Changes in sexually transmitted infections-related sexual risk-taking among young Croatian adults: a 2005-2021 three-wave population-based study.

AIM: To assess the prevalence and dynamics of risky sexual behaviors among Croatian emerging adults in the 2005-2021 period. METHODS: Three surveys were conducted on large-scale national samples of young adults aged 18-24 in 2005 (N=1092) and 18-25 in 2010 and 2021 (N=1005 and N=1210, respectively). The 2005 and 2010 studies were conducted with face-to-face interviews on stratified probabilistic samples. The 2021 study was conducted by computer-assisted web-interviewing on a quota-based random sample from the largest national online panel. RESULTS: Compared with 2005 and 2010, the age at coital debut increased for both genders in 2021 (by a median of one year, to 18 years, and by a mean of half a year, to 17.5 years, in men and to 17.9 in women). In the 2005-2021 period, condom use increased by about 15% both at first intercourse (to 80%) and in consistent use (to 40% in women and 50% in men). When we controlled for basic socio-demographics, Cox and logistic regressions indicated that, for both genders, in 2005 and 2010 compared with 2021, the risks/odds were significantly higher for reporting an earlier sexual debut (adjusted hazard ratio 1.25-1.37), multiple sexual partners (adjusted odds ratio [AOR] 1.62-3.31), and concurrent relationships (AOR 3.36-4.64), while the odds were lower for condom use at first sexual intercourse (AOR 0.24-0.46) and consistently (AOR 0.51-0.64). CONCLUSION: Risky sexual behaviors decreased in the 2021 survey compared with the previous two waves, in both genders. Nonetheless, sexual risk-taking is still frequent among young Croatian adults. The introduction of sexuality education and other national-level public health interventions to reduce sexual risk-taking thus remains a public health imperative.

The Role of Mental Health and Delinquent Behaviors in the Cycle of Sexual Violence Among Croatian Adolescents: A Longitudinal Exploration with Replication.

The "cycle of violence" perspective links the experience of being a victim of violence with later aggressive or violent behavior. While the association between victimization and aggression is relatively established, the mechanisms involved in the cycle of violence are less understood. The current study considered the role of mental health and delinquency on the pathway between sexual victimization and sexual aggression in two independent longitudinal samples of Croatian adolescents (Mage at baseline = 16 years). Using data from the first panel (six data waves, 2015-2018; n = 1289), structural equation modeling analysis pointed to a psychosocial mechanism, a combination of symptoms of depression/anxiety and delinquency, that mediated the link between the experience of sexual victimization and self-reported sexual aggression. We also observed a significant role of family environment in this psychosocial mechanism. The pattern of findings was partially replicated in the second panel with five waves of data (2015-2017; n = 750). The study's results can help inform conversations around designing policies to prevent and address peer sexual violence among Croatian adolescents.

Gendered association between sexual self-identification and police encounters perceived as unfair.

PURPOSE: Policing is a critical public health issue for minority populations. Yet few studies have examined policing among sexual minority persons, a group that has long been a target of punitive action by law enforcement. The purpose of this study is to examine whether sexual self-identification is associated with ever having been unfairly stopped, searched, or questioned by the police. METHODS: The cross-sectional data are from Wave 5 of the National Longitudinal Study of Adolescent to Adult Health collected between 2016 and 2018 (N = 11,592). We used gender-stratified multivariable logistic regression models to examine associations with police encounters perceived as unfair. RESULTS: Across all groups of women identifying as a sexual minority, the odds of experiencing a police encounter perceived as unfair were higher relative to women who identified as "100% heterosexual (straight)." The association among men was only consistent for men who identified as "100% homosexual (gay)," but in the opposite direction from the association among women. CONCLUSION: Our findings suggest that policing should be examined as a significant public health concern for sexual minority women, specifically because of the adverse health consequences of involuntary police encounters.

How Comprehensive Are Media-Based Data on Police Officer-Involved Shootings?

