| 1. |
- Cedstrand, Emma, et al.
(författare)
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Co-Creating an Occupational Health Intervention within the Construction Industry in Sweden : Stakeholder Perceptions of the Process and Output
- 2021
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Ingår i: International Journal of Environmental Research and Public Health. - : MDPI. - 1661-7827 .- 1660-4601. ; 18:24
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Tidskriftsartikel (refereegranskat)abstract
- One way to prevent work-related stress, is to implement primary occupational health interventions aimed at improving the psychosocial work environment. However, such interventions have shown a limited effect, often due to implementation failure and poor contextual fit. Co-creation, where researchers, together with end-users and other relevant stakeholders, develop the intervention is increasingly encouraged. However, few studies have evaluated the effects of co-created interventions, and participants' experience of the co-creation process. This is one of the first studies evaluating stakeholder perceptions of co-creating an occupational health intervention. We applied a thematic analysis, with data from 12 semi-structured interviews with stakeholders involved in the co-creation. Our results show that the respondents, in general, were satisfied with engaging in the co-creation, and they reported an increased awareness regarding risk factors of stress and how these should be handled. Additionally, the respondents described trust in the intervention activities and a good fit into the context. The study indicates that co-creating occupational health interventions can enhance the implementation and the contextual fit.
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| 2. |
- Albin, Maria, et al.
(författare)
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Ageing workers and an extended working life
- 2017
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Ingår i: Arbetslivet och socialförsäkringen. - Stockholm : Försäkringskassan. ; , s. 45-58
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Bokkapitel (övrigt vetenskapligt/konstnärligt)
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| 3. |
- Albin, Maria, et al.
(författare)
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Ska alla behöva arbeta längre?
- 2020
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Ingår i: Förlängt arbetsliv – förutsättningar, utmaningar och konsekvenser. - Stockholm : Försäkringskassan. ; , s. 72-83
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Bokkapitel (övrigt vetenskapligt/konstnärligt)abstract
- Det finns flera skäl till att öppna för att människor skall ha möjlighet att arbeta längre. Hit hör en i allmänhet förbättrad folkhälsa, behovet av arbetskraft och att ett gott och meningsfullt arbete kan berika livet för den enskilde samtidigt som det bidrar till samhällets välstånd och finansieringen av välfärdssystemen. Men ett arbetsmedicinskt svar på om alla ska behöva arbeta längre är klart Nej. Det grundar sig på: • folkhälsans ojämlika utveckling • att de fysiska kraven fortfarande är höga i många yrken, främst arbetaryrken • att arbetets fysiska krav är det som främst är begränsande vid högre åldrar • att många rapporterar att arbetets fysiska krav överstiger deras förmåga • den sjunkande tillgången till kvalificerad arbetsanpassning genom exempelvis företagshälsovård, särskilt för kvinnor och i arbetaryrken.
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| 4. |
- Albin, Maria, et al.
(författare)
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Sustainable work for health and job longevity
- 2021
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Ingår i: European Journal of Workplace Innovation. - : University of Agder. - 2387-4570. ; 6:2, s. 147-162
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Tidskriftsartikel (refereegranskat)abstract
- While improved public health in groups with high or middle socioeconomic status (e.g. educational level) permits many to work for more years, the gap is widening for less advantaged groups, such as those with only compulsory level education. Within manual jobs, individual health status and the challenges of physical demands exceed the physical capacity of many middle-aged, and with a low bargaining power, constitute major threats to job longevity. Artificial intelligence and digitization are also rapidly transforming the labour market, especially for low-mid grade (level) white-collar workers. Young workers often have insecure job contracts, while older workers may have a permanent position but have a fear of leaving a safe position for a new one, and ultimately may be forced to leave their job when they are unable to meet the demands.Current economic incentives to prolong working life – often combined with more restrictive unemployment and disability benefits – may overall increase work participation but may also decrease sustainability in the more disadvantaged part of the labour market.Recent research suggests that unemployment is the most important factor behind lost working years among workers with less education, and that primary prevention focused on the work environment rather than individual health promotion (lifestyle habits), will enhance sustainability together with inclusive welfare systems. Resilience, or reduced vulnerability, in the workforce on a macro- and workplace level can be achieved by well-established societal measures.
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| 5. |
- Almroth, Melody, 1989-, et al.
(författare)
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Labour market exit routes in high- and low-educated older workers before and after social insurance and retirement policy reforms in Sweden
- 2024
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Ingår i: Ageing & Society. - 0144-686X .- 1469-1779.
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Tidskriftsartikel (refereegranskat)abstract
- Few previous studies have investigated how socioeconomic differences in labour market exit have changed after restrictions in social insurance policies. The aim of this register-based study is to investigate how early labour market exit pathways among older men and women with different levels of education changed after major restrictive social insurance and retirement policy reforms in Sweden. Cohort 1 (pre-reform) consisted of individuals who were 60 or 61 years old in 2005 (N = 186,145) and Cohort 2 (post-reform) consisted of individuals who were 60 or 61 years old in 2012 (N = 176,216). Educational differences in four labour market exit pathways were investigated using Cox proportional hazards regression; the exit pathways were disability pension, early old-age pension with and without income respectively, and no income for two consecutive years. As expected, exits through disability pension were rarer in Cohort 2. Lower education was also more strongly associated with disability pension in Cohort 2. Parallel to this, lower education showed a stronger association with both early old-age pension types in Cohort 2. Additionally, a tendency towards a relatively higher likelihood of earning no income was seen among the less educated. Increases in inequalities tended to be greater for women. Our results indicate that educational inequalities in labour market exit have grown significantly after restrictions in social insurance and changes in retirement policies, which can have negative financial repercussions for those already in a vulnerable position. These results indicate that careful analyses of effects on disparities are needed before making major changes in welfare systems.
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| 6. |
- Badarin, Kathryn, et al.
(författare)
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Safety and health among undeclared workers : A mixed methods study investigating social partner experiences and strategies
- 2024
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Ingår i: Safety Science. - : Elsevier B.V.. - 0925-7535 .- 1879-1042. ; 175
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Tidskriftsartikel (refereegranskat)abstract
- Little is known about the experiences of the social partners in helping undeclared workers resist Occupational Safety and Health (OSH) issues. This study draws upon Walter Korpi’s ‘power resource theory’ to gain a deeper understanding of how power resources within the construction, transport, and cleaning sectors influence the ability of social partners to respond to OSH issues related to undeclared work. This mixed-method study uses survey data from employer representatives in the construction (n = 686) and transport (n = 650) sectors in Sweden in 2019 to estimate the nature and magnitude of undeclared work-related problems. To also study the view of union representatives, a duplicate survey was sent to union representatives in the transport, construction, and cleaning sectors (n = 57) in 2020, followed by 13 semi-structured interviews with Regional Safety Representatives (RSRs) in 2021–2023. Our findings show that employer representatives in construction and transport reported that the violation of OSH regulations was uncommon and remained unchanged, most union representatives said the opposite. We found a gradient of activism among the unions towards OSH issues related to undeclared work dependent on their power resources. Furthermore, structural and organizational factors limited the RSRs’ ability to address undeclared work. The RSRs identified strategies to tackle OSH issues related to undeclared work in their sectors, these included but were not limited to, dismantling the language barrier between unions and undeclared foreign-born workers, for OSH coordinators and main contractors to be held responsible for OSH violations and greater cooperation between the relevant authorities dealing with undeclared work.
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| 7. |
- Bodin, Theo, et al.
(författare)
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Activity in neck-shoulder and lower arm muscles during computer and smartphone work
- 2019
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Ingår i: International Journal of Industrial Ergonomics. - : ELSEVIER. - 0169-8141 .- 1872-8219. ; 74
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Tidskriftsartikel (refereegranskat)abstract
- Relevance to industry: There is emerging evidence of musculoskeletal problems related to smartphone work and a rapid transition to mobile workplaces, where smartphones are key working tools. Aim: The study's aim was to compare muscle activity during computer work with smartphone work and to see what possible effects ergonomic recommendations for smartphone usage have on muscle activity. Methods: Activity was measured bilaterally from the upper trapezius muscle and from lower arm muscles on the right hand side, on twelve participants with surface electromyography who performed e-mail work on the computer using ergonomic recommendations, smartphone in a self-chosen way of working and on smartphone with ergonomic recommendations. Effects on productivity was not assessed in this study. Results: Activity in m. trapezius and m. extensor digitorum was significantly higher during computer work (p < 0.05) than during the two smartphone usages and activity in m. interossei dorsalis 1 was, vice versa, significantly higher during smartphone work fp < 0.05). Comparison of smartphone in self-chosen way of working and smartphone with ergonomic recommendations showed no significant differences. Conclusions: Previous research has highlighted the benefits of variation of work postures. This paper indicates that replacing the computer with a smartphone gives the trapezius muscle an opportunity to rest.
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| 8. |
- Bodin, Theo, et al.
(författare)
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Annoyance, Sleep and Concentration Problems due to Combined Traffic Noise and the Benefit of Quiet Side.
- 2015
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Ingår i: International Journal of Environmental Research and Public Health. - : MDPI AG. - 1660-4601. ; 12:2, s. 1612-1628
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Tidskriftsartikel (refereegranskat)abstract
- Access to a quiet side in one's dwelling is thought to compensate for higher noise levels at the most exposed façade. It has also been indicated that noise from combined traffic sources causes more noise annoyance than equal average levels from either road traffic or railway noise separately.
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| 9. |
- Bodin, Theo, et al.
(författare)
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Road traffic noise, air pollution and myocardial infarction: a prospective cohort study.
