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Pratap P, Dickson A, Love M, Zanoni J, Donato C, Flynn MA, Schulte PA. Public Health Impacts of Underemployment and Unemployment in the United States: Exploring Perceptions, Gaps and Opportunities. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:10021. [PMID: 34639322 PMCID: PMC8508259 DOI: 10.3390/ijerph181910021] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 09/14/2021] [Accepted: 09/16/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Unemployment, underemployment, and the quality of work are national occupational health risk factors that drive critical national problems; however, to date, there have been no systematic efforts to document the public health impact of this situation. METHODS An environmental scan was conducted to explore the root causes and health impacts of underemployment and unemployment and highlight multilevel perspectives and factors in the landscape of underemployment and unemployment. METHODS included a review of gray literature and research literature, followed by key informant interviews with nine organizational representatives in employment research and policy, workforce development, and industry to assess perceived needs and gaps in practice. RESULTS Evidence highlights the complex nature of underemployment and unemployment, with multiple macro-level underlying drivers, including the changing nature of work, a dynamic labor market, inadequate enforcement of labor protection standards, declining unions, wage depression, and weak political will interacting with multiple social determinants of health. Empirical literature on unemployment and physical, mental, and psychological well-being, substance abuse, depression in young adults, and suicides is quite extensive; however, there are limited data on the impacts of underemployment on worker health and well-being. Additionally, organizations do not routinely consider health outcomes as they relate to their work in workforce or policy development. DISCUSSION AND CONCLUSIONS Several gaps in data and research will need to be addressed in order to assess the full magnitude of the public health burden of underemployment and unemployment. Public health needs to champion a research and practice agenda in partnership with multisector stakeholders to illuminate the role of employment quality and status in closing the gap on health inequities, and to integrate workforce health and well-being into labor and economic development agendas across government agencies and industry.
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Affiliation(s)
- Preethi Pratap
- School of Public Health, University of Illinois Chicago, Chicago, IL 60612, USA; (M.L.); (J.Z.); (C.D.)
| | - Alison Dickson
- Champaign School of Labor and Employment Relations, University of Illinois Urbana, Chicago, IL 60607, USA;
| | - Marsha Love
- School of Public Health, University of Illinois Chicago, Chicago, IL 60612, USA; (M.L.); (J.Z.); (C.D.)
| | - Joe Zanoni
- School of Public Health, University of Illinois Chicago, Chicago, IL 60612, USA; (M.L.); (J.Z.); (C.D.)
| | - Caitlin Donato
- School of Public Health, University of Illinois Chicago, Chicago, IL 60612, USA; (M.L.); (J.Z.); (C.D.)
| | - Michael A. Flynn
- National Institute for Occupational Safety and Health, Cincinnati, OH 45226, USA; (M.A.F.); (P.A.S.)
| | - Paul A. Schulte
- National Institute for Occupational Safety and Health, Cincinnati, OH 45226, USA; (M.A.F.); (P.A.S.)
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Khlat M, Wallace M, Guillot M. Divergent mortality patterns for second generation men of North-African and South-European origin in France: Role of labour force participation. SSM Popul Health 2019; 9:100447. [PMID: 31497637 PMCID: PMC6718938 DOI: 10.1016/j.ssmph.2019.100447] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 07/03/2019] [Accepted: 07/04/2019] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION In France, second generation men of South-European origin were recently found to experience a mortality advantage, as opposed to second generation men of North-African origin, subjected to a large amount of excess mortality. We analyze the roles of education and labor force participation in the explanation of these contrasting mortality patterns. MATERIALS AND METHODS Our data consisted of a nationally-representative sample of individuals aged 18-64 years derived from the 1999 census, with mortality follow-up until 2010. RESULTS The two groups of second generation men, and particularly those of North-African origin, were less educated than the native-origin population, but only the latter was disadvantaged in terms of labor force participation. Relative to the native-origin population, the mortality hazard ratio for second generation men of North-African origin (HR = 1.71 [1.09-2.70]) remained significant after adjusting for level of educational attainment (HR = 1.59 [1.01-2.50]), but not after adjusting for economic activity (HR = 1.20 [0.76-1.89]) or for both variables (1.16 [0.74-1.83]). Conversely, the mortality hazard ratio for second generation men of South-European origin (HR = 0.64 [0.46-0.90]) remained unchanged after adjustment for level of educational attainment and/or economic activity. CONCLUSION The findings shed light on the salient role of labor market disadvantage in the explanation of the mortality excess of second generation men of North-African origin in France, and on the favorable situation of second-generation men of South-European origin in terms of labour market position and mortality. The theoretical and policy implications of the findings are discussed.
