Job loss from poor health, smoking and obesity: a national prospective survey in France

The impact of body mass index (BMI) on satisfaction with work life: An international BODY-Q study

Obesity is a global health issue known to have a major influence on health-related quality of life (HR-QOL). HR-QOL is a concept evaluating physical and psychological health. Work life can impact HR-QOL in people with obesity. The aim of this study was to measure the association between body mass index (BMI) and satisfaction with work life. This study included participants from an international multicenter field-test study of BODY-Q scales. Recruitment took place at hospitals in Denmark, The Netherlands and USA between June 2019 and January 2020. The BODY-Q Work Life scale was used to measure work life satisfaction. The difference between BMI groups and work life satisfaction was examined using one-way analysis of variance. Multivariable linear regression analysis was used to examine the association between BMI and work life satisfaction, adjusted for significant confounders. Of 4123 participants, 2515 completed the BODY-Q Work Life scale. BMI groups showed significant difference in work life satisfaction (p < .0001). The Work Life scale mean score was 77.6 for the normal BMI group, 78.5 for the overweight group and 75.0, 68.9 and 63.8 for Class 1, 2 and 3 obesity, respectively. Furthermore, BMI was significantly associated with satisfaction with work life (adjusted regression coefficient -.962, p < .0001). Higher BMI was associated with lower work life satisfaction. This finding suggests that a reduction in BMI may have a positive influence on work life satisfaction in people with obesity.

Back to Work After Bariatric Surgery? A Belgian Population Study

INTRODUCTION

Aside from an impact on health, obesity is also associated with higher social and economic costs such as impaired productivity, increased work absenteeism, and higher rates of unemployment. The aim of this study was to assess the effect of bariatric surgery on employment status in a large nationwide database, using data from all patients that underwent bariatric surgery in Belgium.

METHODS

This is a retrospective analysis of all Belgian patients that underwent bariatric surgery between 2014 and 2015. The work status of these patients was examined yearly: 4 years before and 3 years after surgery. Increased employment after surgery was defined (1) as a reduction in days of unemployment and incapacity and (2) as the resumption of work among the unemployed.

RESULTS

In total, 16,276 patients were included. The number of working people rose from 49.7% before to 61.2% 3 years after bariatric surgery, i.e., an increase of 11.5% between pre- and post-surgery. The largest improvement in reduction in unemployment was found in individuals who were absent from work for more than 9 months, namely, a reduction from 13.4 to 7.2%. In the population of unemployed patients, 20.9% became employed after bariatric surgery.

CONCLUSION

We found an increase in employment rate and a decrease in work incapacity and unemployment after bariatric surgery. Higher rates of employment after bariatric surgery may also contribute to an increased cost-effectiveness of bariatric surgery. It would be interesting to research possible targeting strategies to increase the employment rate even more after bariatric surgery.

Smoking and labour market participation: a 5-year prospective cohort study of transitions between work, unemployment and sickness absence

AIM

To examine whether smokers are at higher risk of unemployment and sickness absence and have a lower chance of getting employed compared to never smokers.

METHODS

The study sample in this prospective register-based cohort study consisted of 87,830 men and women between 18 and 60 years of age from the Danish National Health Survey 2010. Assessment of smoking status was obtained at baseline and the participants were followed in the Danish register-based evaluation of marginalisation database from 2010 to 2015. Data were analysed by Cox proportional hazards.

RESULTS

The median age was 44.5 years and 47.3% were men. At baseline, 88.8% were categorised as working, 7.7% as unemployed and 3.5% as being on sickness absence. At the 5-year follow-up, hazard ratios for transitions from work to unemployment were 1.31 (95% confidence interval (CI) 1.22-1.40; P<0.001) for current smokers (<15/day) and 1.52 (95% CI 1.43-1.62; P<0.001) for current heavy smokers (⩾15/day), compared to never smokers. Hazard ratios for transitions from work to sickness absence were 1.31 (95% CI 1.24-1.38; P<0.001) for current smokers (<15/day) and 1.64 (95% CI 1.56-1.71; P<0.001) for current heavy smokers (⩾15/day). Current heavy smokers (⩾15/day) also had a lower chance of becoming re-employed with a hazard ratio of 0.81 (95% CI 0.75-0.88; P<0.001) compared to never smokers.

Smoking was associated with a higher risk of unemployment and sickness absence, and a lower chance of becoming employed. More focus on smoking prevention and smoking cessation could therefore be implemented in relation to job seeking and sickness absence.

The bidirectional relationship of obesity and labor market status - Findings from a German prospective panel study

Background

Given the inconsistent findings regarding associations between obesity and unemployment, our analysis is one of the few that explores bidirectional changes in obesity and unemployment. In our prospective study, we address factors associated with the

transition into and transition out of obesity, including unemployment, and

transition into and out of unemployment, including obesity.

Subjects and methods

The Labor Market and Social Security-Panel (PASS) consists of two independent, nationally representative German subsamples: residents receiving unemployment benefits (50%) and a representative sample of residents (50%). The sample contains N = 11 361 observations between two measurement points three years apart of N = 8440 individuals participating in two or three waves between 2009 and 2015. We analyzed potential predictors of the transition in and out of obesity and unemployment, including health-related quality of life (HrQoL) and physical activity, using logistic regression models.

Results

Transition into obesity: Unemployed participants had a higher probability of exhibiting a body mass index (BMI) ≥ 35 kg/m² three years later (transition into obesity classes II and III; Exp(B) = 1.5).

Transition out of obesity: Unemployment did not predict transition out of obesity. Physical activity at least once weekly increased the probability of no longer having a BMI ≥ 35 kg/m² three years later (Exp(B) = 2.0).

Transition into unemployment: Obesity was not associated with becoming unemployed three years later. Participants with a lower mental HrQoL were more likely to become unemployed (Exp(B) = 0.98).

Transition out of unemployment: Unemployed individuals reporting a BMI of 30–34.9 kg/m² were less likely to leave unemployment (Exp(B) = 0.67). A better physical HrQoL was associated with a higher probability of leaving unemployment (Exp(B) = 1.01).

Conclusions

Obesity does not predict future unemployment, but unemployed individuals with obesity have a lower probability of labor market re-entry. Unemployment increases obesity risk. Interactions between obesity and possible confounding variables and their effect on unemployment warrants further examination.

The impact of late-career job loss and genetic risk on body mass index: Evidence from variance polygenic scores

Unemployment shocks from the COVID-19 pandemic have reignited concerns over the long-term effects of job loss on population health. Past research has highlighted the corrosive effects of unemployment on health and health behaviors. This study examines whether the effects of job loss on changes in body mass index (BMI) are moderated by genetic predisposition using data from the U.S. Health and Retirement Study (HRS). To improve detection of gene-by-environment (G × E) interplay, we interacted layoffs from business closures-a plausibly exogenous environmental exposure-with whole-genome polygenic scores (PGSs) that capture genetic contributions to both the population mean (mPGS) and variance (vPGS) of BMI. Results show evidence of genetic moderation using a vPGS (as opposed to an mPGS) and indicate genome-wide summary measures of phenotypic plasticity may further our understanding of how environmental stimuli modify the distribution of complex traits in a population.

Effects of increased body mass index on employment status: a Mendelian randomisation study

BACKGROUND

The obesity epidemic may have substantial implications for the global workforce, including causal effects on employment, but clear evidence is lacking. Obesity may prevent people from being in paid work through poor health or through social discrimination. We studied genetic variants robustly associated with body mass index (BMI) to investigate its causal effects on employment.

