Smoking, drinking and body weight after re-employment: does unemployment experience and compensation make a difference?

Changes in Smoking Status and Behaviors After the First 10 Months of COVID-19 Pandemic in Indonesia

INTRODUCTION

There remains inconclusive evidence on potential changes in smoking status and behaviors during the coronavirus disease 2019 (COVID-9) pandemic, especially in developing countries.

AIMS AND METHODS

This study explores the direction of changes in smoking status and behaviors after 10 months of the COVID-19 pandemic in Indonesia as well as examining the association between economic shocks and changes in smoking behaviors. Primary data were gathered through a phone survey targeting productive-age mobile-phone users in Indonesia (n = 1082). Descriptive analysis was employed to determine changes in smoking status and behaviors 10 months into the pandemic, while logistic regression analysis was used to investigate how employment shocks, financial strain, COVID-19-related indicators, and demographic characteristics were associated with smoking behaviors of people who continue smoking.

RESULTS

Respondents experiencing changes in smoking status were dominated by people who persistently smoked during the pandemic, while those who quit, relapsed, and started smoking, was extremely small. Nevertheless, a considerable portion of people who continue smoking adjusted their smoking behaviors: 40.3% reduced smoking intensity and 25.3% switched to lower-price cigarettes. Multivariable regression analysis revealed that, among people who continue smoking, those who experienced financial strain during the pandemic had higher odds of reducing smoking intensity, while those who switched to lower job status had higher odds of switching to cheaper cigarettes.

CONCLUSIONS

The research has shown that smoking status and behaviors of people who continue smoking mostly remained unchanged after 10 months of the COVID-19 pandemic. Changes in employment and financial conditions during the pandemic were associated with modified smoking behaviors.

IMPLICATIONS

This study is the first to determine the direction and analyze the factors of changes in smoking during the COVID-19 pandemic in Indonesia. This new understanding should help improve predicting the trends in smoking in future crises or pandemics in developing countries, specifically Indonesia. The discovered patterns on smokers' reaction to an exogenous shock may provide evidence to support tobacco control policies in Indonesia.

A systematic review of evidence on employment transitions and weight change by gender in ageing populations

Background

Becoming unemployed is associated with poorer health, including weight gain. Middle- and older-age adults are a growing segment of workforces globally, but they are also more vulnerable to changes to employment status, especially during economic shocks. Expected workforce exits over the next decade may exacerbate both the obesity epidemic and the economic burden of obesity. This review extends current knowledge on economic correlates of health to assess whether employment transitions impact body weight by sex/gender among middle-aged and older adults.

Methods

Eight bibliometric databases were searched between June and July 2021, supplemented by hand-searches, with no restriction on publication date or country. Longitudinal studies, or reviews, were eligible when examining body weight as a function of employment status change in adults ≥50 years. Data extraction and quality appraisal used predefined criteria; reported findings were analysed by narrative synthesis.

Results

We screened 6,001 unique abstracts and identified 12 articles that met inclusion criteria. All studies examined retirement; of which two also examined job-loss. Overall, studies showed that retirement led to weight gain or no difference in weight change compared to non-retirees; however, reported effects were not consistent for either women or men across studies or for both women and men within a study. Reported effects also differed by occupation: weight gain was more commonly observed among retirees from physical occupations but not among retirees from sedentary occupations. Few studies assessed the role of health behaviours; sleep was the least studied. Most studies were medium quality.

Conclusions

Existing studies do not provide a clear enough picture of how employment transitions affect body weight. Firm conclusions on the impact of employment transitions on weight cannot be made without further high-quality evidence that considers the role of gender, job-type, other health behaviours, and other transitions, like job-loss.

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

Unemployment is an economic and social phenomenon that has economic, social, personal, and health consequences. This study aimed to investigate the relationship between unemployment and alcohol use and smoking as a systematic review and meta-analysis.

The two databases PubMed and Scopus were selected for the search and using a set of keywords, these two sources of scientific information were searched from 2004 to June 2021 and 1996 until June 2021, respectively. To meta-analyze the relationship between unemployment and smoking and alcohol use, odds ratio and confidence interval were calculated for this relationship. The meta-analysis was performed based on a random-effects. Subgroups were also performed for men and women. Heterogeneity in studies as well as publication bias were also examined.

