2018
Association between good work ability and health behaviours among
unemployed: A cross-sectional survey
Hult, Marja
Elsevier BV
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© Elsevier Inc
CC BY-NC-ND https://creativecommons.org/licenses/by-nc-nd/4.0/
http://dx.doi.org/10.1016/j.apnr.2018.07.008
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among unemployed: A cross-sectional survey
Marja Hult, Anna-Maija Pietilä, Päivikki Koponen, Terhi Saaranen
PII: S0897-1897(17)30545-1
DOI: doi:10.1016/j.apnr.2018.07.008
Reference: YAPNR 51092
To appear in: Applied Nursing Research Received date: 27 September 2017
Revised date: 15 June 2018
Accepted date: 25 July 2018
Please cite this article as: Marja Hult, Anna-Maija Pietilä, Päivikki Koponen, Terhi Saaranen , Association between good work ability and health behaviours among unemployed: A cross-sectional survey. Yapnr (2018), doi:10.1016/j.apnr.2018.07.008
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Title
Association between good work ability and health behaviours among unemployed: a cross-sectional survey
Authors
Marja Hulta, Anna-Maija Pietiläa,b, Päivikki Koponenc, Terhi Saaranena
a University of Eastern Finland, Faculty of Health Sciences, Department of Nursing Science, Kuopio, Finland
bSocial and Health Care Services, Kuopio, Finland
cNational Institute of Health and Welfare, Department of Health, Health Monitoring Unit, Helsinki, Finland
Corresponding author Marja Hult
University of Eastern Finland Faculty of Health Sciences Department of Nursing Science PO Box 1627, 70211 Kuopio, Finland marja.hult@iki.fi
Tel: +358 400 691 431
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Association between good work ability and health behaviours among unemployed: a cross-sectional survey
Abstract
Background: There has not been much research on the possible factors promoting good work ability among unemployed people. Consequently, the role of health behaviours in good work ability among the unemployed is unknown.
Purpose: To explore the work ability and health behaviours of unemployed people through sociodemographic factors and examine the association between good work ability and health behaviours.
Design: A cross-sectional survey.
Methods: The study is based on the Finnish nationwide Regional Health and Well-being Study using mailed and online questionnaires in 2014–2015. A total of 1973
unemployed or laid-off people between the ages of 20 and 65 responded to the survey.
The associations of work ability with sociodemographic factors – gender, age, marital status, minors (i.e. under-18s) living in the household, education, living environment, and duration of unemployment – and health behaviours with sociodemographic factors were first explored using cross-tabulations. Health behaviours included body mass index, daily smoking, alcohol consumption, vegetable consumption, health promotion groups, physical exercise, and sitting in one’s leisure time. Health behaviours were then examined using logistic regression analyses, in association with good work ability; the latter was measured with the Work Ability Score.
Results: Being aged below 45, being married or cohabiting, having a high level of education, and short-term unemployment were associated with good work ability. A quarter of participants were daily smokers. A proportion of women with risk level alcohol use (79%) was higher than that of men (59.9%). A third of unemployed people participated in high-intensity physical activity. In regression analyses, high-intensity physical activity (OR 2.25, 95% CI 1.06–4.78) was associated with good work ability.
Conclusions: Unemployed women and men widely exhibited unhealthy behaviours such as daily smoking and a risk level use of alcohol. Health promotion actions for enhancing
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a healthy lifestyle and good work ability among unemployed people, particularly in emphasizing the importance of physical activity, are highly recommended.
Keywords
health behaviour, health promotion, unemployed, work ability, high-intensity physical activity
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1 Introduction
Good work ability is one of the key factors in successful re-employment for
unemployed people (Brouwer et al., 2015; McGonagle et al., 2015). Unemployment, however, has been shown to be positively associated with decline in perceived work ability, particularly when the unemployment is prolonged (Hult et al., 2017; Kerätär et al., 2016; Szlachta et al., 2012). Maintaining and promoting work ability during
unemployment is therefore also important for preventing the well-documented decrease in general health and well-being that is associated with unemployment (McKee-Ryan et al., 2005). Work ability is a holistic concept that includes individual resources, such as health, functional capacity, expertise, values, and attitudes, and many work-related and social factors that are not directly controlled by the individual (El Fassi et al., 2013;
Ilmarinen et al., 2008). Nonetheless, an individual can influence his or her state of health, as well as his or her work ability by health behaviour (Mohammadi et al., 2015).
