Trajectories of cigarette smoking from adolescence to adulthood as predictors of unemployment status

Smoking status and voting behaviour and intentions in countries of the former Soviet Union

Smokers experience multiple disadvantages throughout their lives, yet there is another disadvantage, political, that is less widely recognised. Smokers are less likely to vote but only so far in studies conducted in Western democratic regimes. This cross-sectional study aimed to examine the association between current smoking and voting behaviour and intentions in nine countries of the former Soviet Union (FSU). Data were analysed from 18,000 individuals aged ≥ 18 in Armenia, Azerbaijan, Belarus, Georgia, Kazakhstan, Kyrgyzstan, Moldova, Russia and Ukraine, collected in the Health in Times of Transition (HITT) survey in 2010/11. Information was obtained on smoking status and voting behaviour and intentions. In a fully adjusted logistic regression analysis, current smoking was associated with significantly higher odds of 'never voting' (not having voted in the past or intending to vote in future) in the pooled sample (OR: 1.29, 95% CI 1.13-1.47). In stratified analyses, smoking was associated with never voting in women but not men and in young but not middle-aged or older adults. The smoking-never voting association was observed in flawed democracies (OR: 1.57, 95% CI 1.07-2.32) and hybrid regimes (OR: 1.31, 95% CI 1.08-1.59) but not in authoritarian regimes (OR: 1.02, 95% CI 0.81-1.29). Smoking is associated with never voting in these FSU countries although not in all population subgroups or types of political regime. A necessary task for future research will be determining the factors associated with not voting among smokers in these countries.

Association Between Unemployment and Mental Disorders: A Narrative Update of the Literature

The relationship between unemployment and mental disorders has been a significant subject of study since at least the Industrial Revolution. However, most data show associations of unemployment and isolated mental disorders, and this study field has been neglected in the last years. Therefore, this narrative review aims to provide an updated overview of the association between unemployment and mental health in general as well as the most prevalent mental disorders. A literature search was conducted using PubMed with the initial search terms "unemployment" and "mental health". The identified disorders were then used as search terms for a more in-depth search. Two raters screened abstracts and identified the literature containing relevant information. As a main result, it could be demonstrated that regardless of age and sex, there is still a broad association between unemployment and mental well-being in general (e.g., quality of life measure for example by the General Health Questionnaire), suicide attempts, suicide rates, as well as specific psychiatric disorders (substance use disorder, schizophrenia, depression, bipolar disorders, compulsive/obsessive disorders, eating disorders, specific personality disorders, intelligence disorders/impairment, and ADHD). The most significant association was found for affective disorders (depression) and substance use disorders. The association in general was particularly evident for long-term unemployment and mental disorders. Returning to work reduced the prevalence rates of mental disorders significantly. The literature review confirms the results of much older and disease centered studies that unemployment and mental disorders are associated with each other. The main conclusion is that early medical detection and intervention among the mentally ill are as crucial as labor market policy interventions to prevent, avoid, and reduce unemployment.

Pre-hospital management and patient-related factors affecting access to the surgical care of appendicitis - a survey study

BACKGROUND AND AIMS

Long pre-hospital delay substantially increases the likelihood of perforated appendicitis. This study aimed to find patient-related factors affecting this delay.

METHODS

A survey was conducted for patients with acute appendicitis after appendectomy. The participants were asked about their path to the surgical center and socioeconomic status. Variables affecting delays and the rate of complicated appendicitis were analyzed.

