Tutkimuksessamme tarkastelimme rekisteriaineiston avulla Ohjaamoasioinnin yhteyttä nuorten työssäoloon, opiskeluun, palkkatuettuun työhön osallistumiseen sekä toimeentulotuen asiakkuuteen 0–3 vuoden ...aikavälillä. Vertasimme OhjaamossaTE-asiakkaina asioineita nuoria tavanomaisessa TE-palveluprosessissa asioineisiin nuoriin. Tutkimusaineistona käytimme hallinnollisista rekistereistä koottua pitkittäisaineistoa (n =14 141) ja menetelmänä lineaarista todennäköisyysmallinnusta. Verrokkiryhmä muodostettiin niistä nuorista, joiden asuinkunnassa ei ollut Ohjaamoa. Ohjaamoissa TEasiakkaina olleet nuoret päätyivät seurantajakson ensimmäisten vuosien aikana opiskelemaan ja palkkatuettuun työhön todennäköisemmin kuin tavanomaisessaTE-palveluprosessissa olleet nuoret. Seuranta-ajan lopulla ryhmien välillä ei kuitenkaan enää ollut eroa opiskelun todennäköisyydessä. Avoimilla työmarkkinoilla työskentely oli Ohjaamossa asiakkaina olleilla nuorilla epätodennäköisempää kuin vertailuryhmän nuorilla seuranta-ajan alkupuolella, mutta seuranta-ajan lopulla ryhmien välillä ei enää ollut eroa avoimilla työmarkkinoilla työssä olon todennäköisyydessä. Sen lisäksi, että Ohjaamossa asiakkaina asioineet nuoret päätyivät seuranta-aikana todennäköisemmin opiskelemaan kuin tavanomaisessa TE-palveluprosessissa olleet nuoret, heillä oli pienempi todennäköisyys jäädä toimeentulotuen asiakkaaksi seuranta-ajan loppuun mennessä. Tämä viittaa siihen, että tavanomaisessa palveluprosessissa TE-asiakkaina olevat nuoret putoavat ja jäävät todennäköisemmin toimeentulotuen varaan kuin Ohjaamossa, jossa nuorille tarjotaan laaja-alaista moniammatillista tukea.
Drug courts are criminal justice programs to divert people with substance use disorders from incarceration into treatment. Drug courts have become increasingly popular in the US and other countries. ...However, their effectiveness in reducing important public health outcomes such as recidivism and substance-related health harms remains ambiguous and contested. We used nationwide register data from Sweden to evaluate the effectiveness of contract treatment sanction, the Swedish version of drug court, in reducing substance misuse, adverse somatic and mental health outcomes, and recidivism.
In this prospective cohort study, two quasi-experimental designs were used: difference-in-differences and the within-individual design. In the latter, we compared the risk of outcomes during time on contract treatment to, 1) parole after imprisonment and, 2) probation.
The cohort included 11,893 individuals (13% women) who underwent contract treatment. Contract treatment was associated with a reduction of 7 percentage points (95% CI: -.088, -.055) in substance misuse, 5 percentage points (-.064, -.034) in adverse mental health events, 9 percentage points (-.113, -.076) in adverse somatic health events, and 3 fewer charges (-3.16, -2.85) for crime in difference-in-differences analyses. Within-individual associations suggested that the same individual had longer times-to-event for all outcomes during contract treatment than on parole or on probation.
Contract treatment is an effective intervention from both public health and criminal justice perspective. Our findings suggest that it is a superior alternative to incarceration in its target group. Further, we find that an implementation approach that is less punitive and more inclusive than what is typical in the US can be successful.
Lower autonomic arousal is a well-known correlate of criminal offending and other risk-taking behaviors in men, but few studies have investigated this association in women.
To test associations ...between autonomic arousal and criminal offending as well as unintentional injuries among female conscripts.
All women born 1958-1994 in Sweden who participated in voluntary military conscription (n = 12,499) were identified by linking Swedish population-based registers. Predictors were resting heart rate (RHR) and systolic blood pressure (SBP). Covariates were height, weight, and physical energy capacity. Main outcomes were criminal convictions (any, violent, and non-violent) from the National Crime Register. Secondary outcome was unintentional injuries requiring medical treatment or causing death. We used survival analyses to test for associations between predictors and outcomes.
