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ObjectiveTo investigate to what extent being outside education, employment or training after completed secondary education in Sweden might affect the risk of subsequent alcohol use disorders (AUDs), with sociodemographic indicators, such as sex, domicile and origin, taken into account.DesignPopulation register-based cohort study with 485 839 Swedish youths.SettingSweden.ParticipantsAll youths who were born between 1982 and 1991 and were aged between 19 and 24 years when they completed secondary education in Sweden, between 2005 and 2009.Primary outcome measureCox regression models were used to estimate the HR of first record of entry into alcohol-related medical care with a diagnosis of an AUD, by level of labour market attachment, from 1 January 2009 to 31 December 2016.ResultsAbout 4% of the youth population were outside education, employment or training and 25% were in insecure workforce after they completed secondary education. The risk of AUD was higher among youths in insecure workforce, HR 1.40 (95% CI 1.30 to 1.50), and among those outside education, employment or training, HR 1.30 (95% CI 1.11 to 1.51), compared with youths within the core workforce, also after adjusting for age, domicile, sex and origin. Being in education was associated with lower HR of AUD, HR=0.84 (95% CI 0.78 to 0.90).ConclusionYouths who are in insecure workforce and outside education, employment or training are at higher risk of AUD. Targeted policy actions are needed to support a successful school-work transition to secure equal opportunities for young people.

Introduction Cervical cancer (CC) remains a leading cause of morbidity and mortality among women in Sub-Saharan Africa, particularly in Tanzania, despite being preventable through screening and human papillomavirus (HPV) vaccination. Although national strategies exist, uptake remains low. This study explored awareness of CC screening, care, and vaccination among men and women in both urban and rural areas of Kilimanjaro, Tanzania. Method A qualitative descriptive design was conducted from April to May 2024. Four Focus Group Discussions with a total of 31 participants (including men and women) were conducted in both urban and rural communities. Simple random sampling was used to select the participants. A semistructured guide covered CC awareness, vaccination, screening, and community engagement. Transcripts were translated, coded, and categorized. Inductive content analysis was used. The study report used Consolidated Criteria for Reporting Qualitative Research guidelines. Results Participants showed limited knowledge of CC, its causes, and the benefits of HPV vaccination and screening. Three main categories with eight subcategories emerged: (1) Low health literacy, (2) Challenges in accessing CC prevention, and (3) Community involvement. Myths (e.g., vaccination causing infertility), healthcare system barriers, financial constraints, and stigma contributed to poor uptake. Male and opinion leader involvement was identified as crucial, but both groups lacked accurate information and were not actively promoting CC prevention. Conclusion This study highlights limited knowledge and persistent misconceptions about CC and its prevention among men and women in both urban and rural areas of Tanzania. Structural and sociocultural barriers, including low health literacy, financial constraints, gender norms, and misinformation, hinder access to screening and HPV vaccination. Engaging male partners, opinion leaders, and communities through targeted education and improved health communication is essential. These findings provide foundational knowledge to inform policy and design context-sensitive interventions to reduce the CC burden in Tanzania and similar low-resource settings.

Social participation plays a key role in the integration of refugees and asylum seekers into their host societies, and is also closely tied to the mental health of those populations. The aim of this scoping review was to study how the concept of social participation is described in empirical research, and how it is associated with mental health outcomes. Methods: In total, 64 studies were identified through searches in PubMed, PsycInfo, and Sociological Abstracts. These studies describe various forms of social participation among refugees and asylum seekers, and 33 of them also addressed various forms of mental health outcomes. Results: The identified studies described forms and conditions of social participation—both in the host country and transnationally—that could be synthesized into three broad dimensions: (1) Regulatory frameworks, conditions and initiatives; (2) Established societal organizations and social structures; and (3) Community organized groups. Each of these consisted of several sub-domains. The identified dimensions of social participation were also associated with psychosocial well-being and decreased psychological distress. Conclusions: There is a need for policies to enable and support the participation of refugees and asylum seekers in various dimensions of social structures in host societies. Social participation enhances resilience, re-establishes social lives, and acts as a protective factor against poor mental health outcomes.

Objective To investigate the associations between low education and risk of mental disorders, substance use disorders and self‐harm in different age‐groups. Methods All subjects in Stockholm born between 1931 and 1990 were linked to their own or their parent's highest education in 2000 and followed‐up for these disorders in health care registers 2001–2016. Subjects were stratified into four age‐groups: 10–18, 19–27, 28–50, and 51–70 years. Hazard Ratios with 95% Confidence Intervals (CIs) were estimated with Cox proportional hazard models. Results Low education increased the risk of substance use disorders and self‐harm in all age‐groups. Males aged 10–18 with low education had increased risks of ADHD and conduct disorders, and females a decreased risk of anorexia, bulimia and autism. Those aged 19–27 years had increased risks of anxiety and depression, and those aged 28–50 had increased risks of all mental disorders except anorexia and bulimia in males with Hazard Ratios ranging from 1.2 (95% CIs 1.0–1.3) for bipolar disorder to 5.4 (95% CIs 5.1–5.7) for drug use disorder. Females aged 51–70 years had increased risks of schizophrenia and autism. Conclusion Low education is associated with risk of most mental disorders, substance use disorders and self‐harm in all age‐groups, but especially among those aged 28–50 years.