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Affiliation(s)
- Myriam Khlat
- French Institute for Demographic Studies (INED), 133 boulevard Davout, 75980, Paris Cedex 20, France
| | - Matthew Wallace
- French Institute for Demographic Studies (INED), 133 boulevard Davout, 75980, Paris Cedex 20, France
| | - Michel Guillot
- French Institute for Demographic Studies (INED), 133 boulevard Davout, 75980, Paris Cedex 20, France
- Population Studies Center, 239 McNeil Building, University of Pennsylvania, 3718 Locust Walk Philadelphia, PA, 19104-6298, University of Pennsylvania, Philadelphia, USA
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Sia D, Miszkurka M, Batal M, Delisle H, Zunzunegui MV. Chronic disease and malnutrition biomarkers among unemployed immigrants and Canadian born adults. ACTA ACUST UNITED AC 2019; 77:41. [PMID: 31548886 PMCID: PMC6751622 DOI: 10.1186/s13690-019-0367-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 08/27/2019] [Indexed: 11/18/2022]
Abstract
Background Immigration status and unemployment may intersect on the health outcomes of men and women. This study aimed to identify intersections between unemployment and immigration in inflammatory, metabolic and nutritional blood markers and assess gender differences. Methods We used Canadian Health Measures Survey data on 2493 participants aged 18 to 65. Outcomes were chronic inflammation (high-sensitivity C-reactive protein (hsCRP) and fibrinogen), nutritional (albumin and hemoglobin), and metabolic blood markers (glycosylated hemoglobin, blood glucose, total and high density lipoprotein (HDL) cholesterol). Multivariate linear regressions were used to assess the associations between each biomarker, unemployment and immigrant status, controlling for age, education, province, smoking, physical inactivity and body mass index and testing for multiplicative interactions between unemployment, immigrant status and gender. Results Unemployment was associated with higher inflammation (hsCRP and fibrinogen) in Canadian born men; Canadian born employed women showed higher hsCRP values compared with corresponding employed men. Unemployed immigrant women presented the highest values of hsCRP while employed immigrant women had the lowest hsCRP. Unemployment was associated with higher glucose; immigrant status was associated with higher glucose and glycosylated hemoglobin. Unemployed immigrants had significantly lower levels of hemoglobin and albumin than employed immigrants, and Canadian-born citizens regardless of their employment status. Some of these associations were attenuated after adjustment by body mass index, physical inactivity and smoking. Conclusion Blood biomarkers unveil intersections among unemployment, immigration and gender. This study provides evidence on biological pathways of unemployment on the likelihood of common chronic diseases, inflammation and potential malnutrition with some increased vulnerabilities in unemployed immigrants, and particularly in unemployed immigrant women.
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Affiliation(s)
- Drissa Sia
- 1Département des sciences infirmières, Campus de Saint-Jérôme, Université du Québec en Outaouais, 5, rue Saint-Joseph, bureau J-3226, Saint Jérôme, Québec J7Z 0B7 Canada
| | - Malgorzata Miszkurka
- 2Département de médecine sociale et préventive, Université de Montréal, Montréal, Québec Canada
| | - Malek Batal
- 3Département de nutrition, Faculté de Médecine, Université de Montréal, Montréal, Québec Canada
| | - Hélène Delisle
- 3Département de nutrition, Faculté de Médecine, Université de Montréal, Montréal, Québec Canada
| | - Maria Victoria Zunzunegui
- 4Département de médecine sociale et préventive, Université de Montréal, Montréal, Québec Canada.,5École de santé publique, Université de Montréal, Montréal, Québec Canada
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Kajula L, Balvanz P, Kilonzo MN, Mwikoko G, Yamanis T, Mulawa M, Kajuna D, Hill L, Conserve D, Reyes HLM, Leatherman S, Singh B, Maman S. Vijana Vijiweni II: a cluster-randomized trial to evaluate the efficacy of a microfinance and peer health leadership intervention for HIV and intimate partner violence prevention among social networks of young men in Dar es Salaam. BMC Public Health 2016; 16:113. [PMID: 26842360 PMCID: PMC4738785 DOI: 10.1186/s12889-016-2774-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Accepted: 01/22/2016] [Indexed: 12/01/2022] Open
Abstract
Background Intimate partner violence (IPV) and sexually transmitted infections (STIs), including HIV, remain important public health problems with devastating health effects for men and women in sub-Saharan Africa. There have been calls to engage men in prevention efforts, however, we lack effective approaches to reach and engage them. Social network approaches have demonstrated effective and sustained outcomes on changing risk behaviors in the U.S. Our team has identified and engaged naturally occurring social networks comprised mostly of young men in Dar es Salaam in an intervention designed to jointly reduce STI incidence and the perpetration of IPV. These stable networks are locally referred to as “camps.” In a pilot study we demonstrated the feasibility and acceptability of a combined microfinance and peer health leadership intervention within these camp-based peer networks. Methods design We are implementing a