RESULTS

The study included 510 patients; 157 (31%) had complicated appendicitis with a median prehospital delay of 42 h. In patients with uncomplicated appendicitis, the delay was 21 h, p < .001. Forty-six (29%) patients with complicated appendicitis were not referred to the hospital after the first doctor's visit. The multivariate analysis discovered factors associated with long pre-hospital delay: age 40-64 years (OR 1.63 (95% CI 1.06-2.52); compared to age 18-39), age more than 64 years (OR 2.84 (95% CI 1.18-6.80); compared to age 18-39), loss of appetite (OR 2.86 (95% CI 1.64-4.98)), fever (OR 1.66 (95% CI 1.08-2.57)), non-referral by helpline nurse (OR 2.02 (95% CI 1.15-3.53)) and non-referral at first doctors visit (OR 2.16 (95% CI 1.32-3.53)). Age 40-64 years (OR 2.41 (95% CI 1.50-3.88)), age more than 64 years (OR 8.79 (95% CI 2.19-35.36)), fever (OR 1.83 (95% CI 1.15-2.89)) and non-referral at first doctors visit (OR 1.90 (95% CI 1.14-3.14)) were also risk factors for complicated appendicitis.

CONCLUSIONS

Advanced age, fever and failure to suspect acute appendicitis in primary care are associated with prolonged pre-hospital delay and complicated appendicitis.

Unemployment and Substance Use: An Updated Review of Studies from North America and Europe

Since the industrial revolution, the relationship between unemployment and psychiatric disorders has been a subject of high interest. Currently, regarding the correlation between unemployment and substance-use disorders (SUDs), only older, often isolated and fragmented research results are available in the literature. This review was based on an extensive literature search of the European and North American literature in most relevant databases for "unemployment" and "substance use" related to "drugs", "alcohol", "nicotine", and "tobacco" between November 2022 and January 2023, according to the PRISMA (Preferred Reporting Items for Systematic review and Meta-Analysis) guidelines. A total of 59,117 papers were identified, of which only 33 articles were identified as relevant to the research objective. The literature showed significantly higher prevalence rates of SUDs involving divergent psychotropic substances among unemployed people. Unemployment was found to be a risk factor for SUD, and vice versa. However, the correlation between unemployment and relapses or smoking cessation was inconsistent. In addition, there appeared to be a mild effect of business cycles on SUD. The results showed significant multifaceted correlations between unemployment and SUD, indicating that prevention and early intervention are required to prevent harmful psychosocial consequences, such as social disintegration and severe psychiatric disorders.

Smoking and alcohol use in unemployed populations: a systematic review and meta-analysis

Unemployment is an economic and social phenomenon that has economic, social, personal, and health consequences. This study aimed to investigate the relationship between unemployment and alcohol use and smoking as a systematic review and meta-analysis. The two databases PubMed and Scopus were selected for the search and using a set of keywords, these two sources of scientific information were searched from 2004 to June 2021 and 1996 until June 2021, respectively. To meta-analyze the relationship between unemployment and smoking and alcohol use, odds ratio and confidence interval were calculated for this relationship. The meta-analysis was performed based on a random-effects. Subgroups were also performed for men and women. Heterogeneity in studies as well as publication bias were also examined. A total of 52 cross-sectional and cohort studies were included in the meta-analysis. In the relationship between unemployment and alcohol use, the odds ratio was 1.25 and the confidence interval was between 1.12 and 1.41. In the relationship between unemployment and smoking, the odds ratio was 1.43 and the confidence interval was between 1.13 and 1.81. According to the results, it can be said that unemployment increases the likelihood of alcohol use and smoking. Therefore, policymakers must pay more attention to the health consequences of economic problems, especially unemployment.

Adolescent depression and adult labor market marginalization: a longitudinal cohort study