DATASET/METHODS

White UK ethnicity participants of working age (men 40-64 years, women 40-59 years), with suitable genetic data were selected in the UK Biobank study (N = 230,791). Employment status was categorised in two ways: first, contrasting being in paid employment with any other status; and second, contrasting being in paid employment with sickness/disability, unemployment, early retirement and caring for home/family. Socioeconomic indicators also investigated were hours worked, household income, educational attainment and Townsend deprivation index (TDI). We conducted observational and two-sample Mendelian randomisation (MR) analyses to investigate the effect of increased BMI on employment-related outcomes.

RESULTS

Regressions showed BMI associated with all the employment-related outcomes investigated. MR analyses provided evidence for higher BMI causing increased risk of sickness/disability (OR 1.08, 95% CI 1.04, 1.11, per 1 Kg/m² BMI increase) and decreased caring for home/family (OR 0.96, 95% CI 0.93, 0.99), higher TDI (Beta 0.038, 95% CI 0.018, 0.059), and lower household income (OR 0.98, 95% CI 0.96, 0.99). In contrast, MR provided evidence for no causal effect of BMI on unemployment, early retirement, non-employment, hours worked or educational attainment. There was little evidence for causal effects differing by sex or age. Robustness tests yielded consistent results.

DISCUSSION

BMI appears to exert a causal effect on employment status, largely by affecting an individual's health rather than through increased unemployment arising from social discrimination. The obesity epidemic may be contributing to increased worklessness and therefore could impose a substantial societal burden.

Social determination, health selection or indirect selection? Examining the causal directions between socioeconomic status and obesity in the Chinese adult population

Using nationally representative longitudinal data from 2010 to 2016 in China, this paper aims to systematically investigate the dynamic relationship between socioeconomic status (SES) and obesity in the Chinese adult population. We apply maximum likelihood estimations of dynamic panel models with fixed effects to evaluate the causal directions between SES and obesity, thus providing empirical evidence of the relative importance of the "social determination" hypothesis (SES determines obesity), the "health selection" hypothesis (obesity influences SES) and the "indirect selection" hypothesis (some third factors cause obesity and SES). All analyses were conducted for women and men separately. Our analyses mostly support the contention that after two years, there are no significant causal effects of either lagged SES on Body Mass Index (BMI) or BMI on SES, after controlling for time-invariant unobserved confounders. While there is weak evidence of social determination among men, non-manual workers tend to have a higher BMI than those who are unemployed. We conclude that the indirect selection hypothesis may be the most important explanation in understanding the relationship between SES and obesity in China.

Social Causation, Social Selection, or Common Determinants? Examining Competing Explanations for the Link Between Young Adult Unemployment and Nicotine Dependence

INTRODUCTION

Unemployment has been related to smoking, yet the causal nature of the association is subject to continued debate. Social causation argues that unemployment triggers changes in smoking, whereas the social selection hypothesis proposes that pre-existing smoking behavior lowers the probability of maintaining employment. The present study tested these competing explanations while accounting for another alternative explanation-common liability.

METHODS

Data were from the Christchurch Health and Development Study, a longitudinal cohort followed from birth to age 35. Odds were generated for having nicotine dependence in models for social causation and being unemployed in models for social selection. These models were extended to include possible common liability factors during childhood (eg, novelty seeking) and young adulthood (eg, major depression).

RESULTS

In the model testing social causation, coefficients representing the impacts of unemployment on nicotine dependence remained statistically significant and robust (odds ratio [OR] = 1.55; 95% confidence interval [CI] = 1.20, 2.00), even after accounting for common determinant measures. In contrast, a reverse social selection model revealed that coefficients representing the impacts of nicotine dependence on unemployment substantially attenuated and became statistically nonsignificant as childhood factors were added (OR = 1.14; 95% CI = 0.90, 1.45).

CONCLUSIONS

Unemployment may serve as inroads to nicotine addiction among young adults, not the other way, even in the context of nicotine dependence, a more impaired form of smoking that may arguably hold higher potential to generate social selection processes. This social causation process cannot be completely attributable to common determinant factors.

IMPLICATIONS

It is critical to clarify whether unemployment triggers changes in smoking behaviors (ie, social causation) or vice versa (ie, social selection)-the answers to the question will lead to public health strategies with very different intervention targets to break the linkage. The current study findings favor social causation over social selection, regardless of gender, and support a needed shift in service profiles for unemployed young adults-from a narrow focus on job skills training to a more holistic approach that incorporates knowledge from addiction science in which unemployed young adults can find needed services to cope with job loss.

Health and socioeconomic circumstances over three generations as predictors of youth unemployment trajectories

BACKGROUND

Youth unemployment is a critical life event, which may trigger other labour market-related disadvantages and detrimental health implications. To better understand the processes causing unemployment, we study how socioeconomic circumstances of successive generations and familial and health factors in adolescence predict youth unemployment trajectories between ages 16 and 28 in Finland from 2000 to 2009.

METHODS

We used survey data from 1979 to 1997 on 12- to 18-year-old Finns (n = 43 238) linked with 1970-2009 registry-based data of their grandparents, parents and themselves. Growth mixture modelling and multivariate logistic regression analyses were used.

RESULTS

Three latent youth unemployment trajectories emerged; low (46%), decreasing (38%) and high (16%) risk groups. Of adolescent factors, low school achievement was the most important predictor of youth unemployment followed by smoking, stress symptoms and poor self-rated health. Grandparents' education predicted their grandchildren's unemployment but the effects of other grandparental socioeconomic circumstances mediated through parents' socioeconomic status (SES). Parents' low SES and education, and long-term unemployment increased the risk of the child's unemployment. Youth unemployment was related to low education at the age of 29.

CONCLUSION

Grandparents' education, family socioeconomic circumstances and adolescents' health and school achievement predict the developmental trajectory of youth unemployment. Youth unemployment is also related to low education in early adulthood. Our findings suggest that the health selection of unemployment works already in adolescence.

Implications of Professional Occupation Related to Obesity in Patients Undergoing Bariatric Surgery

Obesity is an epidemic with severe consequences on the professional development of patients. Bariatric surgery has proven to be a safe treatment with effective results in weight control. The aim of this study is to assess the implications of professional occupation in relation to the development of obesity and weight changes after bariatric surgery. We analyzed 500 obese patients (77.8% women, 22.2% men) who underwent one anastomosis gastric bypass surgery at the Centre of Excellence for the Study and Treatment of Obesity and Diabetes (2014–2019), assessing the influence of professional occupation on body composition and evolution of weight loss up to two years after surgery. Preoperative obesity type III and IV was higher in men than in women (45.9–19.8% vs. 43.7–9.5%; respectively). Prevalent clinical history in women was depression (46.7%), varicose veins (35.6%), and thyroid disease (9.7%), while in men it was respiratory failure (98.2%), high blood pressure (56.8%), hepatic steatosis (82%). Postoperative weight loss was effective in every professional field, reaching normal weight values from 12 months after surgery.

Substance Use Disorders and COVID-19: Multi-Faceted Problems Which Require Multi-Pronged Solutions

COVID-19 shocked health and economic systems leaving millions of people without employment and safety nets. The pandemic disproportionately affects people with substance use disorders (SUDs) due to the collision between SUDs and COVID-19. Comorbidities and risk environments for SUDs are likely risk factors for COVID-19. The pandemic, in turn, diminishes resources that people with SUD need for their recovery and well-being. This article presents an interdisciplinary and international perspective on how COVID-19 and the related systemic shock impact on individuals with SUDs directly and indirectly. We highlight a need to understand SUDs as biopsychosocial disorders and use evidence-based policies to destigmatize SUDs. We recommend a suite of multi-sectorial actions and strategies to strengthen, modernize and complement addiction care systems which will become resilient and responsive to future systemic shocks similar to the COVID-19 pandemic.