- 2016
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Ingår i: International Archives of Occupational and Environmental Health. - : Springer Science and Business Media LLC. - 1432-1246 .- 0340-0131. ; 89:5, s. 793-802
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Tidskriftsartikel (refereegranskat)abstract
- Both road traffic noise and air pollution have been linked to cardiovascular disease. However, there are few prospective epidemiological studies available where both road traffic noise and air pollution have been analyzed simultaneously. The aim of this study was to investigate the relation between road traffic noise, air pollution and incident myocardial infarction in both current (1-year average) and medium-term (3-year average) perspective.
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| 10. |
- Bodin, Theo, et al.
(författare)
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Road traffic noise and hypertension: results from a cross-sectional public health survey in southern Sweden.
- 2009
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Ingår i: Environmental Health. - 1476-069X. ; 8:38
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Results from studies of road traffic noise and hypertension are heterogeneous with respect to effect size, effects among males and females and with respect to effects across age groups. Our objective was to further explore these associations. METHODS: The study used cross-sectional public health survey data from southern Sweden, including 24,238 adults (18 - 80 years old). We used a geographic information system (GIS) to assess the average road noise (LAeq 24 hr) at the current residential address. Effects on self-reported hypertension were estimated by logistic regression with adjustment for age, sex, BMI, alcohol intake, exercise, education, smoking and socioeconomic status. RESULTS: Modest exposure effects (OR approximately 1.1) were generally noted in intermediate exposure categories (45 -64 dB(A)), and with no obvious trend. The effect was more pronounced at > 64 dB(A) (OR 1.45, 95% CI 1.04 - 2.02). Age modified the relative effect (p = 0.018). An effect was seen among middle-aged (40 - 59 years old) at noise levels 60 - 64 dB(A) (OR = 1.27, 95% CI 1.02 - 1.58)) and at > 64 dB(A) (OR = 1.91, 95% CI 1.19 - 3.06)). An effect was also indicated among younger adults but not among elderly. No apparent effect modification by gender, country of origin, disturbed sleep or strained economy was noted. CONCLUSION: The study supports an association between road traffic noise at high average levels and self-reported hypertension in middle-aged. Future studies should use age group -specific relative effect models to account for differences in prevalence.
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| 11. |
- Bodin, Theo
(författare)
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Road Traffic Noise - Factors modifying its relation to annoyance and cardiovascular disease
- 2014
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Traffic noise causes annoyance and sleep disturbance and has been linked with several other adverse effects on life quality and health, including increased risk of hypertension and myocardial infarction. Conservative estimates assume that at least one million healthy life years are lost every year from traffic related noise in the western part of Europe. We know from earlier studies that the adverse effects of environmental noise may be modified by social, demographic and individual factors. However, there is a need to better evaluate exposure-response in susceptible groups. The aim of this thesis was to test a number of factors hypothesised to modify the association between road traffic noise, annoyance and cardiovascular disease. Paper I-III are cross-sectional, while paper IV is a cohort study. The four different study populations in this thesis were selected through stratified random sampling of men and women aged 18-80 years old in the county of Skåne and its major city Malmö in southern Sweden. Exposures of road traffic and railway noise as well as air pollution were modelled using geographic information system (GIS) for the survey participants’ residential addresses. Possible confounding and modifying factors were mainly drawn from survey responses while outcomes were based on both self-reporting and inpatient registers. We were not able to show a relation between current and medium-term noise exposure to road traffic noise and incident myocardial infarction or ischemic heart disease in the general population. Air-pollution at low levels did not modify this effect. An association was however found between road traffic noise and hypertension in a cross-sectional study >60dB(A). We also found strong and positive relations between road traffic noise and annoyance. Railway noise was found to be less annoying at intermediate levels, but not >55dB(A). Access to quiet side had a protective effect and decreased the risk of annoyance, sleep and concentration problems equal to a 5dB(A) decrease in noise exposure. Generally middle-aged persons were found to be more susceptible to noise. Higher socioeconomic status and educational level were related to noise annoyance. With regard to sex, findings were less consistent. We also found that results in our studies might be biased due to selective participation, that noise sensitive individuals were likely to have a higher response rate and that inter-study comparison may be difficult since different annoyance scales can produce very different results. In conclusion, the health effects of noise are modified by noise source, co-exposures, environmental and socio-demographic factors (as well as personal traits) and research methodology. To develop better policies for residential noise environment, future research should focus on combined exposures and stressors as well as further explaining age differences and developing better ways to account for social class.
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| 12. |
- Bodin, Theo, et al.
(författare)
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Survey context and question wording affects self reported annoyance due to road traffic noise: a comparison between two cross-sectional studies.
- 2012
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Ingår i: Environmental health : a global access science source. - 1476-069X. ; 11:1
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Tidskriftsartikel (refereegranskat)abstract
- ABSTRACT: BACKGROUND: Surveys are a common way to measure annoyance due to road traffic noise, but the method has some draw-backs. Survey context, question wording and answer alternatives could affect participation and answers and could have implications when comparing studies and/or performing pooled analyses. The aim of this study was to investigate the difference in annoyance reporting due to road traffic noise in two types of surveys of which one was introduced broadly and the other with the clearly stated aim of investigating noise and health METHODS: Data was collected from two surveys carried out in the municipality of Malmo, southern Sweden in 2007 and 2008 (n = 2612 and n = 3810). The first survey stated an aim of investigating residential environmental exposure, especially noise and health. The second survey was a broad public health survey stating a broader aim. The two surveys had comparable questions regarding noise annoyance, although one used a 5-point scale and the other a 4-point scale. We used geographic information systems (GIS) to assess the average road and railway noise (LAeq,24h) at the participants' residential address. Logistic regression was used to calculate odds ratios for annoyance in relation to noise exposure. RESULTS: Annoyance at least once a week due to road traffic noise was significantly more prevalent in the survey investigating environment and health compared to the public health survey at levels >45 dB(A), but not at lower exposure levels. However no differences in annoyance were found when comparing the extreme alternatives "never" and "every day". In the study investigating environment and health, "Noise sensitive" persons were more likely to readily respond to the survey and were more annoyed by road traffic noise compared to the other participants in that survey. CONCLUSIONS: The differences in annoyance reporting between the two surveys were mainly due to different scales, suggesting that extreme alternatives are to prefer before dichotomization when comparing results between the two. Although some findings suggested that noise-sensitive individuals were more likely to respond to the survey investigating noise and health, we could not find convincing evidence that contextual differences affected either answers or participation.
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| 13. |
- Bodin, Theo, et al.
(författare)
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Trends in Precarious Employment in Sweden 1992–2017 : A Social Determinant of Health
- 2022
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Ingår i: International Journal of Environmental Research and Public Health. - : MDPI AG. - 1661-7827 .- 1660-4601. ; 19:19
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to identify trends in precarious employment in the Swedish workforce from 1992 to 2017. This is a repeated cross-sectional study, analyzing the total working population aged 16–75 in Sweden at five-year intervals. We used version 2.0 of the Swedish Register-based Operationalization of Precarious Employment, covering the following dimensions: employment insecurity, income inadequacy, lack of rights and protection. The proportion in precarious employment increased from 9.7 to 12% between 1992 and 2017, a relative increase of 24%. The prevalence was higher among those of lower age, of low education, and immigrants. Differences between sexes converged, and there were slightly more precarious men than women in 2017. The relative increase was most pronounced among men, especially those with low educational attainment and of European origin. The increasing proportion of precarious employees is a clear challenge to the tripartite Nordic model, which requires sufficient trade-union bargaining power.
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| 14. |
- Bosmans, Kim, et al.
(författare)
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Experiences of insecurity among non-standard workers across different welfare states : A qualitative cross-country study
- 2023
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Ingår i: Social Science and Medicine. - : Elsevier. - 0277-9536 .- 1873-5347. ; 327
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Tidskriftsartikel (refereegranskat)abstract
- In recent decades, economic crises and political reforms focused on employment flexibilization have increased the use of non-standard employment (NSE). National political and economic contexts determine how employers interact with labour and how the state interacts with labour markets and manages social welfare policies. These factors influence the prevalence of NSE and the level of employment insecurity it creates, but the extent to which a country’s policy context mitigates the health influences of NSE is unclear. This study describes how workers experience insecurities created by NSE, and how this influences their health and well-being, in countries with different welfare states: Belgium, Canada, Chile, Spain, Sweden, and the United States. Interviews with 250 workers in NSE were analysed using a multiple-case study approach. Workers in all countries experienced multiple insecurities (e.g., income and employment insecurity) and relational tension with employers/clients, with negative health and well-being influences, in ways that were shaped by social inequalities (e.g., related to family support or immigration status). Welfare state differences were reflected in the level of workers’ exclusion from social protections, the time scale of their insecurity (threatening daily survival or longer-term life planning), and their ability to derive a sense of control from NSE. Workers in Belgium, Sweden, and Spain, countries with more generous welfare states, navigated these insecurities with greater success and with less influence on health and well-being. Findings contribute to our understanding of the health and well-being influences of NSE across different welfare regimes and suggest the need in all six countries for stronger state responses to NSE. Increased investment in universal and more equal rights and benefits in NSE could reduce the widening gap between standard and NSE.
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| 15. |
- Canivet, Catarina, et al.
