Unemploymen in he eens
and ajec o ies o alcohol consump ion
in adul hood
Pekka Vi anen,
1,2
Tomi Lin onen,
3
Hugo Wes e lund,
4
Tapio Nummi,
5
U ban Janle ,
2
Anne Hamma s öm
2
To ci e: Vi anen P,
Lin onen T, Wes e lund H,
e al. Unemploymen in he
eens and ajec o ies o
alcohol consump ion in
adul hood. BMJ Open
2016;6:e006430.
doi:10.1136/bmjopen-2014-
006430
▸P epublica ion his o y o
his pape is a ailable online.
To iew hese iles please
isi he jou nal online
(h p://dx.doi.o g/10.1136/
bmjopen-2014-006430).
Recei ed 22 June 2015
Re ised 4 Sep embe 2015
Accep ed 21 Oc obe 2015
1
Uni e si y o Tampe e,
Ins i u e o Ad anced Social
Resea ch and School o
Heal h Sciences, Tampe e,
Finland
2
Depa men o Public Heal h
and Clinical Medicine, Umeå
Uni e si y, Umeå, Sweden
3
The Finnish Founda ion o
Alcohol S udies, Helsinki,
Finland
4
Uni e si y o S ockholm,
S ess Resea ch Cen e,
S ockholm, Sweden
5
Uni e si y o Tampe e,
School o Heal h Sciences,
Tampe e, Finland
Co espondence o
D Pekka Vi anen;
[email p o ec ed]i
ABSTRACT
Objec i es: The unemployed a e assumed o adop
unheal hy beha iou s, including ha m ul use o
alcohol. This s udy sough o elucida e he ela ions
be ween unemploymen be o e age 21 yea s and
consump ion o alcohol om 21 o 42 yea s. The
design was based on he concep ion o you h as a
sensi i e pe iod o ob aining ‘d inking sca s’ ha a e
isible up o middle age.
Se ing: The No he n Swedish Coho S udy has
ollowed up a popula ion sample om 1981 o 2007
wi h i e su eys.
Pa icipan s: All pupils (n=1083) a ending he las
yea o compulso y school in Luleå pa icipa ed in he
baseline su ey in class ooms, and 1010 o hem (522
men and 488 women) pa icipa ed in he las ollow-up
su ey ha was conduc ed a classma e eunions o by
pos o by phone.
Ou come measu e: The ajec o y o alcohol
consump ion om 21 o 43 yea s, ob ained wi h la en
class g ow h analyses, was scaled.
Resul s: Men we e assigned o i e and women o
h ee consump ion ajec o ies. The ajec o y
membe ship was eg essed on accumula ion o
unemploymen om 16 o 21 yea s, wi h mul inomial
logis ic eg ession analyses. The ajec o y o mode a e
consump ion was p eceded by lowes exposu e o
unemploymen in men and in women. Wi h e e ence
o his, he ela i e isk a ios o high-le el ajec o y
g oups we e 3.49 (1.25 o 9.79) in men and 1.41
(0.74 o 2.72) in women, bu also he ajec o ies o
low-le el consump ion we e mo e p obable ( ela i e
isk a io 3.18 (1.12 o 9.02) in men and 2.41 (1.24 o
4.67) in women).
Conclusions: High-le el alcohol consump ion
h oughou adul hood is, pa icula ly among men,
pa ly due o ‘sca s’ om you h unemploymen ,
pa icula ly in men, bu he e a e also g oups o men
and women whe e unemploymen in he eens p edic s
a ajec o y o low consump ion.
BACKGROUND
A lo o esea ch has been de o ed o show
ha unemploymen inc eases in ake o
alcohol, binge d inking and diagnosed
alcohol use diso de s.
1–4
The esea ch is
based on he heo e ical easoning ha
losing one’s job and being jobless may be
accompanied by condi ions— o example,
inc eased dis ess, wo sening men al heal h,
eelings o us a ion and shame, loss o
s uc u es o daily li e and ensions in amily
and o he social ela ions— ha p edispose
indi iduals o inc ease hei d inking.