The role of comorbidity in the association of obesity with unemployment and disability

PURPOSE

The association of obesity with a large range of physical conditions and numerous psychiatric disorders has been extensively studied. Our study sought the extent to which physical conditions or psychiatric disorders associated with obesity mediate the association of obesity with unemployment or disability.

METHODS

Using data from the National Epidemiologic Survey on Alcohol and Related Conditions-III (NESARC-III, 2012-2013), we estimated the prevalence of unemployment as a function of obesity taking into account these comorbidities. Data on self-reported height and weight were available for 35,725 respondents. Clinician-diagnosed physical conditions were self-reported and lifetime psychiatric disorders were assessed with a semistructured interview.

RESULTS

The adjusted prevalence of obesity was 30.4%. Participants with obesity were more likely than participants without obesity to report at least one of the 31 assessed physical conditions (64.46% vs. 46.87%; P < .001). Participants with obesity were more likely to report at least one of the 24 assessed psychiatric diagnoses than respondents without obesity (60.57 vs. 56.75%; P < .001). The rates of unemployment were higher in participants with obesity than in those without obesity (15.75% vs. 11.26%; P < .001). Similarly, participants with obesity reported higher rates of disability than those without obesity. Although the number of physical conditions and psychiatric disorders partly explains this association, obesity remained significantly associated with unemployment and greater disability when controlling for the number of physical conditions and psychiatric disorders.

CONCLUSIONS

Obesity is associated with high rates of unemployment and with high disability. This is not explained solely by the high rate of physical conditions and psychiatric disorders associated with obesity.

Body mass index trajectories among the Canadian workforce and their association with work environment trajectories over 17 years

OBJECTIVE

To determine the number of latent body mass index (BMI) trajectories from 1994 to 2010 among working Canadians and their association with concurrent trajectories in work environment exposures.

METHODS

Data of employed individuals from the longitudinal Canadian National Population Health Survey were used. Group-based trajectory modelling was used to determine the number of latent BMI trajectories and concurrent psychosocial work environment trajectories. A multinomial logistic regression of BMI trajectory membership on trajectories in work environment dimensions (skill discretion, decision latitude, psychological demands, job insecurity, social support, physical exertion) was then explored.

RESULTS

Four latent BMI trajectories corresponding to normal, overweight, obese and very obese BMI values were found. Each trajectory saw an increase in BMI (~2-4 kg/m²) over the 17-year period. A higher decision authority trajectory was associated with lower odds of belonging to the overweight and obese trajectories when compared with the normal weight trajectory. A decreasing physical exertion trajectory was associated with higher odds of belonging to the very obese trajectory when compared with the normal weight trajectory.

CONCLUSIONS

Four BMI trajectories are present in the Canadian workforce; all trajectories saw increased body weight over time. Declining physical exertion and lower decision authority in the work environment over time is associated with increased likelihood of being in overweight and obese trajectories.

Body Mass Index (BMI) and Work Ability in Older Workers: Results from the Health and Employment after Fifty (HEAF) Prospective Cohort Study

This study explores associations between BMI and prolonged sickness absence; cutting down at work; and health-related job loss (HRJL) over two years of follow-up among workers aged ≥50 years. A cohort of 2299 men and 2425 women (aged 50–64 years) self-reported height and weight at baseline and provided information about work ability at 12 and 24 months for the Health and Employment after Fifty (HEAF) Study. Associations between BMI and work ability were assessed by logistic regression and HRJL by multiple-record Cox’s proportional hazards models, with adjustment for other risk factors. The prevalence of obesity/severe obesity was 22.6%/1.2% amongst men and 21.4%/2.6% amongst women, respectively. In men and women, obesity and severe obesity predicted having to cut down at work for health over two years. In women, severe obesity predicted prolonged sickness absence, and also HRJL even after adjustment for age, proximity to retirement, financial difficulties, and lifestyle factors (hazard ratio [HR] 2.93, 95% CI 1.38, 6.23), and additional adjustment for health conditions (HR 2.52, 95% CI 1.12, 5.67). Obesity, and particularly severe obesity, negatively impacts work ability amongst people aged 50–64 years, with greatest effects in women. Obesity can be expected to hinder attempts to encourage work to older ages.

Child living arrangements following separation and mental health of parents in Sweden

Father involvement and joint physical custody in post-separation families are increasingly common. In Sweden, 35 percent of the children of separated parents live equally much with both parents. Since parenthood is gendered, the associations between child living arrangement and parental health may vary between women and men. This study analyzes the association between children's living arrangement and mental health of parents, and how this interacts with material and social circumstances. Drawing on The Swedish Survey of Living Conditions (ULF) 2008–2013, the association between child living arrangements and mental health (worry/anxiety) of parents in five family structures: two biological parents, reconstituted with joint or main/sole custody arrangements, single with joint physical custody, and single with main or sole custody, were analyzed. Data on 9,225 mothers and fathers with resident children aged 0–17 were analyzed by logistic regressions for average marginal effects adjusting for socio-demographic, socio-economic and social factors. Analyses of interaction effects were made using the synergy index.

Substantial family type differences were found in mental health between two biological parent family and all other family types for mothers, and two biological parent family and single parents for fathers. For the single mothers, the higher risk for worry and anxiety was still found following controls for socioeconomic factors. For fathers, the only differences that remained following control for socioeconomic factors was that of single fathers with children in joint physical custody. Interaction effects were found for the combination of single motherhood and non-employment, indicating a higher risk of mental health problems for single mothers (both with joint and sole custody), than would be expected from a simple addition of these exposures, suggesting that this is a vulnerable group. The results indicate that joint custody is associated with higher risk for worry and anxiety for the parents, especially for mothers both re-partnered and single, but also for single fathers.

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Economic and social conditions explain part of the differences in mental health.

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Single mothers lacking employment is a particularly vulnerable group.

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Shared residence is associated with higher risk for worry and anxiety in parents.

BMI and Labor Market Participation: A Cohort Study of Transitions Between Work, Unemployment, and Sickness Absence

OBJECTIVE

This study aimed to test the hypotheses that individuals with obesity are at higher risk of unemployment and sickness absence and have a lower chance of getting employed compared with individuals with normal weight.

METHODS

Data on weight and height were collected at baseline from 87,796 participants in the Danish National Health Survey 2010. Participants were then followed in national registers for 5 years. Outcome measures were transitions from employment to unemployment and sickness absence and the transitions from unemployment or sickness absence to employment. Data were analyzed by Cox proportional hazards models adjusted for potential confounders.

RESULTS

Hazard ratios for unemployment were 1.18 (95% CI: 1.10-1.26) for individuals with obesity and 1.27 (95% CI: 1.14-1.41) for individuals with severe obesity compared with individuals with normal weight. Participants with obesity also had a higher risk of sickness absence. Additionally, participants with obesity who were unemployed at baseline had a lower chance of becoming employed compared with participants with normal weight.

CONCLUSIONS

Obesity was associated with a higher risk of unemployment and sickness absence compared with individuals with normal weight. Additionally, obesity was associated with a lower chance of employment.

Alcohol, tobacco and cannabis use are associated with job loss at follow-up: Findings from the CONSTANCES cohort

BACKGROUND

Substance use is more prevalent among unemployed subjects compared to employed ones. However, quantifying the risk subsequent of job loss at short-term according to substance use remains underexplored as well as examining if this association persist across various sociodemographic and occupational positions previously linked to job loss. We examined this issue prospectively for alcohol, tobacco, cannabis use and their combination, among a large population-based sample of men and women, while taking into account age, gender, overall health status and depressive symptoms.