Adolescent depression is linked to adult ill-health and functional impairment, but recent research suggests that individual/contextual factors might account for this association. This study aimed to test whether the clinical heterogeneity of adolescent depression is related to marginalization from the labor market across early to middle adulthood. Data were drawn from the Uppsala Longitudinal Adolescent Depression Study, a community-based cohort initially assessed with structured clinical interviews at age 16-17. The cohort (n = 321 depressed; n = 218 nondepressed) was followed up after 2+ decades through linkage to nationwide population-based registries. Outcomes included consecutive annual data on unemployment, work disability, social welfare recipiency, and a composite marginalization measure, spanning from age 21 to 40. Longitudinal associations were examined using logistic regression analysis in a generalized estimating equations modeling framework. Subsequent depressive episodes and educational attainment in early adulthood were explored as potential pathways. The results showed that adolescent depression was associated with adult marginalization outcomes, but the strength of association varied across depressed subgroups. Adolescents with persistent depressive disorder had higher odds of all outcomes, including the composite marginalization measure (adjusted OR = 2.0, 95% CI = 1.4-2.7, p < 0.001), and this was partially (31%) mediated by subsequent depressive episodes in early adulthood. Exploratory moderation analysis revealed that entry into tertiary education mitigated the association with later marginalization, but only for adolescents with episodic major depression. In conclusion, the risk for future labor market marginalization is elevated among depressed adolescents, particularly those presenting with persistent depressive disorder. Targeted interventions seem crucial to mitigate the long-lasting impact of early-onset depression.

Unemployment and mortality in a large Italian cohort

BACKGROUND

Aim of this study was to examine the association between unemployment and mortality, taking into account potential confounders of this association. A secondary objective was to assess whether the association between unemployment and mortality was modified by lack of household economic resources.

METHODS

Prospective cohort composed of a representative sample of Italian subjects 30-55 years who participated in the Italian National Health Survey 1999-2000, followed up for mortality up to 2012 (15 656 men and 11 463 women). Data were analyzed using Cox regression models, stratified by gender and adjusted for health status, behavioral risk factors, socioeconomic position and position in the household. The modifying effect of the lack of economic resources was assessed by testing its interaction with unemployment on mortality.

RESULTS

Among women, unemployment was not associated with mortality, whereas among men, higher mortality was found from all causes (HR = 1.82), which was not modified by lack of economic resources, and from neoplasms (HR = 1.59), cardiovascular diseases (HR = 2.58) and suicides (HR = 5.01).

CONCLUSIONS

Results for men were robust to the adjustment for main potential confounders, suggesting a causal relationship between unemployment and mortality. The lack of effect modification by economic resources supports the relevance of the loss of non-material benefits of work on mortality.

Asymmetric behavior of tobacco consumption in Spain across the business cycle: a long-term regional analysis

Many theoretical and empirical studies have analyzed the relationship between the economic cycle and tobacco consumption using the GDP and unemployment rates as the key variables for measuring economic phases. However, few studies focus on the pathways that cause tobacco consumption to be linked with the economic cycle, and there are no studies analyzing the heterogeneous effects underlying this relationship across nations and regions. This article explores the relationship and its pathways in 16 Spanish regions for the period 1989-2018. To this end, we apply a Granger causality analysis based on the augmented vector autoregressive (VAR) model in levels and extra lags. This method provides more efficient and robust results than the standard VAR model, which can lead to biased results with limited samples, especially in a region-by-region analysis. The empirical results suggest that the impact of the business cycle on tobacco consumption is heterogeneous and specific to each region. In addition, although recession phases cause a decline in tobacco consumption in Spain, in line with the literature, this procyclical relationship does not occur for expansion phases in all regions. One of the main findings of this article is that in expansion phases, tobacco consumption is sensitive to GDP, while in recession phases, tobacco consumption is affected by unemployment. National and regional governments should consider these results when they develop smoking control policies because homogeneous strategies can lead to heterogeneous results. Thus, the results can be useful for policymakers dealing with tobacco control strategies.

Educational differences in labor market marginalization among mature-aged working men: the contribution of early health behaviors, previous employment histories, and poor mental health

BACKGROUND

Social inequalities in labor force participation are well established, but the causes of these inequalities are not fully understood. The present study aims to investigate the association between educational qualification and labor market marginalization (LMM) among mature-aged working men and to examine to what extent the association can be explained by risk factors over the life course.

METHOD

The study was based on a cohort of men born between 1949 and 1951 who were examined for Swedish military service in 1969/70 and employed in 2000 (n = 41,685). Data on educational qualification was obtained in 2000 and information on the outcome of LMM (unemployment, sickness absence, and disability pension) was obtained between 2001 and 2008. Information on early health behaviors, cognitive ability, previous employment histories, and mental health was collected from conscription examinations and nationwide registers.