In the absence of systematic data collection by the state and federal governments, efforts to collect information on officer-involved shootings (OIS) have been assumed by the public and news agencies. In a combination of journalistic reporting and what is known as crowdsourcing, media and masses of individuals volunteer their time to identify OIS incidents and enter them into online databases. These efforts are invaluable in describing interpersonal violence between citizens and law enforcement, but it is not well known to what extent the media-based datasets are comprehensive. In the present study, we compared data from three major media-based websites to official data from five police departments that made their data available-Dallas, Denver, Jacksonville, Orlando, and Knoxville. We found a higher rate of matches than discrepancies with regard to fatalities but a much lower rate with regard to non-fatal shootings. Systematically recording and reporting OIS incidents should be the function of the government. Before-and if-that happens, our findings add to the growing evidence that media-based efforts, combined with crowdsourcing, can be useful though limited alternatives.

The thin blue line of health: Police contact and wellbeing in Europe.

Increasing evidence suggests that even minor forms of contact with the criminal justice system-such as being stopped by police-may be implicated in poor health. Police use of force can increase the risk of physical injury, whereas interactions accompanied by abusive rhetoric or threats can lead to psychological and emotional harm. Police contact may also have no health consequences for individuals or even be linked to good health because of an increased sense of public safety and confidence in law enforcement. This is the first study that explores whether contact with law enforcement is related to health and wellbeing in Europe. We estimated multilevel models with data from 26 countries that participated in the 2010 round of the European Social Survey. Across all outcomes-self-rated health, functional limitations, happiness, loneliness, and emotional wellbeing-having been approached, stopped or contacted by police was associated with worse health and wellbeing, especially when police treatment was perceived as unsatisfactory.

Incarceration as a Health Determinant for Sexual Orientation and Gender Minority Persons.

Incarceration is considerably more prevalent among sexual and gender minority persons (SGM) than among the general population. Once behind bars, they are at the greatest risk for health-related harms. Although a growing number of studies have assessed health disparities produced by mass incarceration, scholars are yet to systematically assess the health consequences of incarceration on the basis of sexual orientation and gender identity. We invite public health scholars to study the effects of incarceration on health in the SGM population and provide a roadmap to aid these research efforts. First, we document the disproportionate presence of SGM persons in jails and prisons. Second, we note health-related risks that are the most salient for this population. Third, we recommend examining heterogeneity in the effects of incarceration by teasing out distinct risks for groups defined by sexual orientation, gender identity, and race/ethnicity. Fourth, we note methodological challenges with respect to measurement and assessing causality. Finally, we discuss the importance of health care access and quality and the need to study health during incarceration and afterward.

Measuring inequalities in health from survey data using self-assessed social class.

Background: Asking participants to assess their social class may be an efficient approach to examining inequalities in heath from survey data. The present study investigated this possibility empirically by testing whether subjective class identification is related to overall health. Methods: I used pooled cross-sectional data from the 2012 and the 2014 General Social Survey, a nationally representative survey carried out among adults in the United States. The association between health and class was estimated separately by gender, race and age. Results: The association follows a gradient pattern where health deteriorates with lower class position even after controlling for indicators typically used in research that examines class differences in health-educational attainment, family income and occupational prestige. The results largely hold when the data are stratified by gender, race and age. Conclusions: These findings demonstrate the empirical value of subjective class identification for assessing social inequalities in health from survey data.

Availability of Health-Related Programs in Private and Public Prisons.

Little is known about the resources available to protect inmates' health in private prisons compared to their public counterparts. This is the first national-level study that exclusively examined the availability of health-related programs in private and public prisons in the United States. We applied propensity score weighting and doubly robust estimation to compare private prisons to comparable public prisons. Data were self-reported by prison administrators as part of the 2005 Census of State and Federal Adult Correctional Facilities. We found that private prisons offered fewer substance dependency, psychological/psychiatric, and HIV/AIDS-related programs. But the differences were progressively reduced when the comparison was limited to public prisons most similar on a variety of facility-level characteristics. The extent to which the two types of prisons differ is closely tied to the characteristics of the facilities that are compared.