METHODS

From the French population-based CONSTANCES cohort, 18,879 working participants were included between 2012 and 2016. At baseline, alcohol use disorder risk according to the Alcohol Use Disorders Identification Test (mild, dangerous, problematic or dependence), tobacco (non-smoker, former smoker, 1-9, 10-19, >19 cigarettes/day) and cannabis use (never, not in past year, less than once a month, once a month or more) were assessed. Employment status at one-year (working versus not working) was the dependent variable. Logistic regressions provided Odds Ratios(OR(95%CI)) of job loss at one-year, adjusting for age, gender, self-reported health and depressive state (measured with the Center of Epidemiologic Studies Depression scale). Stratified analyses were performed for education, occupational grade, household income, job stress (measured with the Effort-Reward Imbalance), type of job contract, type of work time and history of unemployment. In sensitivity analyses, employment status over a three-year follow-up was used as dependent variable.

RESULTS

Alcohol, tobacco and cannabis use were associated with job loss, from the second to the highest category: 1.46(95%CI:1.23-1.73) to 1.92(95%CI:1.34-2.75), 1.26(95%CI:1.09-1.46) to 1.78(95%CI:1.26-2.54) and 1.45(95%CI:1.27-1.66) to 2.68(95%CI:2.10-3.42), respectively, and with dose-dependent relationships (all p for trend <0.001). When introduced simultaneously, associations remained significant for the three substances without any between-substance interactions. Associations remained significant across almost all stratifications and over a three-year follow-up as well as after adjustment for all the sociodemographic and occupational factors.

CONCLUSIONS

Alcohol, tobacco and cannabis use were independently associated with job loss at short-term, with dose-dependent relationships. This knowledge will help refining information and prevention strategies. Importantly, even moderate levels of alcohol, tobacco or cannabis use are associated with job loss at short-term and all sociodemographic and occupational positions are potentially concerned.

Plus size and obese workers: anthropometry estimates to promote inclusive design

A significant proportion of the adult population globally is overweight, obese or classed as 'plus size'. This has led to variability in size and shape across the working population and exclusion in the workplace. A new dataset of the anthropometry of plus size people has been created. Length dimensions were similar to other data, but breadth, circumference, and depth measurements were substantially larger. The hip breadth and abdominal depth were important for predicting largeness in this population. These data help explain the high exclusion rates from design and the number of fit, reach, posture and clearance issues reported by participants with a high BMI: generally, the higher the BMI the greater prevalence of problems. It is hoped that a better understanding of the anthropometric characteristics of the plus size worker will inform the design of safe, productive work environments to promote inclusion for a wider range of people. Practitioner Summary: A new anthropometry dataset of plus size people has been created. The higher the BMI the greater the problems with design in the workplace for fit, reach, posture and clearance. To ensure inclusion and reduce stigma it is important to understand more about the size and shape of this population.

Impact of unemployment on self-perceived health : Evidence from French panel data

This article investigates the impact of unemployment on self-perceived health using the French Longitudinal Labour Force Survey over the period 2013-2016. We apply a difference-in-difference propensity score matching approach to identify the health effect of unemployment. By combining both methods, we minimise selection bias and remove unobserved individual fixed effects that are time-invariant as well as common period effects. In the French context, characterised by high and persistent unemployment and relatively long unemployment spells, we show that the experience of unemployment has no significant effect on self-perceived health. Moreover, we find no heterogenous effect by carrying out separate analyses by age, gender, marital status, education, occupation, employment contract, local unemployment rate, or past labour market history. Robustness checks, performed by testing alternative types of matching technology, different definitions of the unemployment experience, and other measures of health confirm our findings. Health selection and confounding factors appear to be important determinants of the cross-sectional association between unemployment and poor health.

The physical activity level and aerobic capacity estimation (VO2max) among the administrative staff of the Pars Special Economic Energy Zone (Assaluyeh, Iran) with different BMIs

Background The purpose of this study was to examine the level of physical activity (PA) and maximal aerobic capacity (VO2max) among office workers of the Pars Special Economic Energy Zone in Iran with different body mass indexes (BMIs). Materials and methods This research was descriptive, and a correlation of variables was applied as its execution method. Administrative staff of two centers were randomly selected from 20 to 30 administrative centers of the Pars Special Economic Energy Zone, Assaluyeh, Iran, and included 294 male employees who were willing to participate in this research and who met the inclusion criteria (being in the age range of 20-60 years, lacking specific diseases, and who had enough physical fitness to do PA) who were purposefully selected. Results The age-adjusted means for the PA score (7.93 ± 1.12) and VO2max (48.66 ± 6.95) mL/min/kg were calculated. After adjusting for other variables, significant difference was found between BMI and age (β = 0.20; p = 0.005), BMI and VO2max (β = 0.302; p = 0.001), as well as BMI and the total PA score (β = -0.304; p = 0.045). Conclusions The results of this study showed low levels of PA (work, exercise and leisure) and respiratory capacity in the administrative staff of the oil and gas industry, which is associated with overweight and obesity.

The association of mobility disability and obesity with risk of unemployment in two cohorts from Sweden

Background

People with mobility disability (MD) or obesity often have more health problems and are less able to participate in work than individuals without these conditions. This study investigated whether people burdened with MD and obesity have a greater risk of unemployment than people with either one (MD only or obesity only) or none of these conditions.

Methods

The study included two Swedish population-based cohorts, a national cohort (n = 39,947) and a regional cohort (n = 40,088). Six exposure groups were created using baseline self-reported data on MD and body mass index from participants aged 19 to 64 years. The MD definition differed between the cohorts. Various sources of socio-demographic factors were used to address confounding. Participants’ risks of unemployment were assessed longitudinally in a nationwide register with objective data and with almost no loss of follow-up (< 1%). Cox regression was used to analyse associations of MD and/or obesity (BMI ≥ 30) with risk of any (≥1 day) and long-term unemployment (≥90 days during two consecutive years). Quantile regression was used to estimate participants’ unemployment risks as average days of unemployment. Normal-weight people without MD were used as a reference group. The Wald test was applied for specific group comparisons other than to the reference group.

Results

In summary, the groups with MD and the obese group without MD had a higher risk of becoming unemployed than the reference group (regional survey adjusted hazard ratio range: 1.30–1.59; 95% CI range: 1.06–1.90, national survey adjusted hazard ratio range: 1.11–1.34; 95% CI range: 0.88–1.81). The obese group with MD did not differ from the groups with MD only or obesity only in terms of unemployment risk.

Conclusions

People with MD and/or obesity are vulnerable groups at risk of prolonged unemployment during their working life in a country with a highly developed welfare system.

Electronic supplementary material

The online version of this article (10.1186/s12889-019-6627-2) contains supplementary material, which is available to authorized users.

Prevalence and association between triglyceride level and lifestyle factors among Malay obese class I and II adults

OBJECTIVE

Hypertriglyceridemia is an independent risk factor for cardiovascular diseases. This study aimed to determine the prevalence and association of triglyceride level and lifestyle factors among Malay obese class I and II adults.

METHOD

This is a cross-sectional study of 65 Malay obese class I and class II adults aged 20-62 years (21 male, 44 female) from sub-urban areas of Malaysia. Overnight fasting venous blood samples were obtained to determine the triglyceride level (mmol/L). Subjects were classified into either normal or elevated triglyceride level groups based on the triglyceride level (normal < 1.6 mmol/L, elevated > 1.7 mmol/L). Unhealthy lifestyle behaviors, defined as smoking status, hours per day spent on sitting passively and sitting with active motion, and the amount of saturated fat, mono-unsaturated and polyunsaturated fat from dietary intake, were measured from 24-h dietary intake and physical activity recall. We compare the variables of unhealthy lifestyle behaviors between subjects with normal and elevated triglyceride level using independent samples t-test.