A total of 52 cross-sectional and cohort studies were included in the meta-analysis. In the relationship between unemployment and alcohol use, the odds ratio was 1.25 and the confidence interval was between 1.12 and 1.41. In the relationship between unemployment and smoking, the odds ratio was 1.43 and the confidence interval was between 1.13 and 1.81.

According to the results, it can be said that unemployment increases the likelihood of alcohol use and smoking. Therefore, policymakers must pay more attention to the health consequences of economic problems, especially unemployment.

Unemployment and mortality in a large Italian cohort

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Connections between unemployment insurance, poverty and health: a systematic review

Background

Since the global economic crisis in 2007, unemployment rates have escalated in most European and North American countries. Unemployment protection policies, particularly the unemployment insurance (UI) system, have become a weighty issue for many modern welfare states. Decades of research have established concrete findings on the adverse impacts of unemployment on poverty- and health-related outcomes. This provided a foundation for further exploration into the potential protective effects of UI in offsetting these adverse outcomes.

Methods

We developed a systematic review protocol in four stages (literature search, study selection, data extraction and quality appraisal) to ensure a rigorous data collection and inter-rated reliability. We examined the full body of empirical research published between 2000 and 2013 on the pathways by which UI impacts poverty and health.

Results

Out of 2233 primary studies identified, a total of 12 met our inclusion criteria. The selected studies assessed poverty-related outcomes (absolute/relative poverty and material hardship) or one or more health-related outcomes (health behaviors, self-rated health, well-being and mental health). Across various UI systems, jurisdictions from high income countries, and study designs, we found good support for our conceptual framework, by which UI attenuates the effect of unemployment on both poverty and health, with a few exceptions.

Conclusion

Whether UI impacts differ by age and region might be explored further in future research. The complex mediating relationship between unemployment, UI, poverty and health should further be assessed in light of economic and historical contexts. This could inform decision-making processes during future periods of economic recession.

Unemployment insurance and cigarette smoking

We provide evidence for the causal relationship between unemployment insurance (UI) and individuals' smoking behavior using the 1995-2011 Current Population Survey-Tobacco Use Supplement data. Our identification relies on the exploitation of the exogenous variations of the maximum UI weekly benefits across states and over years. Instead of focusing on all unemployed people, we concentrate on those who are eligible for UI benefits. We find that when the maximum UI weekly benefit level increases by $100, smoking cessation increases by approximately 2.9 percentage points among the UI-eligible unemployed. The results are robust to various model specifications. We also explore the mechanism and find suggestive evidence that the increase in the maximum UI weekly benefit leads to a decrease in the probability of over-work of the respective spouse. Moreover, the unemployed who are less educated are more responsive to the increasing UI benefits.

Association between dimensions of the psychosocial and physical work environment and latent smoking trajectories: a 16-year cohort study of the Canadian workforce

BACKGROUND

This study aimed to determine the number of latent smoking trajectories among Canadians employed in the workforce over a 16-year period, and if latent trajectories in dimensions of the physical and psychosocial work environment were associated with specific smoking trajectories.

METHODS

We studied 5461 employed adults from the longitudinal Canadian National Population Health Survey. Daily cigarette consumption was measured biannually from 1994 to 2010. Work environment factors (skill discretion, decision authority, psychological demands, job insecurity, physical exertion and workplace social support) were measured in 1994 and then from 2000 to 2010 using an abbreviated form of the Job Content Questionnaire. Smoking and work environment trajectories were derived using group-based trajectory modelling. Associations between work environment trajectory classes and smoking trajectory classes were estimated using multinomial logistic regression.

RESULTS

Four latent smoking trajectories were seen: non-smokers; ceasing smokers (consuming ~14 cigarettes/day in 1994 and 0 in 2008-2010); smokers (consuming ~7 cigarettes/day between 1994 and 2010); and heavy smokers (consuming ~22 cigarettes/day in 1994 and ~14 in 2010). Lower skill discretion, high psychological demands, high physical exertion and low social support trajectories were associated with membership in the heavy smoking trajectory compared with the non-smoking trajectory. Low decision authority, high psychological demands and high physical exertion trajectories were associated with membership in the ceasing compared with the non-smoking trajectory.