Gender and validity of self-rated health in nineteen European countries.

AIMS: The aims of this study were to: (1) examine the concurrent validity of self-rated health for mental and physical health in Europe; and (2) evaluate whether self-rated health predicts health problems differentially by gender. METHODS: Data are from 19 European countries surveyed in the 2014 European Social Survey. We applied ordinary least squares regression to examine the association between self-rated health and summary indicators of physical and mental health problems. RESULTS: We observed an association between self-rated health and both physical and mental health problems in all countries. Gender differences in the concurrent validity of self-rated health were documented in eleven out of 19 countries. CONCLUSIONS: Self-rated health is a valid and efficient measure of physical and mental health across the European continent, with significantly greater concurrent validity among women.

Victimization and HIV Risks Among Croatian Female Sex Workers: Exploring the Mediation Role of Depressiveness and the Moderation Role of Social Support.

To assess the association between victimization and HIV vulnerability among Croatian female sex workers (FSWs), a survey involving 157 FSWs recruited from Croatia's two largest urban areas was conducted in 2014. A majority of participants reported direct and indirect victimization, which was found to be significantly associated with condom use at most recent noncommercial sexual intercourse and sexually transmitted infection (STI) diagnosis in the past 12 months. The association between victimization and STI diagnosis was partially mediated by depressiveness and moderated by social support. The buffering role of social support points to the importance of including counseling services in HIV prevention programs in Croatia.

An empirical assessment of the "healthy prisoner hypothesis".

Lower mortality among inmates, compared to the general population, is typically ascribed to access to health care during incarceration and the low risk of death due to homicide, accidents, and drug overdose. In this study, we test an alternative explanation based on selection of healthy individuals into jails and prisons-"the healthy prisoner hypothesis." According to this hypothesis, inmates have to be healthy to commit crimes and become incarcerated, which explains why they experience lower mortality than comparable segments of the general population. Using ten waves of data from the National Longitudinal Survey of Youth 1997, we compare individuals who become incarcerated the following year to those who do not on four measures of health-depression, self-rated health, functional limitations, and injury or illness requiring medical attention. Results from matched samples indicate that future inmates are hardly ever in significantly better health the year prior to their incarceration. These findings strongly suggest that the paradoxical mortality advantage of inmates is not due to health selection.

The increasing predictive validity of self-rated health.

Using the 1980 to 2002 General Social Survey, a repeated cross-sectional study that has been linked to the National Death Index through 2008, this study examines the changing relationship between self-rated health and mortality. Research has established that self-rated health has exceptional predictive validity with respect to mortality, but this validity may be deteriorating in light of the rapid medicalization of seemingly superficial conditions and increasingly high expectations for good health. Yet the current study shows the validity of self-rated health is increasing over time. Individuals are apparently better at assessing their health in 2002 than they were in 1980 and, for this reason, the relationship between self-rated health and mortality is considerably stronger across all levels of self-rated health. Several potential mechanisms for this increase are explored. More schooling and more cognitive ability increase the predictive validity of self-rated health, but neither of these influences explains the growing association between self-rated health and mortality. The association is also invariant to changing causes of death, including a decline in accidental deaths, which are, by definition, unanticipated by the individual. Using data from the final two waves of data, we find suggestive evidence that exposure to more health information is the driving force, but we also show that the source of information is very important. For example, the relationship between self-rated health and mortality is smaller among those who use the internet to find health information than among those who do not.

Hepatitis C virus infection and related risk factors among injection drug users in Montenegro.