The work ability of the unemployed has been sparsely researched, and the role of health behaviour in supporting good work ability during unemployment is unknown.
Health behaviours, alongside physical and social environmental factors and psychosocial aspects such as social support and life control, contribute to socio- economic inequalities in health. Health behaviour cannot be considered merely a personal choice, because educational, financial, and social circumstances have an impact on the resources and services that are available to individuals. In a study by Strickland et al. (2017), the risk of engaging in unhealthy behaviours was bigger for individuals with a low education and lower worker status than for individuals with a high education and upper occupational groups. Especially those with physically burdensome jobs such as construction workers are at bigger risk. Occupational groups have divergent attitudes and beliefs that influence the adoption of health behaviours. For instance, the prevalence of smoking and risky alcohol intake differs according to
occupational group (Sydén and Landberg, 2016).
Risky health behaviours undoubtedly increase the risk of developing non-communicable diseases that have an adverse effect on health (Huijts et al., 2017), and thus have an
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impact on mortality. Even though health behaviours are closely connected to social and economic status, risky health behaviours are amendable by individuals (Nevanperä et al., 2016).
There are two plausible explications as to why unemployed individuals might engage in health behaviours that are detrimental for health more often than employed ones. One explanation is the relation of unemployment and a low educational level. In average, unemployment rate was almost three times higher for people with education below upper secondary level compared to those with tertiary level (OECD 2018). Individuals with a low level of education working in low-skilled jobs are at bigger risk of becoming unemployed, especially during an economic recession (Leonardi et al., 2018). Low level education increases the likelihood of adopting an unhealthy lifestyle (Robroek et al., 2013; Schuring et al., 2013). Large European study showed the association of high education and healthy lifestyle. This association predicted positive health outcomes and higher life expectancy compared to less educated. (Becchetti et al., 2018.) This is because education is one of the key determinants in adopting behaviours that promote health by helping in the acquisition of knowledge of health risks and benefits. The other possible explanation is that the adverse impact of unemployment weakens health and well-being; in particular, unemployment is found to worsen mental health (e.g. Strandh et al., 2014) and self-esteem (Szlachta et al., 2012), and thereby may weaken the adoption and maintenance of a healthy lifestyle.
Health behaviours have been studied widely in the context of unemployment. Smoking is one of the unhealthy behaviours that seem to be closely connected to unemployment (Al-Sudani et al., 2016; Prochaska et al., 2013). For instance, in Finland, the number of daily smokers among unemployed people was almost three times higher than that of the entire population according to a population study (Murto et al., 2017). Prochaska et al.
(2016) found that re-employment was more difficult for smoking job-seekers, and once they had succeeded in getting a job, they were less well paid than non-smokers.
There is ample evidence to show that risky use of alcohol is also associated with unemployment (Al-Sudani et al., 2016; Boden et al., 2017; Virtanen et al., 2013). Even
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though highly educated workers are found to consume more frequently than
unemployed people, binge drinking is more common among the unemployed (Huijts et al., 2017; Rolland et al., 2017). Risk level users tend to be men, single, under 50 years old, unskilled manual workers with prolonged unemployment (Nurmela et al., 2015).
Robroek et al. (2013) found that a lack of physical activity was associated with ending up unemployed. And once unemployed, people who did not engage in physical exercise faced longer spells of unemployment on average (Gabrys et al., 2013). A high leisure time sitting rate indicates a physically inactive lifestyle, and Gabrys et al. (2013) found that unemployed men spent more time sitting than employed men. Un employed women, however, spent less time sitting than employed women, according to Kwak et al. (2016).