RESULTS

Among 65 obese class I and II adults, 16 subjects (24.6%) were found to have elevated triglyceride levels (mean ± standard deviation of body mass index 31.89 ± 3.29 kg/m²). There are significant differences between subjects having normal and elevated triglyceride level with gender, marital status, the number of children, smoking status, weight and monounsaturated fat intake (all P-values < .05).

CONCLUSIONS

The findings of this study highlighted elevated triglyceride level in obese adults might be influenced by unhealthy lifestyle behaviors. We suggest that lifestyle modification intervention is appropriate to prevent cardiovascular disease among Malay obese class I and II adults.

Widening health inequalities between the employed and the unemployed: A decomposition of trends in Canada (2000-2014)

Recent developments in the social epidemiological literature indicate that health inequalities between the employed and the unemployed are widening in many advanced capitalist countries. At present, we know relatively little about why these inequalities are worsening. Drawing on nationally-representative data from the largest health survey in Canada, we explored this question by analyzing changes in self-rated health inequalities between employed and unemployed Canadians from 2000 to 2014. Using a regression-based method that decomposes a given inequality into its component sources, we investigated the extent to which risk factors that account for unemployment-related health inequalities at a single point in time can also explain the extent and direction of change in these unemployment-related health inequalities over time. Our results indicate that relative and absolute health inequalities between employed and unemployed Canadians widened over the study period. Between 2000 and 2014, the prevalence of poor self-rated health among unemployed Canadians increased from 10.8% to 14.6%, while rates among employed Canadians were stable at around 6%. Our findings suggest that the demographic, socioeconomic, and proximal risk factors that are routinely used to explain unemployment-related health inequalities may not be as powerful for explaining how and why these inequalities change over time. In the case of unemployment-related health inequalities in Canada, these risk factors explain neither the increasing prevalence of poor self-rated health among the unemployed nor the growing gap between the unemployed and their employed counterparts. We provide several possible explanations for these puzzling findings. We conclude by suggesting that widening health inequalities may be driven by macrosocial trends (e.g. widening income inequality and declining social safety nets) which have changed the meaning and context of unemployment, as well as its associated risk factors, in ways that are not easy to capture using routinely available survey data.

Perceived stress as a risk factor of unemployment: a register-based cohort study

Background

Although unemployment and high levels of perceived stress have been associated in cross-sectional studies, the direction of causation is unknown. We prospectively examined if high levels of perceived everyday life stress increased the risk of subsequent unemployment and further if differences existed between socioeconomic status-groups.

Methods

We included 9335 18–64-year-old employed respondents of a health survey (North Denmark Health Profile 2010) in which Cohen’s Perceived Stress Scale was used to assess the level of perceived stress. Data were linked individually to national administrative registers. Cox proportional hazards model was used to investigate the association between perceived stress quintiles and risk of unemployment during 98 weeks of follow-up. Analyses were further performed in subgroups defined by education and income.

Results

In total, 224 people (10.4%) of the high stress group became unemployed during follow-up, which was higher than the lower stress groups. After adjusting for gender, age, education and income, the risk of unemployment was 1.64 (95% CI: 1.28;2.11) in the high stress group compared to the low stress group. After adjusting for gender and age, a similar trend was observed across different education levels and among the lower income groups, but no higher risk of unemployment due to perceived stress was found among the higher income groups. However, there was no statistically significant interaction between perceived stress and income level (p = 0.841) or perceived stress and education level (p = 0.587).

Conclusion

Perceived everyday life stress nearly doubled the risk of subsequent unemployment in a working population. No statistically significant interactions between SES and perceived stress were found. This indicates that stress prevention among the working population should not solely focus on stress in the workplace but also include stress from everyday life.

Electronic supplementary material

The online version of this article (10.1186/s12889-018-5618-z) contains supplementary material, which is available to authorized users.

Gender career divide and women's disadvantage in depressive symptoms and physical limitations in France

This study investigated the relationship between women's disadvantage in mental health and physical functioning and gender differences in career backgrounds. Sexual division of labor persists and key career characteristics are overrepresented in women: low-skilled first job, downward occupational trajectory, interruptions. These interrelated characteristics are usually linked to poor health. Their overrepresentation in women may be related to the female-male health gap; however, it may not if overrepresentation transposed into substantially weaker associations with poor health outcomes. To address this question, we used the French population survey "Health and Occupational Trajectories" (2006) and focused on 45-74 year-old individuals who ever worked (n=7537). Past career characteristics were qualified by retrospective information. Logistic regressions identified past characteristics related to current depressive symptoms and physical limitations. Non-linear decomposition showed whether these characteristics contributed to the gender health gap, through their different distribution and/or association with health. The overrepresentation of unskilled first jobs, current and past inactivity and unemployment in women contributed to their excess depressive symptoms. These contributions were only slightly reduced by the weaker mental health-relatedness of current inactivity in women and increased by the stronger relatedness of low-skilled and self-employed first jobs. Overrepresentation of current inactivity, past interruptions and downward trajectories also contributed positively to women's excess physical limitations. Gender-specific career backgrounds were significantly linked to women's disadvantage in mental health and physical functioning. We need to further explore whether equalization of opportunities, especially at the early stages and in terms of career continuity, could help to reduce women's mental and physical health disadvantage.

Employment Status and Mental Health: Mediating Roles of Social Support and Coping Strategies

Although it has been established that unemployment and underemployment increase distress and depression, the psychological mechanisms involved are not very clear. This study examines the roles of social support and coping strategies as mediators of the association between employment status and mental health, as well as gender and age differences as moderators. Residents from the epidemiological catchment area of south-west Montreal responded to a randomized household survey for adults in 2009. A follow-up was conducted based on participants' employment status 2 and 4 years later. ANOVAs tests were computed with SPSS to evaluate group differences, and structural equation modeling was performed with AMOS to test mediation effects. At baseline, among participants between 18 and 64 years old (n = 2325), 14.3 % were unemployed/not studying, 14.4 % worked part-time, and 56.5 % worked full-time. Employment status was found to significantly affect depression among those under 45 years old (chi-square = 23.4, p < 0.001). Results showed a negative association of full-time employment with depression, which was fully mediated by social support, less coping with drugs/medication, and less distress. A negative association with full-time employment was also noted with distress, which was partially mediated by increased social support, coping with alcohol, and less coping with drugs/medication. The total indirect effect suggests that full-time employees generally have more resources and do not tend to use avoidance strategies like coping with drugs/medication, resulting in less distress (β = -0.05; p < 0.01) and depression (β = -0.028; p < 0.01). Results suggest that optimal impact on mental health could be attained when increasing employment, namely full-time employment, in communities.

Tobacco cessation and household spending on non-tobacco goods: results from the US Consumer Expenditure Surveys

Objectives

To estimate the impact of tobacco cessation on household spending on non-tobacco goods in the USA.

Methods

Using 2006–2015 Consumer Expenditure Survey data, 9130 tobacco-consuming households were followed for four quarters. Households were categorised during the fourth quarter as having: (1) recent tobacco cessation, (2) long-term cessation, (3) relapsed cessation or (4) no cessation. Generalised linear models were used to compare fourth quarter expenditures on alcohol, food at home, food away from home, housing, healthcare, transportation, entertainment and other goods between the no-cessation households and those with recent, long-term or relapsed cessation. The full sample was analysed, and then analysed by income quartile.