Low RHR, relative to high RHR, was associated with an increased risk of any criminal conviction, non-violent criminal convictions, and unintentional injuries. Low SBP, relative to high SBP, was associated with an increased risk of violent criminal convictions.
Results support lower autonomic arousal, particularly lower RHR, as a correlate of criminal offending among women that warrants further examination, as the reported findings have potential implications for the prediction of future female crime.
Abstract Background Adolescent substance use is associated with lower educational achievement but the directionality of the association remains uncertain. We analyzed data on drinking, smoking and ...educational achievement to study the associations between substance use and education from early adolescence to young adulthood. Methods Longitudinal data from four time points (ages 12, 14, 17, and 19–27 years) from a population-based cohort study of Finnish twin individuals were used to estimate bivariate cross-lagged path models for substance use and educational achievement, adjusting for sex, parental covariates, and adolescent externalizing behavior. A total of 4761 individuals (49.4% females) were included in the analyses. Educational achievement was assessed with teacher-reported grade point average at ages 12 and 14, and with self-reported student status and completed education at age 17 and in young adulthood. From self-reported questionnaire items, frequency of any drinking, frequency of drinking to intoxication, any smoking and daily smoking were analyzed. Results Alcohol use and smoking behaviors at ages 12 and 14 predicted lower educational achievement at later time points even after previous achievement and confounding factors were taken into account. Lower school achievement in adolescence predicted a higher likelihood of engaging in smoking behaviors but did not predict later alcohol use. Higher educational attainment at age 17 predicted more frequent drinking in young adulthood. Conclusions Adolescent drinking behaviors are associated with lower future educational achievement independently of prior achievement, whereas smoking both predicts and is predicted by lower achievement. Early substance use indexes elevated risk for poor educational outcomes.
ObjectivesSociodemographic and mental health characteristics are associated with contraceptive choices. We aimed to describe the sociodemographic, reproductive and mental health characteristics of ...all fertile-aged women in Finland who used hormonal contraception (HC) in 2017.DesignA nationwide, register-based study.SettingAll women living in Finland in 2017; data from the Care Register of Health Care, Medical Birth Register, Population Register Centre, Prescription Centre, Register of Induced Abortions.ParticipantsAll women aged 15–49 with one redeemed HC prescription in 2017 (n=294 356), and a same-sized, age-matched and residence-matched, control group of non-users.OutcomesRates of HC use; associations between HC use and mental disorders, sociodemographic and reproductive characteristics.Results25.8% of women aged 15–49 years used HC. Women with the lowest socioeconomic levels had lower odds of using HC than women with upper-level statuses (OR, 95% CI students: 0.97, 0.94 to 0.99; entitled to pension: 0.66, 0.63 to 0.69; other: 0.87, 0.85 to 0.89; unknown: 0.90, 0.85 to 0.90). Women with the highest education (secondary: 1.46, 1.43 to 1.48; tertiary: 1.64, 1.58 to 1.70; academic: 1.60, 1.56 to 1.63) and income (second quarter: 1.57, 1.54 to 1.60; third quarter: 1.85, 1.82 to 1.89; fourth quarter: 2.01, 1.97 to 2.06), and unmarried women had higher odds of using HC than women with the lowest education and income levels, and married (0.61, 0.60 to 0.62), divorced (0.86, 0.84 to 0.88), widowed (0.73, 0.65 to 0.83) or other marital status women (0.26, 0.22 to 0.30).Parous women (0.70, 0.69 to 0.71), those with previous induced abortion(s) (0.91, 0.89 to 0.92) or recent eating (0.68, 0.62 to 0.75) or personality (0.89, 0.79 to 0.97) disorders had lower odds of HC use. Absolute risk differences between women with and without mental disorders ranged from 3.1% (anxiety disorders) to 10.1% (eating disorders).ConclusionsA quarter of the fertile-aged women use HC in Finland. Sociodemographic disparities persist in relation to HC use, although of small effect size. HC use is less common among women suffering from severe to moderate psychiatric disorders, especially eating disorders.