CONCLUSIONS

Certain physical and psychosocial work environment trajectories were associated with heavy and ceasing smoking behaviours over a 16-year period. The role of the work environment should be further considered in smoking cessation programmes.

Do brief alcohol interventions among unemployed at-risk drinkers increase re-employment after 15 month?

Background

At-risk alcohol use is associated bi-directionally to unemployment, and decreases chances of re-employment. Brief alcohol interventions (BAI) can reduce at-risk alcohol use. This study aimed to investigate 15-month effects of BAI on unemployment among persons with at-risk alcohol use.

Methods

As part of the randomized controlled 'Trial on proactive alcohol interventions among job-seekers, TOPAS', 1243 18- to 64-year-old job-seekers with at-risk alcohol use were systematically recruited at three job agencies in Germany (2008/09), and randomized to (i) a stage tailored intervention based on the trans-theoretical model of intentional behavior change (ST), (ii) a non-stage tailored intervention based on the theory of planned behavior (NST) and (iii) assessment only (AO). To test the effects of ST and NST on employment status 15 months after baseline, latent growth models were calculated among those initially unemployed (n = 586).

Results

In all three groups, unemployment significantly decreased over 15 months (ST: odds ratio, OR = 0.06; 95% confidence interval, CI: 0.01-0.27; NST: OR = 0.04; 95% CI: 0.01-0.18; AO: OR = 0.05; 95% CI: 0.01-0.21). No intervention effects were found on unemployment. Age (P = 0.002), school education (P = 0.001), self-rated health (P = 0.04), the Alcohol Use Disorder Identification Test-Consumption score (P = 0.02) and motivation to change (P = 0.04) significantly affected the development of unemployment over time.

Conclusion

After 15 months, no BAI effect on unemployment was found. The mediated effect of BAIs on unemployment could be a longsome process needing longer follow-ups to be detected.

The impact of the 2008 recession on the health of older workers: data from 13 European countries

Background

Fluctuations in the national economy shape labour market opportunities and outcomes, which in turn influence the health conditions of older workers. This study examined whether overall economic shifts during the 2008 recession was associated with four health indicators among older workers.

Method

Data came from 4917 respondents (16 090 contacts) aged 50-70 in 13 European countries (Austria, Belgium, Czech Republic, Denmark, France, Germany, Israel, Italy, Netherlands, Poland, Spain, Sweden, Switzerland) participating in the Survey of Health, Ageing and Retirement in Europe. Health and employment assessments from 2004-13 were linked to annual data on fluctuations in Gross Domestic Product (GDP) per capita, life expectancy and unemployment rates for each country. Using fixed effects models, we assessed the recession's implications on four individual health outcomes: body mass index (BMI), drinking alcohol, depression and general health, while isolating cyclical variation within countries and individual changes over time.

Results

Overall economic shifts had an effect on older workers: decreases in GDP were associated with a decline in average BMI, consumption of alcohol and deterioration in self-rated health; country-level unemployment rate had no effect on health outcomes, while life expectancy at birth was significant but not consistently across models. Being employed or retired were associated with fewer depressive symptoms and better self-rated health.

Conclusions

Overall economic shifts during recessions affect certain health outcomes of older workers, and better health conditions together with being employed or retired may limit the negative health consequences of a recession.

Harmful drinking after job loss: a stronger association during the post-2008 economic crisis?

OBJECTIVES

This study investigated, among the Dutch working population, whether job loss during the post-2008 economic crisis is associated with harmful drinking and whether this association is stronger than before the crisis.

METHODS

Repeated cross-sectional data from the Dutch Health Interview Survey 2004-2013 were used to define episodic drinking (≥6 glasses on 1 day ≥1/week) and chronic drinking (≥14 glasses/week for women and ≥21 for men). These data were linked to longitudinal data from tax registries, to measure the experience and duration of job loss during a 5-year working history.

