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From young to adult: health consequences of unemployment from a gender perspective
Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Family Medicine.
2009 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background The point of departure in this thesis is that unemployment is a recognised determinant of health, which may vary between different ages and among men and women. Despite governmental policies to tackle unemployment and ease its effects on health, unemployment continues to bea growing public health problem.

Aim The objective of the thesis was to analyse, from a gender perspective, the relationships between ill health and unemployment as well as other unstable labour market positions in the transition from youth to adulthood.

The aim of each paper was: I. Does the association between ill health and unemployment differ between young people and adults? II. Is the transition from an unstable labour market position to permanent paid job health-protective? III. Is participation in labour market programmes related to mental health? IV. What is the association between ill health among men and women and how could it be analysed with a relational theory of gender?

Methods The longitudinal study was carried out in Luleå - a medium-sized industrial town in the Northern Sweden. The cohort, consisting of all 1083 pupils (506 girls and 577 boys) aged 16 who attended the last year of compulsory school in 1981, was followed up at the ages of 16, 18, 21 and 30. The response rates were high e.g. 96.4% at 14 years follow-up. The cohort was followed with extensive and well-validated questionnaires. Multivariate logistic regression was used in all papers, while propensity score matchingwas used in Paper III.

Results Paper I. Health effects of long-term unemployment differed between young people and adults. Long-term unemployment was more related to psychological ill health and smoking in young people than in adults. Paper II. The results indicated that after controlling for gender as well as for an indicator of health-related selection, possible confounders and mediators transition from an unstable labour market position to permanent employment could be health-promoting. Paper III. No association was found between participation in active labour market programmes and psychological symptoms. Due to methodological shortages the results have to be interpreted with caution. Adjustment for either all background selection variables or the propensity score in multivariate logistic regression showed similar associations suggesting that propensity score could be used to adjust for background selection variables. Paper IV. A strong association between unemployment and suboptimal self-rated health among women and high alcohol consumption among men was found and a theory of structural relations was used to discuss the gendered patterns for ill health.

Conclusion The thesis indicated gendered patterns of relations between unemployment and the health outcomes, in the transition from youth to adulthood. The policy implications of my thesis are that full employment policies should be promoted to reduce the health inequalities associated with unemployment.

Place, publisher, year, edition, pages
Umeå: Umeå university , 2009. , 68 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1299
Keyword [en]
unemployment, reemployment, unstable labour market position, active labour market measures, psychological health, smoking, alcohol consumption, self-rated health, gender, age
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Social Medicine
Identifiers
URN: urn:nbn:se:umu:diva-26420ISBN: 978-91-7264-871-5 (print)OAI: oai:DiVA.org:umu-26420DiVA: diva2:248925
Distributor:
Allmänmedicin, 901 87, Umeå
Public defence
2009-11-02, Sal 1, byggnad 10, trappa E, Norrlands Universitetssjukhus, Umeå, 09:00 (Swedish)
Opponent
Supervisors
Projects
The Northern Swedish Cohort study
Available from: 2009-10-12 Created: 2009-10-09 Last updated: 2009-10-12Bibliographically approved
List of papers
1. Does the association between ill health and unemployment differ between young people and adults?: results from a 14-year follow-up study with a focus on psychological health and smoking
Open this publication in new window or tab >>Does the association between ill health and unemployment differ between young people and adults?: results from a 14-year follow-up study with a focus on psychological health and smoking
2004 (English)In: Public Health, ISSN 0033-3506, E-ISSN 1476-5616, Vol. 118, no 5, 337-345 p.Article in journal (Refereed) Published
Abstract [en]

Objectives. Research has given a comprehensive picture of the negative health consequences of unemployment without offering sufficient comparison between different age groups.

The aim of this study was to analyse whether the associations between ill health, particularly poor psychological health and smoking, and unemployment differ between young and adult men and women.

Study design. A 14-year follow-up study of graduates of compulsory school in an industrial town in northern Sweden was undertaken. The subjects were analysed at ages 16, 21 and 30 years. Complete data on the cohort were collected for 1044 individuals with the aid of a comprehensive questionnaire. The response rate was 96.4%.

Methods. The main health measurements used in this study were poor psychological health and smoking, analysed by multivariate logistic regression.

Results. After controlling for several background variables, associations between long-term unemployment and poor psychological health were found in young men and women, and adult men. Long-term unemployment was only associated with smoking inyoung people.

Conclusions. The association between long-term unemployment and psychological health, as well as smoking, seemed to be stronger in young people than adults.

Place, publisher, year, edition, pages
Elsevier, 2004
Keyword
psychological health, smoking, long-term unemployment, gender
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Social Medicine
Identifiers
urn:nbn:se:umu:diva-26415 (URN)10.1016/j.puhe.2003.10.008 (DOI)
Projects
The Northern Swedish Cohort study
Available from: 2009-10-12 Created: 2009-10-09 Last updated: 2017-12-13Bibliographically approved
2. Does transition from an unstable labour market position to permanent employment protect mental health?: results from a 14-year follow-up of school-leavers
Open this publication in new window or tab >>Does transition from an unstable labour market position to permanent employment protect mental health?: results from a 14-year follow-up of school-leavers
2008 (English)In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 8, no 159Article in journal (Refereed) Published
Abstract [en]

Background: Having secure employment, in contrast to being unemployed, is regarded as an important determinant of health. Research and theories about the negative health consequences of unemployment indicated that transition from unemployment to a paid job could lead to improved health. The objective of this study was to test the hypothesis that obtaining permanent employment after being in an unstable labour market position protects mental health.