RESULTS

Evidence of a graded association between years of education and LMM was found. In the crude model, compared to men with the highest level of education men with less than 12 years of schooling had more than a 2.5-fold increased risk of health-related LMM and more than a 1.5-fold increased risk of non-health-related LMM. Risk factors measured across the life course explained a large part of the association between education and health-related LMM (33-61%) and non-health-related LMM (13-58%).

CONCLUSIONS

Educational differences remained regarding LMM among mature-aged workers, even after considering several important risk factors measured across the life course. Previous health problems and disrupted employment histories explained the largest part of the associations.

Heterogeneity in past-year smoking, current tobacco use, and smoking cessation behaviors among light and/or non-daily smokers

INTRODUCTION

Prevalence of light daily smoking, <10 cigarettes per day (CPD), and non-daily smoking has increased in the US population. This analysis examined the heterogeneity in past-year smoking behavior, current tobacco use behaviors, and smoking cessation behaviors among light and/or non-daily smokers.

METHODS

Current adult (≥18 years old) smokers (N=26196) participated in the 2010–2011 US Current Population Survey – Tobacco Use Supplement, which reported current (T1) and past 12-month (T0) smoking behaviors. Responses were categorized by intensity (light ≤10 CPD vs heavy >10 CPD) and frequency (non-daily vs daily). Combinations of T0 and T1 smoking behaviors resulted in 15 smoking trajectories ending in light/non-daily smoking and a 16th category of heavy daily smokers at T1. Differences in demographics, tobacco use, and smoking cessation behaviors were assessed by using weighted multivariable regression models.

RESULTS

Overall, 46.1% of US smokers were heavy smokers, 24.6% remained light daily smokers and 12.5% remained light non-daily smokers between T0 and T1. Current cigar, smokeless tobacco, and pipe use differed by smoking trajectories (p<0.05). All light and/or non-daily smokers were more likely than heavy daily smokers to have made a quit attempt (p<0.05) but use of cessation treatments varied. Smokers in many light and/or non-daily smoking trajectories were less likely than heavy daily smokers to be aided by healthcare providers for smoking cessation (p<0.05).

CONCLUSIONS

Among heavy daily smokers who became light non-daily smokers, the mismatch between intent to quit (80.9%) and receiving advice to set a quit date (33.7%) is one example of a potential opportunity for a clinical intervention.

Smoking and Unemployment: A Photo Elicitation Project

Introduction:

Research has documented higher smoking prevalence with unemployment and greater difficulty with gaining re-employment for those who smoke. Using photo elicitation methods, we sought to gain a deeper understanding of the connection between job-seeking and tobacco use.

Methods:

Unemployed daily smokers (18 men, 1 woman) were recruited from the San Francisco Employment Development Department (EDD) and provided disposable cameras with 27 exposures and a list of 20 photo prompts related to job-seeking and tobacco. Study staff reviewed the photos with the participants and audio-recorded their narratives. The photos and narratives were coded for themes.

Results:

Of 363 photos, the most frequent photo imagery related to transportation (n = 56, 15.4%), work or education (n = 39, 10.7%), and littered cigarettes (n = 39, 10.7%). Narrated themes centered on motivators to quit smoking (255 mentions from 15 participants); people, places, and things associated with smoking (248 mentions, 16 participants); and motivators to secure work (157 mentions, 13 participants). The intersection of smoking and unemployment received 92 mentions from 11 participants, with 60 mentions (8 participants) identifying smoking as a barrier to re-employment.

Conclusions:

Both motivators to quit and associated smoking cues were salient in the environments of job-seeking smokers. Struggles with quitting and perceptions that smoking is harming re-employment success suggest the potential for offering tobacco treatment in EDD settings. With permission, the photos and themes have been incorporated into a tobacco treatment intervention for job-seeking smokers.