cluster-randomized trial to evaluate the efficacy of an intervention combining microfinance with health leadership training in 60 camps in Dar es Salaam, Tanzania. Half of the camps have been randomized to the intervention arm, and half to a control arm. The camps in the intervention arm will receive a combined microfinance and health leadership intervention for a period of two years. The camps in the control arm will receive a delayed intervention. We have enrolled 1,258 men across the 60 study camps. Behavioral surveys will be conducted at baseline, 12-months post intervention launch and 30-month post intervention launch and biological samples will be drawn to test for Neisseria gonorrhea (NG), Chlamydia trachomatis (CT), and Trichomonas vaginalis (TV) at baseline and 30-months. The primary endpoints for assessing intervention impact are IPV perpetration and STI incidence. Discussion This is the first cluster-randomized trial targeting social networks of men in sub-Saharan Africa that jointly addresses HIV and IPV perpetration and has both biological and behavioral endpoints. Effective approaches to engage men in HIV and IPV prevention are needed in low resource, high prevalence settings like Tanzania. If we determine that this approach is effective, we will examine how to adapt and scale up this approach to other urban, sub-Saharan African settings. Trial registration Clinical Trials.gov: NCT01865383. Registration date: May 24, 2013.
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Affiliation(s)
- Lusajo Kajula
- Department of Psychiatry and Mental Health, Muhimbili University of Health and Allied Sciences, PO Box 65466, Dar es Salaam, Tanzania.
| | - Peter Balvanz
- Department of Health Behavior, The University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Rosenau Hall, CB 7440, Chapel Hill, NC, 27599, USA
| | - Mrema Noel Kilonzo
- Department of Psychiatry and Mental Health, Muhimbili University of Health and Allied Sciences, PO Box 65466, Dar es Salaam, Tanzania
| | - Gema Mwikoko
- Department of Psychiatry and Mental Health, Muhimbili University of Health and Allied Sciences, PO Box 65466, Dar es Salaam, Tanzania
| | - Thespina Yamanis
- American University, School of International Service, 4400 Massachusetts Avenue, NW, Washington, DC 20016, USA
| | - Marta Mulawa
- Department of Health Behavior, The University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Rosenau Hall, CB 7440, Chapel Hill, NC, 27599, USA
| | - Deus Kajuna
- Department of Psychiatry and Mental Health, Muhimbili University of Health and Allied Sciences, PO Box 65466, Dar es Salaam, Tanzania
| | - Lauren Hill
- Department of Health Behavior, The University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Rosenau Hall, CB 7440, Chapel Hill, NC, 27599, USA
| | - Donaldson Conserve
- Department of Health Behavior, The University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Rosenau Hall, CB 7440, Chapel Hill, NC, 27599, USA
| | - Heathe Luz McNaughton Reyes
- Department of Health Behavior, The University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Rosenau Hall, CB 7440, Chapel Hill, NC, 27599, USA
| | - Sheila Leatherman
- Department of Health Policy and Management, The University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Rosenau Hall, CB 7411, Chapel Hill, NC, 27599, USA
| | - Basant Singh
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 67 President Street, Charleston, SC, 29425, USA
| | - Suzanne Maman
- Department of Health Behavior, The University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Rosenau Hall, CB 7440, Chapel Hill, NC, 27599, USA
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Maman S, Kajula L, Balvanz P, Kilonzo M, Mulawa M, Yamanis T. Leveraging strong social ties among young men in Dar es Salaam: A pilot intervention of microfinance and peer leadership for HIV and gender-based violence prevention. Glob Public Health 2015; 11:1202-1215. [PMID: 26588115 DOI: 10.1080/17441692.2015.1094105] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Gender inequality is at the core of the HIV patterns that are evident in sub-Saharan Africa. Gender-based violence (GBV) and lack of economic opportunity are important structural determinants of HIV risk. We piloted a microfinance and health promotion intervention among social networks of primarily young men in Dar es Salaam. Twenty-two individuals participated in the microfinance component and 30 peer leaders were recruited and trained in the peer health leadership component. We collected and analysed observational data from trainings, monitoring data on loan repayment, and reports of peer conversations to assess the feasibility and acceptability of the intervention. Eighteen of the loan recipients (82%) paid back their loans, and of these 15 (83%) received a second, larger loan. Among the loan defaulters, one died, one had chronic health problems, and two disappeared, one of whom was imprisoned for theft. The majority of conversations reported by peer health leaders focused on condoms, sexual partner selection, and HIV testing. Few peer leaders reported conversations about GBV. We demonstrated the feasibility and acceptability of this innovative HIV and GBV prevention intervention. The lessons learned from this pilot have informed the implementation of a cluster-randomised trial of the microfinance and peer health leadership intervention.