Introduction: While the genetic and environmental underpinnings of body weight and alcohol use are fairly well-known, determinants of simultaneous changes in these traits are still poorly known. We ...sought to quantify the environmental and genetic components underlying parallel changes in weight and alcohol consumption and to investigate potential covariation between them. Methods: The analysis comprised 4,461 adult participants (58% women) from the Finnish Twin Cohort with four measures of alcohol consumption and body mass index (BMI) over a 36-year follow-up. Trajectories of each trait were described by growth factors, defined as intercepts (i.e., baseline) and slopes (i.e., change over follow-up), using latent growth curve modeling. Growth values were used for male (190 monozygotic pairs, 293 dizygotic pairs) and female (316 monozygotic pairs, 487 dizygotic pairs) same-sex complete twin pairs in multivariate twin modeling. The variances and covariances of growth factors were then decomposed into genetic and environmental components. Results: The baseline heritabilities were similar in men (BMI: h 2 = 79% 95% confidence interval: 74, 83; alcohol consumption: h 2 = 49% 32, 67) and women (h 2 = 77% 73, 81; h 2 = 45% 29, 61). Heritabilities of BMI change were similar in men (h 2 = 52% 42, 61) and women (h 2 = 57% 50, 63), but the heritability of change in alcohol consumption was significantly higher (p = 0.03) in men (h 2 = 45% 34, 54) than in women (h 2 = 31% 22, 38). Significant additive genetic correlations between BMI at baseline and change in alcohol consumption were observed in both men (rA = −0.17 −0.29, −0.04) and women (rA = −0.18 −0.31, −0.06). Non-shared environmental factors affecting changes in alcohol consumption and BMI were correlated in men (rE = 0.18 0.06, 0.30). Among women, non-shared environmental factors affecting baseline alcohol consumption and the change in BMI were inversely correlated (rE = −0.11 −0.20, −0.01). Conclusions: Based on genetic correlations, genetic variation underlying BMI may affect changes in alcohol consumption. Independent of genetic effects, change in BMI correlates with change in alcohol consumption in men, suggesting direct effects between them.
Monitoring factors related to hormonal contraception (HC) use is essential to evaluating public health strategies and promoting access to contraception. We aimed to examine municipal social and ...health indicators of HC use at the population level, and to identify patterns of inequality across Finnish municipalities.
We identified all women (15-49 years) with a redeemed HC prescription in Finland in 2017 (n = 294,445), and a control group of non-users. Municipal social and health indicators at the population level were retrieved from the nationwide Statistics and Indicator Bank. Differences between the groups across 309 municipalities were calculated, and associations of municipal-specific proportions of HC users with municipal-specific indicators were studied using LASSO (Least Absolute Shrinkage and Selection Operator) models.
Sociodemographic differences between HC users and non-users were non-homogenous across municipalities. Indicators positively associated with HC use included: larger population and higher proportions of population aged 16-24 years, of household-dwelling units with one person, of persons with higher education, and of divorces among those aged 25-64. Lower HC use was associated with higher proportions of Swedish-speaking population, of those aged 7-15 years, of young people not in education/training, and of household-dwelling units in overcrowded conditions. Lower HC use was also associated with indicators of outpatient and inpatient healthcare, and of municipal finances in welfare and healthcare.
Sociodemographic differences in relation to HC use exist across Finnish municipalities. Municipal indicators of social structure, health and welfare, and investment in and use of healthcare services are related to HC use.
Low resting heart rate (RHR) and low systolic blood pressure (SBP) are associated with criminal behavior. However, knowledge is lacking about their predictive value for reoffending.
We aimed to ...examine associations of RHR and SBP with reoffending in a large population-based sample.
We conducted a cohort study of all convicted male conscripts born in Sweden 1958-1990 (N = 407,533). We obtained data by linking Swedish population-based registers. Predictor variables were RHR and SBP, measured at conscription which was mandatory until 2010 for men at age 18. The outcome variable was reoffending, defined as criminal convictions (any crime, violent crime and non-violent crime), obtained from the National Crime Register. We used survival analyses to test for associations of RHR and SBP with reoffending, adjusting for pertinent covariates such as socioeconomic status, height, weight and physical energy capacity.
