| 1. |
- 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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| 2. |
- Almroth, Melody, 1989-, et al.
(författare)
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The role of working conditions in educational differences in all-cause and ischemic heart disease mortality among Swedish men
- 2024
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Ingår i: Scandinavian Journal of Work, Environment and Health. - 0355-3140 .- 1795-990X. ; 50:4, s. 300-309
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Tidskriftsartikel (refereegranskat)abstract
- Objectives This study aims to investigate the extent to which low job control and heavy physical workload in middle age explain educational differences in all-cause and ischemic heart disease (IHD) mortality while accounting for important confounding factors.Methods The study is based on a register-linked cohort of men who were conscripted into the Swedish military at around the age of 18 in 1969/1970 and were alive and registered in Sweden in 2005 (N=46 565). Cox proportional hazards regression models were built to estimate educational differences in all-cause and IHD mortality and the extent to which this was explained by physical workload and job control around age 55 by calculating the reduction in hazard ratio (HR) after adjustments. Indicators of health, health behavior, and other factors measured during conscription were accounted for.Results We found a clear educational gradient for all-cause and IHD mortality (HR 2.07 and 2.47, respectively, for the lowest compared to the highest education level). A substantial part was explained by the differential distribution of the confounding factors. However, work-related factors, especially high physical workload, also played important explanatory roles.Conclusion Even after accounting for earlier life factors, low job control and especially high physical workload seem to be important mechanistic factors in explaining educational inequalities in all-cause and IHD mortality. It is therefore important to find ways to reduce physical workload and increase job control in order to decrease inequalities in mortality.
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| 3. |
- Berg, Lisa, 1980-, et al.
(författare)
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Using repeated measures to study the contribution of alcohol consumption and smoking to the social gradient in all‐cause mortality : Results from the Stockholm Public Health Cohort
- 2023
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Ingår i: Drug and Alcohol Review. - 0959-5236 .- 1465-3362. ; 42:7, s. 1850-1859
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: The social gradient in consumption behaviours has been suggestedto partly explain health inequalities. The majority of previous studies have onlyincluded baseline measurements and not considered potential changes in behav-iours over time. The study aimed to investigate the contribution of alcohol con-sumption and smoking to the social gradient in mortality and to assess whetherthe use of repeated measurements results in larger attenuations of the main asso-ciation compared to using single baseline assessments.Methods: Longitudinal survey data from the population-based Stockholm PublicHealth Cohort from 2006 to 2014 was linked to register data on mortality until2018 for 13,688 individuals and analysed through Cox regression.Results: Low socioeconomic position (SEP) was associated with increased mortal-ity compared with high SEP; hazard ratios 1.56 (95% CI 1.30–1.88) for occupa-tional status and 1.77 (95% CI 1.49–2.11) for education, after adjustment fordemographic characteristics. Using repeated measurements, alcohol consumptionand smoking explained 44% of the association between occupational status andall-cause mortality. Comparing repeated and baseline measures, the percentageattenuation due to alcohol consumption increased from 11% to 18%, whereas itremained similar for smoking (25–23%).Discussion and Conclusions: Smoking and alcohol consumption explained alarge part of the association between SEP and mortality. Comparing results fromtime-fixed and time-varying models, there was an increase in overall percentageattenuation that was mainly due to the increased proportion explained by alcoholconsumption. Repeated measurements provide a better estimation of the contri-bution of alcohol consumption, but not smoking, for the association between SEPand mortality.
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| 4. |
- Blindow, Katrina J., et al.