The association between work ability and health behaviours has so far been studied mostly among employed people. Numerous studies highlight the importance of high- intensity leisure time physical activity for good work ability (Airila et al., 2012;
Arvidson et al., 2013; Calatayud et al., 2015; Mohammadi et al., 2015; Nevanperä et al., 2016; van den Berg et al., 2009). However, low-intensity leisure time physical activity seems to have no effect on work ability (Calatayud et al., 2015). Closely related to physical activity, the effects of a sedentary lifestyle on work ability have recently been studied extensively. For example, it has been shown by Gao et al. (2016) that a
reduction in sitting time improves work ability. In addition to a lack of physical activity, Robroek et al. (2013) found that obesity was associated with ending up on a disability pension, which involves a total loss of work ability. Furthermore, overweight (El Fassi et al., 2013; Lindberg et al., 2006; Mohammadi et al., 2015) and low fibre intake (van den Berg et al., 2009) are positively associated with decreased work ability. According to numerous studies, smoking (Airila et al., 2012; Lindberg et al., 2006; Mohammadi et al., 2015; Nevanperä et al., 2016) and overuse of alcohol (Nevanperä et al., 2016) are associated with poor work ability. Stress-related eating and drinking (Nevanperä et al., 2016) also have an unfavourable impact on work ability.
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Overall, there has been quite little research on the work ability of unemployed people. It is known, however, that long-term unemployment, being over 45 years of age, and having a low level of education are positively associated with decreased work ability (Lappalainen et al., 2017; Szlachta et al., 2012). There is a need for research that
identifies not only the possible causes of decreased work ability, but also the factors that may improve work ability. In the present study, we explore the work ability and health behaviours of unemployed people through sociodemographic factors and examine the association between good work ability and health behaviours.
2 Methods
2.1 Study design and participants
The Finnish National Institute of Health and Welfare has coordinated the nationwide Regional Health and Well-being Study (ATH) since 2009. The cross-sectional data we used were collected using self-administered questionnaires between January 2014 and January 2015. The random sample of 76,000 people aged 20 and over was drawn from the National Population Registry and was stratified by age and region. Respondents could choose the Internet-based survey or return the mailed questionnaire. A total of 30,598 people responded, and of those, 1973 were included in this study. The inclusion criteria were employment status as being unemployed or laid-off, and age between 20 and 65. The employment status was asked about with eight options given: in full-time work, part-time work, old-age retirement, disability retirement, unemployed or laid-off, family leave, student, and other.
2.2 Measures
2.2.1 Sociodemographic factors
Age and gender were obtained from the Population Registry and other factors were self- reported. Marital status was categorized as married or cohabiting and not married or cohabiting, including separated or divorced, widowed, and single people. Education was
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based on years spent in basic or professional training and divided into less than 13 years and 13 years or more. Duration of unemployment was categorized as short-term and long-term, with the latter category indicating a duration of 12 months or more.
2.2.2 Outcome measure
Work Ability Score (WAS), which is the first part of the seven-item Work Ability Index (WAI), was used to measure work ability with a question about a person’s perceived work ability, on a scale from 0 (totally disabled) to 10 (excellent work ability).
Following El Fassi et al. (2013), work ability was considered good when the score was 8 or more.Subjective evaluation is found to predict work ability reliably as a
component of health and health-related quality of life (Ahlstrom et al., 2010). WAS is largely used in population studies as well as in occupational health care; however, it is most suitable for assessing work ability during unemployment, because it is not based on specific work requirements.
2.2.3 Health behaviours
Body mass index (BMI) was calculated based on self-reported weight and height (kg/m2) and divided into two categories: normal (under 25 kg/m2) and overweight (25 kg/m2 and over). Daily smoking was based on a question on current smoking status; the options were daily smoking, occasional smoking, or not smoking at all. The two latter categories were combined. Alcohol consumption was measured with the three-item AUDIT-C scale, which is a modified version of the full ten-item AUDIT questionnaire.
The questions were: How often do you consume alcoholic beverages? How many drinks containing alcohol do you have on a typical day when you are drinking? How often do you have six or more drinks on one occasion?AUDIT-C is found to reliably identify risk-level users and to perform as well as the full AUDIT for both genders (Jeong et al., 2017). AUDIT-C was scored on a scale of 0 to12. A score of 4 or more for men, and 3 or more for women, was taken as indicating risk level use of alcohol (Frank et al., 2008).