2
The e
a e findings suppo ing his logic, bu he
e idence o unemploymen as a cause o
d inking seems o be less consis en han he
e idence o d inking as a cause o unemploy-
men .
3
The e o e, i is easonable o assume
ha he e a e also condi ions ha may
dec ease d inking: in addi ion o educed
income, unemploymen means, in any case,
lack o job- ela ed s ess and also, in some
cases, dis ance om he ‘we ’cul u e ep e-
sen ed by wo kma es. Indeed, wo king seems
o be associa ed wi h high consump ion, a
leas in adolescence.
5
Unemploymen is qui e common a ound
he en y o wo k li e.
67
Pa ly, pe iods o
you h unemploymen may be conside ed as
ansien and ela i ely unimpo an ic ion
in he a achmen o he labou ma ke . On
he o he hand, unemploymen in he eens
S eng hs and limi a ions o his s udy
▪This was a long (27 yea s) ollow-up o a popu-
la ion coho wi h i ually o al pa icipa ion in
he su eys.
▪Owing o he high pa icipa ion a e, he e was
no d inking- ela ed sample a i ion.
▪By i ue o b eaking he a e age de elopmen
down o ajec o ies, he s udy cla i ied and
quan i ied he dual de elopmen : exposu e o
you h unemploymen inc eases he p obabili y o
bo h high and low-le el consump ion o alcohol
in adul hood.
▪The indings may be limi ed o Sweden and
simila socie ies.
Vi anen P, e al.BMJ Open 2016;6:e006430. doi:10.1136/bmjopen-2014-006430 1
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may be dele e ious, because i occu s du ing a phase o
he li e cou se ha is impo an o he de elopmen o
independence and iden i y o an indi idual. In addi ion
o—and also due o—causing li elong ‘wage penal ies’
8
and pe manen ‘sca s’in he labou ma ke a achmen
and employabili y,
9
unemploymen du ing his sensi i e
pe iod may lea e ‘sca s’, in e ms o socialisa ion, and a
li es yle o isky heal h beha iou s, as well as in e ms o
lowe ed men al well-being and may ul ima ely ha m
soma ic heal h. In his con ex , he ela ion o you h
unemploymen wi h alcohol consump ion in adul hood
poses an essen ial ques ion.
A s udy
10
ha ollowed up 17–19-yea -old No wegians
o 3 yea s ound ha exposu e o unemploymen was
no associa ed wi h alcohol consump ion (measu ed as
cl o pu e alcohol in 1 yea ) when con olling o he
in ake a baseline. In con as , a s udy om he USA
showed ha being hea y d inke (consuming mo e han
fi e d inks on one occasion) a he age o 27–35 yea s
was associa ed wi h exposu e o unemploymen du ing
he p eceding 12-yea pe iod
11
Acco ding o a B i ish
s udy among men,
12
he associa ion o high-alcohol con-
sump ion a he age o 33 yea s (belonging o he op
fi h) wi h unemploymen expe ienced be ween he ages
16 o 33 yea s was non-significan , whe eas unemploy-
men du ing he p eceding yea was associa ed wi h
hea y d inking.
The p esen s udy is based on a 26-yea ollow-up o
he No he n Swedish Coho .