(författare)
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Precarious employment is a risk factor for poor mental health in young individuals in Sweden : a cohort study with multiple follow-ups
- 2016
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Ingår i: BMC Public Health. - : BioMed Central. - 1471-2458. ; 16
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The globalisation of the economy and the labour markets has resulted in a growing proportion of individuals who find themselves in a precarious labour market situation, especially among the young. This pertains also to the Nordic countries, despite their characterisation as well developed welfare states with active labour market policies. This should be viewed against the background of a number of studies, which have shown that several aspects of precarious employment are detrimental to mental health. However, longitudinal studies from the Nordic region that examine the impact of precarious labour market conditions on mental health in young individuals are currently lacking. The present study aims to examine this impact in a general cohort of Swedish young people.METHODS: Postal questionnaires were sent out in 1999/2000 to a stratified random sample of the Scania population, Sweden; the response rate was 58 %. All of those who responded at baseline were invited to follow-ups after 5 and 10 years. Employment precariousness was determined based on detailed questions about present employment, previous unemployment, and self-rated risk of future unemployment. Mental health was assessed by GHQ-12. For this study individuals in the age range of 18-34 years at baseline, who were active in the labour market (employed or seeking job) and had submitted complete data from 1999/2000, 2005, and 2010 on employment precariousness and mental health status, were selected (N = 1135).RESULTS: Forty-two percent of the participants had a precarious employment situation at baseline. Labour market trajectories that included precarious employment in 1999/2000 or 2005 predicted poor mental health in 2010: the incidence ratio ratio was 1.4 (95 % CI: 1.1-2.0) when excluding all individuals with mental health problems at baseline and adjusting for age, gender, social support, social capital, and economic difficulties in childhood. The population attributable fraction regarding poor mental health in the studied age group was 18 %.CONCLUSIONS: This study supported the hypothesis that precarious employment should be regarded as an important social determinant for subsequent development of mental health problems in previously mentally healthy young people.
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| 16. |
- Cedstrand, Emma, et al.
(författare)
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A Participatory Intervention to Improve the Psychosocial Work Environment and Mental Health in Human Service Organisations. A Mixed Methods Evaluation Study
- 2021
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Ingår i: International Journal of Environmental Research and Public Health. - : MDPI. - 1661-7827 .- 1660-4601. ; 18:7
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Tidskriftsartikel (refereegranskat)abstract
- Work-related stress is a global problem causing suffering and economic costs. In Sweden, employees in human service occupations are overrepresented among persons on sick leave due to mental health problems such as stress-related disorders. The psychosocial work environment is one contributing factor for this problem, making it urgent to identify effective methods to decrease stress at the workplace. The aim of the study is to evaluate a participatory intervention to improve the psychosocial work environment and mental health using an embedded mixed methods design. The study is a controlled trial with a parallel process evaluation exploring fidelity and participants' reactions to the intervention activities, experiences of learning and changes in behaviours and work routines. We collected data through documentation, interviews and three waves of questionnaires. Our results show small changes in behaviours and work routines and no positive effects of the intervention on the psychosocial work environment nor health outcomes. One explanation is end-users' perceived lack of involvement over the process causing the intervention to be seen as a burden. Another explanation is that the intervention activities were perceived targeting the wrong organisational level. A representative participation over both content and process can be an effective strategy to change psychosocial working conditions and mental health.
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| 17. |
- Cedstrand, Emma, et al.
(författare)
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Effects of a co-created occupational health intervention on stress and psychosocial working conditions within the construction industry : a controlled trial
- 2022
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Ingår i: Frontiers In Public Health. - : Frontiers Media S.A.. - 2296-2565. ; 10
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Tidskriftsartikel (refereegranskat)abstract
- Background Work-related stress problems, i.e., burnout, depression, and anxiety, is a rising global health challenge. Poor mental health also appears to be a challenge for the construction industry, even though the occupational health focus has traditionally been on the physical work environment and musculoskeletal disorders. Yet, studies targeting the organisational level (i.e., work environment, policy) to enhance mental health within the construction industry are scant. Therefore, our first objective was to evaluate the effectiveness of a co-created occupational health intervention on stress and psychosocial working conditions within the construction industry in Sweden. The second objective was to evaluate whether the intervention was implemented as intended, i.e., implementation fidelity. The trial is registered in the ISRCTN clinical trial registry (ISRCTN16548039, ). Methods This is a controlled trial with one intervention and one matched control group. We co-created the program logic with stakeholders from the intervention group. The essence of the chosen intervention components, duties clarification, and structured roundmaking was enhanced planning and role clarification. We assessed adherence to the intervention and dose delivered (i.e., fidelity). We collected data on the outcomes (role clarity, team effectiveness, planning, staffing, quantitative demands, and the psychosocial safety climate) with online questionnaires at baseline, 12, and 24 months. Marginal means models adjusting for missing data patterns were applied to estimate potential differences in outcomes between groups over time. Results Fidelity was considered reasonably high. Yet, we found no intervention effects on the primary outcome stress. All outcomes, except role clarity deteriorated during the trial in the intervention and control group. However, the results indicate a positive effect of the intervention components on professionals' role clarity. The pandemic appears to have negatively affected stress and psychosocial working conditions. Conclusion The study's results suggest that co-creating occupational health interventions could be one solution for improved implementation fidelity. More studies are needed to evaluate these intervention components. Also, we recommend researchers of future intervention studies consider using missing not at random, sensitivity analysis.
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| 18. |
- Cedstrand, Emma, et al.
(författare)
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Study protocol of a co-created primary organizational-level intervention with the aim to improve organizational and social working conditions and decrease stress within the construction industry : a controlled trial
- 2020
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Ingår i: BMC Public Health. - : Springer Science and Business Media LLC. - 1471-2458. ; 20:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Within construction industry, physical work exposures have long been recognized as possible determinants for musculoskeletal disorders, but less attention has been given the increasing organizational and social work hazards and stress within this industry. There is to date a lack of knowledge about how to improve organizational and social working conditions and decrease stress within the construction industry.Methods: This paper outlines the design of a controlled trial to evaluate the effectiveness of a co-created organizational-level intervention with the aim to improve role clarity, quantitative demands, staffing, planning, team effectiveness, psychosocial safety climate and stress. Two regions (> 700 employees) within one large construction company in Sweden will participate as intervention and control group. Further we present the design of the process evaluation assessing fidelity, support from managers, readiness for change and contextual factors. We will utilize questionnaires, semi-structured interviews, observations and documentation as means for data collection, hence a mixed methods approach is applied.Discussion: The study is expected to contribute to the understanding of how adverse organizational and social working conditions and stress can be improved within the construction industry. By applying co-creation we wish to develop an intervention and implementation strategies that fit to the context, are in line with the needs of end-users and are supported by all management levels - all of which are highlighted features in successful workplace interventions.
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| 19. |
- Ekström, Ulf, et al.
(författare)
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Insufficient mixing of thawed serum samples leading to erroneous results - experience from a field study and use of a correction procedure
- 2020
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Ingår i: Scandinavian Journal of Clinical & Laboratory Investigation. - : Informa UK Limited. - 0036-5513 .- 1502-7686. ; 80:2, s. 99-105
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Tidskriftsartikel (refereegranskat)abstract
- Incorrect analysis results that are close to expected might not be recognized in scientific studies or routine patient care. In two field studies we obtained unexpected results in a large number of samples. The present study aimed to identify the source of error in the samples from these studies and to validate a method to obtain correct results. Pre-analytical procedures were scrutinized, giving no indications of inappropriate pre-analytical sample handling in the field or during transport in a tropical climate. Using a new set of samples from volunteers in simulation experiments, we observed the known concentration gradient of analytes sampled in gel as well as plain tubes after freezer storage and thawing. Experiments demonstrated that mixing of samples by vortexing alone was not sufficient to disrupt the gradient formed by freezing and thawing, which appeared to cause the problem encountered when we in field studies analyzed and biobanked large sample sets by robot pipetting. A correction procedure was introduced, in which the obtained value of an analyte was multiplied by a correction factor calculated for each sample using the expected sodium level (140 mmol/L) divided by the measured sodium value. When it was validated on results from the simulation experiments, we repeatedly found that the correction lead to results very close to true values for analytes of different size and charge. Usefulness of the procedure was demonstrated when applied to a large set of field study results.
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| 20. |
- Falkstedt, Daniel, et al.
(författare)
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Disability pensions related to heavy physical workload : a cohort study of middle-aged and older workers in Sweden
- 2021
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Ingår i: International Archives of Occupational and Environmental Health. - : Springer Science and Business Media LLC. - 0340-0131 .- 1432-1246. ; 94, s. 1851-1861
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Tidskriftsartikel (refereegranskat)abstract
- Objectives The aim of the study was to examine the associations between heavy physical workload among middle-aged and older workers and disability pension due to any diagnosis, as well as musculoskeletal, psychiatric, cardiovascular or respiratory diagnoses. The population-based design made it possible to examine dose-response and potential gender differences in the associations. Methods About 1.8 million men and women aged 44-63 years and registered as living in Sweden in 2005 were followed regarding disability pension during 2006-2016, until ages 55-65 years. Mean values of physical workload and job control, estimated through gender-specific job-exposure matrices (JEMs), were assigned to individuals through their occupational titles in 2005. Exposure values were ranked separately for women and men and divided into quintiles. Associations were analyzed with Cox proportional-hazards regression. Results The analyses showed robust, dose-response associations between physical workload and disability pension with a musculoskeletal diagnosis in both genders: the adjusted hazard ratio and 95% confidence interval for those with the heaviest exposure was 2.58 (2.37-2.81) in women and 3.34 (2.83-3.94) in men. Dose-response associations were also seen in relation to disability pension with a cardiovascular or a respiratory diagnosis, though the hazard ratios were smaller. Physical workload was not associated with disability pension with a psychiatric diagnosis after adjustment for job control. Conclusion This study of the entire Swedish population of middle-aged and older workers suggests that higher degrees of physical workload may increase the risk of disability pension overall, and specifically with musculoskeletal, cardiovascular or respiratory diagnosis, in both women and men.
