Karl Gauffin. Economic and Labour Relations Review 31 (2), 279-298

  Article

  The purpose of this article is to investigate emerging areas of precarious employment in Sweden. Based on the literature on dimensions of precariousness and neoliberalism, this article will begin with an analysis of the transitioning Swedish welfare state and the contextual environment of precarious employment in Sweden. This will serve as a point of departure for the development of an occupational classification scheme including measures of income and employment security. In an empirical analysis, the occupational classification will be applied to a population-based register material including two birth cohorts of employed Swedish residents aged 28–33, with a registered income. The development of income and employment security will be described and discussed. By applying this newly developed measure of precarious employment, this article will provide a platform for future theoretical and empirical research on precarious employment in a transitioning welfare state.

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• Climate crisis and child health inequity

  2022. Karl Gauffin, Nick Spencer. BMJ Paediatrics Open 6 (1)

  Article

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• Precariousness in Norway and Sweden

  2021. Karl Gauffin, Kristian Heggebø, Jon Ivar Elstad. European Societies

  Article

  Precariousness in working life is a rising concern in Europe, but scant statistical evidence exists as to the prevalence and development of longstanding precarious employment. Using high-quality individual-level population-wide register data across several decades, this study addresses this issue in Norwayand Sweden. Longstanding precarious attachment to the labour market was defined as low/marginal work income during eight years, with frequent substantial income drops and/or reliance on income maintenance schemes. In the core working-age population, 15.3 percent in Norway and 20.0 percent in Sweden had this employment attachment during 1996–2003. Women, low educated, and foreign-born were at higher risk. Contrary to expectations, in 2008–2015, longstanding precarious attachment had declined to 12.7 percent in Norway and 14.5 percent in Sweden. Women in particular, but also immigrants, had attained stronger labour market attachment in the latter period. These results could indicate that key welfare state elements such as trade union strength, strong employment protection and active labour market policies have been successful in shielding workers from negative labour market developments. However, certain population categories with particularly high risk of precarious employment, such as young adults and short-term and undocumented immigrants, have not been analysed by this study.

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• The illusion of universality

  2020. Karl Gauffin. Scandinavian Journal of Public Health

  Article

  Aims: Nordic register material is often considered to be a gold standard for studies of social epidemiology and population health, but it comes with certain limitations. This short communication aims to draw attention to lacking coverage as a potentially growing problem of Nordic register material. Methods: The article is based on a short review of previous studies and commentaries on the strengths and limitations of Nordic register data with a particular focus on studies of employment and migration. Results: In times of institutional and demographic change in the Nordic countries, the assumption of universal register coverage can be challenged. Precarious and informal employment arrangements, important social determinants of health, provide a good illustration of the problem. Work that is carried out in the semi-legal margins of the labour market, sometimes by a 'hidden population' of non-resident, short-term labour immigrants, will not be covered by the registers. Researchers may therefore run the risk of misrepresenting reality if they maintain the belief that population registers cover the entire population. Conclusions: The Nordic registers are an extraordinary resource for public health researchers, but continuous quality control and assessment of validity and completeness will be crucial to maintain relevance in a transitioning society.

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• Health Inequalities in the Diverse World of Self-Employment

  2021. Karl Gauffin, Andrea Dunlavy. International Journal of Environmental Research and Public Health 18 (23)

  Article

  With labor being a central social determinant of health, there is an increasing need to investigate health inequalities within the heterogenous and growing population in self-employment. This study aimed to longitudinally investigate the relationship between income level, self-employment status and multiple work-related health indicators in a Swedish national cohort (n = 3,530,309). The study investigated the relationship between self-employment status and health outcomes later in life. All poor health outcomes, with the exception of alcohol-related disorders, were more common in the self-employed population, compared to the group in regular employment. The income gradient, however, was more pronounced in the group with regular employment than the groups in self-employment. The study found clear connections between low income and poor health in all employment groups, but the gradient was more pronounced in the group in regular employment. This suggests that income has a weaker connection to other types of health promoting resources in the self-employed population. Potentially, lacking social and public support could make it difficult for unhealthy individuals to maintain low-income self-employment over a longer time period.