13
An ea ly s udy wi h he
coho
14
ound ha , bo h among men and women,
hose exposed o unemploymen o mo e han
20 weeks a age 16–21 yea s consumed mo e alcohol a
21 yea s, compa ed wi h hose ha ing less o no expos-
u e. The associa ions be ween exposu e and consump-
ion emained significan a e adjus men s o
consump ion a 16 yea s and a se o socioeconomic
ac o s. In he s udy based on ollow-up un il he age o
30 yea s,
15
he pa icipan s we e classified in oan ea ly
unemploymen g oup (unemployed o e 6 mon hs
be ween he ages o 16 and 21 yea s, i espec i e o la e
unemploymen ), he la e unemploymen g oup
(unemployed o e 18 mon hs be ween he ages o 22
and 30 yea s and unemployed less han 6 mon hs
be ween he ages o 16 and 21 yea s) and he e e ence
g oup consis ing o hose who did no ulfil hese c i-
e ia. A dicho omous measu e (spli a 75 h cen ile, sep-
a a ely o men and women) was used as indica o o
high consump ion o alcohol e sus none. Th oughou
he ollow-up, he figu es o high consump ion we e
g ea es in he ea ly unemploymen g oups. A e adjus -
ing o consump ion a baseline, howe e , nei he in he
ea ly no la e unemploymen g oup did he p obabili y
o being a high consume a he age o 30 yea s di e
significan ly om he e e ence g oup.
In his s udy, we we e asking how exposu e o
unemploymen in he 1980s, when pa icipan s o he
No he n Swedish Coho we e in hei eens, is
eflec ed in hei consump ion o alcohol in he 1990s
and in he 2000s, up o he age o 42 yea s. Ou hypo h-
esis was ha , in spi e o he non-significan findings o
he p e ious s udy, an analysis based on longe - e m
ollow-up and iden ifica ion o longi udinal pa e ns o
consump ion would e eal ha you h unemploymen
p edic s high consump ion in adul hood bo h among
men and women.
DATA AND VARIABLES
The No he n Swedish Coho S udy was se up in 1981
wi h a ques ionnai e o all pupils (n=1083) who
a ended he las yea o compulso y school (age
16 yea s) in all nine schools in a middle-sized municipal-
i y in No he n Sweden. Follow-up su eys we e con-
duc ed in 1983 (age 18 yea s), 1987 (age 21 yea s), 1995
(age 30 yea s) and 2007 (age 42 yea s). The esponse
a es we e e y high: a he 26-yea ollow-up in 2007, a
o al o 522 men and 488 women (n=1010, 94% o hose
s ill ali e) con inued o pa icipa e.
The baseline su ey ook place in class ooms. The
ques ionnai e con ained que ies on soma ic and men al
heal h, amily backg ound, school pe o mance and
en i onmen and, as pa o heal h- ela ed beha iou s,
he use o alcohol. The pupils we e asked o a e hei
consump ion o alcohol as equency o d inking occa-
sions and a e age in ake o bee (numbe o bo les),
wine (numbe o glasses) and s ong be e ages (numbe
o d inks) on each occasion. This ques ion on alcohol
use was included in subsequen su eys ha ook place
a classma e eunions, and hose who did no a end
we e su eyed by pos o by elephone.
The ques ionnai e a 18 yea s o age included a ques-
ion abou o al du a ion o unemploymen in mon hs
du ing he p e ious 2 yea s, ha is, since he end o
compulso y school. The p incipal in es iga o (AH) con-
duc ed pe sonal in e iews abou leng h o unemploy-
men a he ollow-ups a 18 and 21 yea s wi h all hose
who had been unemployed du ing he pe iod. In he
ques ionnai e a 21 yea s, he e was a ma ix ha con-
sis ed o columns ep esen ing sp ing semes e , summe
and au umn semes e du ing he p e ious 3 yea s, and
ows ep esen ing di e en labou ma ke posi ions. I
he esponden ma ked only he posi ion ‘unemployed’,
he o she was classified as ha ing been unemployed o
he whole 6-mon h pe iod; i he e we e, in addi ion,
some o he posi ion(s), he numbe o unemploymen
mon hs was ob ained by di iding du a ion o he pe iod
by numbe o op ions. Values o he pe iods plus he
alues o ages 16 o 18 yea s we e hen summed in o
he a iable ‘mon hs o you h unemploymen ’.