Results

In the full sample, households with long-term and recent cessation had lower spending on alcohol, food, entertainment and transportation (p<0.001). Recent cessation was further associated with reduced spending on food at home (p<0.001), whereas relapsed cessation was associated with higher spending on healthcare and food away from home (p<0.001). In the highest income quartile, long-term and recent cessations were associated with reduced alcohol spending only (p<0.001), whereas in the lowest income quartile, long-term and recent cessations were associated with lower spending on alcohol, food at home, transportation and entertainment (p<0.001).

Conclusions

Households that quit tobacco spend less in areas that enable or complement their tobacco cessation, most of which may be motivated by financial strain. The most robust association between tobacco cessation and spending was the significantly lower spending on alcohol.

The Influence of Workers' Health Status on Employers' Decision-Making During Personnel Restructuring in a Typical Public Limited Enterprise in Slovenia

OBJECTIVES

Alongside individual indicators of job performance, even workers' health status could be a criterion for selection. The mechanisms for health selection are a reduction of productivity in relation to illness or certain health behaviour. The aim of the study was to establish how indicators of workers' health status, which are accessible to the employer, influence the employer's decision-making on which workers to retain and which to dismiss during personnel restructuring in the enterprise.

METHODS

Due to a planned closure of a plant, the observed company began personnel restructuring which included a strategic decrease in the number of employees and the relocation of workers within the company. Two nested case control studies were conducted. The cases were divided into two groups and defined as follows: employees who were relocated and employees whose employment contract was terminated.

RESULTS

The results show that the disability category and long-time sick leave exert the greatest influence on the employer's decision on the selection of workers. Workers with work-related disability have lower odds to be relocated to a new workplace (OR=0.5; 95% CI 0.2 to 1.1) and higher odds to be dismissed (OR=6.51; 95% CI 3.33 to 12.72). The workers with a history of a long-time sick leave also have lower odds to be relocated (OR=0.31; 95% CI 0.11 to 0.88) and higher odds to be dismissed (OR=4.32; 95% CI 2.08 to 8.96).

CONCLUSIONS

Indicators of health which were accessible to the employer actually exerted influence on the employer's decision-making, which could show a direct form of health selection.

Disentangling effects of socioeconomic status on obesity: A cross-sectional study of the Spanish adult population

This paper complements previous estimations regarding socioeconomic inequalities in obesity for Spanish adults, and provides new evidence about the mechanisms through which socioeconomic status (SES) affects obesity. Microdata from the Spanish National Health Survey (SNHS) 2011-2012 are analysed. Corrected concentration indices (CCI) are calculated to measure inequality. Path analysis is employed to disentangle direct and indirect effects of SES on obesity, where dietary patterns, physical activity and sleep habits act as mediator variables. Multivariate logistic models are used to select those exogenous variables to be included in the path diagram. Men and women are analysed separately. Our results show significant pro-rich inequality in the distribution of obesity (the poorer the more obese), particularly for women (CCI=-0.070 for men, CCI=-0.079 for women). The indirect effects of SES on obesity (those transmitted via mediator variables) are quite modest (3.3% for males, 2.4% for females) due to three reasons. Firstly, dietary habits do not show a significant mediating effect. Secondly, the mediating effect of physical activity in leisure time, although significant (14% for males, 11.1% for females), is offset by that related to main activity. Finally, sleep habits contribution to total effect of SES on obesity is statistically significant but small (roughly 1%). Our results indicate that promoting physical activity in leisure time for those with a low SES, particularly for men, would contribute to prevent obesity and to reduce health inequalities. Promotion of adequate sleep habits for women with a low SES might have a similar effect. However, interventions aimed to reduce sedentarism related to main activity, although useful to prevent obesity, would amplify the obesity socioeconomic gradient. Since effects of SES are different for men and women, socioeconomic health inequalities should be addressed also from a gender perspective.

Quantile treatment effects of job loss on health

Studies on health effects of job loss mostly estimate mean effects. We argue that the effects might differ over the distribution of the health status and use quantile regression methods to provide a more complete picture. To take the potential endogeneity of job loss into account, we estimate quantile treatment effects where we rely on job loss due to plant closures. We find that the effect of job loss indeed varies across the mental and physical health distribution. Job loss due to plant closures affects physical health adversely for individuals in the middle and lower part of the health distribution while those in best physical condition do not seem to be affected. The results for mental health, though less distinct, point in the same direction. We find no effects on BMI.

[Intergenerational social mobility and health in Brazil: analyzing the "Social Dimensions of Inequalilies Survey (PDSD)," 2008]

Although most studies consider health to be the result of social and economic insertion of the individuals, health may be considered a determining factor of the social opportunities achieved, especially with respect to chances of social mobility. The scope of this article is to understand the magnitude of the concurrent associations that sociodemographic, health and quality of life conditions (SF-36) exercise on chances of intergenerational social mobility on a probability sample of Brazilian homes in 2008. Social mobility was determined by the transition between occupational groups, which were defined using the Ganzeboom scale. Sociodemographic, health and quality of life features were associated with upward social mobility through logistic regression. A high level of schooling was the main determinant of chances of intergenerational social mobility. Women and youngsters ascended more intergenerationally. A positive association was observed between self assessment of health, physical health scores and upward mobility. Social mobility has become established as a multideterminate event. Physical health and perceived health were capable of influencing social transitions.

[Social inequalities in health less pronounced in women than in men: A question of measurements?]

Social inequalities in mortality are generally less pronounced for women than for men. Are women's health risks and behaviours more homogeneous, or does this pattern arise from a measurement issue inducing an under-estimation of these inequalities? This article reviews a number of studies covering different dimensions of health and different dimensions of social status. Their findings show that there are large social inequalities in health among women. The focus on the working careers, family histories and conciliation of multiple activities provides evidence of major social determinants of health to which women are widely exposed. This article highlights the need to broaden the notion of social inequality and to redefine the social categories, notably by considering the distinct trajectories of men and women and their different spheres of activity. It highlights that gender differences in health are themselves partly socially constructed, as suggested by the gender approaches in the social sciences.

Does obesity influence labour market outcomes among working-age adults? Evidence from Canadian longitudinal data

Although a negative association between obesity and labour market outcomes is commonly reported in many studies, the causal nature of this relationship remains unclear. Using nationally representative longitudinal data from the last six confidential master files (2000/2001-2010/2011) of the National Population Health Survey, we examine the association between obesity and employment participation and earnings among working-age adults in Canada. After controlling for demographic and socioeconomic characteristics, lifestyle factors and time-invariant individual heterogeneity, our results show that obesity is not significantly associated with employment participation but is associated with reduced hourly wage rate and annual income among women by about 4% and 4.5%, respectively. The corresponding results for men show that obesity is associated with about 2% reduction in wage rate and income, but significant at 10% level. However, after controlling for the potential reverse causality bias using the lagged measure of obesity, the effect of obesity on wage rate and income became positive or statistically non-significant. Our findings suggest that obesity is not causally associated with negative labour market outcomes among working-age men in Canada. For working-age women, we find limited evidence of negative labour market outcomes.

The emergence of health inequalities in early adulthood: evidence on timing and mechanisms from a West of Scotland cohort

Background

Evidence is inconsistent as to whether or not there are health inequalities in adolescence according to socio-economic position (SEP) and whether or when they emerge in early adulthood. Despite the large health inequalities literature, few studies have simultaneously compared the relative importance of ‘health selection’ versus ‘social causation’ at this life-stage. This study followed a cohort through the youth-adult transition to: (1) determine whether, and if so, when, health inequalities became evident according to both class of origin and current SEP; (2) compare the importance of health selection and social causation mechanisms; and (3) investigate whether these phenomena vary by gender.