BACKGROUND: In Southeastern Europe, similar to other postsocialist regions on the continent, injection drug users (IDU) are exposed to a high risk of blood-borne infections. In this paper, we report the prevalence of HIV, hepatitis C (HCV) and hepatitis B (HBV) among IDUs in Montenegro. We also examine the risk factors associated with HCV diagnosis. METHODS: In 2008, 322 IDUs in Montenegro participated in a respondent-driven sampling survey. Blood specimens were collected and tested for HIV, HCV and HBV. Behavioral data were collected with self-administered questionnaires. RESULTS: In comparison to 2005, HCV prevalence had increased from an estimated 22 to 53.7%. Only one HIV and no HBV cases were detected. Anti-HCV positivity was associated with the region of origin, income, sharing injection equipment and frequency of injecting drugs. CONCLUSION: The increasing HCV prevalence among IDUs in Montenegro calls for increased and better designed programs to prevent its further spread and a potential HIV outbreak.

Condom use errors and problems in a national sample of young Croatian adults.

In this study, we examined the correlates of condom use errors and problems in a population-based study conducted in 2010 among young Croatian adults aged 18-25 years. Out of a total sample of 1,005 participants, 679 reported condom use in the preceding year. The analyses focused on four outcomes: condom breakage, condom slippage, condom-related erection loss, and delayed condom application. Eighteen percent of participants experienced breakage, 13% reported slippage, 17% reported erection loss, and 34% applied a condom after intercourse started. Multivariate logistic regression analyses were performed to examine the correlates of these condom use errors and problems. Condom breakage was less likely to be reported by women and older participants. The odds of breakage were increased for participants who reported being under the influence of drugs during sex and who reported other condom use errors and problems in the past year. Condom slippage was more likely to occur among younger participants and those who reported condom breakage and delayed condom application. Condom-related erection loss was positively associated with a higher number of sexual partners in the preceding year, condom breakage, and a higher score on the Anti-Erotic Obstacles to Condom Use Scale. Odds of delayed condom application were increased for participants who experienced condom breakage and for those who consumed alcohol before sex in the past year. Having used a condom at first sex significantly reduced the odds of applying a condom after intercourse started. In comparison to non-habitual condom users, habitual users were found less likely to report any of the assessed condom use errors and problems. Improving condom use skills remains an important task in Croatia, which is currently hampered by the absence of evidence-based sex education in schools.

Changes in human immunodeficiency virus and sexually transmitted infections-related sexual risk taking among young Croatian adults: 2005 and 2010 population-based surveys.

AIM: To determine changes in sexual behaviors and other relevant characteristics related to human immunodeficiency virus (HIV) and sexually transmitted infection (STI) risks among young Croatian adults. METHOD: We surveyed adults aged 18-24 in 2005 (n=1092) and 18-25 in 2010 (n=1005). Both samples were probabilistic and stratified by county, settlement size, age, and gender. The samples were non-matched. Trained interviewers conducted structured face-to-face interviews in participants' households. The part of the questionnaire assessing sensitive information was self-administered. RESULTS: A majority of participants at both survey points (85.2%-86.2%) were sexually active. Median age at sexual debut (17 years) remained unchanged. Lifetime number of sexual partners was also stable. More women than men reported only one lifetime sexual partner. The prevalence of condom use at first intercourse increased (from 62.6 to 70%, P=0.002), while the prevalence of condom use at most recent sexual intercourse remained stable (54% in 2005 and 54.7% in 2010). Consistent condom use also remained unchanged. Consistent condom use in the past year was reported by 19.2% participants in 2005 nad 20% in 2010.. At both survey points for both genders, consistent condom use was associated with age (odds ratio [OR] W2005=0.74, P=0.004; ORW2010=0.72, P<0.001; ORM2005=0.73, P<0.001; ORM2010=0.80,P=0.006), negative attitudes toward condom use (ORW2005=0.84, P=0.001; ORW2010=0.90, P=0.026; ORM2005=0.92, P=0.032; ORM2010=0.90, P=0.011)), and condom use at first intercourse (ORW2005=3.87, P<0.001; ORW2010=4.64, P<0.001; ORM2005=5.85, P<0.001; ORM2010=4.03, P<0.001). In the observed period, HIV/AIDS knowledge was stable. CONCLUSION: Risky sexual practices remain common among young Croatian adults. Given the recently reported STI prevalence rates in this age cohort, introduction of school-based sex education that would focus on protective behavioral and communication skills seems to be of crucial epidemiological importance.