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Affiliation(s)
- Suzanne Maman
- a Department of Health Behavior , The University of North Carolina at Chapel Hill, Gillings School of Global Public Health , Chapel Hill , NC , USA
| | - Lusajo Kajula
- b Department of Psychiatry and Mental Health , Muhimbili University of Health and Allied Sciences , Dar es Salaam , Tanzania
| | - Peter Balvanz
- a Department of Health Behavior , The University of North Carolina at Chapel Hill, Gillings School of Global Public Health , Chapel Hill , NC , USA
| | - Mrema Kilonzo
- b Department of Psychiatry and Mental Health , Muhimbili University of Health and Allied Sciences , Dar es Salaam , Tanzania
| | - Marta Mulawa
- a Department of Health Behavior , The University of North Carolina at Chapel Hill, Gillings School of Global Public Health , Chapel Hill , NC , USA
| | - Thespina Yamanis
- c School of International Service , American University , Washington , DC , USA
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Romppainen K, Saloniemi A, Kinnunen U, Liukkonen V, Virtanen P. Does provision of targeted health care for the unemployed enhance re-employment? BMC Public Health 2014; 14:1200. [PMID: 25416020 PMCID: PMC4289058 DOI: 10.1186/1471-2458-14-1200] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2012] [Accepted: 11/03/2014] [Indexed: 11/27/2022] Open
Abstract
Background There is increasing pressure to develop services to enhance the health of the workforce on the periphery of the labour market. Health promotion among unemployed people may improve their health but also to increase their employability. We tested whether re-employment can be enhanced with a health care intervention targeted at the unemployed. Methods A 3-year follow-up, controlled design was used. The data were collected among unemployed people (n = 539) participating in active labour market policy measures. The baseline survey included established habitually used health questionnaires. The intervention consisted of three health check-ups and on-demand health services. Logistic regression analyses were used to obtain the odds ratios of the intervention group versus control group for being re-employed at follow-up. Health-related differences in the re-employment effects of the intervention were assessed through the significance of the interaction in the regression analyses. Results The intervention did not serve to improve re-employment: at follow-up 50% of both the intervention group and the control group were at work. In further analyses, the odds ratios showed that the intervention tended to improve re-employment among participants in good health, whereas an opposite tendency was seen among those with poor health. The differences, however, were statistically non-significant. Conclusion The experimental health service did not show any beneficial effects on re-employment. Nevertheless, rather than considering any particular health care as unnecessary and ineffective, we would like to stress the complexity of providing health services to match the diversity of the unemployed.