Vegetable consumption over the past seven days was self-reported with four options (never, on 1–2 days, on 3–5 days, on 6–7 days) and categorized as 6–7 days and ≤ 5
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days a week. The question of participation in health promotion groups over the past 12 months had nine options: weight control group, neck or back exercise group, groups for quitting smoking, the use of alcohol or of some other intoxicant, gambling addiction group, patient self-help group, relaxation group, discussion group for a life crisis, or other. Participation was categorized as either having participated or not having participated. Leisure time physical exercise was self-reported by choosing from three options: high-intensity physical activity (such as running, skiing, swimming, or ball games, several hours a week), moderate physical activity (such as walking, light housework, or gardening), and low physical activity. The two latter categories were merged. The amount of sitting in one’s leisure time was self-reported as the number of hours spent sitting on an average weekday.
2.3 Ethical approval
The ATH study was approved by the Ethical Committee of the National Institute for Health and Welfare. Participation was voluntary and was done by responding to a postal questionnaire or by filling in an online form. Responding to the survey was taken as proof of implicit consent.
2.4 Data analysis
To describe the study population, we calculated unweighted counts and weighted frequencies for categorized variables and means and standard errors for continuous variables (Table 1). Then we used cross-tabulations and chi-square tests to explore health behaviour variables through sociodemographic variables (Table 2). Next, we applied bivariate logistic regression to analyse the unadjusted odds ratios (ORs) and 95% confidential intervals (CIs) of each health behaviour variable in association with good work ability. In the second step, we adjusted for all health behaviour variables, and last, we added sociodemographic variables into the model. In the multivariate regression model (Model 2), age, level of education, and duration of unemployment were adjusted as continuous variables; otherwise they were treated as categorized (Table 3). Weights were applied in all analyses to correct the effects of non-response
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and different sampling probabilities, and they were based on register data (Härkänen et al., 2014). Nagelkerke pseudo R-squared measures were used to explain the variance of good work ability. The statistically significant p-value was set at the level of < 0.05.
The complex sampling procedures of version 24 of SPSS were used to carry out the analyses.
3 Results
3.1 Sociodemographic factors, work ability, and health behaviours
Over half of the participants were men (57.5%). The mean age was 43.3 years and half of the participants were aged 45 or above. The participants were mainly living in a marriage or cohabiting, and they did not have children under 18 years living in the household for the most part. The average length of education was 13.3 years and over half of the participants had been unemployed for less than a year. Work ability was mainly evaluated as good. A quarter of the unemployed participants were daily smokers and a third of them used alcohol not at all or moderately. Most of the participants did not take part in high-intensity physical activity. Table 1 presents all sociodemographic factors and health behaviours (Table 1).
Cross-tabulations of good and limited work ability as well as categories of health behaviours according to sociodemographic factors are presented in Table 2. Those participants who were younger than 45, who were married or cohabiting, who had a high education, and those who had been unemployed for less than a year perceived their work ability to be good significantly more often. The most remarkable difference was observed between short-term and long-term unemployed people. Three-quarters of short-term unemployed people had good ability, whereas half of the long-term unemployed perceived limited work ability (Table 2).