(författare)
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Gender-based harassment in Swedish workplaces and alcohol-related morbidity and mortality : A prospective cohort study
- 2023
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Ingår i: Scandinavian Journal of Work, Environment and Health. - : Nordic Association of Occupational Safety and Health (NOROSH). - 0355-3140 .- 1795-990X. ; 49:6, s. 395-404
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Tidskriftsartikel (refereegranskat)abstract
- Objective: The study investigated experiences of different types of work-related gender-based harassment (GBH), specifically sexual and gender harassment, as risk factors for alcohol-related morbidity and mortality (ARMM).Methods: Information about experiences of (i) sexual harassment (SH-I) and (ii) gender harassment (GH-I) from inside the organization and (iii) sexual harassment from a person external to the organization (SH-E) were obtained from the Swedish Work Environment Survey 1995–2013, a biannual cross-sectional survey, administered to a representative sample of the Swedish working population. The survey responses from 86 033 individuals were connected to multiple registers containing information about alcohol-related diagnoses, treatment, or cause of death. Cox proportional hazard models were fitted to assess hazard ratios (HR) of incident ARMM during a mean follow-up of eight (SH-I and GH-I) and ten (SH-E) years.Results: A higher prospective risk estimate of ARMM was found among participants who reported experiences of SH-E [HR 2.01, 95% confidence interval (CI) 1.61–2.52], GH-I (HR 1.33, CI 1.03–1.70), or SH-I (HR 2.37, CI 1.42–3.00). Additional analyses, distinguishing one-time from reoccurring harassment experiences, indicated a dose–response relationship for all three harassment types. Gender did not modify the associations. Under the assumption of causality, 9.3% (95% CI 5.4–13.1) of the risk of ARMM among Swedish women and 2.1% (95% CI 0.6–3.6) among Swedish men would be attributable to any of the three types of GBH included in this study.Conclusions: Experiences of GBH in the work context may be a highly relevant factor in the etiology of ARMM.
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| 5. |
- Carlsson, Emma, et al.
(författare)
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Do early life factors explain the educational differences in early labour market exit? A register-based cohort study
- 2023
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Ingår i: BMC Public Health. - 1471-2458. ; 23:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Socioeconomic inequalities in labour market participation are well established. However, we do not fully know what causes these inequalities. The present study aims to examine to what extent factors in childhood and late adolescence can explain educational differences in early labour market exit among older workers.Methods: All men born in 1951–1953 who underwent conscription examination for the Swedish military in 1969–1973 (n = 145 551) were followed from 50 to 64 years of age regarding early labour market exit (disability pension, long-term sickness absence, long-term unemployment and early old-age retirement with and without income). Early life factors, such as cognitive ability, stress resilience, and parental socioeconomic position, were included. Cox proportional-hazards regressions were used to estimate the association between the level of education and each early labour market exit pathway, including adjustment for early life factors.Results: The lowest educated men had a higher risk of exit through disability pension (HR: 2.72), long-term sickness absence (HR: 2.29), long-term unemployment (HR: 1.45), and early old-age retirement with (HR: 1.29) and without income (HR: 1.55) compared to the highest educated men. Factors from early life explained a large part of the educational differences in disability pension, long-term sickness absence and long-term unemployment but not for early old-age retirement. Important explanatory factors were cognitive ability and stress resilience, whilst cardiorespiratory fitness had negligible impact.Conclusions: The association between education and early exit due to disability pension, long-term sickness absence and long-term unemployment was to a large part explained by factors from early life. However, this was not seen for early old-age retirement. These results indicate the importance of taking a life-course perspective when examining labour market participation in later working life.
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| 6. |
- 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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| 7. |
- Landberg, Jonas, 1974-, et al.
(författare)
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Is the association between alcohol use and sickness absence modified by socioeconomic position? findings from the Stockholm public health cohort
- 2023
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Ingår i: BMC Public Health. - 1471-2458. ; 23:1
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundThe distribution of sickness absence tends to be socially patterned less is however known about the underlying mechanisms and pathways of the social gradient found in sickness absence. The present study aims to investigate (i) if the risk function between average volume of alcohol consumption and sickness absence is modified by socio-economic position (SEP), and (ii) whether such an effect modification can be attributed to differences in drinking patterns and other risk factors including other lifestyle behaviours, health status, and working conditions.MethodsThe study was based on data from the Stockholm public health cohort 2006, with an analytical sample of 13 855 respondents aged 18-64 years. Self-reported information on occupational class (a measure of SEP), alcohol consumption, other lifestyle behaviour, health and working conditions was collected from the survey. The outcome of long-term (> 14 days) sickness absence between 2006 and 2008 was obtained from national registers. Negative binomial regression was used to estimate the Incidence Rate Ratios (IRR) with 95% confidence intervals (CI).ResultsIn the initial analyses, heavy drinking manual workers had a 5-fold increased risk of long-term sickness absence compared to non-manual employees who were moderate drinkers, and approximately 60% of the excess risk among heavy drinking manual workers was attributable to an interaction between alcohol use and SEP. Adjusting for working conditions was associated with the largest attenuation of the risk estimate, compared to other lifestyle behaviors and health. In the fully adjusted model, the IRR was further attenuated for the manual workers and the joint effect of SEP and heavy drinking remained in the final model with an attributable proportion of 49%.ConclusionsIndividuals in Sweden with lower levels of SEP appear to be more vulnerable to alcohol consumption in relation to sickness absence, where differences in working conditions explained a large part but not all of the differential vulnerability.