Higher risks of psychiatric disorders and lower-than-average subjective health in adulthood have been demonstrated in offspring of immigrants in Sweden compared with offspring of native Swedes, and linked to relative socioeconomic disadvantage. The present study investigated mortality rates in relation to this inequity from a gender perspective. We used data from national registers covering the entire Swedish population aged 18-65 years. Offspring of foreign-born parents who were either Swedish born or had received residency in Sweden before school age (<7 years) were defined as \"offspring of immigrants.\" We used Cox regression models to examine the association between parental country of birth and mortality between 1990 and 2008, with adjustment for education, income, age and family type. Male offspring of immigrants from the Middle East (HR:2.00, CI:1.66-2.26), other non-European countries (HR:1.80, CI:1.36-2.36) and Finland (HR:1.56, CI:1.48-1.65) showed an age-adjusted excess mortality risk from all causes of death when compared to offspring with Swedish-born parents. Income, but not education, greatly attenuated these increased mortality risks. No excess mortality rates were found among female offspring of immigrants, with the exception of external cause of death among offspring of Finnish immigrants. The study demonstrates high mortality rates in male offspring of immigrants from Finland and non-European countries that are associated with economic, but not educational, disadvantage. No increased mortality rates were found among female offspring of immigrants. Future studies are needed to explain this gender differential and why income, but not education, predicts mortality in male offspring of immigrants.

Background Substance use problems have been associated with poor labour market outcomes. This study investigated whether substance use disorders (SUD) in emerging adulthood increase the likelihood of later being not in employment, education or training (NEET). Methods A national cohort study of 23 5295 males and 227 792 females born between 1981 and 1987. SUD was assessed between ages 17 and 24 years. Logistic regression models were used to estimate the odds ratios (ORs) of NEET, between ages 25–34. Sibling-comparison analysis was performed to account for potential shared genetic and environmental factors. Results Having been diagnosed with a SUD was associated with the likelihood of being NEET among males [OR = 1.37, 95% confidence interval (CI), 1.25–1.49] and females (1.19, 1.13–1.27) after adjusting for domicile, origin, psychiatric diagnosis and parental psychiatric diagnosis. Early SUD was also associated with a gradual increase in the ORs of accumulation of years being NEET. This was more evident among females. In the sibling-comparison analysis, we found a higher OR of NEET among same-sex sibling males 1.39 (1.06–1.82) and females 1.28 (0.99–1.66) with SUD. These risks were fully attenuated when another psychiatric diagnosis was adjusted for. Conclusion Early SUD was associated with an increased likelihood of being NEET in both males and females. Neither origin, domicile, psychiatric diagnoses nor parental psychiatric diagnoses did fully explain the association. The combination of unmeasured familial factors and having other psychiatric disorders largely explained these associations.

Migrants' socioeconomic adversity has been linked to schizophrenia. To investigate whether the more favourable socioeconomic situation of adoptees prevents them from the high risk of schizophrenia found in other migrants. Register study in a cohort of refugees and inter-country adoptees aged 16-40 years, born in East Africa ( =8389), Latin America ( =11 572) and 1.2 million native Swedes. Cox-regression models estimated hazard ratios (HRs) of schizophrenia in data from psychiatric care. Despite diverse income levels, HRs for schizophrenia were similar for refugees and adoptees, with East Africans having the highest HRs: 5.83 (3.30-10.27) and 5.80 (5.03-6.70), followed by Latin Americans: HRs 3.09 (2.49-3.83) and 2.31 (1.79-2.97), compared with native Swedes. Adjustment for income decreased these risks slightly for refugees, but not for adoptees. This study suggests that risk factors associated with origin are more important determinants of schizophrenia than socioeconomic adversity in the country of settlement. None. © 2016 The Royal College of Psychiatrists. This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) licence.

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. 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. 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. 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.

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.

Introduction Breast cancer is increasing in sub-Saharan Africa (SSA), and most women are diagnosed at a late stage. This leads to increased suffering for the patients and challenging care situations for nurses. Limited resources in healthcare, lack of oncology training, and low health literacy in society result in even more demanding situations for nurses. Objective The objective was to explore nurses’ experiences of caring women for with breast cancer in Tanzania. Methods The study employed a descriptive qualitative design. Fifteen nurses, working in oncology units in three major hospitals in Tanzania were interviewed using a semistructured interview guide. The participants had a minimum of 6 months experience of caring for breast cancer patients. Purposive sampling was used. Data were analyzed by qualitative content analysis. Results Two main themes emerged: Challenges in caring for breast cancer patients and Nurses’ psychological distress. The late diagnosis was very challenging for the nurses. Low health literacy regarding breast cancer disease and treatment, patients’ financial difficulties, minimal oncology nursing education, and technology in healthcare systems were also major challenges. The nurses experienced psychological distress, lost hope, and faced ethical dilemmas while providing cancer care. Conclusion The findings of this study conclude that nurses face emotional distress and ethical dilemmas while caring for patients with breast cancer. Late diagnosis, lack of infrastructure and resources, and low health literacy among patients, family, and healthcare providers have a great impact on the stress that the nurses experience.