Accumulated unhealthy behaviors and psychosocial problems in adolescence are associated with labor market exclusion in early adulthood - a northern Finland birth cohort 1986 study

Background

The relevance of health-related behaviors to exclusion from the labor market in early adulthood remains poorly studied in relation to the magnitude of the problem. We explored whether adolescents’ accumulated unhealthy behaviors and psychosocial problems are associated with later labor market exclusion, and whether multisite musculoskeletal pain (MMSP) impacts these relations.

Methods

We gathered questionnaire data on unhealthy behaviors and psychosocial problems and MMSP among adolescents aged 15 to 16 belonging to the Northern Finland Birth Cohort 1986. The findings were combined with registry data on unemployment, employment and permanent work disability during a five-year follow-up between the ages of 25 and 29 (n = 6692). In the statistical modeling we used education, family leave and socioeconomic status of childhood family as potential confounders, as well as latent class and logistic regression analyses.

Results

The Externalizing behavior cluster associated with over one year of unemployment (RR 1.64, CI 1.25–2.14) and permanent work disability (OR 2.49, CI 1.07–5.78) in the follow-up among the men. The Sedentary cluster also associated with over one year (RR 1.41, CI 1.13–1.75) and under one year of unemployment (RR 1.25, CI 1.02–1.52) and no employment days (RR 1.93, CI 1.26–2.95) among the men. Obese male participants were at risk of over one year of unemployment (RR 1.50, CI 1.08–2.09) and no employment days (RR 1.93, CI 1.07–3.50). Among the women, the Multiple risk behavior cluster related significantly to over one year of unemployment (RR 1.77, CI 1.37–2.28). MMSP had no influence on the associations.

Conclusions

Unhealthy behavior patterns and psychosocial problems in adolescence have long-term consequences for exclusion from the labor market in early adulthood, especially among men. Simultaneously supporting psychological well-being and healthy behaviors in adolescence may reduce labor market inclusion difficulties in the early phase of working life.

Discretionary spending priorities of unemployed, job-seeking adults who smoke cigarettes

Objective

Tobacco use is detrimental to physical and financial wellbeing. Smoking is associated with unemployment and a harder time finding re-employment. The current study examined job-seekers' prioritization of smoking over other discretionary items.

Methods

Adult, unemployed job-seekers smoking daily ranked items from 1 (highest) to 13 (lowest) for prioritization of their discretionary spending. The online survey randomly ordered the presentation of items. The Heaviness of Smoking Index (HSI, time to first cigarette and cigarettes per day) assessed severity of nicotine addiction.

Results

The sample (N = 290) was 70% men, 42% African American and 30% non-Hispanic Caucasian, with mean age of 43 (SD = 11), smoking an average of 12 cigarettes per day (SD = 6), and 67% smoking within 30 min of waking. Overall, cigarettes (M = 4.7, SD = 3.1) ranked second in importance behind only food (M = 2.5, SD = 2.7); 45% of the sample ranked tobacco in their top 3 spending priorities, and 26% ranked cigarettes as a higher priority than food. Cellular charges, transportation, grooming, and clothing ranked third through sixth, respectively. Higher HSI scores significantly correlated with greater prioritization of cigarettes (r = -0.25), and lower prioritization of food (r = 0.16) and transportation (r = 0.13), p's < 0.05.

Conclusions

Findings indicate cigarettes were highly prioritized, second only to food among job-seekers who smoke. Cigarettes were prioritized over job-seeking resources and health care, particularly among those who were more heavily addicted. Tobacco addiction can preempt basic life needs and reduce resources for finding re-employment.