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| 8. |
- Thern, Emelie
(författare)
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Alcohol-related health problems and crime : studies on the long-term consequences of increased alcohol availability and unemployment
- 2018
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: The well-being of young people with respect to health and life opportunities is of high importance in society. This thesis examines the long-term adverse consequences of two periods in Sweden marked by high vulnerability for young people; one period with a drastic increase in alcohol availability for young people and one period with exceptionally high youth unemployment. Research has demonstrated immediate beneficial effects of restricting alcohol availability among adolescents and young adults. Less is known about the long-term consequences of exposure to increased alcohol availability during adolescence for the individual’s themselves and the health and well-being of subsequent generations. Evidence suggests that youth unemployment is related to worse self-reported mental and physical health in the long-term. There remains a discussion in the literature regarding the effect of prior poor health and contextual influences on the association, especially in relation to youth unemployment.: Aim: The aim of this PhD thesis was therefore to investigate the potential effects of exposure to increased alcohol availability during adolescence and in utero on disability pension (Study I), alcohol-related health problems (Study II) and criminal behavior (Study III). This thesis also aimed at investigating the effects of youth unemployment on mental health during periods of high and low unemployment rates and to explore whether there was any interaction in mental health between labor force status and levels of unemployment in society (Study IV). Methods: Studies I to III were register-based population-based longitudinal studies using a natural experiment setting of an alcohol policy experiment. During the late 1960s, strong beer became available in regular grocery stores in two regions of Sweden for adolescents under the age of 21 years, instead of being available only in the state-owned monopoly store “Systembolaget” with an age limit of 21 years. Study I investigated the effect of exposure to increased alcohol availability during adolescence on disability pension compared with same- aged unexposed adolescents (age 14–20 years). Studies II and III focused on the long-term effects of increased alcohol availability on children in utero during the time of the alcohol policy experiment. Study IV was a register-linked population-based cohort study based on individuals who had completed the nationwide Labour Force Survey between the ages of 17– 24 years at times of high or low national unemployment rates. Results: An increased risk of being granted disability pension due to an alcohol use disorder and a mental disorder was found among adolescents exposed to increased alcohol availability. No consistent evidence of any long-term consequences in subsequent generations was found. However, a slightly increased risk of alcohol-related health problems later in life was observed among exposed children conceived by young mothers. The results from Study IV showed a positive association between youth unemployment and mental health problems, irrespective of the overall national level of unemployment. Conclusion: Exposure to increased alcohol availability during adolescence can have long-term health consequences, for both the individual and subsequent generations. Furthermore, youth unemployment is longitudinally related to mental health problems, independent of the overall national unemployment rate. These findings are of importance, as alcohol remains a leading cause of morbidity and mortality and youth unemployment rates are currently at a stable high level both nationally and globally.
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| 9. |
- Thern, Emelie, et al.