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| 21. |
- Falkstedt, Daniel, et al.
(författare)
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Job demands and job control and their associations with disability pension—a register-based cohort study of middle-aged and older Swedish workers
- 2023
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Ingår i: International Archives of Occupational and Environmental Health. - 0340-0131 .- 1432-1246. ; 96:8, s. 1137-1147
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Tidskriftsartikel (refereegranskat)abstract
- Objectives Job demands and control at work and their combination, job strain, have been studied in relation to risk of disability pension (DP) previously. In the present study, based on registry data, we aimed to deepen the knowledge by analyzing major disease groups among the DPs, dose–response shape of the associations, and potential confounding effects of physical workload.Methods Approximately 1.8 million workers aged 44 or older and living in Sweden in 2005 were followed up for 16 years, up to a maximum of 65 years of age. We linked mean values of job demands and job control, estimated in a job-exposure matrice (JEM) by gender, to individuals through their occupational titles in 2005. These values were categorized by rank order, and, for the construction of job-strain quadrants, we used a median cut-off. Associations with DP were estimated in Cox proportional-hazards models.Results In models accounting for covariates including physical workload, low levels of job control were associated with higher risk of DP among both men and women. This association was most clear for DP with a psychiatric diagnosis, although a dose–response shape was found only among the men. High levels of job demands were associated with decreased risk of DP across diagnoses among men, but the same association varied from weak to non-existing among women. The high- and passive job-strain quadrants both showed increased risk of DP with a psychiatric diagnosis.Conclusion The results suggest that, at the occupational level, low job control, but not high job demands, contributes to an increased incidence of DP, particularly regarding DP with a psychiatric diagnosis.
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| 22. |
- Gunn, Virginia, et al.
(författare)
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Initiatives addressing precarious employment and its effects on workers' health and well-being : a protocol for a systematic review
- 2021
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Ingår i: Systematic Reviews. - : BioMed Central (BMC). - 2046-4053. ; 10:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Precarious employment is a significant determinant of population health and health inequities and has complex public health consequences both for a given nation and internationally. Precarious employment is conceptualized as a multi-dimensional construct including but not limited to employment insecurity, income inadequacy, and lack of rights and protection in the employment relation, which could affect both informal and formal workers. The purpose of this review is to identify, appraise, and synthesize existing research on the effectiveness of initiatives aiming to or having the potential to eliminate, reduce, or mitigate workers' exposure to precarious employment conditions and its effects on the health and well-being of workers and their families. Methods: The electronic databases searched (from January 2000 onwards) are Scopus, Web of Science Core Collection, and PubMed, along with three institutional databases as sources of grey literature. We will include any study (e.g. quantitative, qualitative, or mixed-methods design) evaluating the effects of initiatives that aim to or have the potential to address workers' exposure to precarious employment or its effects on the health and well-being of workers and their families, whether or not such initiatives were designed specifically to address precarious employment. The primary outcomes will be changes in (i) the prevalence of precarious employment and workers' exposure to precarious employment and (ii) the health and well-being of precariously employed workers and their families. No secondary outcomes will be included. Given the large body of evidence screened, the initial screening of each study will be done by one reviewer, after implementing several strategies to ensure decision-making consistency across reviewers. The screening of full-text articles, data extraction, and critical appraisal will be done independently by two reviewers. Potential conflicts will be resolved through discussion. Established checklists will be used to assess a study's methodological quality or bias. A narrative synthesis will be employed to describe and summarize the included studies' characteristics and findings and to explore relationships both within and between the included studies. Discussion: We expect that this review's findings will provide stakeholders interested in tackling precarious employment and its harmful health effects with evidence on effectiveness of solutions that have been implemented to inform considerations for adaptation of these to their unique contexts. In addition, the review will increase our understanding of existing research gaps and enable us to make recommendations to address them. Our work aligns with the sustainable development agenda to protect workers, promote decent work and economic growth, eliminate poverty, and reduce inequalities.
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| 23. |
- Gunn, Virginia, et al.
(författare)
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Initiatives Addressing Precarious Employment and Its Effects on Workers' Health and Well-Being : A Systematic Review
- 2022
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Ingår i: International Journal of Environmental Research and Public Health. - : MDPI. - 1661-7827 .- 1660-4601. ; 19:4
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Forskningsöversikt (refereegranskat)abstract
- The prevalence of precarious employment has increased in recent decades and aspects such as employment insecurity and income inadequacy have intensified during the COVID-19 pandemic. The purpose of this systematic review was to identify, appraise, and synthesise existing evidence pertaining to implemented initiatives addressing precarious employment that have evaluated and reported health and well-being outcomes. We used the PRISMA framework to guide this review and identified 11 relevant initiatives through searches in PubMed, Scopus, Web of Science, and three sources of grey literature. We found very few evaluated interventions addressing precarious employment and its impact on the health and well-being of workers globally. Ten out of 11 initiatives were not purposefully designed to address precarious employment in general, nor specific dimensions of it. Seven out of 11 initiatives evaluated outcomes related to the occupational health and safety of precariously employed workers and six out of 11 evaluated worker health and well-being outcomes. Most initiatives showed the potential to improve the health of workers, although the evaluation component was often described with less detail than the initiative itself. Given the heterogeneity of the 11 initiatives regarding study design, sample size, implementation, evaluation, economic and political contexts, and target population, we found insufficient evidence to compare outcomes across types of initiatives, generalize findings, or make specific recommendations for the adoption of initiatives.
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| 24. |
- Gunn, Virginia, et al.
(författare)
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Non-Standard Employment and Unemployment during the COVID-19 Crisis : Economic and Health Findings from a Six-Country Survey Study
- 2022
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Ingår i: International Journal of Environmental Research and Public Health. - : MDPI AG. - 1661-7827 .- 1660-4601. ; 19:10
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Tidskriftsartikel (refereegranskat)abstract
- The COVID-19 crisis is a global event that has created and amplified social inequalities, including an already existing and steadily increasing problem of employment and income insecurity and erosion of workplace rights, affecting workers globally. The aim of this exploratory study was to review employment-related determinants of health and health protection during the pandemic, or more specifically, to examine several links between non-standard employment, unemployment, economic, health, and safety outcomes during the COVID-19 pandemic in Sweden, Belgium, Spain, Canada, the United States, and Chile, based on an online survey conducted from November 2020 to June 2021. The study focused on both non-standard workers and unemployed workers and examined worker outcomes in the context of current type and duration of employment arrangements, as well as employment transitions triggered by the COVID-19 crisis. The results suggest that COVID-19-related changes in non-standard worker employment arrangements, or unemployment, are related to changes in work hours, income, and benefits, as well as the self-reported prevalence of suffering from severe to extreme anxiety or depression. The results also suggest a link between worker type, duration of employment arrangements, or unemployment, and the ability to cover regular expenses during the pandemic. Additionally, the findings indicate that the type and duration of employment arrangements are related to the provision of personal protective equipment or other COVID-19 protection measures. This study provides additional evidence that workers in non-standard employment and the unemployed have experienced numerous and complex adverse effects of the pandemic and require additional protection through tailored pandemic responses and recovery strategies.
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| 25. |
- Hansson, Erik, et al.
(författare)
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Pathophysiological mechanisms by which heat stress potentially induces kidney inflammation and chronic kidney disease in sugarcane workers
- 2020
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Ingår i: Nutrients. - : MDPI AG. - 2072-6643. ; 12:6
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Tidskriftsartikel (refereegranskat)abstract
- Background: Chronic kidney disease of non-traditional origin (CKDnt) is common among Mesoamerican sugarcane workers. Recurrent heat stress and dehydration is a leading hypothesis. Evidence indicate a key role of inflammation. Methods: Starting in sports and heat pathophysiology literature, we develop a theoretical framework of how strenuous work in heat could induce kidney inflammation. We describe the release of pro-inflammatory substances from a leaky gut and/or injured muscle, alone or in combination with tubular fructose and uric acid, aggravation by reduced renal blood flow and increased tubular metabolic demands. Then, we analyze longitudinal data from >800 sugarcane cutters followed across harvest and review the CKDnt literature to assess empirical support of the theoretical framework. Results: Inflammation (CRP elevation and fever) and hyperuricemia was tightly linked to kidney injury. Rehydrating with sugary liquids and NSAID intake increased the risk of kidney injury, whereas electrolyte solution consumption was protective. Hypokalemia and hypomagnesemia were associated with kidney injury. Discussion: Heat stress, muscle injury, reduced renal blood flow and fructose metabolism may induce kidney inflammation, the successful resolution of which may be impaired by daily repeating pro-inflammatory triggers. We outline further descriptive, experimental and intervention studies addressing the factors identified in this study.
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| 26. |
- Hernando-Rodriguez, Julio C., et al.