RESULTS

Before the crisis, job loss experience and duration were not associated with harmful drinking. During the crisis, job loss for more than 6 months was associated with episodic drinking [OR 1.40 (95% CI 1.01; 1.94)], while current job loss was associated with chronic drinking [OR 1.43 (95% CI 1.03; 1.98)]. These associations were most clear in men and different between the pre-crisis and crisis period (p interaction = 0.023 and 0.035, respectively).

CONCLUSIONS

The results suggest that economic crises strengthen the potential impact of job loss on harmful drinking, predominately among men.

Effects of Occupational Health and Safety on Healthy Lifestyle Behaviors of Workers Employed in a Private Company in Turkey

BACKGROUND

It has been suggested that inappropriate working conditions and unsafe environments at construction sites, longer working hours, and inadequate workplaces adversely affect the health behaviors of workers.

OBJECTIVE

The aim of this study was to evaluate the effect of occupational health and safety (OHS) practices on healthy lifestyle behaviors of workers employed at a construction site of a private company in Gaziantep, Turkey.

METHODS

The sampling size of this descriptive study consisted of 400 employees working at the construction site between December 2014 and January 2015. In all, 341 employees still working or participating in the study during the period of this questionnaire study were included in the sampling. Data from the survey were derived from responses to questions regarding sociodemographic characteristics, OHS applications, health state, and working conditions, as well as to the questions in on the Healthy Lifestyle Behaviors Scale (HLBS), under direct surveillance.

FINDINGS

Male workers with a mean age of 30.61 ± 8.68 years constituted the study population. Of the workers, 41.9% had a primary school education. The majority received professional and OHS training (65.7% and 79.2%, respectively). Although 83.9% reported using personal protective equipment (PPE), only 2.1% said they had experienced an occupational accident. Total mean score of HLBS scale was 116.91 ± 25.62 points. Workers who had positive thoughts about their jobs demonstrated healthy lifestyle behaviors (P = .0001). A positive direct correlation was detected between the training the workers received and the use of PPE (P = .0001). In all, 38.1% of the workers reported experiencing work stress at the time of the study. Mean HLBS scores of those experiencing work stress were lower than the scores for workers not experiencing stress (P < .05).

CONCLUSION

Receiving OHS and professional training and using of PPE favorably affect healthy lifestyle behaviors.

Age and gender differential relationship between employment status and body mass index among middle-aged and elderly adults: a cross-sectional study

OBJECTIVE

To determine the influence of age and gender, respectively, on the association between employment status and body mass index (BMI) in Korean adults using a large, nationally representative sample.

DESIGN

Cross-sectional study.

SETTING

South Korea.

PARTICIPANTS

7228 from fourth wave of the Korean Longitudinal Study of Aging (KLoSA), the survey's short form and year: 'KLoSA 2012'.

MAIN OUTCOME MEASURES

BMI.

RESULTS

BMI among the employed was higher than among the unemployed for those under 60. In terms of gender, employed men reported higher BMI than their unemployed counterparts, whereas employed women reported lower BMI than did unemployed women.

CONCLUSIONS

Employment status showed varying impacts on obesity by age and gender. Both unemployment at or after 60, as well as unemployment among women, is associated with increased BMI compared with unemployment among younger individuals or men, respectively.

Job-loss and weight gain in British adults: Evidence from two longitudinal studies

Overweight and obesity have been associated with unemployment but less is known about changes in weight associated with changes in employment. We examined weight changes associated with job-loss, retirement and maintaining employment in two samples of working adults in the United Kingdom. This was a prospective study of 7201 adults in the European Prospective Investigation of Cancer (EPIC)-Norfolk study (aged 39–76 years) and 4539 adults in the British Household Panel Survey (BHPS) who were followed up over 43 months and 26 months, respectively. In both samples, changes in measured (EPIC) and self-reported (BHPS) weight were computed for each participant and assessed in relation to three employment transitions: maintaining paid employment, retirement and job-loss. Regression models adjusted for potential confounders. Further analyses evaluated the contribution of diet, physical activity and smoking to weight gain. In EPIC-Norfolk, weight change differed across the three employment transitions for women but not men. The mean (95% CI) annualised change in weight for women who became unemployed over the follow-up period was 0.70 (0.55, 0.85) kg/y while those who maintained employment gained 0.49 (0.43, 0.55) kg/y (P = 0.007). Accounting for changes in smoking, diet and physical activity did not substantially alter the difference in weight gain among groups. In BHPS, job-loss was associated with weight gain of 1.56 (0.89, 2.23) kg/y, while those who maintained employment 0.60 (0.53, 0.68) kg/y (P < 0.001). In both samples, weight changes associated with retirement were similar to those staying in work. In BHPS, job-loss was also associated with significant declines in self-reported well-being and increases in sleep-loss.