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• Rocks, Dandelions or Steel Springs

  2021. Karl Gauffin, Josephine Jackisch, Ylva B. Almquist. International Journal of Environmental Research and Public Health 18 (15)

  Article

  The multifaceted concept of resilience is widely used to describe individual or societal abilities to withstand and adjust to external pressures. In relation to health, resilience can help us to understand a positive health development despite adverse circumstances. The authors of this article aimed to disentangle this complex concept by elaborating on three metaphors commonly used to describe resilience. Similarities and differences between resilience as a rock, a dandelion, and a steel spring are discussed. The metaphors partly overlap but still provide slightly different perspectives on the development and manifestation of resilience. With reference to longitudinal studies of long-term health development, the article also elaborates on how resilience relates to temporal dimensions commonly used in epidemiological studies: age, cohort, and period. Moreover, the interaction between resilience at individual, organizational, and societal levels is discussed. In conclusion, it is argued that public health sciences have great potential to further a theoretical discussion that improves our understanding of resilience and promotes the integration of individual- and community-level perspectives on resilience.

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• Health concerns among children deprived of liberty

  2021. Karl Gauffin.

  Report

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• Health outcomes in young adulthood among former child refugees in Denmark, Norway and Sweden

  2021. Andrea Dunlavy (et al.). Scandinavian Journal of Public Health

  Article

  Aims: This study aimed at comparing several health outcomes in young adulthood among child refugees who settled in the different immigration and integration policy contexts of Denmark, Norway and Sweden. Methods: The study population included refugees born between 1972 and 1997 who immigrated before the age of 18 and settled in the three Nordic countries during 1986-2005. This population was followed up in national registers during 2006-2015 at ages 18-43 years and was compared with native-born majority populations in the same birth cohorts using sex-stratified and age-adjusted regression analyses. Results: Refugee men in Denmark stood out with a consistent pattern of higher risks for mortality, disability/illness pension, psychiatric care and substance misuse relative to native-born majority Danish men, with risk estimates being higher than comparable estimates observed among refugee men in Norway and Sweden. Refugee men in Sweden and Norway also demonstrated increased risks relative to native-born majority population men for inpatient psychiatric care, and in Sweden also for disability/illness pension. With the exception of increased risk for psychotic disorders, outcomes among refugee women were largely similar to or better than those of native-born majority women in all countries. Conclusions: The observed cross-country differences in health indicators among refugees, and the poorer health outcomes of refugee men in Denmark in particular, may be understood in terms of marked differences in Nordic integration policies. However, female refugees in all three countries had better relative health outcomes than refugee men did, suggesting possible sex differentials that warrant further investigation.

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• Climate Change and Child Health Inequality

  2021. Emmanuelle Arpin (et al.). International Journal of Environmental Research and Public Health 18 (20)

  Article

  There is growing evidence on the observed and expected consequences of climate change on population health worldwide. There is limited understanding of its consequences for child health inequalities, between and within countries. To examine these consequences and categorize the state of knowledge in this area, we conducted a review of reviews indexed in five databases (Medline, Embase, Web of Science, PsycInfo, Sociological Abstracts). Reviews that reported the effect of climate change on child health inequalities between low- and high-income children, within or between countries (high- vs low–middle-income countries; HICs and LMICs), were included. Twenty-three reviews, published between 2007 and January 2021, were included for full-text analyses. Using thematic synthesis, we identified strong descriptive, but limited quantitative, evidence that climate change exacerbates child health inequalities. Explanatory mechanisms relating climate change to child health inequalities were proposed in some reviews; for example, children in LMICs are more susceptible to the consequences of climate change than children in HICs due to limited structural and economic resources. Geographic and intergenerational inequalities emerged as additional themes from the review. Further research with an equity focus should address the effects of climate change on adolescents/youth, mental health and inequalities within countries.

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• Finding common ground

  2019. Karl Gauffin, Andrea Dunlavy. Social Theory & Health

  Article

  Within the past few decades, the academic discipline of public health has taken root in universities around the world. As a young and multidisciplinary field with a dual-research/practice focus and a tradition that emphasises method development, the use of theory in public health research has often been neglected. In this article, we argue that explicit utilisation of theory is crucial to further the development of public health as an academic discipline. By examining three core areas of academic activity at universities—education, research and public outreach—we illustrate the role theory plays in establishing public health as an independent research discipline. We discuss the importance and benefits of including theoretical reasoning in teaching, research articles and communication with non-academic audiences. We also highlight the role of postgraduate students and junior researchers who, thanks to a combination of experience and receptiveness, play an important role in developing public health theory. We believe that a key to a successful process of establishing public health as an academic discipline lies in the development of a transdisciplinary approach to the research subject. This will equip public health researchers with appropriate tools to take on the public health challenges of the future.