Is anal sex a marker for sexual risk-taking? Results from a population-based study of young Croatian adults.

BACKGROUND: There is evidence that anal sex is becoming increasingly popular among heterosexual women and men. Several studies carried out in especially vulnerable populations (e.g. sex workers and low-income youth) suggested that anal sex may indicate a more general propensity to sexual risk-taking. METHODS: To assess whether this epidemiologically important finding holds in the case of young adults from the general population, we analysed data from a cross-sectional probability survey carried out in 2010 on 1005 Croatian women and men aged 18-25. RESULTS: Anal intercourse was reported by 36.5% of 861 sexually experienced participants (42.7% of men and 29.8% of women). About one-third of them (34%) used a condom at most recent anal intercourse. The experience of anal sex was significantly associated (P<0.001) with all four indicators of sexual risk-taking (condom use at most recent vaginal intercourse, number of sexual partners in the past year, concurrent sexual relationships and anonymous sex in the past year), as well as with negative attitudes and beliefs about condom use (P<0.01). Sexual sensation-seeking mediated the relationship between anal sex and some of the sexual risk-taking behaviours. CONCLUSION: According to the findings, heterosexual anal sex is directly and indirectly associated with increased behavioural risks of acquiring HIV and other sexually transmissible infections (STI). Sex education and STI prevention programs should focus on the importance of using protection when practicing anal sex.

Religiosity and sexual risk behavior among Croatian college students, 1998-2008.

A substantial increase in religious identification has been observed in most European post-communist countries. As religiosity has been associated with sexually transmitted infection (STI) and HIV vulnerability among young people, this article examined the impact of religious upbringing and personal religiosity (religiousness) on sexual risks among University of Zagreb first-year undergraduate students, using data collected in 1998, 2003, and 2008. Female participants who reported strict religious upbringing were less knowledgeable about human sexuality than other women. Religiousness was negatively correlated with basic knowledge of human sexuality, but again only among women. Contrary to expectations, no significant associations were found between religious upbringing or religiousness and condom use. Both measures of religiosity, however, were related to decreased odds of sexual debut among young women. In the case of male participants, the impact of religiosity was marginal. Religious upbringing was associated (negatively) with sexual literacy and sexual debut-but only at the beginning of the observed period. Overall, religiosity does not seem to substantially reduce STI- and HIV-related risk-taking, particularly among men. Since the observed increase in the proportion of sexually active students during the 1998 through 2008 period was not matched by an increase in condom use, reducing STI and HIV vulnerability among Croatian youth remains an essential task.

HIV risks among female sex workers in Croatia and Montenegro.

The study analyzed the prevalence and determinants of HIV-risks among female sex workers (FSWs) in Croatia and Montenegro. Face-to-face interviews were carried out in Zagreb, Split, and Podgorica during the 2006-2008 period. Croatian participants (n = 154) reported fewer clients, more consistent condom use, higher rates of HIV testing, and greater HIV knowledge. The participants interviewed in Montenegro (n = 119) were more likely to have injected drugs and to have experienced sexual abuse in the previous year. Although Montenegrin FSWs were more exposed to HIV-risks than Croatian FSWs, they reported lower HIV-risk self-assessment. Consistent condom use was significantly associated with education and HIV-risk self-assessment in the Croatian and the experience of physical/sexual abuse in the Montenegrin sample. In spite of a number of methodological limitations, the empirical insights provided by this study may assist in improving the existing HIVV prevention initiatives.