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Clemens T, Popham F, Boyle P. What is the effect of unemployment on all-cause mortality? A cohort study using propensity score matching. Eur J Public Health 2014; 25:115-21. [PMID: 25161201 DOI: 10.1093/eurpub/cku136] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND There is a strong association between unemployment and mortality, but whether this relationship is causal remains debated. This study utilizes population-level administrative data from Scotland within a propensity score framework to explore whether the association between unemployment and mortality may be causal. METHODS The study examined a sample of working men and women aged 25-54 in 1991. Subsequent employment status in 2001 was observed (in work or unemployed) and the relative all-cause mortality risk of unemployment between 2001 and 2010 was estimated. To account for potential selection into unemployment of those in poor health, a propensity score matching approach was used. Matching variables were observed prior to unemployment and included health status up to the year of unemployment (hospital admissions and self-reported limiting long-term illness), as well as measures of socioeconomic position. RESULTS Unemployment was associated with a significant all-cause mortality risk relative to employment for men (hazard ratio [HR] 1.85; 95% confidence interval [CI] 1.33-2.55). This effect was robust to controlling for prior health and sociodemographic characteristics. Effects for women were smaller and statistically insignificant (HR 1.51; 95% CI 0.68-3.37). CONCLUSION For men, the findings support the notion that the often-observed association between unemployment and mortality may contain a significant causal component; although for women, there is less support for this conclusion. However, female employment status, as recorded in the census, is more complex than for men and may have served to underestimate any mortality effect of unemployment. Future work should examine this issue further.
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Affiliation(s)
- Tom Clemens
- 1 School of GeoSciences, The University of Edinburgh, Institute of Geography, Edinburgh EH8 9XP, Scotland2 MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, G12 8RZ, Scotland3 School of Geography & Geosciences, University of St Andrews, Fife, KY16 9AL, Scotland
| | - Frank Popham
- 1 School of GeoSciences, The University of Edinburgh, Institute of Geography, Edinburgh EH8 9XP, Scotland2 MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, G12 8RZ, Scotland3 School of Geography & Geosciences, University of St Andrews, Fife, KY16 9AL, Scotland
| | - Paul Boyle
- 1 School of GeoSciences, The University of Edinburgh, Institute of Geography, Edinburgh EH8 9XP, Scotland2 MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, G12 8RZ, Scotland3 School of Geography & Geosciences, University of St Andrews, Fife, KY16 9AL, Scotland
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Walter S, Glymour M, Avendano M. The health effects of US unemployment insurance policy: does income from unemployment benefits prevent cardiovascular disease? PLoS One 2014; 9:e101193. [PMID: 25025281 PMCID: PMC4098914 DOI: 10.1371/journal.pone.0101193] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2013] [Accepted: 06/04/2014] [Indexed: 11/22/2022] Open
Abstract
Objective Previous studies suggest that unemployment predicts increased cardiovascular disease (CVD) risk, but whether unemployment insurance programs mitigate this risk has not been assessed. Exploiting US state variations in unemployment insurance benefit programs, we tested the hypothesis that more generous benefits reduce CVD risk. Methods Cohort data came from 16,108 participants in the Health and Retirement Study (HRS) aged 50–65 at baseline interviewed from 1992 to 2010. Data on first and recurrent CVD diagnosis assessed through biennial interviews were linked to the generosity of unemployment benefit programmes in each state and year. Using state fixed-effect models, we assessed whether state changes in the generosity of unemployment benefits predicted CVD risk. Results States with higher unemployment benefits had lower incidence of CVD, so that a 1% increase in benefits was associated with 18% lower odds of CVD (OR:0.82, 95%-CI:0.71–0.94). This association remained after introducing US census regional division fixed effects, but disappeared after introducing state fixed effects (OR:1.02, 95%-CI:0.79–1.31).This was consistent with the fact that unemployment was not associated with CVD risk in state-fixed effect models. Conclusion Although states with more generous unemployment benefits had lower CVD incidence, this appeared to be due to confounding by state-level characteristics. Possible explanations are the lack of short-term effects of unemployment on CVD risk. Future studies should assess whether benefits at earlier stages of the life-course influence long-term risk of CVD.