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• Health, Education and Employment Outcomes in Young Refugees in the Nordic Countries

  2019. Anne Sofie Borsch (et al.). Scandinavian Journal of Public Health 47 (7), 735-747

  Article

  Objectives: Since 2000, approximately 500,000 refugees have settled in the Nordic countries, about a third of them being children and young people. To identify general trends, and to detect gaps in the existing knowledge about the socioeconomic and health status of these young refugees, this review discusses the literature regarding three key areas related to welfare policy: health, education and employment. Methods: A systematic search in PubMed, Scopus, SocINDEX, Sociological Abstracts, Embase and Cochrane, and a search for publications from relevant institutions were undertaken. All publications had to be original quantitative studies published since 1980. The total number of studies identified was 1353, 25 publications were included. Results: Young refugees had poorer mental health than ethnic minority and native-born peers. Mental health problems were related to pre-migration experiences but also to post-migration factors, such as discrimination and poor social support. Refugees performed worse in school than native-born and few progressed to higher education. Experiencing less discrimination and having better Nordic language proficiency was associated with higher educational attainment. A higher proportion of refugees were unemployed or outside the labour force compared with other immigrants and native-born. Assessment instruments varied between studies, making comparisons difficult. Conclusions: The study suggests pre-migration factors but also post-migration conditions such as perceived discrimination, social support and Nordic language proficiency as important factors for the mental health, education and employment outcomes of young refugees in the Nordic countries. Further Nordic comparative research and studies focusing on the relationship between health, education and employment outcomes are needed.

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• The Effect of Rotavirus Vaccine on Socioeconomic Differentials of Paediatric Care Due to Gastroenteritis in Swedish Infants

  2019. Lina Schollin Ask (et al.). International Journal of Environmental Research and Public Health 16 (7)

  Article

  Background: Previous Swedish studies have shown a social gradient on paediatric care for viral gastroenteritis. Aim: To study the effect of a free rotavirus vaccine programme on hospital care for viral gastroenteritis. Method: A register-based national cohort study of paediatric in- and outpatient care for viral gastroenteritis in children <2 years old in two Swedish counties in 2014-2017, with the rest of the country as comparison. Adjusted hazard ratios were estimated by the differences-in-differences (DiD) estimator in Cox regression in the entire cohort and by social indicators. Results: Reductions of 37% and 24% for inpatient care, and 11 % and 21% for outpatient care for viral gastroenteritis were found in the Stockholm and Jonkoping counties, respectively, after adjusting for time trends and social indicators. For inpatient care, the change was similar over social groups in both counties. In the larger county of Stockholm, smaller reductions in outpatient care were detected for children in socially disadvantaged families. Conclusions: A free rotavirus vaccination programme moderately reduced paediatric care for viral gastroenteritis. There were indications of an increase in socioeconomic differences in paediatric outpatient care for viral gastroenteritis, but further studies are needed to confirm this result in a broader health care perspective.

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• A decade lost

  2018. Ylva B. Almquist (et al.). Journal of Epidemiology and Community Health 72 (11), 997-1002

  Article

  Background: Past research has consistently identified children with experience of out-of-home care (OHC) as a high-risk group for premature mortality. While many have argued that educational success is a key factor in reducing these individuals’ excessive death risks, the empirical evidence has hitherto been limited. The aim of the current study was therefore to examine the potentially mitigating role of educational success for the association between OHC experience and premature mortality.

  Methods: Drawing on a Stockholm cohort born in 1953 (n=15,117), we analysed the associations between placement in OHC (ages 0-12), school performance (ages 13, 16, and 19), and premature all-cause mortality (ages 20-56) by means of Cox and Laplace regression analysis.

  Results: The Cox regression models confirmed the increased risk of premature mortality among individuals with OHC experience. Unadjusted Laplace regression models showed that these children died more than a decade, based on median survival time, before their majority population peers. However, among individuals who performed well at school, i.e. scored above-average marks at age 16 (grade 9) and age 19 (grade 12), respectively, the risks of premature mortality did not significantly differ between the two groups.

  Conclusion: Educational success seems to mitigate the increased risks of premature death among children with experience of OHC.