The 1981 su ey included ques ions ega ding he
occupa ion o he mo he and he a he o he espond-
en . Applying he Swedish classifica ion sys em,
16
he
occupa ion o each pa en was classified in o social
g oup 1 (including en ep eneu s and highe whi e-
colla wo ke s), social g oup 2 (including lowe whi e
colla wo ke s) and social g oup 3 (including manual
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and non-manual wo ke s). The pa en al social class was
defined as ha ing no, one o wo pa en s om social
g oup 3. The ques ion abou soma ic and men al heal h
o he a he and mo he specified alcoholism as one o
he heal h p oblems; he eplies we e combined in o a
‘pa en al alcoholism’ a iable.
T uancy a 16 yea s o age was included in he analyses
as an indica o o ex e nalised beha iou . Replies o he
fi e-op ion ques ion abou absence om school wi hou
illness o a e asking o and ha ing been g an ed pe -
mission we e dicho omised as ne e /a ew imes in a
semes e .
Measu es o alcohol consump ion
Repo ed amoun s and equencies o in ake o be -
e ages we e calcula ed in o yea ly a e age in ake in cen-
ili es o absolu e alcohol a 21, 30 and 42 yea s, which
was hen used o cons uc wo di e en a iables o
alcohol consump ion. Fi s , hea y d inking a he 21, 30
and 42 yea s was defined as belonging o he uppe con-
sump ion qua ile, sepa a ely o men and women.
Second, he e ogenei y in he longi udinal de elopmen
o he consump ion om 21 o 42 yea s was analysed by
la en class g ow h analysis.
17 18
The consump ion ajec-
o ies we e iden ified using he Flexmix package
19
in R
s a is ical so wa e. Fi s deg ee polynomial (linea )
models we e fi ed and p io p obabili ies es ima ed
using he me hod o maximum likelihood. The Bayesian
In o ma ion C i e ia (BIC) sugges ed h ee ajec o ies
o women and fi e ajec o ies o men as p e e ed
solu ions.
Among women (figu e 1), 47% we e assigned o he
ajec o y cha ac e ised by s eady ‘mode a e le el’con-
sump ion h oughou he ollow-up. The g oup
membe s comp ising 31% o women we e ‘high le el’
consume s al eady a he baseline and sligh ly inc eased
consump ion by age, and 22% o women we e assigned
o he ‘low le el’ ajec o y.
Among men (figu e 2), abou hal we e assigned
ei he o he ‘high le el’(27%) o o he ‘inc easing o
high le el’(22%) ajec o y g oup, he o me showing
a sligh decline o consump ion, while among he la e
he consump ion a he end o he ollow-up was highes
o all. The o he hal o men was dis ibu ed e enly o
he ‘low le el’ ajec o y (18%), he ‘inc easing o mod-
e a e le el’ ajec o y (16%) and he ‘dec easing o mod-
e a e le el’ ajec o y (17%).
S a is ics
The dis ibu ion o alcohol consump ion was highly
skewed o he igh , and he e o e log ans o med
alues o he yea ly alcohol consump ion we e used in
analyses o he d inking ajec o ies, as well as in adjus -
ing o he baseline consump ion (age 16 yea s), and
he eg ession analyses be ween you h unemploymen
and adul d inking. Bina y logis ic eg essions we e used
in analysing he associa ions o you h unemploymen
wi h hea y d inking a di e en ages, and mul inomial
logis ic eg essions in analysing i s associa ions o he a-
jec o ies. In addi ion o baseline consump ion, he ana-
lyses we e adjus ed o uancy, and social class and
alcoholism o he pa en s. Since he iden ified ajec o -
ies a e based on pos e io p obabili ies, he eg ession
analyses we e weigh ed wi h he p obabili y used (ie,
highes one) when assigning indi iduals o he iden ified
ajec o ies.
RESULTS
Associa ions o you h unemploymen wi h adul hood hea y
d inking
High exposu e o you h unemploymen p edic ed hea y
d inking a 21 yea s, in men and in women ( able 1),
independen ly o being a hea y d inke a baseline. A
30 yea s, he associa ion was s a is ically non-significan
e en in he unadjus ed analysis among men. Among
women, he OR was non-significan a e adjus men s. By
42 yea s, he associa ions o you h unemploymen wi h
hea y d inking we e s ill non-significan , and in men he
OR had e en d opped below uni y ( o 0.91 in he
unadjus ed and 0.94 in he adjus ed model).