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Affiliation(s)
- Stefan Walter
- Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, Massachusetts, United States of America
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands
- * E-mail:
| | - Maria Glymour
- Department of Epidemiology & Biostatistics, University of California San Francisco, San Francisco, California, United States of America
- Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, Massachusetts, United States of America
| | - Mauricio Avendano
- Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, Massachusetts, United States of America
- LSE Health and Social Care, London School of Economics and Political Science, London, United Kingdom
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Khlat M, Legleye S, Falissard B, Chau N. Mortality gradient across the labour market core-periphery structure: a 13-year mortality follow-up study in north-eastern France. Int Arch Occup Environ Health 2013; 87:725-33. [PMID: 24136670 DOI: 10.1007/s00420-013-0915-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2013] [Accepted: 10/02/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE This study explores mortality related to temporary employment, about which very little is known to date. METHODS In 1996, a health survey was carried out in the French region of Lorraine, and all members of 8,000 randomly chosen households were followed up for mortality over a 13-year period. Mortality of subjects in relation to their employment situation at baseline was analysed using a Cox survival regression. RESULTS In comparison with permanent workers, for unemployed men, we found age and occupation-adjusted hazard ratios (HR) of 4.1 for all-causes of death and 3.9 for non-violent causes, and for male temporary workers a HR of 2.2 for both all-causes and non-violent causes of death. Bad health, tobacco smoking and alcohol misuse explained 17 % of the excess risk for the unemployed and 41 % of that for temporary workers. CONCLUSION The observation of large mortality inequalities across the labour market core-periphery structure has important policy implications, particularly in terms of prevention focused on unhealthy behaviours among male unemployed and temporary workers.
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Affiliation(s)
- M Khlat
- Institut National d'Etudes Démographiques, 133 Boulevard Davout, 75980, Paris Cedex 20, France,
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Astell-Burt T, Feng X. Health and the 2008 economic recession: evidence from the United Kingdom. PLoS One 2013; 8:e56674. [PMID: 23437208 PMCID: PMC3577686 DOI: 10.1371/journal.pone.0056674] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2012] [Accepted: 01/16/2013] [Indexed: 11/22/2022] Open
Abstract
Introduction The economic recession which began in 2008 has resulted in a substantial increase in unemployment across many countries, including the United Kingdom. Strong association between unemployment and poor health status among individuals is widely recognised. We investigated whether the prevalence of poor health at a population level increased concurrent to the rise in unemployment during the economic recession, and whether the impact on health varied by geographical and socioeconomic circumstances. Method Health, demographic and socioeconomic measures on 1.36 million survey responses aged 16–64 were extracted from the Quarterly Labour Force Survey of the United Kingdom, collected every three months, from January 2006 to December 2010. The likelihood of self-reporting poor health status and specific types of health problems (depression, mental illness, cardiovascular and respiratory) across time were estimated separately using logistic regression. Explanatory variables included economic status (International Labour Organization definition), occupational class, age, gender, country of birth, ethnicity, educational qualifications, couple status, household tenure, number of dependents, and geographical region. Results Unemployment (age-gender adjusted) rose from 4.5% in January 2008 to 7.1% by September 2009. The reporting of poor health status increased from 25.7% in July 2009 to 29.5% by December 2010. Similar increases were found for cardiovascular and respiratory health problems; not depression or mental illness. The prevalence of poor health status among the unemployed decreased from 28.8% in July 2008, to 24.9% by March 2009; but this was followed by an increase in poor health experienced across all regions and by all socioeconomic groups, including those who remained employed, regardless of their occupational class. Interpretation Although our study found no exacerbation of pre-recession health inequalities, the rise in poor health status not only for the unemployed, but also among people who remained employed, regardless of their occupational class, justifies concern voiced among many public health commentators.
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Affiliation(s)
- Thomas Astell-Burt
- School of Science and Health, University of Western Sydney, Sydney, Australia.
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Montgomery S, Udumyan R, Magnuson A, Osika W, Sundin PO, Blane D. Mortality following unemployment during an economic downturn: Swedish register-based cohort study. BMJ Open 2013; 3:bmjopen-2013-003031. [PMID: 23847269 PMCID: PMC3710978 DOI: 10.1136/bmjopen-2013-003031] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE To investigate if unemployment during an economic downturn is associated with mortality, even among men with markers of better health (higher cognitive function scores and qualifications), and to assess whether the associations vary by age at unemployment. DESIGN Longitudinal register-based cohort study. SETTING Study entry was in 1990 and 2001 when Sweden was entering periods of significant economic contraction. PARTICIPANTS A representative sample of men from the general population (n=234 782) born between 1952 and 1956 who participated in military conscription examinations. Men in receipt of disability or sickness benefit at study entry were excluded. MAIN OUTCOME MEASURE All-cause mortality. RESULTS Unemployment compared with employment in 1991 (ages 34-38 years) produced adjusted HRs (with 95% CIs) for all-cause mortality (3651 deaths) during follow-up to 2001 and after stratification by education of 2.35 (1.99 to 2.76) for compulsory education, 2.25 (1.97 to 2.58) for up to 3 years postcompulsory education and 1.90 (1.40 to 2.57) for more than 3 years postcompulsory education. When unemployment was compared with employment in 2001 (ages 45-49 years) with follow-up to 2010, the pattern of mortality risk (4271 deaths) stratified by education was reversed, producing adjusted HRs of 2.81 (2.47 to 3.21) for compulsory education, 2.87 (2.58 to 3.19) for up to 3 years postcompulsory education and 3.44 (2.78 to 4.25) for more than 3 years postcompulsory education. Interaction testing confirmed effect modification by age/period (p=0.003). The degree of gradient reversal was slightly less pronounced after stratification by cognitive function but produced a similar pattern of results (p=0.004). CONCLUSIONS Unemployment at older ages is associated with greater mortality risk than at younger ages, with the greatest relative increase in risk among men with markers of better health, suggesting the greater vulnerability of all older workers to unemployment-associated exposures.