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• Out-of-Home Care and Subsequent Preterm Delivery

  2018. Can Liu (et al.). Pediatrics 142 (2)

  Article

  OBJECTIVES: Adverse early-life experience may affect preterm delivery later in life through priming of stress response. We aim to investigate the links between out-of-home care (OHC) experience in childhood, as a proxy of severe adversities, on subsequent risk of preterm delivery. METHODS: A register-based national cohort of all women born in Sweden between 1973 and 1977 (N = 175 821) was crosslinked with information on these women's subsequent deliveries as recorded in the Swedish medical birth register. During 1986-2012, 343 828 livebirths of these women were identified. The associations between women's OHC experience and her risk of preterm delivery were analyzed through logistic regression models, adjusting for women's own preterm birth, intrauterine growth, and childhood socioeconomic situation. RESULTS: Compared with women that never entered OHC, women with OHC experience up to and after age 10 were both associated with increased risks of preterm delivery (adjusted odds ratio [aOR] = 1.23 [95% confidence interval 1.08-1.40] and aOR = 1.29 [1.13-1.48], respectively). Women who experienced OHC before or at 10 years of age had increased risk of both spontaneous and medically indicated preterm delivery (aOR = 1.19 [1.03-1.38] and aOR = 1.27 [1.02-1.59], respectively). Women who experienced OHC after age 10 had a more pronounced risk of medically indicated preterm delivery (aOR = 1.76 [1.44-2.16]) than for spontaneous preterm delivery (aOR = 1.08 [0.92-1.27]). CONCLUSIONS: Women who were placed in OHC in childhood had increased risk of preterm delivery independent from their own perinatal history. Stress response, as 1 consequence of early life adversities, may take its toll on women's reproductive health and their offspring, calling for integrative efforts in preventing early life adversity.

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• Klass och hälsa

  2018. Karl Gauffin.

  Report

  Samtidigt som den generella folkhälsan har förbättrats i Sverigede senaste 30 åren har de sociala hälsoklyftorna blivit större. Människor med lägre inkomst och mindre utbildning lever kortare och sjukare liv än priviligierade grupper. Förutom attge en beskrivande översikt över den ojämlika hälsan i Sverige diskuterar denna rapport folkhälsans förutsättningar i den kapitalistiska marknadsekonomi som Sverige är i dag.Genom att rikta uppmärksamheten mot politiskt påverkbara fenomen som privat skuldsättning, välfärdsreformer och villkor i arbetslivets marginal kompletterar rapporten den befintliga diskussionen kring bakomliggande orsaker till den ojämlikahälsan i Sverige med ett tydligt klassperspektiv. Framtidens utmaningar är stora och ett helhetsgrepp kommeratt krävas för att uppnå Sveriges folkhälsopolitiska mål – att skapa samhälleliga förutsättningar och en god hälsa på lika villkor för hela befolkningen

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• Hospital admissions due to alcohol related disorders among young adult refugees who arrived in Sweden as teenagers

  2017. Hélio Manhica (et al.). BMC Public Health 17

  Article

  Background

  Psychological distress and lack of family support may explain the mental health problems that are consistently found in young unaccompanied refugees in Western countries. Given the strong relationship between poor mental health and alcohol misuse, this study investigated hospital admissions due to alcohol related disorders among accompanied and unaccompanied young refugees who settled in Sweden as teenagers.

  Methods

  The dataset used in this study was derived from a combination of different registers. Cox regression models were used to estimate the risks of hospital care due to alcohol related disorders in 15,834 accompanied and 4376 unaccompanied young refugees (2005–2012), aged 13 to 19 years old when settling in Sweden and 19 to 32 years old in December 2004. These young refugees were divided into regions with largely similar attitudes toward alcohol: the former Yugoslavian republics, Somalia, and the Middle East. The findings were compared with one million peers in the native Swedish population.

  Results

  Compared to native Swedes, hospital admissions due to alcohol related disorders were less common in young refugees, with a hazard ratio (HR) of 0.65 and 95% confidence interval (CI) between 0.56 and 0.77. These risks were particularly lower among young female refugees. However, there were some differences across the refugee population. For example, the risks were higher in unaccompanied (male) refugees than accompanied ones (HR = 1.49, 95% CI = 1.00–2.19), also when adjusted for age, domicile and income. While the risks were lower in young refugees from Former Yugoslavia and the Middle East relative to native Swedes, independent of their length of residence in Sweden, refugees from Somalia who had lived in Sweden for more than ten years showed increased risks (HR = 2.54, 95% CI = 1.71–3.76), after adjustments of age and domicile. These risks decreased considerably when income was adjusted for.