Associa ions o you h unemploymen wi h adul hood
d inking ajec o y
The ajec o y g oup wi h lowes a e age exposu e o
you h unemploymen was chosen as he e e ence in he
mul inomial logis ic eg essions. The analyses showed
ha women on he ‘Mode a e le el’and men on he
‘Inc easing o mode a e le el’ ajec o y we e he leas
exposed. The ables we e cons uc ed wi h hese g oups
in he le column, and he es o he columns we e
a anged in he o de o inc easing a e age exposu e o
you h unemploymen o he ajec o y g oup.
Figu e 1 Illus a ions o he ajec o ies o alcohol
consump ion om 21 o 42 yea s among women (n=488) o
he No he n Swedish Coho .
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Women
The findings o women a e displayed in able 2. The
e e ence g oup wi h ‘Mode a e le el’consump ion a-
jec o y had on he a e age been exposed o 2.40 mon hs
o you h unemploymen . The exposu e was highes
(3.54 mon hs) in he g oup assigned o he ‘Low le el’
ajec o y. ORs showed he di e ence be ween he ‘High
le el’and he ‘Mode a e le el’ ajec o y g oups as non-
significan , while he di e ence be ween he ‘Low le el’
and he ‘Mode a e le el’g oups was significan .
Mo eo e , in case o he compa ison be ween low and
mode a e le el, he OR g ew when consump ion a base-
line was added o he model.
Men
Among men, he a e age exposu e o you h unemploy-
men anged om 5.43 mon hs in he ‘High le el’
g oup o 1.34 mon hs in he g oup wi h ‘Inc easing o
mode a e le el’consump ion ajec o y ( able 3).
The ajec o y o he g oups ‘Inc easing o high le el’
and ‘Dec easing o mode a e le el’did no di e signifi-
can ly om he e e ence g oup, whe eas he ORs
showed he ‘Low le el’and ‘High le el’ ajec o y g oups
as significan ly di e en . O e all, he ORs d opped a e
adjus men s bu he esul pa e n, as well as s a is ical
significance o he findings, emained unchanged.
DISCUSSION
Acco ding o ea lie s udies o he No he n Swedish
Coho , high exposu e o unemploymen is associa ed
wi h high-alcohol consump ion among you h,
14
bu
you h unemploymen does no ha e an independen
long- e m e ec on hea y consump ion a 30 yea s.
15
In
he p esen s udy, we se ou o analyse in mo e de ail
he po en ial sca ing e ec s o you h unemploymen on
alcohol consump ion du ing he li e cou se, by u ilising
he longe ollow-up un il 42 yea s and ajec o y ana-
lyses. As a kind o baseline analysis, we eplica ed he
Figu e 2 Illus a ions o he
ajec o ies o alcohol
consump ion om 21 o 42 yea s
among men (n=522) o he
No he n Swedish Coho .
Table 1 Associa ions (ORs and 95% CIs) be ween exposu e o unemploymen be ween he ages o 16 and 21 yea s and
hea y consump ion o alcohol (being in he uppe qua ile) a he ages o 21, 30 and 42 yea s, in men and women
Men Women
Age (yea s) Unadjus ed Adjus ed* Unadjus ed Adjus ed*
21 2.47 (1.69 o 3.60) 2.04 (1.36 o 3.07) 2.22 (1.36 o 3.62) 1.82 (1.07 o 3.10)
30 1.29 (0.91 o 1.83) 1.21 (0.83 o 1.78) 1.71 (1.05 o 2.79) 1.53 (0.91 o 2.58)
42 0.91 (0.61 o 1.37) 0.94 (0.61 o 1.44) 1.14 (0.69 o 1.89) 1.04 (0.60 o 1.81)
*Adjus ed o social class and alcoholism o he pa en (s) and o alcohol consump ion and uancy a baseline (age 16 yea s).
