BackgroundIll 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.MethodsA register-linked population-based cohort study was conducted including individuals aged 17–24 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.ResultsIn 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.ConclusionsYouth 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.

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 37 484 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 = 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 = 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.

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.

AimTo examine whether exposure to increased alcohol availability in utero is associated with later alcohol-related health problems.MethodRegister-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.ResultsThe 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).ConclusionResults 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.

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.

AimTo 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.DesignRegister‐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.SettingSweden.ParticipantsA total of 518 810 individuals (70 761 in the intervention group; 448 049 in the control group) born 1948–1953, aged 14–20 years during the policy change.MeasurementsDate 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.FindingsCompared 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).ConclusionIn 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.

BackgroundA 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.MethodsA 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.ResultsIn 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.ConclusionThe 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.

Aim To test if exposure to unemployment in young adulthood is associated with an increased risk of later alcohol‐related morbidity. Design A nation‐wide register‐linked longitudinal population‐based study. Setting Sweden. Participants A 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. Measurement Information 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). Findings Compared 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. Conclusion In 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.