  Conclusion

  Young refugees have lower risks of alcohol disorders compared with native Swedes. The risks were higher in unaccompanied young (male) refugees compared to the accompanied ones. Moreover, Somalian refugees who had lived in Sweden for more than ten years seems to be particularly vulnerable to alcohol related disorders.

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• Childhood Household Dysfunction, Social Inequality and Alcohol Related Illness in Young Adulthood. A Swedish National Cohort Study

  2016. Karl Gauffin (et al.). PLoS ONE 11 (3)

  Article

  The aim of this paper is to estimate the cumulative effect of childhood household dysfunction (CHD) on alcohol related illness and death later in life and to test the interaction between CHD and socioeconomic background. The study utilised Swedish national registers including data of a Swedish national cohort born 1973-82 (n = 872 912), which was followed from age 18 to 29-40 years. Cox regression analyses were used to calculate hazard ratios (HR) for alcohol related illness or death in young adulthood. The CHD measure consisted of seven indicators: parental alcohol/drug misuse, mental health problems, criminality, death, divorce, social assistance, and child welfare interventions. Childhood socioeconomic position (SEP) was indicated by parental occupational status. Outcomes were alcohol related inpatient hospital care, specialised outpatient care or deaths. Using the highest socioeconomic group without CHD experience as a reference, those in the same socioeconomic group with one indicator of CHD had HRs of 2.1 [95% CI: 1.7-2.5], two CHD indicators 5.6 [4.4-7.1], three or more indicators 9.4 [7.1-12.4] for retrieving inpatient care. Socioeconomic disadvantage further increased the risks-those with low socioeconomic background and three CHD indicators or more had a HR of 12.5 [10.9-14.3]. Testing for interaction suggests that the combined HRs deviates from additivity [Synergy index: 1.6, 95% CI: 1.4-1.9]. The results for outpatient care were similar, but not as pronounced. In conclusion, this Swedish national cohort study shows that childhood household dysfunction is strongly and cumulatively associated to alcohol related illness later in life and that it interacts with socioeconomic disadvantage.

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• Working for Integration

  2017. Karl Gauffin, Eveliina Lyytinern.

  Report

  This report provides a comparative analysis of policies affecting the labour market participation of young refugees in the Nordic countries.

  Background statistics, secondary literature, policy evaluations and legal documents from Denmark, Finland, Norway and Sweden are used to generate an overview of Nordic policies affecting employment in the immigrant population. Four policy areas are analysed:a) the right to work, b) integration through labour, c) youth guarantee and d) financial support.

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• Hospital admission and criminality associated with substance misuse in young refugees – a Swedish national cohort study

  2016. Hélio Manhica (et al.). PLoS ONE 11 (11)

  Article

  Background

  High rates of mental health problems have been described in young refugees, but few studies have been conducted on substance misuse. This study aimed to investigate the patterns of hospital care and criminality associated with substance misuse in refugees who settled in Sweden as teenagers.

  Methods

  Gender stratified Cox regression models were used to estimate the risks of criminal convictions and hospital care associated with substance misuse from national Swedish data for 2005–2012. We focused on 22,992 accompanied and 5,686 unaccompanied refugees who were aged 13–19 years when they settled in Sweden and compared them with 1 million native Swedish youths from the same birth cohort.

  Results

  The risks of criminal conviction associated with substance misuse increased with the length of residency in male refugees, after adjustment for age and domicile. The hazard ratios (HRs) were 5.21 (4.39–6.19) for unaccompanied and 3.85 (3.42–4.18) for accompanied refugees after more than 10 years of residency, compared with the native population. The risks were slightly lower for hospital care, at 2.88 (2.18–3.79) and 2.52(2.01–3.01) respectively. Risks were particularly pronounced for male refugees from the Horn of Africa and Iran. The risks for all male refugees decreased substantially when income was adjusted for. Young female refugees had similar risks to the general population.

  Conclusion

  The risks of criminality and hospital care associated with substance misuse in young male refugees increased with time of residency in Sweden and were associated with a low level of income compared with the native Swedish population. Risks were similar in accompanied and unaccompanied refugees.