Two UK-based samples of working adults reveal strong associations between job-loss and excess weight gain. The mediating behaviours are so far unclear but psychosocial mechanisms and sleep-loss may contribute to the excess weight gain among individuals who become unemployed.

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Job-loss is associated with a more weight gain in working UK adults.

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The association between job-loss and weight may be stronger for women.

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Changes in smoking, diet and physical activity did not explain weight gain.

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Job-loss is associated with loss of sleep due to worry.

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Behavioural and psychosocial impacts of job-loss need further elucidation.

The impacts of health insurance coverage on access to healthcare in children entering kindergarten

To examine access to healthcare and health outcomes for kindergartners as they relate to insurance status and type. For the 2008, 2009, and 2010 school years, surveys were distributed to parents with a child entering kindergarten in the state of Nevada. Surveys asked parents to provide information about their child concerning their insurance status, routine medical care, medical conditions, and health behaviors. Compared to their insured peers, uninsured kindergartners were less likely to have had a check-up in the previous 12 months (p < .001; OR 6.14; 95 % CI 5.77-6.53), have a primary physician (p < .001; OR 14.32; 95 % CI 13.49-15.20), or have seen a dentist (p < .001; OR 3.93; 95 % CI 3.70-4.16), and were more likely to have a reported unmet medical need (p < .001; OR 2.60; 95 % CI 2.19-3.07). Additionally, compared to children with private insurance, those children with public insurance were less likely to have had a check-up (p < .001; OR 1.73; 95 % CI 1.59-1.89), have a primary care provider (p < .001; OR 3.87; 95 % CI 3.55-4.21), and were more likely to have unmet medical needs (p < .001; OR 2.27; 95 % CI 1.83-2.81). For children in early development-a deeply critical period-insurance status and type are predictors of important access to healthcare variables.

Elevated inflammatory biomarkers during unemployment: modification by age and country in the UK

BACKGROUND

There is raised risk of mortality following unemployment, and reviews have consistently found worse psychological health among the unemployed. Inflammation is increasingly implicated as a mediating factor relating stress to physical disease and is strongly linked to depression. Inflammation may, therefore, be implicated in processes associated with excess mortality and morbidity during unemployment. This study examined associations of unemployment with inflammatory markers among working-age men and women from England and Scotland.

METHODS

Cross-sectional analyses using data from the Health Survey for England and the Scottish Health Survey collected between 1998 and 2010. Systemic inflammation was indexed by serum concentrations of C reactive protein (CRP) and fibrinogen, and compared between participants currently employed/self-employed, currently unemployed and other groups.

RESULTS

CRP, fibrinogen and odds of CRP >3 mg/L were all significantly raised for the unemployed, as compared to the employed participants (eg, OR for CRP >3 mg/L=1.43, CI 1.15 to 1.78 N=23 025), following adjustment for age, gender, occupational social class, housing tenure, smoking, alcohol consumption, body mass index, long-term illness and depressive/anxiety symptoms. Strengths of associations varied considerably by both age and country/region, with effects mainly driven by participants aged ≥48 and participants from Scotland, which had comparatively high unemployment during this time.

CONCLUSIONS

Current unemployment is associated with elevated inflammatory markers using data from two large-scale, nationally representative UK studies. Effect modification by age suggests inflammation may be particularly involved in processes leading to ill-health among the older unemployed. Country/regional effects may suggest the relationship of unemployment with inflammation is strongly influenced by contextual factors, and/or reflect life course accumulation processes.