(författare)
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Unequal access? Use of sickness absence benefits by precariously employed workers with common mental disorders : a register-based cohort study in Sweden
- 2023
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Ingår i: BMJ Open. - 2044-6055. ; 13:7
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Tidskriftsartikel (refereegranskat)abstract
- Objective This study compares the use of sickness absence benefits (SABs) due to a common mental disorder (CMD) between precariously employed and non-precariously employed workers with CMDs. DesignRegister-based cohort study. Participants The study included 78 215 Swedish workers aged 27-61 who experienced CMDs in 2017, indicated by a new treatment with selective serotonin reuptake inhibitors (SSRIs). Excluded were those who emigrated or immigrated, were self-employed, had an annual employment-based income <100 Swedish Krona, had >90 days of unemployment per year, had student status, had SABs due to CMDs during the exposure measurement (2016) and the two previous years, had an SSRI prescription 1 year or less before the start of the SSRI prescription in 2017, had packs of >100 pills of SSRI medication, had a disability pension before 2017, were not entitled to SABs due to CMDs in 2016, and had no information about the exposure. Outcome The first incidence of SABs due to CMDs in 2017. Results The use of SABs due to a CMD was slightly lower among precariously employed workers compared with those in standard employment (adjusted OR [aOR] 0.92, 95% CI 0.81 to 1.05). Particularly, women with three consecutive years in precarious employment had reduced SABs use (aOR 0.48, 95% CI 0.26 to 0.89), while men in precarious employment showed weaker evidence of association. Those in standard employment with high income also showed a lower use of SABs (aOR 0.74, 95% CI 0.67 to 0.81). Low unionisation and both low and high-income levels were associated with lower use of SABs, particularly among women. ConclusionsThe study indicates that workers with CMDs in precarious employment may use SABs to a lower extent. Accordingly, there is a need for (1) guaranteeing access to SABs for people in precarious employment and/or (2) reducing involuntary forms of presenteeism.
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| 27. |
- Håkansta, Carin, et al.
(författare)
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Power resources and the battle against precarious employment : Trade union activities within a tripartite initiative tackling undeclared work in Sweden
- 2024
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Ingår i: Economic and Industrial Democracy. - : Sage Publications. - 0143-831X .- 1461-7099. ; 45:1, s. 29-56
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this case study was to explore the abilities and limitations of trade unions in their response to undeclared work, which has received scant attention in research on working conditions and industrial relations. The authors use power resource theory to examine the outcome of a Swedish government initiative aimed to boost the ability of the social partners to tackle undeclared work. The findings confirm previous literature suggesting cross-sectoral differences in the extent and nature of undeclared work and an association between low levels of power resources and high risk of undeclared work. The authors recommend that future initiatives take account of cross-sectoral differences in the nature and extent of undeclared work and available power resources. Future research should consider how different actors can contribute to the ability of the social partners in different sectors to engage in the battle against undeclared work.
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| 28. |
- Jonsson, Johanna, et al.
(författare)
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Exploring multidimensional operationalizations of precarious employment in swedish register data – a typological approach and a summative score approach
- 2021
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Ingår i: Scandinavian Journal of Work, Environment and Health. - : Scandinavian Journal of Work, Environment and Health. - 0355-3140 .- 1795-990X. ; 47:2, s. 117-126
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Tidskriftsartikel (refereegranskat)abstract
- Objectives This study aimed to explore multidimensional operationalizations of precarious employment (PE) in Swedish register data using two approaches: (i) a typological approach and (ii) a dimensional, summative scale approach. It also examined the distribution of sociodemographic and occupational characteristics of precarious employees in Sweden. Method Register data was retrieved on individuals and their employers in the Swedish workforce. Five items corresponding to three dimensions of PE were operationalized: contractual relationship insecurity, contractual temporariness, multiple jobs/sectors, income level, and lack of unionization. First, latent class analysis was applied and a typology of six employment types emerged. Second, a summative scale was constructed by scor-ing all PE-items. Results Three types of PE were found using the typological approach, which were characterized by direct employment, solo self-employment and multiple job holding, respectively. The summative scale score ranged between-10 and +2 (average:-1.8). Particularly poor scores were seen for solo self-employed, multiple job hold-ers/multiple sectors, and low income. Female gender, young age, low education and foreign origin were prone to precariousness. PE was more frequent among certain economic sectors and occupations. Conclusions Using an existing register of labor market data, two operationalizations of PE were constructed and rendered promising for exposure assessment. Hence, the operationalizations could be of interest for countries with similar data structure. Both approaches highlighted precarious combinations of employment conditions and pointed towards the existence of a wide continuum of precariousness on the labor market. Etiological studies and research assessing trends over time are needed to validate these findings.
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| 29. |
- Jonsson, Johanna, et al.
(författare)
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Low-quality employment trajectories and risk of common mental disorders, substance use disorders and suicide attempt : a longitudinal study of the Swedish workforce
- 2021
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Ingår i: Scandinavian Journal of Work, Environment and Health. - : Scandinavian Journal of Work, Environment and Health. - 0355-3140 .- 1795-990X. ; 47:7, s. 509-520
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Tidskriftsartikel (refereegranskat)abstract
- Objective High-quality longitudinal evidence exploring the mental health risk associated with low-quality employment trajectories is scarce. We therefore aimed to investigate the risk of being diagnosed with common mental disorders, substance use disorders, or suicide attempt according to low-quality employment trajectories.Methods A longitudinal register-study based on the working population of Sweden (N=2 743 764). Employment trajectories (2005–2009) characterized by employment quality and pattern (constancy, fluctuation, mobility) were created. Hazard ratios (HR) were estimated using Cox proportional hazards regression models for first incidence (2010–2017) diagnosis of common mental disorders, substance use disorders and suicide attempt as dependent on employment trajectories.Results We identified 21 employment trajectories, 10 of which were low quality (21%). With the exception of constant solo self-employment, there was an increased risk of common mental disorders (HR 1.07–1.62) and substance use disorders (HR 1.05–2.19) for all low-quality trajectories. Constant solo self-employment increased the risk for substance use disorders among women, while it reduced the risk of both disorders for men. Half of the low-quality trajectories were associated with a risk increase of suicide attempt (HR 1.08–1.76).Conclusions Low-quality employment trajectories represent risk factors for mental disorders and suicide attempt in Sweden, and there might be differential effects according to sex – especially in terms of self-employment. Policies ensuring and maintaining high-quality employment characteristics over time are imperative. Similar prospective studies are needed, also in other contexts, which cover the effects of the Covid-19 pandemic as well as the mechanisms linking employment trajectories with mental health.
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| 30. |
- Jonsson, Johanna, et al.
(författare)
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Precarious employment and general, mental and physical health in Stockholm, Sweden : a cross-sectional study
- 2021
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Ingår i: Scandinavian Journal of Public Health. - : Sage Publications. - 1403-4948 .- 1651-1905. ; 49:2, s. 228-236
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Tidskriftsartikel (refereegranskat)abstract
- Objectives:To investigate the association between precarious employment and health in a sample of non-standard employees in Stockholm County, Sweden, by addressing three specific research questions: is the degree of precarious employment (low, moderate, high) associated with self-rated. . . (a) general health, (b) mental health, (c) musculoskeletal pain?Methods:Web-based respondent-driven sampling was used to recruit a sample of 415 employees in Stockholm, Sweden, during 2016-2017. Questionnaire data were collected on employment conditions (the Swedish version of the employment precariousness scale (EPRES-Se)), general health, mental health and musculoskeletal pain. EPRES-Se scores were categorised as low, moderate or high. Generalised linear models with Poisson distribution, log link functions and robust variances were applied for calculating crude and adjusted prevalence ratios (PR; aPR) with 95% confidence intervals (CIs) for all outcomes.Results:The prevalence ratios of poor self-rated general and mental health increased with increased degree of precariousness, as indicated by estimates of moderate precarious employment (a(2)PR(Moderate)1.44 (CI 0.98-2.11); a(2)PR(Moderate)1.13 (CI 0.82-1.62)), and high precarious employment (a(2)PR(High)1.78 (CI 1.21-2.62); a(2)PR(High)1.69 (CI 1.25-2.28)), albeit only significantly so for high precarious employment.Conclusions:This is the first study in Sweden reporting on the association between precarious employment, as measured with a multidimensional scale, and multiple health outcomes. The results add to the evidence of an association between precarious employment and self-rated poor general and mental health. Larger, representative studies with longitudinal designs using the EPRES-Se are called for in order to strengthen these results and the already existing evidence of the harm of precarious employment.
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| 31. |
- Kreshpaj, Bertina, et al.
(författare)
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Business performance and occupational injuries trajectories in the construction sector in Sweden
- 2022
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Ingår i: Safety Science. - : Elsevier. - 0925-7535 .- 1879-1042. ; 152
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To identify patterns in business performance and occupational injuries (OIs) in the Swedish construction sector between 2003 and 2015 and investigate associations between these trajectories. Methods: Company-level data were gathered from national registers. An open cohort of 13,089 private construction companies were classified by size. Yearly business performance indicators were return on equity, operating margin, and labor-to-revenue ratio. OIs rate was defined as number of injuries divided by number of employees. Group-based trajectory models were performed to identify companies with similar patterns in business performance and OIs rate over time. Associations were investigated with binomial regression models. Results: The model identified two main patterns (high/low) of injuries and business indicators for all company sizes. Trends in low labor-to-revenue ratio were associated with a high injury rate with a pooled estimate of 1.43 (95% CI 1.22–1.64) with some variation by company size: super small OR 1.3 (95% CI 1.01–1.62), small, OR 1.74 (95% CI 1.39–2.18), medium OR 1.3 (95% CI 0.9–1.8) and large OR 2.1 (95% CI 0.77–5.7). Similarly, low patterns of returns on equity were associated with high injury rate patterns across all company sizes, excluding small enterprises. No associations were found for operating margin patterns. Conclusions: Low returns on equity and labor-to-revenue ratio were associated with higher OIs rate trajectories in the Swedish construction sector, which has implications for injury prevention as well as targeted surveillance and inspection. Further studies could investigate other economic sectors and possible mechanisms for this association.
