Evaluating the impact of health reforms in the Netherlands: Assessing the impact of an alcohol ban on sexually transmitted infections in national surveillance data |
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Institution: | 1. Penn State College of Nursing, University Park, PA 16802, USA;2. Division of Biostatistics, College of Public Health, The Ohio State University, USA;3. Department of Social Sciences and Health Policy, Wake Forest School of Medicine, USA;4. Department of Social Medicine, Population, and Public Health, University of California Riverside School of Medicine, Riverside, CA 92501, USA;5. School of Public Health, the University of Illinois at Chicago, USA |
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Abstract: | BackgroundOn 1 January 2014, the minimum age to buy alcohol increased (16–18 years), accompanied by a public awareness campaign (NIX18). Decreases in alcohol consumption are associated with less risky sexual behaviour. This study analyzed the association between the health reforms andChlamydia trachomatis infections (chlamydia) among young heterosexual people.MethodsChlamydia positivity rates, age, and gender from all STI-clinic attendees between 16 and 19 years old in the Netherlands of 2010 to 2016 were obtained. Interrupted time-series assessed immediate and gradual trends in chlamydia rates.ResultsAmong the control group (18–19 year olds) chlamydia rates increased 0.5% each post-ban month (95% Confidence Interval CI] 1.002–1.008, p = .001). Among 16–17 year olds there was no monthly increase post-ban (Rate Ratio 1.000, 95% CI 0.993–1.007, p = .948). In terms of confounders, only controlling for partner notification dissolved these time trends.ConclusionsWe found that chlamydia rates after the alcohol ban differed between 16–17 year olds and 18–19 year olds. This demonstrates that the health reforms might have affected this secondary outcome, but obtaining certainty using national surveillance data is difficult. Specific studies should be designed, as now changes in chlamydia over time could be explained by STI-clinic policy changes, by changes on an individual level including reduced alcohol consumption or most likely by the combination of these factors. |
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Keywords: | Health reforms Alcohol ban Public awareness campaign Sexually transmitted infections Routine surveillance data |
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