Association between voluntary/involuntary job loss and the development of stroke or cardiovascular disease: a prospective study of middle-aged to older workers in a rapidly developing Asian country

Background

The aim of this research was to investigate the association between job loss and the development of stroke or cardiovascular disease among middle-aged to older individuals in Korea. We also examined how this relationship was modified by gender and the nature of the job loss.

Methods

This study used samples from the first- to fourth-wave datasets from the Korean Longitudinal Study of Aging (KLoSA), which were collected in 2006, 2008, 2010, and 2012. The study collected data from a total of 10,254 subjects aged ≥45 years at baseline. After applying exclusion criteria, the final sample size for analysis consisted of 4,000 individuals. Information about employment status, development of stroke or cardiovascular disease, and covariates (age, income level, and behavioral factors) was obtained. Cox proportional hazards models were used to evaluate the association between voluntary/involuntary job loss and the development of stroke or cardiovascular disease. We performed these analyses separately according to disease, gender, and the nature of the job loss.

Results

Involuntary job loss significantly increased the risk of stroke or cardiovascular disease among males (adjusted hazard ratio [HR] = 3.560, 95% confidence interval [CI] = 2.055–6.168). Voluntary retirement also increased the risk of cardiovascular disease or stroke among males (adjusted HR = 2.879, 95% CI = 1.533–5.409). Job loss was more closely associated with stroke than with cardiovascular disease (stroke, adjusted HR = 6.208, 95% CI = 2.417–15.943; cardiovascular disease, adjusted HR = 2.768, 95% CI = 1.402–5.465).

Conclusion

Our findings suggest that both voluntary retirement and involuntary job loss increase the risk for stroke or cardiovascular disease in middle-aged to older individuals, especially males.

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.

Clinically significant weight gain 1 year after occupational back injury

OBJECTIVE

To examine the incidence of clinically significant weight gain 1 year after occupational back injury, and risk factors for that gain.

METHODS

A cohort of Washington State workers with wage-replacement benefits for back injuries completed baseline and 1-year follow-up telephone interviews. We obtained additional measures from claims and medical records.

RESULTS

Among 1263 workers, 174 (13.8%) reported clinically significant weight gain (≥7%) 1 year after occupational back injury. Women and workers who had more than 180 days on wage replacement at 1 year were twice as likely (adjusted odds ratio = 2.17, 95% confidence interval = 1.54 to 3.07; adjusted odds ratio = 2.40, 95% confidence interval = 1.63 to 3.53, respectively; both P < 0.001) to have clinically significant weight gain.

CONCLUSIONS

Women and workers on wage replacement for more than 180 days may be susceptible to clinically significant weight gain after occupational back injury.

No causal effect of unemployment on smoking? A German panel study

OBJECTIVES

This study analyses the effects of different unemployment durations on smoking behaviour in Germany by investigating smoking take-up, relapse, quitting and smoking intensity.

METHODS

Longitudinal data from the German Socio-Economic Panel from the years 1998, 2001, 2002, 2004, 2006, and 2008 were used to examine the effect of unemployment (52,940 observations from 17,028 respondents, aged 17-65 years). Unemployment duration was measured at 1-6, 7-12, 13-24, and 24+ months. Effects were estimated using zero-inflated negative binomial regressions and fixed effects logistic panel regressions.

RESULTS

The zero-inflated negative binomial regression models suggest that the likelihood of smoking increases with unemployment, while smoking intensity is not affected. However, fixed effects logistic regression models demonstrate that unemployment is neither a significant predictor for taking up smoking, relapsing, nor quitting.

CONCLUSIONS

The results indicate that in Germany, there is no direct causal effect of unemployment on smoking behaviour. The observed relationship between smoking and unemployment appears to be driven by stable, unobserved differences between employed and unemployed respondents.

Unemployment and hospitalization owing to an alcohol-related diagnosis among middle-aged men in Sweden

BACKGROUND

Unemployment is associated with alcohol-related morbidity. However, the extent to which the association is causal is unclear, and it is not known whether other risk factors remain uncontrolled for. This study examines the association between unemployment and later alcohol-related hospitalization, adjusted for preexisting alcohol disorders, psychiatric diagnoses, behavioral risk factors, and social factors.