(författare)
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Educational differences in labor market marginalization among mature-aged working men : the contribution of early health behaviors, previous employment histories, and poor mental health
- 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: Social inequalities in labor force participation are well established, but the causes of these inequalities are not fully understood. The present study aims to investigate the association between educational qualification and labor market marginalization (LMM) among mature-aged working men and to examine to what extent the association can be explained by risk factors over the life course.Method: The study was based on a cohort of men born between 1949 and 1951 who were examined for Swedish military service in 1969/70 and employed in 2000 (n=41,685). Data on educational qualification was obtained in 2000 and information on the outcome of LMM (unemployment, sickness absence, and disability pension) was obtained between 2001 and 2008. Information on early health behaviors, cognitive ability, previous employment histories, and mental health was collected from conscription examinations and nationwide registers.Results: Evidence of a graded association between years of education and LMM was found. In the crude model, compared to men with the highest level of education men with less than 12years of schooling had more than a 2.5-fold increased risk of health-related LMM and more than a 1.5-fold increased risk of non-health-related LMM. Risk factors measured across the life course explained a large part of the association between education and health-related LMM (33-61%) and non-health-related LMM (13-58%).Conclusions: Educational differences remained regarding LMM among mature-aged workers, even after considering several important risk factors measured across the life course. Previous health problems and disrupted employment histories explained the largest part of the associations.
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| 10. |
- 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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| 11. |
- Thern, Emelie, et al.
(författare)
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Effects of increased alcohol availability during adolescence on the risk of all-cause and cause-specific disability pension : a natural experiment
- 2017
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Ingår i: Addiction. - : Wiley. - 0965-2140 .- 1360-0443. ; 112:6, s. 1004-1012
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Tidskriftsartikel (refereegranskat)abstract
- Aim To test if being exposed to increased alcohol availability during adolescence is associated with an increased risk of receiving disability pension due to all-cause, alcohol use disorders and mental disorders. Design Register-based population-based study using a natural experiment setting, the alcohol policy change in Sweden (1967-68), with increased access to strong beer in a narrow time window and geographical area. The individuals exposed to the policy change were compared with non-exposed individuals living in the rest of Sweden, excluding a border area. Setting Sweden. Participants A total of 518810 individuals (70761 in the intervention group; 448049 in the control group) born 1948-1953, aged 14-20 years during the policy change. Measurements Date and diagnosis of the outcome variable of disability pension due to all-cause, alcohol use disorders and mental disorders were obtained from the Swedish National Social Insurance Agency database from 1971 to 2013. Individual and family level socio-demographic and health-related covariates, as well as a regional level covariate, were included. Findings Compared with the control group, adolescents exposed to the alcohol policy change were at an increased risk of receiving disability pension due to all-causes [hazard ratio (HR)=1.09, 95% confidence interval (CI)=1.07-1.11], alcohol use disorders (HR=1.17, 95% CI=1.05-1.30) and mental disorders (HR=1.19, 95% CI=1.15-1.23). Conclusion In Sweden, a natural experiment with a 43-year follow-up suggests that exposure to increased alcohol availability during adolescence is associated with an increased risk of receiving a disability pension due to all-cause, alcohol use disorder and mental disorder diagnoses.
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| 12. |
- Thern, Emelie, et al.
(författare)
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Exercise and factors associated with active commuting
- 2014
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Background: In order to increase the current levels of physical activity new strategies have been suggested where it is incorporated into daily routines, such as commuting to and from school/work. Active commuting i.e. cycling or walking to and from school/work is an excellent strategy to increase the overall activity levels. Even though the health benefits of active commuting are well documented, non-active modes of transportation (i.e. cars, bus, train) remain the main mode of transportation. The purpose of the present study is to examine the prevalence and what factors are influencing participation in active commuting in the municipality of Karlskrona, Sweden. Method: A cross-sectional study, including base-line data from parents-to- be was carried out, including 432 participants. Questionnaires were filled in and data collection was conducted during a year in 2008 and 2009. The results were calculated using multivariate logistic regression with odds ratios (OR) and 95% confidence interval (CI). Results: The main mode of commuting was motorised vehicle (63.0%), whilst active commuters were a minority (8.3%). The regression model demonstrated a negative association between being Swedish and AC; as such immigrants were more likely to be active commuters (CI 0.08-0.80). The variable mostly associated with AC was the type of residential area. Participants living in an urban area had 5.4 times higher odds of AC compared to participants living in a rural area (CI 1.51-18.54). Being surrounded by a green-space environment decreased the probability of engaging in AC compared to being surrounded by buildings the majority of time (CI 0.07-0.60). Another important variable was outdoor recreational PA, were engaging resulted in 3.9 times higher odds of AC compared to those not engaging in outdoor recreational PA (CI 1.31-11.71). Although the variable pet-ownership remained in the last step of the model non-significant, it explains some of the variance in the model (0.10-1.24). Conclusions: The number of people being active are modest and are instead using other modes of transportation. This study found several factors both facilitating and impeding active commuting, signifying the importance of applying a broad health promotional approach to active commuting.