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| 32. |
- Kreshpaj, Bertina, et al.
(författare)
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Precarious employment and occupational injuries in Sweden between 2006 and 2014 : a register-based study
- 2023
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Ingår i: Occupational and Environmental Medicine. - : BMJ Publishing Group Ltd. - 1351-0711 .- 1470-7926. ; 80, s. 179-185
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundPrecarious employment (PE) has been suggested as a risk factor for occupational injuries (OIs). However, several issues such as under-reporting and time at risk pose obstacles to obtaining unbiased estimates of risk ObjectiveTo investigate if PE is a risk factor for OIs in Sweden. MethodsThis register-based study included employed workers aged 18-65, resident in Sweden between 2006 and 2014. PE was operationalised as a multidimensional construct (score) and by its five items (contract insecurity, contractual temporariness, multiple jobs/multiple sectors, income level, collective bargaining agreement). Our outcome was OI in the following year. Pooled ORs for OIs in relation to PE and PE items were calculated by means of multivariate logistic regression models for women and men separately. ResultsPrecarious workers were at lower risk of OIs as compared with non-precarious workers among both males and females (OR <1) also when applying weights for under-reporting and adjusting for time at risk (part-time work). Male agencies workers had a higher risk of OIs (OR 1.19, 95% CI 1.15 to 1.23), as did male and female workers in multiple jobs/sectors (OR 1.25, 95% CI 1.23 to 1.28 and OR 1.10, 95% CI 1.07 to 1.13 respectively), and female workers in the low-income groups (OR 1.11, 95% CI 1.09 to 1.12). Low coverage of collective bargaining agreements was associated with a lower risk of OIs for both men and women (OR 0.30, 95% CI 0.29 to 0.31 and OR 0.26, 95% CI 0.24 to 0.27, respectively). ConclusionsWhile several mechanisms may explain why precarious workers in Sweden present lower risks of OIs, several dimensions of PE such as temp agency work and multiple job-holding could be important risk factors for OIs and merit further research.
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| 33. |
- Kreshpaj, Bertina, et al.
(författare)
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Under-reporting of non-fatal occupational injuries among precarious and non-precarious workers in Sweden
- 2022
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Ingår i: Occupational and Environmental Medicine. - : BMJ. - 1351-0711 .- 1470-7926. ; 79:1, s. 3-9
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Tidskriftsartikel (refereegranskat)abstract
- Background Under-reporting of occupational injuries (OIs) among precariously employed workers in Sweden challenges effective surveillance of OIs and targeted preventive measures.Objective To estimate the magnitude of under-reporting of OIs among precarious and non-precarious workers in Sweden in 2013.Methods Capture–recapture methods were applied using the national OIs register and records from a labour market insurance company. Employed workers 18–65 resident in Sweden in 2013 were included in the study (n=82 949 OIs). Precarious employment was operationalised using the national labour market register, while injury severity was constructed from the National Patient Register. Under-reporting estimates were computed stratifying by OIs severity and by sociodemographic characteristics, occupations and precarious employment.Results Under-reporting of OIs followed a dose–response pattern according to the levels of precariousness (the higher the precarious level, the higher the under-reporting) being for the precarious group (22.6%, 95% CI 21.3% to 23.8%), followed by the borderline precarious (17.6%, 95% CI 17.1% to 18.2%) and lastly the non-precarious (15.0%, 95% CI 14.7% to 15.3%). Under-reporting of OIs, decreased as the injury severity increased and was higher with highest level of precariousness in all groups of severity. We also observed higher under-reporting estimates among all occupations in the precarious and borderline precarious groups as compared with the non-precarious ones.Conclusions This is the first register-based study to empirically demonstrate in Sweden that under-reporting of OIs is 50% higher among precariously employed workers. OIs under-reporting may represent unrecognised injuries that especially burden precariously employed workers as financial, health and social consequences shift from the employer to the employee.
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| 34. |
- Kreshpaj, Bertina, et al.
(författare)
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What is precarious employment? A systematic review of definitions and operationalizations from quantitative and qualitative studies
- 2020
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Ingår i: Scandinavian Journal of Work, Environment and Health. - : Scandinavian Journal of Work, Environment and Health. - 0355-3140 .- 1795-990X. ; 46:3, s. 235-247
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Forskningsöversikt (refereegranskat)abstract
- Objectives The lack of a common definition for precarious employment (PE) severely hampers the comparison of studies within and between countries, consequently reducing the applicability of research findings. We carried out a systematic review to summarize how PE has been conceptualized and implemented in research and identify the construct's dimensions in order to facilitate guidance on its operationalization.Methods According to PRISMA guidelines, we searched Web of Science and Scopus for publications with variations of PE in the title or abstract. The search returned 1225 unique entries, which were screened for eligibility. Exclusion criteria were (i) language other than English, (ii) lack of a definition for PE, and (iii) non-original research. A total of 63 full-text articles were included and qualitative thematic-analysis was performed in order to identify dimensions of PE.Results We identified several theory-based definitions of PE developed by previous researchers. Most definitions and operationalizations were either an accommodation to available data or the direct result of qualitative studies identifying themes of PE. The thematic-analysis of the selected articles resulted in a multidimensional construct including the following three dimensions: employment insecurity, income inadequacy, and lack of rights and protection.Conclusions Despite a growing number of studies on PE, most fail to clearly define the concept, severely restricting the advancement of the research of PE as a social determinant of health. Our combined theoretical and empirical review suggests that a common multidimensional definition could be developed and deployed in different labor market contexts using a variety of methodological approaches.
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| 35. |
- Kvart, Signild, et al.
(författare)
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Precarious employment and psychosocial hazards : A cross-sectional study in Stockholm county
- 2021
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Ingår i: International Journal of Environmental Research and Public Health. - : MDPI AG. - 1661-7827 .- 1660-4601. ; 18:21
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Tidskriftsartikel (refereegranskat)abstract
- Precarious employment (PE) has been linked to adverse health effects, possibly mediated through psychosocial hazards. The aim of this cross-sectional study is to explore if higher levels of PE are associated with psychosocial hazards (experiences of violence, sexual harassment, bullying, discrimination, high demands, and low control) and to explore gender differences in these patterns. The study is based on survey-and register data from a sample of 401 non-standard employees in Stockholm County (2016–2017). The level of PE (low/high) was assessed with the Swedish version of the employment precariousness scale (EPRES-Se) and analysed in relation to psychosocial hazards by means of generalized linear models, with the Poisson family and robust variances. After controlling for potential confounders (gender, age, country of birth, and education), the prevalence of suffering bullying (PR 1.07, 95% CI: 1.01–1.13) and discrimination (PR 1.52, 95% CI: 1.00–2.32) was higher among individuals with a high level of PE. Regarding the demand/control variables, a high level of PE was also associated with low control (PR 1.59, 95% CI: 1.30–1.96) and passive work (the combination of low demands and low control) (PR 1.60, 95% CI: 1.23–2.08). Our findings suggest that workers in PE are more likely to experience psychosocial hazards, and these experiences are more prevalent among women compared to men. Future longitudinal studies should look further into these associations and their implications for health and health inequalities.
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| 36. |
- Matilla-Santander, N., et al.
(författare)
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COVID-19 and Precarious Employment : Consequences of the Evolving Crisis
- 2021
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Ingår i: International Journal of Health Services. - : Sage Publications. - 0020-7314 .- 1541-4469. ; 5:2, s. 226-228
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Tidskriftsartikel (refereegranskat)abstract
- The world of work is facing an ongoing pandemic and an economic downturn with severe effects worldwide. Workers trapped in precarious employment (PE), both formal and informal, are among those most affected by the COVID-19 pandemic. Here we call attention to at least 5 critical ways that the consequences of the crisis among workers in PE will be felt globally: (a) PE will increase, (b) workers in PE will become more precarious, (c) workers in PE will face unemployment without being officially laid off, (d) workers in PE will be exposed to serious stressors and dramatic life changes that may lead to a rise in diseases of despair, and (e) PE might be a factor in deterring the control of or in generating new COVID-19 outbreaks. We conclude that what we really need is a new social contract, where the work of all workers is recognized and protected with adequate job contracts, employment security, and social protection in a new economy, both during and after the COVID-19 crisis.
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| 37. |
- Matilla-Santander, Nuria, et al.
(författare)
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Trajectories of precarious employment and the risk of myocardial infarction and stroke among middle-aged workers in Sweden : A register-based cohort study
- 2022
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Ingår i: The Lancet Regional Health. - : Elsevier BV. - 2666-7762. ; 15
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Tidskriftsartikel (refereegranskat)abstract
- Background The aim is to identify trajectories of precarious employment (PE) over time in Sweden to examine associations of these with the subsequent risk of myocardial infarction (MI) and stroke.Methods This is a nation-wide register-based cohort study of 1,583,957 individuals aged 40 to 61 years old residing in Sweden between 2003-2007. Trajectories of PE as a multidimensional construct and single PE components (contractual employment relationship, temporariness, income levels, multiple job holding, probability of coverage by collective agreements) were identified for 2003-2007 by means of group-based model trajectories. Risk Ratios (RR) for MI and stroke according to PE trajectories were calculated by means of generalized linear models with binomial family.Findings Adjusted estimates showed that constant PE and borderline PE trajectories increased the risk of MI (RR: 1.08, CI95%:1.05-1.11 and RR:1.13, CI95%: 1.07-1.20 respectively) and stroke (RR:1.14, CI95%: 1.10-1.18 and HR:1.24, CI95%: 1.16-1.33 respectively) among men. A higher risk of stroke in men was found for the following unidimensional trajectories: former agency employees (RR:1.32, CI95%:1.04-1.68); moving from high to a low probability of having collective agreements (RR: 1.10, CI95%:1.01-1.20). Having constant low or very low income was associated to an increased risk of MI and Stroke for both men and women.Interpretation The study findings provide evidence that PE increases the risk of stroke and possibly MI. It highlights the importance of being covered by collective bargaining agreements, being directly employed and having sufficient income levels over time.
