To Örebro University

BACKGROUND: Chemsex, typically defined as the use of specific psychoactive substances to enhance sexual experiences, has been linked to increased sexual health risks among men who have sex with men (MSM). This study examines frequency of chemsex use and associations between chemsex, risk-taking, and sexual practices among MSM on pre-exposure prophylaxis against HIV (PrEP) attending Sweden's largest sexual health clinic.

METHODS: A survey among MSM on PrEP (n = 290) mapped demographics, sexualized drug use, sexual practices, and alcohol use at Venhälsan, (South General Hospital), Stockholm, Sweden.

RESULTS: 18 % engaged in chemsex at least once in the past year and 49 % of respondents using chemsex reported high-risk alcohol use or alcohol dependence and 13 % classified as dependent. Most individuals on PrEP practiced unprotected sex, 42 % used condoms as passive/bottom, only 31 % as active/top. Chemsex tripled the odds of not using a condom at least 50 % of the time: adjusted for age, education, AUDIT, and being born in Sweden. Participants using chemsex were 3 times more likely, to have more than 14 temporary partners (past year) and were twice as likely to engage in group sex (82 %) compared to those not using chemsex (40 %).

CONCLUSIONS: Chemsex was associated with a threefold increased risk of condomless sex and showed a significant link to alcohol dependency. While PrEP offers effective protection against HIV infection, it does not prevent sexually transmitted infections. Health professionals and social workers should identify MSM who engage in chemsex and tailor interventions to address their specific needs.

The COVID-19 pandemic has had a profound impact on society, including on physical and mental health. This study investigated changes in mental health parameters among a Swedish sample during and after the pandemic. Using a longitudinal study, we investigated the relationships among life dissatisfaction, psychological distress, and worries, with factors such as age, sex, education, severe illness, and job loss due to the pandemic among 588 men (mean age 54.9 years), and 653 women (mean age 52.9 years). The results reveal sex differences in life dissatisfaction and psychological distress; in addition, younger individuals reported more life dissatisfaction, and psychological distress compared with older groups. Women were 4.5 times more likely than men to report worries in 2021 and 2.3 times more likely in 2022, even after adjusting for age, education, severe illness, and job loss. This study shows how societal expectations and sex roles may exacerbate these differences in mental well-being during a time of crisis. The conclusions emphasize the importance of considering factors such as sex, age, education, and employment status when developing interventions and support systems during a global crisis. The COVID-19 pandemic will continue to affect society for a long time, indicating a need for ongoing research into population-level consequences.

Purpose: Assess changes in health-promoting physical activity (HPPA), according to the WHO guidelines, among Swedish adults during the COVID-19 pandemic. HPPA has been ignored as an outcome in the physical activity (PA) studies during the pandemic.

Methods: A population-based repeated cross-sectional study was conducted among 18-79-year-old Swedes (n ¼ 1035 in December 2020 [response rate 52%], n ¼ 1095 in January 2022 [55%], n ¼ 1027 in December 2022 [55%]). Data was collected via online questionnaires, including sex, age, civil status, education, employment, and country of birth. PA was measured using the International Physical Activity Questionnaire-Short Form (IPAQ-SF). In 2020, recall questions about PA one year earlier were included. The WHO guidelines for moderate, vigorous, or combined HPPA were applied, and the proportions of respondents completing the guidelines for these three HPPA categories were calculated.

Differences in proportions of moderate, vigorous, and combined HPPA across the survey timepoints were tested by chi-square tests, and by McNemar tests concerning differences between the recall in 2019 and December 2020. Binary logistic regression analyses were performed for women and men to assess whether the survey time-points or the sociodemographic variables were independently associated with HPPA. Interaction terms between each sociodemographic factor and survey timepoint were added to the models to assess differences in changes in HPPA in different sociodemographic subgroups.

Results: While the proportions of moderate, vigorous, and combined HPPA decreased substantially from 2019 (recall) to 2020 in both sexes, the changes seen between 2020 and 2022 were statistically non-significant. No significant interactions between sociodemographic factors and survey timepoint were observed, and survey timepoint was not associated with HPPA in the logistic regression models. Factors most consistently associated with the different HPPA categories were education in women and employment in men. In women, compulsory and/or high school indicated less HPPA than university education. Among men, white-collar and/or retired had less HPPA than the blue-collar employment category.