Methods

Data are from a West-of-Scotland cohort, surveyed five times between age 15 (in 1987, N=1,515, response=85%) and 36. Self-reported physical and mental health were obtained at each survey. SEP was based on parental occupational class at 15, a combination of own education or occupational status at 18 and own occupational class (with an additional non-employment category) at older ages. In respect of when inequalities emerged, we used the relative index of inequality to examine associations between both parental and own current SEP and health at each age. In respect of mechanisms, path models, including SEP and health at each age, investigated both inter and intra-generational paths from SEP to health (‘causation’) and from health to SEP (‘selection’). Analyses were conducted separately for physical and mental health, and stratified by gender.

Results

Associations between both physical and mental health and parental SEP were non-significant at every age. Inequalities according to own SEP emerged for physical health at 24 and for mental health at 30. There was no evidence of selection based on physical health, but some evidence of associations between mental health in early adulthood and later SEP (intra-generational selection). Paths indicated intra-generational (males) and inter-generational (females) social causation of physical health inequalities, and intra-generational (males and females) and inter-generational (females) social causation of mental health inequalities.

Conclusions

The results suggest complex and reciprocal relationships between SEP and health and highlight adolescence and early adulthood as a sensitive period for this process, impacting on future life-chances and health.

Electronic supplementary material

The online version of this article (doi:10.1186/s12889-015-2674-5) contains supplementary material, which is available to authorized users.

Health and unemployment: 14 years of follow-up on job loss in the Norwegian HUNT Study

BACKGROUND

Many studies have investigated how unemployment influences health, less attention has been paid to the reverse causal direction; how health may influence the risk of becoming unemployed. We prospectively investigated a wide range of health measures and subsequent risk of unemployment during 14 years of follow-up.

METHODS

Self-reported health data from 36 249 participants in the Norwegian HUNT2 Study (1995-1997) was linked by a personal identification number to the National Insurance Database (1992-2008). Exact dates of unemployment were available. Cox's proportional hazard models were used to estimate hazard ratios (HR) for the association of unemployment with several health measures. Adjustment variables were age, gender, education, marital status, occupation, lifestyle and previous unemployment.

RESULTS

Compared to reporting no conditions/symptoms, having ≥3 chronic somatic conditions (HR 1.78, 95% CI 1.46-2.17) or high symptom levels of anxiety and depression (HR 1.57, 95% CI 1.35-1.83) increased the risk of subsequent unemployment substantially. Poor self-rated health (HR 1.36, 95% CI 1.24-1.51), insomnia (HR 1.19, 95% CI 1.09-1.32), gastrointestinal symptoms (HR 1.17, 95% CI 1.08-1.26), high alcohol consumption (HR 1.17, 95% CI 0.95-1.44) and problematic use of alcohol measured by the CAGE questionnaire (HR 1.32, 95% CI 1.17-1.48) were also associated with increased risk of unemployment.

CONCLUSION

People with poor mental and physical health are at increased risk of job loss. This contributes to poor health amongst the unemployed and highlights the need for policy focus on the health and welfare of out of work individuals, including support preparing them for re-employment.

Educational Inequalities in Exit from Paid Employment among Dutch Workers: The Influence of Health, Lifestyle and Work

Background

Individuals with lower socioeconomic status are at increased risk of involuntary exit from paid employment. To give sound advice for primary prevention in the workforce, insight is needed into the role of mediating factors between socioeconomic status and labour force participation. Therefore, it is aimed to investigate the influence of health status, lifestyle-related factors and work characteristics on educational differences in exit from paid employment.

Methods

14,708 Dutch employees participated in a ten-year follow-up study during 1999–2008. At baseline, education, self-perceived health, lifestyle (smoking, alcohol, sports, BMI) and psychosocial (demands, control, rewards) and physical work characteristics were measured by questionnaire. Employment status was ascertained monthly based on tax records. The relation between education, health, lifestyle, work-characteristics and exit from paid employment through disability benefits, unemployment, early retirement and economic inactivity was investigated by competing risks regression analyses. The mediating effects of these factors on educational differences in exit from paid employment were tested using a stepwise approach.

Results

Lower educated workers were more likely to exit paid employment through disability benefits (SHR:1.84), unemployment (SHR:1.74), and economic inactivity (SHR:1.53) but not due to early retirement (SHR:0.92). Poor or moderate health, an unhealthy lifestyle, and unfavourable work characteristics were associated with disability benefits and unemployment, and an unhealthy lifestyle with economic inactivity. Educational differences in disability benefits were explained for 40% by health, 31% by lifestyle, and 12% by work characteristics. For economic inactivity and unemployment, up to 14% and 21% of the educational differences could be explained, particularly by lifestyle-related factors.

Conclusions

There are educational differences in exit from paid employment, which are partly mediated by health, lifestyle and work characteristics, particularly for disability benefits. Health promotion and improving working conditions seem important measures to maintain a productive workforce, particularly among workers with a low education.

Losing jobs and lighting up: Employment experiences and smoking in the Great Recession

The Great Recession produced the highest rates of unemployment observed in decades, in part due to particularly high rates of people losing work involuntarily. The impact of these job losses on health is unknown, due to the length of time required for most disease development, concerns about reverse causation, and limited data that covers this time period. We examine associations between job loss, employment status and smoking, the leading preventable cause of death, among 13,571 individuals participating in the 2001-2011 waves of the U.S.-based Panel Study of Income Dynamics. Results indicate that recent involuntary job loss is associated with an average 1.1 percentage point increase in smoking probability. This risk is strongest when people have returned to work, and appears reversed when they leave the labor market altogether. Although some job loss is associated with changes in household income and psychological distress levels, we find no evidence that these changes explain smoking behavior modifications. Smoking prevention programs and policies targeted at displaced workers or the newly employed may alleviate some negative health effects produced by joblessness during the Great Recession.

Employment, smoking, and health: the role of the hygienist

The association between smoking and poverty is well established but the relationship between smoking and employment is less clear. Those in work are less likely to smoke, with recent data from Scotland suggesting the unemployed are nearly 2.5 times more likely to smoke than those in employment. This commentary looks at emerging evidence that work may have a positive role in reducing smoking prevalence. Occupational hygienists are uniquely placed to provide health-based information and risk communication that may help workers and those seeking employment to become smoke-free. The public health benefits of such intervention are likely to be substantial and are entirely in keeping with the health protection aims of the discipline of Occupational Hygiene.

Take it or leave: a five-year prospective study of workplace bullying and indicators of expulsion in working life

Workplace bullying is often held as a precursor of expulsion in working life, but the　claim builds on sparse empirical groundwork. In the present study, bullying is investigated as an antecedent to indicators of expulsion, be it from the workplace (change of employer) or from working life itself (disability benefit recipiency and unemployment), using a nationally representative sample (n=1,613), a five-year time-lag as well as two separate measures of workplace bullying. In line with the hypotheses, logistic regression analyses revealed that both exposure to bullying behaviors and self-labeled bullying are significantly associated with change of employer (OR=1.77 and 2.42, respectively) and disability benefit recipiency (OR=2.81 and 2.95, respectively). Moreover, exposure to bullying behaviors was found to be significantly related to unemployment five years on (OR=4.6). For the self-labeling measure of bullying, this tendency only held true at the 0.1 significance level (OR=3.69, p=0.098). Together, the present results indicate that targets of bullying are at a greater risk of expulsion, both from the workplace and from working life itself, thus representing strong incentives to combat bullying both from the perspective of the individual, the organization and society at large.