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Table 1. Descriptive characteristics of unemployed persons
na (%b) mean (se) Sociodemographic factors
Gender (n = 1973)
Women 976 (42.5)
Men 997 (57.5)
Age, years (n = 1973) 43.3 (0.32)
< 45 years 773 (49.7)
≥ 45 years 1200 (50.3)
Marital status (n = 1956)
Married or cohabiting 1162 (55.1)
Not married or cohabiting 794 (44.9)
Minors (under 18 years) in the household (n = 1973)
Yes 800 (39.5)
No 1173 (60.5)
Education, years (n = 1926) 13.3 (0.09)
High 1041 (52.2)
Low 885 (47.8)
Living environment (n = 1973)
Urban 1508 (76.2)
Rural 465 (23.8)
Duration of unemployment, months (n = 1224) 15.9 (0.65)
Short-term 663 (56.7)
Long-term 561 (43.3)
Work ability
Work ability, WAS score (n = 1887) 7.4 (0.06)
Good (≥ 8) 1159 (61.4)
Limited (< 8) 728 (38.6)
Health behaviours
BMI, kg/m2 (n = 1910) 24.9 (0.11)
Normal (< 25) 1146 (60.0)
Overweight (≥ 25) 764 (40.0)
Daily smoking, years (n = 1153) 9.0 (0.21)
No 872 (75.4)
Yes 281 (24.6)
Alcohol consumption, Audit-C (n = 1761) 4.4 (0.06)
No or moderate use 542 (31.8)
Risk level use 1219 (68.2)
Vegetable consumption (n = 1922)
6–7 days a week 483 (24.6)
≤ 5 days a week 1439 (75.4)
Health promotion groups (n = 1973)
Participated 876 (44.9)
Did not participate 1097 (55.1)
Physical exercise (n = 1940)
High-intensity physical activity 677 (35.5)
Low physical activity 1263 (64.5)
Leisure time sitting, h/day (n = 1864) 3.9 (0.06)
0–2 h/day 556 (29.8)
≥ 3 h/day 1308 (70.2)
a Unweighted count, n varies due to item non-response
b Weighted prevalence
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Men consumed alcohol more often than women in a moderate manner. Unemployed people who were younger than 45 participated more often than older people in health promotion groups. Participants who had young children living in the household were more often overweight, used alcohol moderately more often, and had less leisure time sitting during the day than those who did not have young children. Living environment was not associated with work ability or health behaviours (Table 2).
3.2 Association of health behaviours with good work ability
In bivariate analyses, significant associations were not found between health behaviours and good work ability (Model 0). When adjusting for all health behaviours, no
associations were found either (Model 1). After controlling for sociodemographic factors (Model 2), high-intensity physical activity (OR 1.60, 95% CI 1.06–2.43) became significantly associated with good work ability (Table 3). The model explained 11.5%
of the variation of good work ability.
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Table 2. Prevalence of work ability and health behaviours by sociodemographic factors
Gender Age Marital status Minors (< 18
years) Education Living
environment Duration of unemployment Women Men < 45 ≥ 45 Married or
cohabiting Not married
or cohabiting Yes No High Low Urban Rural Short-
term Long- term
Work ability
Good (WAS ≥ 8) 62.7 60.4 68.3* 54.5 66.4* 55.3 59.9 62.4 69.9* 52.3 62.6 57.5 72.5* 49.8 Limited (WAS < 8) 37.3 39.6 31.7 45.5 33.6 44.7 40.1 37.6 30.1 47.7 37.4 42.5 27.5 50.2
Health behaviours
BMI
Normal (< 25) 60.3 59.8 62.1 57.9 58.9 61.6 56.1 62.5* 61.1 58.6 60.3 59.1 59.0 57.2 Overweight (≥ 25) 39.7 40.2 37.9 42.1 41.1 38.9 43.9 37.5 38.9 41.1 39.7 40.9 41.0 42.8
Daily smoking
No 75.3 75.5 75.4 75.3 75.8 74.6 75.6 75.2 77.4 72.9 75.6 74.6 79.5 73.0
Yes 24.7 24.5 24.6 24.7 24.2 25.4 24.4 24.8 22.6 27.1 24.4 25.4 20.5 27.0
Alcohol consumption
No or moderate use 21.0 40.1* 31.1 32.5 32.0 31.9 34.8* 29.9 29.9 70.1 32.2 30.8 32.5 31.4 Risk level use 79.0 59.9 68.9 67.5 68.0 68.1 65.2 70.1 33.6 66.4 67.8 69.2 67.5 68.6
Vegetable consumption
6–7 days/week 24.7 24.4 24.3 24.9 24.0 25.2 25.2 24.2 26.6 73.4 24.3 25.6 23.7 27.9 ≤ 5 days/week 75.6 75.3 75.7 75.1 76.0 74.8 74.8 75.8 22.5 77.5 75.7 74.4 76.3 72.1
Health promotion groups
Participated 45.2 44.8 47.5* 42.2 43.2 47.1 43.4 45.9 46.2 43.5 44.4 46.4 45.1 45.7 Did not participate 55.2 54.8 52.5 57.8 56.8 52.9 56.6 54.1 53.8 56.5 55.6 53.6 54.9 54.3
Physical exercise