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• School performance and alcohol-related disorders in early adulthood

  2015. Karl Gauffin, Bo Vinnerljung, Anders Hjern. International Journal of Epidemiology 44 (3), 919-927

  Article

  Background Alcohol misuse is an important global health determinant and a major contributor to health inequalities. We aimed to investigate the association between school performance and alcohol-related disorders in early adulthood in a longitudinal register-based national cohort study. Methods We followed a register-based national cohort of Swedish citizens born 1973-1984 (N = 948 440) from compulsory school graduation at age 15-16 to 2009. We divided the population into five groups: high school marks (> mean+1 SD); high average (between mean and mean - 1 SD); low average (between mean and mean - 1 SD); low (< mean - 1SD); and missing. Cox proportional hazard models were used to investigate the relation between school marks at time of graduation and hospital care for alcohol-related disorders in early adulthood. Results There was a steep gradient in the risk of alcohol-related disorders related to school performance. In comparison with peers in the top category of school marks, students with low marks had adjusted hazard ratios of 8.02 [95% confidence interval (CI) 7.20 to 8.91], low average 3.02 (2.72 to 3.35) and high average 1.55 (1.39 to 1.73). The risk associated with low school marks was stronger in the male population and in the group from high socioeconomic background. Conclusions The study demonstrated a strong graded relation between low school performance and alcohol-related disorders in young adulthood. School performance should be taken into account when developing prevention programmes/policies targeting alcohol misuse among teenagers and young adults, especially if the aim is to reach high-risk groups.

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• Childhood socio-economic status, school failure and drug abuse

  2013. Karl Gauffin (et al.). Addiction 108 (8), 1441-1449

  Article

  Aim To investigate whether socio-economic status (SES) in childhood and school failure at 15 years of age predict illicit drug abuse in youth and young adulthood. Design setting and participantsRegister study in a Swedish national cohort born 1973-88 (n=1405763), followed from age 16 to 20-35 years. Cox regression analyses were used to calculate hazard ratios (HR) for any indication of drug abuse. Measurements Our outcomes were hospital admissions, death and criminality associated with illicit drug abuse. Data on socio-demographics, school grades and parental psychosocial problems were collected from censuses (1985 and 1990) and national registers. School failure was defined as having mean school grades from the final year in primary school lower than -1standard deviation and/or no grades in core subjects. Findings School failure was a strong predictor of illicit drug abuse with an HR of 5.87 (95% CI: 5.76-5.99) after adjustment for age and sex. Childhood SES was associated with illicit drug abuse later in life in a stepwise manner. The lowest stratum had a HR of 2.28 (95% CI: 2.20-2.37) compared with the highest stratum as the reference, when adjusted for other socio-demographic variables. In the fully adjusted model, the effect of SES was greatly attenuated to an HR of 1.23 (95% CI: 1.19-1.28) in the lowest SES category, while the effect of school failure remained high with an HR of 4.22 (95% CI: 4.13-4.31). Conclusions School failure and childhood socio-economic status predict illicit drug abuse independently in youth and young adults in Sweden.

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• The effect of childhood socioeconomic position on alcohol-related disorders later in life

  2013. Karl Gauffin, Tomas Hemmingsson, Anders Hjern. Journal of Epidemiology and Community Health 67 (11), 932-938

  Article

  Background: Alcohol use is the third most important global-health risk factor and a main contributor to health inequalities. Previous research on social determinants of alcohol-related disorders has delivered inconsistent results. We aimed to investigate whether socioeconomic position (SEP) in childhood predicts alcohol-related disorders in young adulthood in a Swedish national cohort.

  Methods: We studied a register-based national cohort of Swedish citizens born during 1973–1984 (N=948 518) and followed them up to 2009 from age 15. Childhood SEP was defined by a six-category socioeconomic index from the Censuses of 1985 and 1990. Rs of alcohol-related disorders, as indicated by register entries on alcohol-related death and alcohol-related medical care, were analysed in Cox regression models with adjustment for sociodemographic variables and indicators of parental morbidity and criminality.

  Results: Low childhood SEP was associated with alcohol-related disorders later in life among both men and women in a stepwise manner. Growing up in a household with the lowest SEP was associated with risk for alcohol-related disorders of HR: 2.24 (95% CI 2.08 to 2.42) after adjustment for sociodemographic variables, compared with the highest SEP group. Adjusting the analysis for parental psychosocial problems attenuated the association to HR 1.87 (95% CI 1.73 to 2.01).

  Conclusions: The study demonstrates that low SEP in childhood predicts alcohol-related disorders in young adulthood. Alcohol abuse needs to be addressed in policies to bridge the gap of health inequalities.                                                                                 

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