Bold ype ace ep esen s s a is ical signi icance (p<0.05).
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s udy o Hamma s öm and Janle
15
in o he ex ended
se ing, and ound ha he e ec o you h unemploy-
men on hea y d inking con inues a enua ing up o
middle age in bo h gende s. Nex , we b oke down he
popula ion coho in o g oups wi h di e en adul hood
consump ion ajec o ies and ela ed hem wi h expos-
u e o you h unemploymen . The esul s sugges ed ha ,
among men wi h high-le el consump ion h oughou he
pe iod om ea ly adul hood o ea ly middle age, pa o
he consump ion may be due o ‘sca s’ om you h
unemploymen . Among women assigned o he ajec o y
o high-le el consump ion, co esponding sca ing was
less e iden . These findings suppo ou hypo hesis, a
leas in men. Howe e , we also ound ‘in e se sca ing’:
bo h among men and among women he e we e g oups
o conside able size ha assumed low-le el consump ion
ajec o ies in adul hood, in spi e o ha ing a his o y o
ela i ely high exposu e o you h unemploymen .
The whole-coho analysis is in line wi h he esul s o
he B i ish s udy, which ound ha hea y d inking was
associa ed wi h ecen bu no wi h ea lie exposu e o
unemploymen .
12
Resul s o he US s udy on hea y
d inking as he ou come,
11
howe e , ends o con adic
ou findings by showing ha he e is an associa ion
be ween exposu e o in olun a y unemploymen du ing
eens and ea ly adul hood on he one hand, and alcohol
consump ion in ea ly middle age on he o he .
In he ajec o y analyses, we chose o use unca e-
go ised consump ion figu es as he ou come. In his
espec , he p esen s udy is simila o he ea lie men-
ioned s udy om No way,
10
which, howe e , used
a e age consump ion whe eas he ou come in ou s udy
was a spec um o consump ion ajec o ies. In he ligh
o ou esul s, he No wegian finding, acco ding o
which exposu e o unemploymen in he eens does no
p edic consump ion, can be unde s ood as a mix u e o
di e en ial associa ions. In o he wo ds, he e seems o
be a genuine dual associa ion be ween unemploymen and
use o alcohol: among hose exposed o you h unemploy-
men he e a e bo h hose wi h high and hose wi h low
consump ion in adul hood. The e o e, conclusions d awn
om analyses o a e age de elopmen may con ey an
o e ly uni o m and simplified depic ion o eali y.
Use o he amoun o alcohol— ega dless o he
pa e n o consump ion—as he ou come, is in line wi h
he ideology o ajec o y analysis, which is no o p efix
Table 2 Exposu e o you h unemploymen ( om 16 o 21 yea s) and alcohol consump ion ajec o ies om 21 o 42 yea s in
women
Consump ion ajec o y
Mode a e le el
n=224
High le el
n=150
Low le el
n=106
Mon hs o you h unemploymen (mean) 2.40 3.15 3.54
OR (95% CI)* e 1.49 (0.82 o 1.71) 1.87 (1.02 o 3.40)
OR (95% CI)† e 1.72 (0.93 o 2.20) 1.89 (1.01 o 3.55)
OR (95% CI)‡ e 1.41 (0.74 o 2.72) 2.41 (1.24 o 4.67)
ORs wi h 95% CIs o belonging o he ajec o y g oup in o de o inc easing exposu e, ha is, wi h ze o exposu e o he ‘mode a e le el’
g oup as he e e ence.
*Unadjus ed.
†Adjus ed o social class and alcoholism o he pa en (s).
‡Adjus ed o (2) and alcohol consump ion and uancy a baseline (age 16 yea s).
Bold ype ace ep esen s s a is ical signi icance (p<0.05).