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| 13. |
- Thern, Emelie, et al.
(författare)
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Factors associated with active commuting among parents-to-be in Karlskrona, Sweden
- 2015
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Ingår i: Scandinavian Journal of Public Health. - : SAGE. - 1403-4948 .- 1651-1905. ; 43:1, s. 59-65
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Tidskriftsartikel (refereegranskat)abstract
- Aim: The purpose of the present study is to examine the prevalence of active commuting and factors associated with participation in active commuting in the municipality of Karlskrona, Sweden. Active commuting is defined here as walking or cycling to and from school/work for at least 15 min one-way. Method: A cross-sectional study was carried out, which included baseline data from parents-to-be. Pregnant females and their partners were invited to participate in the study when they contacted either of the municipality’s two antenatal clinics. Data collection ran from March 2008 to February 2009. When completing the questionnaire, the participants were asked to reflect on their situation one month before the female became pregnant. The final sample consisted of 432 participants (response rate 51.9% for females and 85.0% for males). Results: The main mode of commuting was motor vehicle (63.0%), with active commuters forming a minority (8.3%). The main facilitating factor for active commuting was living in an urban as opposed to a rural area. Regular participation in outdoor recreational physical activity was significantly positively associated with active commuting. Being Swedish and being surrounded by a green space environment were significantly negatively associated with active commuting. Conclusions: This study found that the number of people who are active commuters is modest and other modes of transportation are preferred. Several facilitating and impeding factors associated with active commuting were also found, indicating the importance of applying a broad health-promoting approach to encouraging active commuting.
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| 14. |
- Thern, Emelie, et al.
(författare)
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Long-term effects of youth unemployment on alcoholrelated morbidity
- 2020
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Ingår i: Addiction. - : Wiley. - 0965-2140 .- 1360-0443. ; 115:3, s. 418-425
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Tidskriftsartikel (refereegranskat)abstract
- AimTo test if exposure to unemployment in young adulthood is associated with an increased risk of later alcohol‐related morbidity.DesignA nation‐wide register‐linked longitudinal population‐based study.SettingSweden.ParticipantsA total of 16 490 individuals born between 1967 and 1978, who had participated in the Labour Force Survey between the ages of 16–24 years during 1990–95.MeasurementInformation on the outcome of alcohol‐related morbidity was obtained from the National Hospital Discharge Register. The Swedish index of alcohol‐related in‐patient care was used to define the outcome. Information on sex, age and country of birth, as well as parents’ level of education, socio‐economic status and alcohol‐related health problems, were also obtained. Average follow‐up time was 22 years. Cox regression analysis was used to obtain hazard ratios (HR) with 95% confidence intervals (CI).FindingsCompared with full‐time students, individuals who experienced short‐ and long‐term unemployment spells at a young age were at an increased risk of later alcohol‐related morbidity; < 3 months (HR = 2.04, 95% CI = 1.35–3.09), 3–6 months (HR = 2.20, 95% CI = 1.29–3.75) and > 6 months (HR = 1.99, 95% CI = 1.06–3.71) of unemployment, after adjusting for several important individual and family level covariates.ConclusionIn Sweden, a nation‐wide register‐based study with a 22‐year follow‐up suggests that being unemployed in young adulthood is associated with an increased risk of alcohol‐related morbidity later in life.
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| 15. |
- Thern, Emelie, et al.
(författare)
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Long-term effects of youth unemployment on mental health : does an economic crisis make a difference?