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| 38. |
- Méndez-Rivero, Fabrizio, et al.
(författare)
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Can psychosocial risk factors mediate the association between precarious employment and mental health problems in Sweden? Results from a register-based study
- 2024
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Ingår i: Scandinavian Journal of Work, Environment and Health. - 0355-3140 .- 1795-990X.
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Tidskriftsartikel (refereegranskat)abstract
- Objectives The aim of this study was to examine the mediating effect of the psychosocial work environment on the association between precarious employment (PE) and increased risk of common mental disorders (CMD), substance use disorders and suicide attempts.Methods This longitudinal register-study was based on the working population of Sweden, aged 25-60 years in 2005 (N=2 552 589). Mediation analyses based on a decomposition of counterfactual effects were used to estimate the indirect effect of psychosocial risk factors (PRF) (mediators, measured in 2005) on the association between PE (exposure, measured in 2005) and the first diagnosis of CMD, substance use disorders, and suicide attempts occurring over 2006-2017.Results The decomposition of effects showed that the indirect effect of the PRF is practically null for the three outcomes considered, among both sexes. PE increased the odds of being diagnosed with CMD, substance use disorders, and suicide attempts, among both men and women. After adjusting for PE, low job control increased the odds of all three outcomes among both sexes, while high job demands decreased the odds of CMD among women. High job strain increased the odds of CMD and suicide attempts among men, while passive job increased the odds of all three outcomes among women. Conclusion The results of this study did not provide evidence for the hypothesis that psychosocial risks could be the pathways linking precarious employment with workers' mental health. Future studies in different social contexts and labour markets are needed.
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| 39. |
- Nelhans, Gustaf, 1973-, et al.
(författare)
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Methodological Considerations for Identifying Questionable Publishing in a National Context – the Case of Swedish Higher Education Institutions
- 2020
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Ingår i: Quantitative Science Studies. - Cambridge, Mass : MIT Press - Journals. - 2641-3337. ; 1:2, s. 505-524
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Tidskriftsartikel (refereegranskat)abstract
- The overall scope of this study is an attempt at a methodological framework for matching publication lists at the national level against a combined set of blacklists for questionable publishing. Using the total verified set of publications from Swedish Higher Education Institutions (HEI) as a case, we examined the number, distribution, and proportion of publishing in questionable journals at the national level. Journal publication data was extracted from the national SwePub database and matched against three curated blacklists of questionable publishing. For the period 2012–2017, we identified 1,743 published papers in blacklisted journals, equal to an average of 0.5–0.9% of the total publications from Swedish HEIs. There was high variability between different HEI categories, with more established universities at the lower end of the spectrum, while university colleges and new universities had a much higher proportion (∼2%). There was a general decreasing trend during the study period (ρ = 0.83) for all categories of HEI:s. The study presents a methodology to identify questionable publishing in academia which could be applied to other countries with similar infrastructure. Thus, it could serve as a starting point for the development of a general framework for cross-national quantitative estimation of questionable publishing.
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| 40. |
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| 41. |
- Orellana, Cecilia, et al.
(författare)
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Organisational factors and under-reporting of occupational injuries in Sweden : a population-based study using capture-recapture methodology
- 2021
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Ingår i: Occupational and Environmental Medicine. - : BMJ. - 1351-0711 .- 1470-7926. ; 78:10, s. 745-752
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Tidskriftsartikel (refereegranskat)abstract
- Objective To estimate the magnitude of under-reporting of non-fatal occupational injuries (OIs) by different organisational factors in Sweden for the year 2013.Methods Capture–recapture methods were applied using two data sources: (1) the national OI register and (2) records from a labour market insurance company. To assure comparability of data sources, the analysis was restricted to the public sector and private companies with at least 50 employees. OIs were matched using personal identification number and reported injury dates (±7 days). Organisational factors were obtained from the national labour market register and injury severity (no healthcare/only outpatient/hospitalised) from the National Patient Register. Total number of OIs and ascertainment by data sources were estimated assuming data source independence.Results There were an estimated 98 493 OIs in 2013. Completeness of reporting OIs to the national register and to the insurance company was estimated at 73% and 43%, respectively. No report to either source was estimated at 15 000 OIs (~15%). Under-reporting to the national register differed by selected organisational factors, being higher among organisations in the public sector, those with more females, with a younger workforce and with a higher proportion of immigrants. Overall under-reporting was more common in agriculture (19.7%), other services (19.3%), commerce and hospitality (19.1%), health (18.4%) and education (18.4%). Under-reporting decreased as injury severity increased, with little variations across sectors of economic activity.Conclusions Results suggest considerable under-reporting of OIs in Sweden and differential under-reporting by organisational factors. Results are relevant for official estimates of burden and for setting priorities for workplace safety and prevention.
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| 42. |
- Orellana, Cecilia, et al.
(författare)
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Precarious employment, business performance and occupational injuries : a study protocol of a register-based Swedish project
- 2019
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Ingår i: BMJ Open. - : BMJ. - 2044-6055. ; 9:2
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Tidskriftsartikel (refereegranskat)abstract
- Introduction There is uncertainty regarding the trends in occupational injuries (OIs) in Sweden due to a significant and increasing problem with under-reporting to injury registers. Under-reporting, in general, is likely to be exacerbated by the rise in precarious employment (PE), a set of unfavourable employment characteristics that would benefit from formal definition and study. PE and global trends are believed also to affect companies and their commitment to health and safety. The present study attempts to bridge these knowledge gaps and presents a study protocol for planned studies, with three main objectives: first, to review the literature for definitions of PE emphasising those that are multidimensional and operationalise components in routinely collected register data; second, to estimate the under-reporting of OI in Swedish registers and third, using results from the first objective, to conduct large, register-based prospective studies, designed to measure effect sizes and interactions between PE, business performance and OI. Methods and analysis First, a scientific literature review will be conducted, including scientific databases and grey literature. Second, data from two major OI registers will be used to estimate the magnitude of under-reporting using capture-recapture methodology. Finally, all residents aged 18-65 in Sweden with any registered income during 2003-2015 will be included. Data sources encompass Swedish population and labour market registers with linkage to both the main OI register with national coverage and hospital records. Trends in PE and OI will be explored, together with risk of OI associated with PE and business performance. Ethics and dissemination The project has been approved by the Regional Ethics Committee, Stockholm (dnr: 2016/2325-31; 2017/2173-32). Dissemination of study results will include a series of peer-reviewed papers, at least one PhD thesis and one report in Swedish, engaging relevant stakeholders. Results will be presented in national and international conferences and through press releases to mass media.
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| 43. |
- Thern, Emelie, et al.
(författare)
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Educational qualification differences and early labor market exit among men : the contribution of labor market marginalization measured across the working life
- 2022
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Ingår i: BMC Public Health. - : Springer Science and Business Media LLC. - 1471-2458. ; 22:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: The present study aims to investigate the association between educational qualification and early labor market exit among men and to examine the contribution of labor market marginalization measured across the working life on this association.Method: A register-linked cohort study was conducted including men who completed military service in 1969/70 (born between 1949 and 1951) and were alive at age 55 and not disability pension beneficiaries (n = 40 761). Information on the highest level of educational qualification and the outcome of early exit (disability pension, sickness absence, unemployment, and early old-age pension) was obtained from Swedish nationwide registers between the ages of 55 and 64 years. Labor market marginalization was defined as periods of long-term unemployment and sickness absence over the working life and up to follow-up. Cox regression analyses were used to obtain hazard ratios (HR) with 95% confidence intervals (CI).Results: Low-educated men were more likely to leave the labor force early due to disability pension or sickness absence (HR: 2.48), unemployment (HR: 2.09), and early old-age pension with- (HR:1.25) and without -income (HR: 1.58). Labor market marginalization across the working life explained a large part of the association for the more involuntary early exit routes (disability pensions, sickness absence, unemployment) and explained very little with regards to the more voluntary early exit routes (early old-age pension with and without income).Conclusion: Exposure to labor market marginalization across the working life was important in explaining educational differences in early labor market exit due to disability pension or sickness absence and unemployment. This study underscores the importance of identifying and implementing preventive measures in the workplace (e.g. adaptions) to prevent new spells of sickness absence and unemployment, especially among low educated individuals.
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| 44. |
- Thern, Emelie, 1987-, et al.