In fully adjusted Cox regression models, men with lower RHR (≤60 bpm) had higher risk of reoffending (any crime: HR = 1.17, 95% CI: 1.14, 1.19, violent crime: HR = 1.23, 95% CI: 1.17, 1.29, non-violent crime: HR = 1.16, 95% CI: 1.14, 1.19), compared to men with higher RHR (≥ 82 bpm). Men with lower SBP (≤80 mmHg) had higher risk of reoffending (any crime: HR = 1.19, 95% CI: 1.17, 1.21, violent crime: HR = 1.16, 95% CI: 1.12, 1.20, non-violent crime: HR = 1.20, 95% CI: 1.18, 1.22), compared to men with higher SBP (≥138 mmHg).
Low autonomic arousal is associated with increased risk of reoffending. RHR and SBP should be investigated further as potential predictors for reoffending as they each may have predictive value in risk assessment protocols.
Genome-wide, polygenic risk scores (PRS) have emerged as a useful way to characterize genetic liability. There is growing evidence that PRS may prove useful for early identification of those at ...increased risk for certain diseases. The current potential of PRS for alcohol use disorders (AUD) remains an open question. Using data from both a population-based sample the FinnTwin12 (FT12) study and a high-risk sample the Collaborative Study on the Genetics of Alcoholism (COGA), we examined the association between PRSs derived from genome-wide association studies (GWASs) of (1) alcohol dependence/alcohol problems, (2) alcohol consumption, and (3) risky behaviors with AUD and other substance use disorder (SUD) criteria. These PRSs explain ~2.5-3.5% of the variance in AUD (across FT12 and COGA) when all PRSs are included in the same model. Calculations of area under the curve (AUC) show PRS provide only a slight improvement over a model with age, sex, and ancestral principal components as covariates. While individuals in the top 20, 10, and 5% of the PRS distribution had greater odds of having an AUD compared to the lower end of the continuum in both COGA and FT12, the point estimates at each threshold were statistically indistinguishable. Those in the top 5% reported greater levels of licit (alcohol and nicotine) and illicit (cannabis and opioid) SUD criteria. PRSs are associated with risk for SUD in independent samples. However, usefulness for identifying those at increased risk in their current form is modest, at best. Improvement in predictive ability will likely be dependent on increasing the size of well-phenotyped discovery samples.
ObjectivesThe relationship between the use of contraception and of psychiatric medications is understudied. We examined whether the current and past use of psychotropic medications is associated with ...the use and type of hormonal contraception (HC).DesignNationwide register-based matched case–control study.SettingsAll fertile-aged (15–49 years) girls and women living in Finland in 2017; data from several national registers.Participants294 356 girls and women with a redeemed prescription of HC in 2017, and their same-sized control group of non-users (n=294 356) identified through the Prescription Centre.Main outcome measuresAssociations between the use of psychotropic medications and the use of HC, and the type of HC tested in logistic regression models.ResultsAltogether 19.5% of the HC users, and 18% of the HC non-users received at least one prescription for a psychotropic medication in 2017. Among HC users, the proportions of occasional and regular users of psychotropic medications in 2013–2016 were 4.5% and 14.8%, while among HC non-users the respective figures were 4.3% and 14.6%, respectively. In multivariable logistic regression models both the use of psychotropic medications in 2017, and their occasional or regular use between 2013–2016 were associated with higher odds of HC use, although with small to very small effect sizes (ORs between 1.37 and 1.06 and 95% CIs 1.22 to 1.53, and 1.03 to 1.09, respectively). After adjustment for covariates, when fixed combinations of progestogens and oestrogens for systemic use was the reference category, women using almost any class of psychotropic medications had higher odds of using other types of HC.ConclusionsFertile-aged girls and women with current and past use of psychotropic medications have higher odds of using HC, with a specific pattern in the type of contraceptives used. Further research is warranted to examine whether our observations indicate a reduction of unwanted pregnancies in women with psychiatric disorders.
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