Table 3 Exposu e o you h unemploymen ( om 16 o 21 yea s) and alcohol consump ion ajec o ies om 21 o 42 yea s o
age in men
Consump ion ajec o y
Inc easing o
mode a e le el
n=86
Inc easing o high
le el
n=133
Dec easing o
mode a e le el
n=95
Low le el
n=84
High le el
n=117
Mon hs o you h
unemploymen
(mean)
1.34 1.86 2.40 4.16 5.43
OR (95% CI)* e 1.56 (0.51 o 4.82) 2.21 (0.73 o 6.76) 3.76 (1.34 o 10.6) 4.85 (1.76 o 13.4)
OR (95% CI)† e 1.53 (0.49 o 4.77) 2.11 (0.68 o 6.50) 3.73 (1.31 o 10.6) 5.02 (1.80 o 14.0)
OR (95% CI)‡ e 1.24 (0.40 o 3.86) 1.66 (0.54 o 5.13) 3.18 (1.12 o 9.02) 3.49 (1.25 o 9.79)
ORs wi h 95% CIs o belonging o he ajec o y g oup in o de o inc easing exposu e, ha is, wi h ze o exposu e o he ‘inc easing o
mode a e le el’g oup as he e e ence.
*Unadjus ed.
†Adjus ed o social class and alcoholism o he pa en (s).
‡Adjus ed o (2) and alcohol consump ion and uancy a baseline (age 16 yea s).
Bold ype ace ep esen s s a is ical signi icance (p<0.05).
Vi anen P, e al.BMJ Open 2016;6:e006430. doi:10.1136/bmjopen-2014-006430 5
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o ca ego ise he phenomenon o in e es bu , a he , o
see wha kind o ajec o ies he da a include and o
in e p e hem—in a sense, o ell associa ed ‘de elop-
men al s o ies’. Mo eo e , we a gue ha , by i ue o
using consump ion as he ou come a iable, he p esen
s udy e ealed phenomena ha ha e emain unde ec ed
in analyses wi h p oblema ic d inking ( equency o
occasions, binge d inking, e c) as he ou come. Despi e
he di e en numbe s o ajec o ies, we ound ha in
bo h gende s he ajec o y g oups associa ed wi h lowes
you h unemploymen ha e been cha ac e ised as d ink-
ing ‘mode a ely’. In women, his g oup includes almos
hal o he coho (44%), while in men he p opo ion
is smalle (16%).
We included consump ion and uancy a baseline in
he analyses when he coho was s ill a ending com-
pulso y school and had no ye been a isk o exposu e
o unemploymen bu was acing he en y o labou
ma ke —o o he ma ke o pos basic educa ion. A
his poin o ime in li e, uancy can be seen as an
indica o o ela i ely low in e es and mo i a ion o
pu sue u he s udies, as well as being a symp om o
ex e nalised beha iou . Some o he inhe i ed isk o
alcohol use diso de s was aken in o accoun wi h he
pa en al alcoholism a iable, and in line wi h he
design o he s udy, we conside ed i mo e app op ia e
o con ol o he socioeconomic condi ions by pa en al
social class han by own occupa ional posi ion a ained
du ing he ollow-up. Fo simila easons, we did no
include adul hood unemploymen in he mul i a ia e
models.
Ou s udy e ealed, on i s pa , a complexi y o he
associa ions be ween alcohol consump ion and wo k li e
cou se. Fo ins ance, he ajec o y g oup o men wi h
‘inc easing o high le el’consump ion had su e ed ela-
i ely li le om you h unemploymen . This aises he
ques ion o consump ion pa e ns: maybe hese indi i-
duals end o d ink a he equen ly, bu small amoun s
on each occasion, and he e o e can keep a s able
labou ma ke posi ion. Mo eo e , we can ques ion how
a he low-le el ajec o y can be seen as an indica o o
an ad an ageous li e cou se: maybe hese men and
women a e less socially ac i e and he e o e d ink less,
o hey canno a o d o d ink so much (especially o go
ou ), and some migh e en abs ain om d inking
because hey ha e had ea lie p oblems wi h alcohol
and belie e ha d inking could ha m hei chances in
he labou ma ke . The ajec o ies p o ide a no el s a -
ing poin o u u e s udies conce ning ‘disad an aged
low consume s’, bu also po en ial ‘ad an aged high
consume s’.