Unemployment is associated with high cardiovascular event rate and increased all-cause mortality in middle-aged socially privileged individuals

PURPOSE

To assess prospectively the association between employment status and cardiovascular health outcomes in socially privileged individuals.

METHODS

The incidence of fatal and non-fatal cardiovascular events and all-cause mortality rate were monitored during 12 years in a national sample of 5,852 French volunteers, aged 45-64 years, who were free of cardiovascular disease or other overt disease at baseline. The association between health outcomes and employment status was tested using Cox proportional modelling with adjustment for confounding factors.

RESULTS

Compared to randomly selected individuals, these volunteers were characterized by higher education level and socio-economic status and lower cardiovascular risk and mortality rate. A total of 242 cardiovascular events (3.5 events per 1,000 person-years) and 152 deaths from all causes (2.2 deaths per 1,000 person-years) occurred during follow-up. After adjustment for age and gender, both cardiovascular event risk [HR (95% CI) 1.84 (1.15-2.83), p = 0.01] and all-cause mortality [2.79 (1.66-4.47), p = 0.0002] were increased in unemployed individuals compared to workers. These poor health outcomes were observed to the same extent after further adjustment for clinical, behavioural and socio-demographic characteristics of individuals at baseline [HR (95% CI) 1.74 (1.07-2.72), p = 0.03 and 2.89 (1.70-4.69), p = 0.0002, respectively]. In contrast, neither cardiovascular event risk nor all-cause mortality was significantly increased in retired individuals compared to workers after adjustment for confounding factors.

CONCLUSIONS

These results support the existence of a link between unemployment and poor cardiovascular health and suggest that this link is not mediated by conventional risk factors in middle-aged socially privileged individuals.

Do employment protection policies reduce the relative disadvantage in the labour market experienced by unhealthy people? A natural experiment created by the Great Recession in Europe

Unhealthy persons are more likely to lose their jobs than those who are healthy but whether this is affected by recession is unclear. We asked how healthy and unhealthy persons fared in labour markets during Europe's 2008-2010 recessions and whether national differences in employment protection helped mitigate any relative disadvantage experienced by those in poor health. Two retrospective cohorts of persons employed at baseline were constructed from the European Statistics of Income and Living Conditions in 26 EU countries. The first comprised individuals followed between 2006 and 2008, n = 46,085 (pre-recession) and the second between 2008 and 2010, n = 85,786 (during recession). We used multi-level (individual- and country-fixed effects) logistic regression models to assess the relationship (overall and disaggregated by gender) between recessions, unemployment, and health status, as well as any modifying effect of OECD employment protection indices measuring the strength of policies against dismissal and redundancy. Those with chronic illnesses and health limitations were disproportionately affected by the recession, respectively with a 1.5- and 2.5-fold greater risk of unemployment than healthy people during 2008-2010. During severe recessions (>7% fall in GDP), employment protections did not mitigate the risk of job loss (OR = 1.06, 95% CI: 0.94-1.21). However, in countries experiencing milder recessions (<7% fall in GDP), each additional unit of employment protection reduced job loss risk (OR = 0.72, 95% CI: 0.58-0.90). Before the recession, women with severe health limitations especially benefited, with additional reductions of 22% for each unit of employment protection (AORfemale = 0.78, 95% CI: 0.62-0.97), such that at high levels the difference in the risk of job loss between healthy and unhealthy women disappeared. Employment protection policies may counteract labour market inequalities between healthy and unhealthy people, but additional programmes are likely needed to protect vulnerable groups during severe recessions.

Employment status and perceived health condition: longitudinal data from Italy

Background

The considerable increase of non-standard labor contracts, unemployment and inactivity rates raises the question of whether job insecurity and the lack of job opportunities affect physical and mental well-being differently from being employed with an open-ended contract. In this paper we offer evidence on the relationship between self-reported health and the employment status in Italy using the Survey on Household Income and Wealth (SHIW); another aim is to investigate whether these potential inequalities have changed with the recent economic downturn (time period 2006-2010).

Methods

We estimate an ordered logit model with self-reported health status (SRHS) as response variable based on a fixed-effects approach which has certain advantages with respect to the random-effects formulation: the fixed-effects nature of the model also allows us to solve the problems of incidental parameters and non-random selection of individuals into different labor market categories.

Results

We find that temporary workers, first-job seekers and unemployed individuals are worse off than permanent employees, especially males, young workers, and those living in the center and south of Italy.

Conclusion

Health inequalities between permanent workers and job seekers widen over time for male and young workers, and arise in the north of the country as well.

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

INTRODUCTION

This longitudinal study examined the association between trajectories of cigarette smoking and unemployment across a 29-year time period from mean age 14 to mean age 43.

METHODS

Participants came from a community-based random sample of residents in 2 upstate New York counties. Data were collected at 7 timepoints.

RESULTS

Using growth mixture modeling, 5 trajectory groups of cigarette smokers were identified. The trajectory groups were as follows: heavy/continuous smokers, occasional smokers, late-starting smokers, quitters/decreasers, and nonsmokers. Multivariate logistic regression analysis was used to study the relationship between the participant's trajectory group membership and unemployment in the fifth decade of life. The association was determined with controls for age, gender, current cigarette use, current alcohol use, current marijuana use, physical diseases, occupation, educational level, past unemployment experience, socioeconomic status measures of family of origin, depressive mood, and self-control from adolescence through the early 40s. The findings indicate that patterns of adolescent and young adult cigarette smoking have implications for later unemployment. Overall, the results showed that people who fell into the categories of heavy/continuous smokers (adjusted odds ratio [AOR] = 3.84) and occasional smokers (AOR = 4.03) were more likely to be unemployed at mean age 43 when compared with nonsmokers. There was no significant difference between the quitters/decreasers and the nonsmokers with respect to unemployment.

CONCLUSIONS

Intervention programs designed to deal with unemployment should consider focusing on heavy/continuous and occasional cigarette smokers as risk factors for unemployment.

Effect of unemployment on cardiovascular risk factors and mental health

BACKGROUND

Following the economic changes in Poland, increasing health discrepancies were observed during a period of 20 years, which may be partly attributable to the consequences of unemployment.

AIMS

To assess the association between unemployment, major cardiovascular risk factors and mental health.

METHODS

A cross-sectional study in which data were collected between 2009 and 2010 during preventive health examinations by an occupational medicine service in Gdansk, Poland. Data on blood pressure, resting heart rate, information about smoking habits, body mass index and history of use of mental health services were collected during these assessments. Multiple logistic regression was used during data analysis to adjust for age, gender, education and length of employment.

RESULTS

Study participants comprised 3052 unemployed and 2059 employed individuals. After adjustment for age, gender, education and number of previous employments, the odds ratio (OR) for hypertension in relation to unemployment was 1.02 [95% confidence interval (95% CI) 0.84-1.23]. There was a statistically significant negative association between being overweight and unemployment (OR = 0.81, 95% CI: 0.66-0.99). Smoking was positively associated with unemployment after adjustment for age and sex (OR = 1.45, 95% CI: 1.25-1.67). There was a positive relationship between mental ill-health and unemployment among study participants (OR = 2.05, 95% CI: 0.91-4.65), but this was not statistically significant.

CONCLUSIONS

The patterns of major cardiovascular risk factors differed between unemployed and employed individuals in Poland. Our observations suggest employment status is a predictor of specific disease risk profiles; consequently, specific preventive measures are needed in unemployed individuals.