- 2017
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Ingår i: Journal of Epidemiology and Community Health. - : BMJ. - 0143-005X .- 1470-2738. ; 71:4, s. 344-349
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Tidskriftsartikel (refereegranskat)abstract
- Background Ill health is a risk factor and a consequence of unemployment, which might vary depending on the national rate of unemployment. We investigated the long-term effect of youth unemployment on mental health and explored the possible interaction during periods of high (economic crisis) and low (non-crisis) unemployment rates. Methods A register-linked population-based cohort study was conducted including individuals aged 1724 years. The crisis cohort (n= 6410) took part in the Labour Force Survey during the economic crisis (1991-1994) in Sweden and the non-crisis cohort (n= 8162) took part in the same survey before the crisis (1983-1986). Follow-up was 19 years. Adjusted HRs and 95% CIs for an inpatient care discharge mental diagnosis with employed people as the reference group were calculated by Cox regressions models. Results In fully adjusted models, <3 months (HR: 1.69; 95% CI 1.14 to 2.49), 3-6 months (2.19; 1.43 to 3.37) and > 6 months (2.70; 1.71 to 4.28) of unemployment were associated with increased risks of getting a mental diagnosis in the crisis cohort. In the non-crisis cohort the risks were: 1.92; 1.40 to 2.63, 2.60; 1.72 to 3.94 and 3.33; 2.00 to 5.57, respectively. No interactions between labour force status and level of unemployment were found. Conclusions Youth unemployment is related to mental health problems, independent of the overall national rate of unemployment, which is important as the youth unemployment rates are currently at stable high level.
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| 16. |
- Thern, Emelie, et al.
(författare)
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No effects of increased alcohol availability during adolescence on alcohol-related morbidity and mortality during four decades : a natural experiment
- 2017
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Ingår i: Journal of Epidemiology and Community Health. - : BMJ. - 0143-005X .- 1470-2738. ; 71:11, s. 1072-1077
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: A strict high legal age limit for alcohol purchases decreases adolescents' access to alcohol, but little is known about long-term health effects. The aim was to estimate the effect of increased alcohol availability during adolescence on alcohol-related morbidity and mortality.METHODS: A nationwide register-based study using data from a natural experiment setting. In two regions of Sweden, strong beer (4.5%-5.6% alcohol by volume) became temporarily available for purchase in grocery stores for individuals 16 years or older (instead of 21) in 1967/1968. The intervention group was defined as all individuals living in the intervention area when they were 14-20 years old (n=72 110). The remaining Swedish counties excluding bordering counties, without the policy change, were used as the control group (n=456 224). The outcomes of alcohol-related morbidity and mortality were collected from the Hospital Discharge Register and Cause of Death Register, in which average follow-up times were 38 years and 41 years, respectively. HRs with 95% CIs were obtained by Cox regression analysis.RESULTS: In the fully adjusted model, no clear evidence of an association between increased alcohol availability during adolescence and alcohol-related morbidity (HR: 0.99, 95% CI 0.96 to 1.02) or mortality (HR: 1.02, 95% CI 0.95 to 1.10) was found.CONCLUSION: The initial elevated risk of alcohol-related morbidity and mortality later in life among adolescents exposed to increased access to strong beer in Sweden vanished when a regional measure population density of locality was included in the model, which is important to consider in future research.
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| 17. |
- 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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| 18. |
- 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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| 19. |
- 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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| 20. |
- Thern, Emelie, et al.
(författare)
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The associations between unemployment at a young age and binge drinking and alcohol-related problems
- 2020
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Ingår i: European Journal of Public Health. - : Oxford University Press (OUP). - 1101-1262 .- 1464-360X. ; 30:2, s. 368-373
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Tidskriftsartikel (refereegranskat)abstract
- Background: Youth unemployment remains at a high stable level in many countries making it a public health problem of importance. The aim was to examine the short-term effect of unemployment at a young age (aged 17-29 years) on self-reported binge drinking and alcohol-related problems. Methods: We used data from a cross-sectional national study that took place in 2013, with a follow-up in 2014. A sample of young adults aged 17-29 years (n = 1188, response rate of 46.3%) that completed both surveys served as the study sample in the current study. The same self-reported questionnaire, consisting of questions regarding their alcohol habits and sociodemographic information, was used on both occasions. Information on the outcomes of binge drinking and alcohol-related harm were obtained from the 2014 survey. From the 2013 survey, information on individual and family level covariates were collected. Odds ratios (ORs) with 95% confidence intervals (CIs) with employed individuals as the reference group were estimated by logistic regression analysis. Results: At baseline, results indicate that employed individuals reported the greatest prevalence of weekly binge drinking. In the fully adjusted models, unemployment appeared to be associated with an increased risk of alcohol-related problems (OR 1.37, 95% CI 0.77-2.45); however, this was not the case for weekly binge drinking (OR 0. 94, 95% CI 0.45-1.96). Conclusion: Unemployment at a young age may be a risk factor for later alcohol-related problems. Thus, targeting youth unemployment could be one element in an effective health policy aimed at reducing rates of alcohol use disorders.