High-intensity physical activity 36.7 34.7 36.5 34.6 34.7 36.4 33.1 36.9 35.7 35.5 35.1 36.9 33.7 38.3 Low physical activity 65.3 63.3 63.5 65.4 65.3 63.6 66.9 62.9 64.3 64.5 64.9 63.1 21.7 21.5
Leisure time sitting
0–2 h/day 28.0 31.2 29.4 30.2 28.3 31.8 34.3* 27.0 30.6 29.1 29.5 30.9 29.6 32.6
≥ 3 h/day 72.0 68.8 70.6 69.8 71.7 68.2 65.7 73.0 69.4 70.9 70.5 69.1 70.4 67.4
* p significant at the < 0.05 level
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Table 3. Associations between health behaviours and good work ability among unemployed people, odds ratio (OR) and 95% confidence interval (CI)
Health behaviours Model 0a
OR (95% CI) Model 1b
OR (95% CI) Model 2c OR (95% CI) BMI
Normal (< 25) 1.08 (0.88–1.32) 0.94 (0.71–1.25) 0.97 (0.67–1.41)
Overweight (≥ 25) 1 1 1
Daily smoking
No 1.20 (0.89–1.62) 1.12 (0.81–1.57) 0.90 (0.58–1.38)
Yes 1 1 1
Alcohol consumption
No or moderate use 1.11 (0.88–1.39) 1.07 (0.77–1.50) 1.13 (0.71–1.79)
Risk level use 1 1 1
Vegetable consumption
6–7 days a week 0.92 (0.73–1.15) 0.79 (0.57–1.11) 0.90 (0.58–1.42)
≤ 5 days a week 1 1 1
Health promotion groups
Participated 0.94 (0.77–1.15) 0.95 (0.72–1.26) 0.86 (0.59–1.25)
Did not participate 1 1 1
Physical exercise
High-intensity physical activity 1.12 (0.91–1.38) 1.10 (0.81–1.51) 1.60* (1.06–2.43)
Low physical activity 1 1 1
Leisure time sitting
0–2 h/day 0.97 (0.78–1.21) 0.99 (0.73–1.35) 1.01 (0.67–1.52)
≥ 3 h/day 1 1 1
a Unadjusted estimates.
b Adjusted for all other health behaviours.
c Adjusted for all other health behaviours and sociodemographic factors (gender, age, marital status, minors (under-18s), education, living environment, and duration of unemployment).
* p significant at the < 0.05 level.
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4 Discussion
We described the health behaviours of the unemployed and explored the association between good work ability and health behaviours. We show the importance of high-intensity physical activity in the good work ability of unemployed people. We found that no previous studies targeted this association among the unemployed. Instead, our results that show a high prevalence of daily smoking and risk level use of alcohol are supported by previous studies among unemployed people (Al-Sudani et al., 2016; Prochaska et al., 2013).
Our finding that shows the association of high-intensity physical activity with good work ability of the unemployed is supported, however, by the research among the employed. The most substantial health behaviour that is positively associated with work ability is physical exercise (Airila et al., 2012; Arvidson et al., 2013; Calatayud et al., 2015; Mohammadi et al., 2015; Nevanperä et al., 2016; van den Berg et al., 2009). In our analyses, high-intensity physical activity became significant only after adjusting for sociodemographic factors. However, none of them were associated with physical activity in cross-tabulations. Some of the sociodemographic factors had associations with health behaviours, though. Surprisingly, we found that significantly more women were risk level users of alcohol than men. Also, people who had young children living in the household were more often overweight, used alcohol moderately more often, and had less leisure time sitting than those without young children in the household. As Virtanen et al. (2013) showed, unemployed people with children were also more often capable of avoiding long-term unemployment.
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The number of women who used alcohol moderately was alarmingly low, at only one-fifth. We calculated means for AUDIT-C scores for both genders, and the mean score for women was 4.4 and for men 4.3. It is known that people tend to understate their alcohol consumption, and the real number of men using alcohol at a risky level might have been higher. There is also evidence that single men with a low
education and prolonged unemployment are at high risk of alcohol overuse (Nurmela et al., 2015). On the other hand, one worldwide trend in recent years has been an increase in alcohol consumption by women. The gap between women and men is closing due to changes in traditional gender roles, and broader social, cultural, and economic developments (Slade et al., 2016).