Conclusions: No clear changes in HPPA were observed between December 2020 and December 2022. Differences in HPPA according to education and employment indicate need for research on targeted PA promotion measures.

Physical activity (PA) and sedentary behavior (SB) changed during the COVID-19 pandemic; hence, this study examined PA and SB at four time points between December 2019 and December 2022. The participants' PA decreased during the pandemic and did not recover afterwards. Among women, PA increased slightly in 2022 but not at all in men. From 2019 to 2020, SB increased and then decreased to near the pre-pandemic level in both sexes. Regarding age, PA decreased in the oldest age group (65-79 years) across all time points, while SB increased in all age groups during 2019-2020 and then returned close to pre-pandemic levels among the two middle age groups (30-64 years), but not among the youngest and oldest groups. Considering occupation, PA decreased from 2020 to December 2022 among retired and "other" participants, while SB decreased among nonmanual workers and retired participants. The regression models associated better self-reported health, male sex, and those born overseas with higher PA. Higher age, better self-reported health, poor education, and later survey time points were associated with lower SB. These findings highlight the need to return PA and SB to at least pre-pandemic levels and that subgroups may need different interventions.

Rapporten presenterar resultaten från en utvärdering av det våldsförebyggande programmet Viktig intressant person (VIP). VIP är ett strukturerat målgruppsanpassat utbildningsprogram med pedagogiska inriktning som bedrivits i Eskilstuna kommun sedan 2014. Insatsen utgör en arbetsmetod som har utvecklats för att hjälpa personer med intellektuella funktionsnedsättningar. Målgruppen för insatsen kvinnor och män som har insatser med stöd av Socialtjänstlagen (SoL) eller Lagen om stöd och service (LSS). Syftet med VIP-insatsen är att minska våldsutsattheten för denna grupp genom att ge dem det stöd de behöver och har rätt till.Utvärderingens övergripande syfte kan konkretiseras i tre delar. Del ett att undersöka; giltigheten i VIP-programmet, det vill säga insatsens programteori. Del två att undersöka hur insatsen genomförts, det vill säga programtroheten i insatsen. Del tre att utvärdera programmets resultat, det vill säga om deltagande i VIP leder till positiv förändring avseende psykisk hälsa, utsatthet för våld och Känsla av sammanhang (KASAM).Utvärderingen har genomförts under perioden hösten 2016 till våren 2018 genom en kombination av olika utvärderingssteg. Det första steget utgörs av ett programteoretiskt arbete och en forskningsöversikt. Fokus i forskningsöversikten har varit på vilka våldspreventiva insatser som finns för gruppen samt vilken förändringspotential dessa har. Det andra steget består i att studera insatsen programtrohet. Det tredje steget har sökt fånga den förändring som sker för brukarna före (T1) och efter (T2) insatsens genomförande. Detta har skett genom att med hjälp av skattningsskalor göra mätningar av KASAM, psykisk hälsa och utsatthet för våld- och konflikter. Utöver detta har även semistrukturerade kvalitativa intervjuer kring upplevda förändringar i relation till de nämnda områdena genomförts med brukarna.Utvärderingens empiriska underlag utgörs av skattningar och intervjuer före- och efter insatsen med totalt 26 brukare, två intervjuer med skaparna av programmet, sex intervjuer med VIP-ledare samt material hämtade från tre forskningsseminarier som genomförts med VIP-ledare, styrgruppen för VIP samt andra intressenter.Det empiriska underlaget för utvärderingen är relativt begränsat för att i alla avseenden, kunna säkerställa förändringar som sker hos brukarna. När det gäller KASAM visar resultatet emellertid att det sker signifikanta förändringar till det bättre för brukarna. Resultaten är inte lika tydliga när det gäller deltagarnas psykiska hälsa. När det gäller detta område är emellertid ett viktigt resultat att för de deltagare som innan insatsen hade måttlig till hög3grad av psykisk ohälsa så minskade denna efter insatsen. Förändringar i relation till våld och konflikter visar en likande tendens som psykisk hälsa. Även i detta hänseende sker en positiv förändring. Resultatet bygger på ett begränsat antal brukare vilket gör att de förändringar som sker i relation till psykisk ohälsa samt våld och konflikter inte går att säkerställa statistiskt. Det tydligaste tecknet på att det skett en positiv förändring för brukarna erhålls när resultaten från samtliga tre undersökta områden (KASAM, psykisk hälsa samt våld- och konflikter) summeras. Resultatet visar då att samtliga brukare fått en positiv utveckling på minst ett av de nämnda områdena och att merparten av deltagarna fått en positiv förändring på flera av dem. Det finns också brukare som visar en negativ utveckling över tid. Exempelvis uppger några av brukarna att den psykiska ohälsan ökat över tid. Det finns flera olika förklaringar till att det sker en negativ utveckling för några brukare över tid men det mesta pekar på att detta inte kan hänvisas till insatsen.Utvärderingen belyser vidare insatsen programteoretiska antaganden. När det gäller dessa dras slutsatsen att programmet har en rimlig logiskt-teoretisk utgångspunkt som följs genom hela dess genomförande. I förhållande till programteorin identifieras emellertid även behovet av att ytterligare tydliggöra insatsen teoretiska antagande. Programtroheten i programtroheten belyses också i utvärderingen. Resultatet av detta arbete tyder på en hög grad av följsamhet, det vill säga att andel centrala behandlingsmoment (kärnkomponenter) som genomförs med skicklighet och noggrannhet. Denna slutsats gäller för merparten av de totalt 12 lektionerna. Några lektioner visar på lägre grad av följsamhet. För dessa utbildningstillfällen finns det således möjlighet att ytterligare förbättra följsamheten.Den sammantagna bedömningen av utvärderingen är att våldspreventionsprogrammet VIP skapat en positiv utveckling för deltagarna. Förutom att insatsen visar att Känslan av sammanganhang ökat signifikant vittnar flertalet brukare om både kunskapsmässig, attitydmässiga och beteendemässiga förändringar som ett direkt resultat av insatsen. I det fall det sker en negativ utveckling för brukarna är det möjligt att hänvisa detta till insatsen.Samtidigt som detta sägs kan det emellertid konstateras att det föreligger ett behov av fortsatt kunskapsutveckling, genom systematisk uppföljning och utvärdering av VIP-insatsen.