Methods: A 14-year follow-up of all graduates from compulsory school in an industrial town in northern Sweden was performed at ages 16, 18, 21 and 30 years. Complete data on the cohort were collected for 1044 individuals with the aid of a comprehensive questionnaire. The response rate was 96.4%. The health measurement used in this study was the psychological symptoms analysed by multivariate logistic regression. Those who obtained permanent employment were the focus of the analysis. This group consisted of people who were in an unstable labour market position for a year or more between the ages of 25 and 29, and who had acquired a permanent job one year before and at the time of the investigation.

Results: After controlling for gender as well as for an indicator of health-related selection, possible confounders and mediators, an association was found between the lower probability of psychological symptoms and obtaining permanent employment (OR = 0.35, 95% CI 0.19–0.63) as well as having permanent employment (OR = 0.22, 95% CI 0.10–0.51).

Conclusion: Our findings suggest that transition from an unstable labour market position topermanent employment could be health-promoting, even after controlling for possible confounders and mediators, as well as for an indicator of health-related selection. However, as there are few studies in the field, there is a need for more longitudinal studies in order to further analyse the relationship and to examine possible explanations. The policy implication of our study is that the transformation of unstable labour market positions into permanent employment could contribute to better public health.

Place, publisher, year, edition, pages
BioMed Central, 2008
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Social Medicine
Identifiers
urn:nbn:se:umu:diva-26418 (URN)10.1186/1471-2458-8-159 (DOI)
Projects
The Northern Swedish Cohort study
Available from: 2009-10-12 Created: 2009-10-09 Last updated: 2017-12-13Bibliographically approved
3. Is participation in labour market programmes related to mental health?: results from a 14-year follow-up of the Northern Swedish cohort
Open this publication in new window or tab >>Is participation in labour market programmes related to mental health?: results from a 14-year follow-up of the Northern Swedish cohort
2011 (English)In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 39, no 1, 26-34 p.Article in journal (Refereed) Published
Abstract [en]

Aims: There is a lack of empirical studies assessing the possible impact of active labour market programmes (ALMP) on health. The aim of this study was to analyze whether participation in ALMP, in contrast to being unemployed and not participating in ALMP (UNALMP), was related to mental health at different ages.

Methods: The study was carried out in a medium-sized industrial town in the north of Sweden. The cohort, consisting of all 1,083 pupils who attended or should have attended the last year of compulsory school in 1981, was followed up at the ages of 16, 18, 21 and 30. Data on 381 individuals at age 21, and 281 at age 30 were used in the study. The main health measurement was psychological symptoms among participants of ALMP in contrast to UNALMP at ages 21 and 30, and was analyzed by propensity score matching method (PSM) and multivariate logistic regression.

Results: Generally, ALMP had higher scores of psychological symptoms than UNALMP. Nevertheless, participation in ALMP was not related to mental health. Due to methodological shortages our results have to be interpreted with caution. Adjustment for either all background selection variables or the propensity score in multivariate logistic regression showed similar associations, suggesting that propensity score could be used to adjust for background selection variables.

Conclusions: There is a need for more well-designed studies, using a theoretical framework, within the field, that are based on larger samples.

Keyword
Age, gender, longitudinal, propensity score
National Category
Family Medicine
Identifiers
urn:nbn:se:umu:diva-26494 (URN)10.1177/1403494810391523 (DOI)
Available from: 2009-10-12 Created: 2009-10-12 Last updated: 2017-12-12Bibliographically approved
4. Unemployment and ill health - a gender analysis: results from a 14-year follow-up of the Northern Swedish cohort
Open this publication in new window or tab >>Unemployment and ill health - a gender analysis: results from a 14-year follow-up of the Northern Swedish cohort
2013 (English)In: Public Health, ISSN 0033-3506, E-ISSN 1476-5616, Vol. 127, no 3, 214-222 p.Article in journal (Refereed) Published
Abstract [en]

Objectives. To investigate the experience of suicidal expressions (death wishes, life weariness, ideation, plans and attempts) in young Swedish Sami, their attitudes toward suicide (ATTS), and experience of suicidal expressions and completed suicide in significant others and to compare with Swedes in general. Methods. A cross-sectional study comprising 516 Swedish Sami, 18-28 years of age together with an age and geographically matched reference group (n = 218). Parts of the ATTS questionnaire have been used to cover different aspects of the suicidal complex. Data were analysed with regard to gender, occupation, counties and experience of negative societal treatment due to Sami background. Results. Both young Sami and young Swedes reported suicidal ideation, life weariness, and death wishes in a high degree (30-50%), but it was more common among the Sami. Having had plans to commit suicide showed a significant gender difference only in the Sami. The prevalence of suicide attempts did not differ significantly between Sami and Swedes. Subgroups of the Sami reported a higher degree of suicidal behaviour, Sami women and reindeer herders reported a 3, 5-fold higher odds of suicide attempts and a 2-fold higher odds having had plans committing suicide. Sami living in Vasterbotten/Jamtland/Vasternorrland and Sami with experience of ethnicity related bad treatment 2-fold higher odds of suicidal plans compared to those living in other counties. Conclusion. An increased occurrence of suicidal ideation/death wishes/life weariness in young Sami compared to young majority Swedes was found, but not an increased prevalence of suicide attempts and positive attitudes together with an increased awareness to handle suicide problems could be a contributing factor. Severe circumstances and experience of ethnicity-related bad treatment seems to contribute to increased levels of suicidal plans and attempts in subgroups of Sami.

Place, publisher, year, edition, pages
Saunders Elsevier, 2013
Keyword
suicide ideation, suicide attempts, gender, reindeer herders, indigenous Sami, attitudes toward suicide
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-26495 (URN)10.1016/j.puhe.2012.12.005 (DOI)000316797100004 ()
Note

Original included in thesis in manuscript form.

Available from: 2009-10-12 Created: 2009-10-12 Last updated: 2017-12-12Bibliographically approved

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