Smoking Trajectory Classes and Impact of Social Smoking Identity in Two Cohorts of U.S. Young Adults

This study describes cigarette smoking trajectories, the influence of social smoker self-identification (SSID), and correlates of these trajectories in two cohorts of U.S. young adults: a sample from the Chicago metropolitan area (Social Emotional Contexts of Adolescent and Young Adult Smoking Patterns [SECAP], n = 893) and a national sample (Truth Initiative Young Adult Cohort Study [YA Cohort], n = 1,491). Using latent class growth analyses and growth mixture models, five smoking trajectories were identified in each sample: in SECAP: nonsmoking (n = 658, 73.7%), declining smoking (n = 20, 2.2%), moderate/stable smoking (n = 114, 12.8%), high/stable smoking (n = 79, 8.9%), and escalating smoking (n = 22, 2.5%); and in YA Cohort: nonsmoking (n = 1,215, 81.5%), slowly declining smoking (n = 52, 3.5%), rapidly declining smoking (n = 50, 3.4%), stable smoking (n = 139, 9%), and escalating smoking (n = 35, 2.4%). SSID was most prevalent in moderate/stable smoking (35.5% SECAP), rapidly declining smoking (25.2% YA Cohort), and nonsmoking. Understanding nuances of how smoking identity is formed and used to limit or facilitate smoking behavior in young adults will allow for more effective interventions to reduce tobacco use.

Cumulative psychosocial risks, internal asse, and past 30-day tobacco use among middle and high school students: The promise of internal assets

INTRODUCTION

Research has demonstrated a robust relationship between psychosocial risk factors (e.g., perceptions of health risk, peer and parent influences, and school climate) and adolescent tobacco use. However, whether internal assets (IAs), factors that promote healthy youth development, can mitigate the adverse effects of psychosocial risks on tobacco use has not been well researched.

METHOD

Using a population-based sample of middle and high school students (N = 112,364), multilevel logistic and negative binomial regression models estimated the direct effects of cumulative psychosocial risks and IAs on student tobacco use (e.g., combustible, non-combustible, alternative delivery systems) and assessed whether IAs moderated the relationship between psychosocial risks and tobacco use.

RESULTS

Results indicate that every additional psychosocial risk factor was associated with an estimated 100% (AOR: 2.04, 95% CI: 1.88-2.22) to 57% (AOR: 1.57, 95% CI: 1.52-1.62) increase in the odds of using tobacco and a 60% increase in the estimated number of products used. IAs were inversely associated with tobacco use and attenuated the association between cumulative psychosocial risks and use. Among students experiencing all five psychosocial risks, boys had an estimated 20% reduction, and girls an estimated 50% reduction, in the probability of tobacco use at the highest mean scores of IAs.

CONCLUSION

Universal, school-based prevention programs will benefit from identifying and targeting a set of shared risk and protective factors for tobacco use. Bolstering resilience by facilitating students' IAs represents a promising direction for youth focused prevention efforts.

Discontinuous Patterns of Cigarette Smoking From Ages 18 to 50 in the United States: A Repeated-Measures Latent Class Analysis

INTRODUCTION

Effective cigarette smoking prevention and intervention programming is enhanced by accurate understanding of developmental smoking pathways across the life span. This study investigated within-person patterns of cigarette smoking from ages 18 to 50 among a US national sample of high school graduates, focusing on identifying ages of particular importance for smoking involvement change.

AIMS AND METHODS

Using data from approximately 15,000 individuals participating in the longitudinal Monitoring the Future study, trichotomous measures of past 30-day smoking obtained at 11 time points were modeled using repeated-measures latent class analyses. Sex differences in latent class structure and membership were examined.

RESULTS

Twelve latent classes were identified: three characterized by consistent smoking patterns across age (no smoking; smoking < pack per day; smoking pack + per day); three showing uptake to a higher category of smoking across age; four reflecting successful quit behavior by age 50; and two defined by discontinuous shifts between smoking categories. The same latent class structure was found for both males and females, but membership probabilities differed between sexes. Although evidence of increases or decreases in smoking behavior was observed at virtually all ages through 35, 21/22 and 29/30 appeared to be particularly key for smoking category change within class.

CONCLUSIONS

This examination of latent classes of cigarette smoking among a national US longitudinal sample of high school graduates from ages 18 to 50 identified unique patterns and critical ages of susceptibility to change in smoking category within class. Such information may be of particular use in developing effective smoking prevention and intervention programming.

