Karl Gauffin

Karl Gauffin


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Works at Department of Public Health Sciences
Telephone 08-674 79 94
Visiting address Sveavägen 160, Sveaplan
Room 347
Postal address Institutionen för folkhälsovetenskap 106 91 Stockholm

About me


Karl Gauffin is a postdoctoral researcher in public health science with a background in political science. His research interests include three main areas:

  • Work conditions and health: precarisation of the labour market, health effects of low wage labour and work insecurity, new forms of self-employment and health

  • Theory development in public health research: theories of social determinants of health; the connection between social justice and health; the interplay between individual and structural factors in the preservation of health inequalities

  • Migration and health: education, labour market participation and health among young refugees in the Nordic countries; global health, development and inequity

Karl Gauffin has been affiliated with the department of public health sciences and Centre for Health Equity Studies (CHESS) since 2011. Before and during this time, he has studied and been visiting student researcher at Karolinska institutet, Freie Universität Berlin, University of Edinburgh and University of California, Berkeley. 




Course manager

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

  • Theory in public health research and explanatory models of health inequality

  • Gender and health inequalities

  • A life course perspective on alcohol related disorders




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, researcher, study coordinator and deputy team leader for Sweden, University of Copenhagen (2015-2019)

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 refugees in the Nordic countries 

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


    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.


    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.


    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.


    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.

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

    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.

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


    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.

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

    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.

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

    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.

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

    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.                                                                                 

  • Hélio Manhica (et al.).
Show all publications by Karl Gauffin at Stockholm University

Last updated: May 16, 2018

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