The long ollow-up ime and high pa icipa ion a e
a e e iden s eng hs o ou s udy. The sample also
included hose ma ginalised indi iduals wi h mo e
se e e alcohol abuse, and he e o e he ajec o ies ep-
esen a eal dis ibu ion o he popula ion.
Measu emen o unemploymen by a ques ionnai e,
ins ead o egis e da a, also can be conside ed a
s eng h, as sel - epo ed unemploymen indica es ha
he unemploymen expe ience has been significan . A
limi a ion is ha he findings may be conside ed locali y
specific, al hough i has been shown ha he coho in
many espec s is ep esen a i e o he whole coun y.
11
Wes e n coun ies do no di e in he main s uc u es o
hei educa ional sys ems: a e compulso y school, some
g adua es en e in o pos basic educa ion while o he s
en e he labou ma ke . Wi h espec o his, ou esul s
can be gene alised, al hough in Sweden, en y in o edu-
ca ion may be mo e common han in mos o he
coun ies.
The p esen s udy is pa o he esea ch p ojec
‘Unemploymen Sca ing’. Acco ding o he sca ing
hypo hesis, he beha iou al changes ha ake place
du ing unemploymen do no change ins an aneously a
he end o unemploymen , bu es o a ion akes ime
and may emain incomple e o e a long pe iod o ime.
The na u e o sca s may be assumed o depend, in add-
i ion o he amoun o exposu e o unemploymen , on
he momen o exposu e du ing he li e cou se. The
yea s o en y in o he labou ma ke may be a pe iod o
pa icula sensi i i y o he consequences o unemploy-
men
20
as well as o ob aining sca s o unemploymen .
The sca ing app oach was also he eason we did no
analyse po en ial di e ences in he s eng h o he asso-
cia ions be ween d inking and ac ual unemploymen a
di e en ages. This in e es ing ques ion emains a opic
o u u e esea ch.
Wi h espec o policy implica ions, measu es ha e-
duce you h unemploymen migh educe he ela i ely
la ge p opo ion (abou hal o he s udied coho )
assuming high-le el consump ion in adul hood. Al hough
he p opo ion o hose assuming low-le el d inking a-
jec o ies may also dec ease, he ne e ec would p obably
be educ ion o consump ion and also o p oblema ic use
o alcohol.
Con ibu o s PV concei ed he s udy, pa icipa ed in i s design and d a ed
he manusc ip . TL and HW pa icipa ed in design o he s udy and
in e p e a ion o he esul s, and commen ed on he manusc ip . TN
pa icipa ed in he design o he s udy, pe o med he ajec o y analyses
and d a ed co esponding pa s o he manusc ip . UJ and AH concei ed
he s udy, pa icipa ed in i s design and coo dina ion, and con ibu ed o
d a ing o he manusc ip . All he au ho s ead and app o ed he inal
manusc ip .
Funding The s udy has been inanced by The Swedish Resea ch Council o
En i onmen , Ag icul u al Sciences and Spa ial Planning dn 259-2012-37 and
by he Academy o Finland (g an numbe 132668).
Compe ing in e es s None decla ed.
E hics app o al Regional E hical Re iew Boa d in Umeå, Sweden.
P o enance and pee e iew No commissioned; ex e nally pee e iewed.
Da a sha ing s a emen No addi ional da a a e a ailable.
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o alcohol consump ion in adul hood
Unemploymen in he eens and ajec o ies
Janle and Anne Hamma s öm
Pekka Vi anen, Tomi Lin onen, Hugo Wes e lund, Tapio Nummi, U ban
doi: 10.1136/bmjopen-2014-006430
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