IMPLICATIONS

This study examined cigarette smoking among a national longitudinal US sample of high school graduates from ages 18 to 50 and identified distinct latent classes characterized by patterns of movement between no cigarette use, light-to-moderate smoking, and the conventional definition of heavy smoking at 11 time points via repeated-measures latent class analysis. Membership probabilities for each smoking class were estimated, and critical ages of susceptibility to change in smoking behaviors were identified.

Beyond experimentation: Five trajectories of cigarette smoking in a longitudinal sample of youth

The first goal of this study was to identify the most appropriate measure of cigarette smoking for identifying unique smoking trajectories among adolescents; the second goal was to describe the resulting trajectories and their characteristics. Using 15 annual waves of smoking data in the National Longitudinal Survey of Youth 1997 (NLSY97), we conducted an exploratory latent class growth analysis to determine the best of four outcome variables for yearly smoking (cigarettes per day on days smoked, days smoked per month, mean cigarettes per day, and total cigarettes per month) among individuals aged 12 to 30 (n = 8,791). Days smoked per month was the best outcome variable for identifying unique longitudinal trajectories of smoking and characteristics of these trajectories that could be used to target different types of smokers for prevention and cessation. Objective statistics were used to identify four trajectories in addition to never smokers (34.1%): experimenters (13.6%), quitters (8.1%), early established smokers (39.0%), and late escalators (5.2%). We identified a quitter and late escalator class not identified in the only other comparable latent class growth analysis. Logistic regressions were used to identify the characteristics of individuals in each trajectory. Compared with never smokers, all trajectories except late escalators were less likely to be black; experimenters were more likely to be out of school and unemployed and drink alcohol in adolescence; quitters were more likely to have a mother with a high school degree/GED or higher (versus none) and to use substances in adolescence and less likely to have ever married as a young adult; early established smokers were more likely to have a mother with a high school diploma or GED, be out of school and unemployed, not live with both parents, have used substances, be depressed, and have peers who smoked in adolescence and to have children as young adults and less likely to be Hispanic and to have ever married as young adults; and late escalators were more likely to be Hispanic, drink alcohol, and break rules in adolescence and less likely to have ever married as young adults. Because of the number of waves of data analyzed, this analysis provided a clearer temporal depiction of smoking behavior and more easily distinguishable smoking trajectories than previous analyses. Tobacco control interventions need to move beyond youth-focused approaches to reach all smokers.

Not in Education, Employment, or Training status among young Swiss men. Longitudinal associations with mental health and substance use

PURPOSE

Not in Education, Employment, or Training (NEET) youth are youth disengaged from major social institutions and constitute a worrying concern. However, little is known about this subgroup of vulnerable youth. This study aimed to examine if NEET youth differ from other contemporaries in terms of personality, mental health, and substance use and to provide longitudinal examination of NEET status, testing its stability and prospective pathways with mental health and substance use.

METHODS

As part of the Cohort Study on Substance Use Risk Factors, 4,758 young Swiss men in their early 20s answered questions concerning their current professional and educational status, personality, substance use, and symptomatology related to mental health. Descriptive statistics, generalized linear models for cross-sectional comparisons, and cross-lagged panel models for longitudinal associations were computed.

RESULTS

NEET youth were 6.1% at baseline and 7.4% at follow-up with 1.4% being NEET at both time points. Comparisons between NEET and non-NEET youth showed significant differences in substance use and depressive symptoms only. Longitudinal associations showed that previous mental health, cannabis use, and daily smoking increased the likelihood of being NEET. Reverse causal paths were nonsignificant.

CONCLUSIONS

NEET status seemed to be unlikely and transient among young Swiss men, associated with differences in mental health and substance use but not in personality. Causal paths presented NEET status as a consequence of mental health and substance use rather than a cause. Additionally, this study confirmed that cannabis use and daily smoking are public health problems. Prevention programs need to focus on these vulnerable youth to avoid them being disengaged.