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| 21. |
- Thern, Emelie, et al.
(författare)
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The effect of increased alcohol availability on alcohol-related health problems up to the age of 42 among children exposed in utero : A natural experiment
- 2018
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Ingår i: Alcohol and Alcoholism. - : Oxford University Press (OUP). - 0735-0414 .- 1464-3502. ; 53:1, s. 104-111
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Tidskriftsartikel (refereegranskat)abstract
- Aim: To examine whether exposure to increased alcohol availability in utero is associated with later alcohol-related health problems. Method: Register-linked population-based longitudinal study using data from a natural experiment setting, including 363 286 children born 1965-71. An experimental alcohol policy change was piloted in two regions of Sweden in 1967-68, where access to strong beer increased for 16-20 year old. Children exposed in utero to the policy change were compared to children born elsewhere in Sweden (excluding a border area), and to children born before and after the policy change. The outcome was obtained from the National Hospital Discharge Register using the Swedish index of alcohol-related inpatient care. Hazard ratios (HR) with 95% confidence intervals (CI) were estimated by Cox regression analysis. Results: The results suggest that children conceived by young mothers prior to the policy change but exposed to it in utero had a slightly increased risk of alcohol-related health problems later in life (HR 1.26, 95% CI 0.94-1.68). A tendency towards an inverse association was found among children conceived by older mothers (HR 0.88, 95% CI 0.74-1.06). Conclusion: Results obtained from a natural experiment setting found no consistent evidence of long-term health consequences among children exposed in utero to an alcohol policy change. Some evidence however suggested an increased risk of alcohol-related health problems among the exposed children of young mothers.
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| 22. |
- Thern, Emelie, et al.
(författare)
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Understanding the differential effect of alcohol consumption on the relation between socio-economic position and alcohol-related health problems : results from the Stockholm Public Health Cohort
- 2021
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Ingår i: Addiction. - : Wiley. - 0965-2140 .- 1360-0443. ; 116:4, s. 799-808
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Tidskriftsartikel (refereegranskat)abstract
- Aim To test (i) whether the harmful effects of average volume of alcohol consumption (AC) and heavy episodic drinking (HED) differ by socio‐economic position (SEP), and (ii) if so, to what extent such differential effects can be attributed to an unequal distribution of harmful levels and patterns of drinking, health, life‐style and social factors. Design A longitudinal cohort study with baseline in 2002 or 2006, with record‐linkage to national registers. Setting Stockholm County, Sweden. Participants A total of 37484 individuals, aged 25–70 years, responding to the survey in 2002 or 2006. Measurements The outcome of alcohol‐related health problems was obtained from the National Patient Register and Cause of Death Register using the Swedish index diagnoses related to alcohol use. Self‐reported information on occupational class (measure of SEP), AC, HED as well as other health‐related factors were extracted from the surveys. Average follow‐up time was 13.3 years. Findings During follow‐up, a total of 1237 first‐time events of alcohol‐related health problems occurred. After initial adjustments, heavy drinking appeared to be more harmful to individuals with low SEP compared with high SEP (P ¼ 0.001). Differences in HED frequency explained the largest part of the differential effect of AC. Engaging in weekly HED was more harmful to individuals with low SEP (P ¼ 0.031) than high SEP. Differences in AC, together with other factors, explained a large part of the differential effect of HED. Conclusions The greater adverse impact of alcohol consumption on health in Sweden on people with lower socio‐economic position may be largely attributable to higher prevalence of heavy episodic drinking, as well as other behavioral and social risk factors.
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