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Affiliation(s)
- Scott Montgomery
- Clinical Epidemiology and Biostatistics, Örebro University Hospital, Örebro, Sweden
- School of Health and Medical Sciences, Örebro University, Örebro, Sweden
- Clinical Epidemiology Unit, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Ruzan Udumyan
- Clinical Epidemiology and Biostatistics, Örebro University Hospital, Örebro, Sweden
- School of Health and Medical Sciences, Örebro University, Örebro, Sweden
| | - Anders Magnuson
- Clinical Epidemiology and Biostatistics, Örebro University Hospital, Örebro, Sweden
| | - Walter Osika
- Stress Research Institute, Stockholm University, Stockholm, Sweden
| | - Per-Ola Sundin
- School of Health and Medical Sciences, Örebro University, Örebro, Sweden
- Department of Medicine, Örebro University Hospital, Örebro, Sweden
| | - David Blane
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK
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Rosenthal L, Carroll-Scott A, Earnshaw VA, Santilli A, Ickovics JR. The importance of full-time work for urban adults' mental and physical health. Soc Sci Med 2012; 75:1692-6. [PMID: 22858166 DOI: 10.1016/j.socscimed.2012.07.003] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2011] [Revised: 03/26/2012] [Accepted: 07/02/2012] [Indexed: 10/28/2022]
Abstract
Unemployment and underemployment have adverse mental and physical health consequences, such as increased stress and depression. Health damaging behaviors like unhealthy eating, smoking, and alcohol use may be used to cope, contributing to chronic disease risk. In this adverse economic climate, it is vital to understand the health implications of unemployment and underemployment as well as underlying mechanisms. A randomized household survey of adults in six low resource communities was conducted in New Haven, Connecticut in 2009, yielding a sample of 1205 (73% participation) racially diverse adults (61% Black, 20% Latino, 12% White) ages 18-65 (61% women). We used ANOVA to test group differences and structural equation modeling to test mediation. 14.5% were unemployed and looking for work, 18.4% worked part-time, 38.2% worked full-time. Those employed full-time reported the least damaging psychological factors and health behaviors: lowest levels of stress and depression, most healthy and least unhealthy eating, most physical activity, and lowest levels of smoking and drinking. Those employed part-time fell in the middle, and those unemployed fell on the unhealthy end of all psychological and behavioral factors. Stress significantly mediated the associations of full-time employment with frequency of unhealthy eating and physical activity, and amount of cigarette smoking and alcohol consumption. Depression significantly mediated the association of full-time employment with frequency of healthy eating. Compared to <10% nationwide, rates of unemployment in this sample were high. Both those unemployed and employed part-time reported adverse health behaviors as compared to those employed full-time, partially mediated by heightened stress and depression. It is vital for the health and well-being of the nation to increase not simply employment, but specifically full-time employment. Provision of mental health services to those unemployed and underemployed should be a priority to promote healthier lifestyles and prevent costly future chronic disease.
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Affiliation(s)
- Lisa Rosenthal
- Yale School of Public Health, CARE - Community Alliance for Research and Engagement, 135 College Street, Suite 200, New Haven, CT 06510, USA.
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García AM. Mercado laboral y salud. Informe SESPAS 2010. GACETA SANITARIA 2010; 24 Suppl 1:62-7. [DOI: 10.1016/j.gaceta.2010.07.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2010] [Revised: 06/04/2010] [Accepted: 07/01/2010] [Indexed: 12/01/2022]
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