Young people is at the center of many of the rapid changes taking place in contemporary society and has to deal with the uncertainties that follows. One uncertainty is linked to the transition between leaving full time studies and entering employment were unemployment has become a natural step in becoming an adult. Hence the "becoming" has become a longer period of time in young people’s lives. The economic crisis in many European countries in recent years are the cause of many problems young people experience today. In relation to this brief background the thesis examines how social problems i.e. unemployment, deprivation, dependent on social welfare, low education and disability (affecting a person’s ability to work) is accumulated over time. The thesis point of departure is what Merton (1968) described in terms of The Matthew effect according to the Gospel of St. Matthew:

For unto every one that hath shall be given, and he shall have abundance: but from him that hath not shall be taken away even that which he hath.

It is the last part of this “effect” that is the center of attention. The research questions are: is there such a thing as the Matthew effect and if so how this process can be understood. Theoretically the study at hand elaborates the accumulation process by drawing on the concept of marginalization and social exclusion.

By analyzing changes over time (3 years) in the five social problems described above (unemployment, deprivation etc.) for 64236 young people in the age of 19 to 25 years living in Sweden it is possible to describe patterns of social problem and how and why one specific problem or social problems in combination may lead to the accumulation of problem over time. These results are also combined with data from in-depth interviews whit young people that have accumulated social problem over time. It is argued that the combination of research methods gives a better understanding to the phenomenon at hand.

The theoretical contribution relates to a better understanding of the process of accumulation of social problems for young people and to a better understanding of different steps in the accumulation process as well as central fault lines in this process. These findings can be used in practice for pinpointing groups of young adults in need of more as well as less support in handling and overcoming social problem and the transition from school to work.