METHODS

The study was based on a military conscription cohort (men born in 1949 to 1951), with information on psychiatric diagnosis and psychological assessment and from a drug-use survey, which was then linked to national registers. The analyses were performed on data on the 37,798 individuals who were in paid employment in 1990 to 1991.

RESULTS

It was found that short- and long-term unemployment (1 to 89 days and ≥90 days) were associated with hospitalization owing to an alcohol-related diagnosis at 12-year follow-up (HR(crude) = 2.25, 95% CI 1.64 to 3.09 and HR(crude) = 2.95, 95% CI 2.51 to 3.48, respectively). After adjustment for confounders, the hazard ratios (HRs) decreased but were still significantly elevated (HR(adjusted) = 1.52, 95% CI 1.10 to 2.10 and HR(adjusted) = 1.61, 95% CI 1.36 to 1.92, respectively). When follow-up was split into 3 time bands, it was found that the short- and medium-term associations were about the same and independent of unemployment duration, with adjusted HRs ranging between 1.70 and 1.76. No significant long-term associations were found after adjustment.

CONCLUSIONS

Unemployment was related to becoming hospitalized owing to an alcohol-related diagnosis. A substantial part of the elevated relative risk of alcohol-related hospitalization related to unemployment was found to be associated with already existing individual risk factors.

Losing life and livelihood: a systematic review and meta-analysis of unemployment and all-cause mortality

Unemployment rates in the United States remain near a 25-year high and global unemployment is rising. Previous studies have shown that unemployed persons have an increased risk of death, but the magnitude of the risk and moderating factors have not been explored. The study is a random effects meta-analysis and meta-regression designed to assess the association between unemployment and all-cause mortality among working-age persons. We extracted 235 mortality risk estimates from 42 studies, providing data on more than 20 million persons. The mean hazard ratio (HR) for mortality was 1.63 among HRs adjusted for age and additional covariates. The mean effect was higher for men than for women. Unemployment was associated with an increased mortality risk for those in their early and middle careers, but less for those in their late career. The risk of death was highest during the first 10 years of follow-up, but decreased subsequently. The mean HR was 24% lower among the subset of studies controlling for health-related behaviors. Public health initiatives could target unemployed persons for more aggressive cardiovascular screening and interventions aimed at reducing risk-taking behaviors.

Patterns of smoking and its association with psychosocial work conditions among blue-collar and service employees of hospitality venues in Shenyang, PR China

Background

To characterize the smoking patterns of hospitality employees in blue-collar and service occupations, and to examine its relations with psychosocial work conditions.

Methods

The Shenyang Hospitality Industry Employees Survey-a face-to-face cross-sectional study of representative hospitality industry employees-was conducted between March and July 2008. A total of 4,213 workers were selected using stratified random cluster sampling designs, and final analyses were performed on 2,508 blue-collar and service subjects. Multilevel-logistic regression models were used to estimate the contribution of psychosocial work conditions to smoking status.

Results

Blue-collar and service employees smoked at a rate 1.4 times that of the general population (49.4% vs. 35.8%), more particularly for females (12.9% vs. 3.08%). Strain jobs had significantly higher odds ratio of daily smoking (OR 2.09, 95%CI: 1.28-3.41) compared to the relaxed category. The passive jobs (OR 2.01, 95%CI 1.27 to 3.17), highest job demands (OR 1.72, 95%CI: 1.13-2.61), and lowest job control (OR 2.56, 95%CI: 1.57-4.16) were also associated with a significantly higher daily smoking ratio. The negative relationship between job stability and smoking behavior was slightly stronger among daily than occasional smokers. However, neither job strain nor any of its components was found to be significantly associated with occasional smoking.

Conclusions

Smoking in hospitality blue-collar and service employees is certainly a major occupational health problem in Shenyang. This evidence also suggests an association between psychosocial-work conditions and smoking status, and implies that more intervention studies where changes in work environment are carried out in combination with health promotion interventions should be performed.