Overall, the high prevalence of risk level alcohol use among both genders can be partially explained by chosen cut-offs for the AUDIT-C scale. Aalto et al. (2009) suggested that the threshold for binge drinking in Finland is higher than that internationally; it should be noted, however, that there is no precise threshold for what constitutes risk level alcohol use. Obviously, the physiological and social harms of risk level alcohol use are globally similar. In any case, the number of unemployed people who were risk level users was high, and this problem should be vigorously targeted. The only factor that protected persons from risk level alcohol use was having young children in the
household, which indicates responsibility among parents.
The proportion of smokers, a quarter, among unemployed people was almost three times higher than in the rest of the population (Murto et al., 2017). The obvious conclusion to be drawn from this is that services for unemployed people should include help to quit smoking. Non- smoking is not only beneficial for health, but non-smoking job-seekers are also more likely find a new job than smokers (Prochaska et al., 2016).
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We did not find any association between marital status and health behaviours. This is contradictory to previous studies that highlight the protective role of a partner. According to van der Meer (2014), being single was strongly connected to a decrease in health and well-being among unemployed people. De Montigny et al. (2017) showed that spouses’ positive social control had a favourable influence on men’s health behaviours. In our study, marital status as living in a partnership, whether it be married or cohabiting, had a significant association with good work ability.
Our findings strongly suggest that unemployed job-seekers should be encouraged to be more physically active, and to frequently take intense exercise. Gough (2017) found that women were able to increase their physical activity during unemployment, whereas men’s activity did not change; this difference should be considered by health promotion actors. There is strong evidence that health behaviour change is possible to achieve by interventions that are specifically designed for unemployed people (Gabrys et al., 2013; Kreuzfeld et al., 2013). Interventions can be developed by adopting models used in occupational settings, for instance on how to conduct brief interventions for risk level alcohol use (Watson et al., 2015). According to a Finnish study, in general, unemployed people are willing to seize the
opportunity; they have changed their health behaviours in a positive direction more often than other groups (Helldán and Helakorpi, 2015).
All the barriers should be removed to enable unemployed people to search for jobs, particularly given the context of economic recovery in Europe.
There are, of course, strengths and limitations in the present study. We expand the understanding of factors that might improve the work ability of the unemployed. To the best of our knowledge, this is the first study to associate work ability with health behaviours among unemployed people. Also, we consider the population-based sampling and large study population as strengths, and therefore our results can be generalized to a certain extent. The weights used in the analyses were aimed at correcting for the effect of non-responses and stratified
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sampling. The weights were based on inverse probability weighting (IPW), using sociodemographic variables such as age, gender, marital status, language, education, occupation, and geographical area from registers (Härkänen et al., 2014). However, the response rate was rather low, 40.3%, which weakens slightly our results. The cross-sectional study design could also be considered a limitation since it does not allow the examination of causal mechanisms. Also, self-reports on health behaviours have some limitations concerning their reliability.
For example, alcohol use is often underestimated, and physical activity may be overestimated due to social desirability. Finally, we did not measure mental health status of the participants, which might be a limitation, since depression may hinder the maintenance of a healthy lifestyle.
5 Conclusions
This research extends the knowledge of factors that are associated with good work ability of unemployed people. Our study has shown the importance of high-intensity physical activity in maintaining and promoting good work ability. The results also indicate that among the participants, the rates of risk level alcohol use and daily smoking were high. Based on our findings, we conclude that health promotion actions aimed at enhancing a healthy lifestyle, with particular emphasis on the importance of physical activity, for unemployed job-seekers are highly recommended. Furthermore, physical activity plays an important role in overall health and well-being. Nursing professions throughout the health care systems are in front line in promoting health and healthy habits of this vulnerable group. Improved health and work ability may result as decreased costs of health care, and as a final target, increased employment rate.
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Conflict of interest
The authors declare no conflict of interest.
Funding
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
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Highlights
High-intensity physical activity was positively associated with good work ability among unemployed people.
The prevalence of risk level alcohol use was high among the unemployed and women seemed to consume alcohol even more than men.
Smoking was common among the unemployed; a quarter of unemployed people were daily smokers.