(författare)
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Precarious employment at a young age and labor-market marginalization during middle-adulthood : A register-linked cohort study
- 2023
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Ingår i: Scandinavian Journal of Work, Environment and Health. - : Scandinavian Journal of Work, Environment and Health. - 0355-3140 .- 1795-990X. ; 49:3, s. 201-210
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Tidskriftsartikel (refereegranskat)abstract
- Objective The present study aims to investigate the association between exposure to precarious employment three years after graduation and the risk of labor market marginalization (LMM) ten years later.Methods A registered-linked cohort study based on the Swedish Work, Illness, and Labor-market Participation (SWIP) cohort was conducted among all individuals born between 1973 and 1976, who were registered in Sweden the year they turned 27 years old (N=365 702). Information on the exposure of labor market establishment three years after graduating from school and outcome of LMM ten years after graduating was collected from nationwide registers. Relative risk ratios (RRR) with 95% confidence intervals (CI) were obtained by multinominal logistic regression.Results After considering important covariates, young adults in precarious employment three years after graduation were at an increased risk of future long-term unemployment (RRR 2.31), later precarious employment (RRR 2.85), and long-term sickness absence/disability pension (RRR 1.43) compared to individuals who had obtained standard employment arrangements within three years of graduating. Young precariously employed men had a slightly strong association compared to females with regards to all outcomes.Conclusion The result of this study suggests that both young men and women in precarious employment three years after graduation are more likely to have a weaker attachment to the labor force later in life compared to individuals of the same age in standard employment. This is important as the prevalence of precarious employment is increasing globally, and young adults appear to be especially vulnerable.
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| 45. |
- Thern, Emelie, et al.
(författare)
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Precarious employment in early adulthood and later mental health problems : a register-linked cohort study
- 2023
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Ingår i: Journal of Epidemiology and Community Health. - 0143-005X .- 1470-2738. ; 77:12, s. 755-761
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundPrecarious employment is a determinant of self-reported mental health problems among young adults. Less is known about more severe and objectively measured health outcomes, such as mental health problems requiring inpatient care. The current study aims to investigate the effect of precarious employment in early adulthood on later mental health problems requiring inpatient care. MethodA register-based cohort study, based on the Swedish Work, Illness and Labor-market Participation cohort, was conducted, following a cohort of young adults aged 27 years between 2000 and 2003 (born between 1973 and 1976) (n=339 403). Information on labour market position in early adulthood (precarious employment, substandard employment, unemployment and standard employment) was collected from registers 3 years after graduating from school. Information on the outcome of mental health problems (depression, anxiety and stress-related disorders) was collected from the National Patient Register. HRs with 95% CIs were obtained by Cox regression analyses. ResultsAfter adjusting for important covariates, such as prior mental health problems, compared with individuals in standard employment, individuals who were precariously employed in early adulthood had an increased risk of later mental health problems (HRadjusted: 1.51 95% CI 1.42 to 1.60). The association between precarious employment and mental health was slightly stronger for males. ConclusionsIn Sweden, entry into the labour market with precarious employment is associated with an increased risk of mental health problems, which is important given that precarious employment is becoming more prevalent among young adults.
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| 46. |
- Thern, Emelie, 1987-, et al.
(författare)
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Precarious employment in young adulthood and later alcohol-related morbidity : a register-based cohort study
- 2024
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Ingår i: Occupational and Environmental Medicine. - 1351-0711 .- 1470-7926. ; 81:4, s. 201-208
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Tidskriftsartikel (refereegranskat)abstract
- Objectives The prevalence of precarious employment is increasing, particularly among young adults where less is known about the long-term health consequences. The present study aims to test if being precariously employed in young adulthood is associated with an increased risk of alcohol-related morbidity later in life.Methods A register-based cohort study was conducted in Sweden. The Swedish Work, Illness, and Labor-market Participation (SWIP) cohort was used to identify individuals who were aged 27 years between 2000 and 2003 (n=339 403). Information on labour market position (precarious employment, long-term unemployment, substandard employment and standard employment relations) was collected for young people 3 years after graduation from school using nationwide registers. Details about alcohol-related morbidity during a 28-year follow-up period were collected from the National Hospital Discharge Register. Data on sex, age, country of birth, education and previous poor health were also obtained from the registers.Results Young adults in precarious employment had an increased risk of alcohol-related morbidity compared with individuals of the same age in standard employment (HR 1.43, 95% CI 1.32 to 1.55), after adjusting for several important covariates. A stronger association was found among young men who were precariously employed compared with young women.Conclusion This nationwide register-based study conducted in Sweden with a long-term follow-up suggests that being precariously employed in young adulthood is associated with an increased risk of alcohol-related morbidity later in life.
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| 47. |
- Viklund, Andreas, et al.
(författare)
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Night and shift work patterns and incidence of type 2 diabetes and hypertension in a prospective cohort study of healthcare employees
- 2023
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Ingår i: Scandinavian Journal of Work, Environment and Health. - 0355-3140 .- 1795-990X. ; 49:6, s. 439-448
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: This study aimed to evaluate effects of night and shift work patterns on type 2 diabetes (T2D) and hypertension in a longitudinal study, with detailed information on working hours.METHODS: The cohort comprised about 28 000 nurses and nursing assistants employed for more than one year 2008-2016 in Stockholm, Sweden. The employee register held detailed individual information on daily working hours. Information on diagnoses came from national and regional registers. Hazard ratios (HR) and confidence intervals (CI) were estimated by discrete-time proportional hazard models, adjusting for sex, age, country of birth, and profession.RESULTS: During follow-up in 2013-2017, we identified 232 cases of T2D and 875 of hypertension. We observed an increased risk of T2D, but not hypertension, among employees who worked only night shifts the previous year (HR 1.59, 95% CI 1.02-2.43) and those with intensive shift work (>120 afternoon and/or night shifts the previous year: HR 1.67, 95% CI 1.11-2.48) compared to only day work. There was a non-significantly increased risk of T2D related to mixed day and afternoon shifts (HR 1.34, 95% CI 0.97-1.88). We observed tendencies in increased risk of T2D related to frequent spells of ≥3 consecutive night shifts and with number of years with exclusive (but not mixed) night work.CONCLUSIONS: Permanent night work and frequent afternoon and/or night shifts were associated with an increased risk of T2D the following year, but not hypertension. The T2D risk was, to some extent, affected by frequent spells of several night shifts in a row and by cumulative years with permanent night work.
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| 48. |
- Wegman, D. H., et al.
(författare)
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Intervention to diminish dehydration and kidney damage among sugarcane workers
- 2018
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Ingår i: Scandinavian Journal of Work Environment & Health. - : Scandinavian Journal of Work, Environment and Health. - 0355-3140 .- 1795-990X. ; 44:1, s. 16-24
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Tidskriftsartikel (refereegranskat)abstract
- Objective The aim of this study was to assess the potential to reduce kidney function damage during the implementation of a water, rest, shade (WRS) and efficiency intervention program among sugarcane workers. Methods A WRS intervention program adapted from the US Occupational Safety and Health Administration (OSHA) coupled with an efficiency program began two months into the 5-month harvest. One of the two groups of workers studied was provided with portable water reservoirs, mobile shaded tents, and scheduled rest periods. Health data (anthropometric and questionnaires), blood, and urine were collected at baseline and at three subsequent times over the course of the harvest. Daily wet bulb globe temperatures (WBGT) were recorded. Results Across a working day there were changes in biomarkers indicating dehydration (urine osmolality) and serum albumin and reduced estimated glomerular filtration rate (eGFR). Cross-shift eGFR decrease was present in both groups; -10.5 mL/min/1.73m(2) [95% confidence interval (95% CI) -11.8- -9.1], but smaller for the intervention group after receiving the program. Decreased eGFR over the 5-month harvest was seen in both groups: in the one receiving the intervention -3.4 mL/min/1.73m(2) (95% CI -5.5- -1.3) and in the other -5.3 (95% CI -7.9-2.7). The decrease appeared to halt after the introduction of the intervention in the group receiving the program. Conclusion A WRS and efficiency intervention program was successfully introduced for workers in sugarcane fields and appears to reduce the impact of heat stress on acute and over-harvest biomarkers of kidney function. Further research is needed to determine whether biomarker changes predict reduced risk of chronic kidney disease in this type of work.
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| 49. |
- Östergren, Per-Olof, et al.
(författare)
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Selling one's future : over-indebtedness and the risk of poor mental health and the role of precarious employment - results from the Scania Public Health Cohort, Sweden
- 2022
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Ingår i: BMJ Open. - : BMJ. - 2044-6055. ; 12:11, s. 1-10
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: The credit market has expanded rapidly, increasing the risk of over-indebtedness among those who lack secure employment or adequate income, an issue of concern in the COVID-19 aftermath. We investigated the role of over-indebtedness for developing poor mental health, and whether this impact is modified by age, gender, educational level or being in precarious employment.METHODS: This is a cohort study using data from the Swedish Scania Public Health Cohort, based on individuals randomly selected from the general adult population in Scania, southern Sweden, initiated in 1999/2000 (response rate 58%) with follow-ups in 2005 and 2010. Over-indebtedness was assessed by combining information on cash margin and difficulty in paying household bills. Mental health was assessed by General Health Questionnaire-12. Those with poor mental health at baseline were excluded, and the analyses were further restricted to vocationally active individuals with complete data on main variables, resulting in 1256 men and 1539 women.RESULTS: Over-indebtedness was more common among women, among persons with a low educational level, born abroad and with a precarious employment at baseline. The age-adjusted incidence rate ratio (IRR) for poor mental health in 2010 among individuals exposed to over-indebtedness in 1999/2000 or 2005 was 2.2 (95% CI 1.7 to 2.8). Adjusting for educational level, country of origin and precarious employment in 1999/2000 or 2005, yielded an IRR of 2.0 (95% CI 1.6 to 2.6). An interaction analysis indicated that a high level of education may act synergistically with over-indebtedness, regarding poor mental health among men.CONCLUSIONS: Over-indebtedness was related to unfavourable societal power relations, regarding social class, gender and foreign birth. Precarious employment was independently linked to poor mental health and may also mediate the effect by over-indebtedness. The COVID-19 pandemic might entail increased over-indebtedness, which should be acknowledged in policies aiming at buffering social effects of the pandemic.
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