Unemployment, cigarette smoking, alcohol consumption and body weight in young British men

Transcription

1 EUROPEAN IOURNAL OF PUBLIC HEALTH 199S-. S: S U B S T A N C E A B U S E Uemploymet, cigarette smokig, alcohol cosumptio ad body weight i youg British me SCOTT M. MONTGOMERY, DEREK G. COOK, MEL J. BARTLEY, MICHAEL E.J. WADSWORTH * The relatioship of uemploymet experieced betwee the ages of ad years with smokig, alcohol cosumptio ad obesity was examied i 2,887 me who were members of the 1958 logitudial British birth cohort study (NCDS). Cigarette smokig, alcohol cosumptio, measured as uits cosumed i the past week ad as problem drikig usig the CAGE questioaire ad the body mass idex (BMI) were measured at age years. Both the amout of uemploymet accumulated betwee the ages of ad years ad recet uemploymet experieced i the year prior to iterview at age years were examied. Whe compared with me who had ever bee uemployed, the usted relative odds amogst me with over three years of accumulated uemploymet (after ustmet for possible cofoudig socioecoomic ad behavioural factors measured prior to uemploymet) were 2.11 (95 Cl: ) for smokig, 2.13 (95 Cl: ) for a low BMI ad o-sigificat for a high BMI; 1.52 (95 Cl: ) for o alcohol cosumed; o-sigificat for high alcohol cosumptio, but 2.15 (95 Cl: ) for problem drikig. Me who had experieced uemploymet i the year prior to the iterview, compared to those who had ot, after ustmet, were sigificatly more likely to smoke (RO 2.92, 95 Cl: ), drik heavily (RO 1.73, 95 Cl: ) ad to have a drik problem (RO 2.90, 95 Cl: ). Uemploymet may play a sigificat part i establishig life-log patters of hazardous behaviour i youg me. Key words: alcohol, body mass idex, cigarette smokig, uemploymet -excess morbidity 1 " 4 ad mortality 5 7 have both bee covicigly associated with uemploymet. Oe explaatio for this associatio, described as the selectio hypothesis, is that poorer health or health behaviour itself icreases the risk of uemploymet. 8 " 12 A secod explaatio is that the experiece of uemploymet may be damagig to health, 1-3 possibly because job loss is a stressful life evet 1 '*" 1 " ad uemploymet ca result i relative material hardship 19 ad social exclusio. 20 It has also bee suggested that the experiece of uemploymet is associated with hazardous health behaviours ad weight gai. 21 There is some debate as to whether the hazardous health behaviours pre-date the uemploymet or are cosequeces of experiecig uemploymet. 22 A deterioratio i health behaviours has bee reported i S.M. Motgomery 1, D.G. Cook 2, M.J. Bartley 3, M.EJ. Wadsworth 4 1 Uiversity Departmet of Medicie, Royal Free Hospital School of Medicie, Lodo, UK 2 Departmet of Public Health Scieces, St George's Hospital Medical School, Lodo, UK 3 Departmet of Epidemiology ad Public Health, Uiversity College Lodo Medical School, UK4 MRC Natioal Survey of Health ad Developmet Uiversity College Lodo Medical School, UK Correspodece: Dr S.M. Motgomery, Uiversity Departmet of Medicie, Royal Free Hospital School of Medicie, Rowlad Hill Street Lodo NW3 2PF, UK, tel , fax youg me, 23 but this chage has ot bee observed as clearly i older me. 21 We have examied the relatioship betwee uemploymet, cigarette smokig, alcohol cosumptio ad body mass idex (BMI) (which ca be partly cosidered as a outcome of various health behaviours) i me from a atioal logitudial birth cohort study at age years. I this study of youg British me we are able to cosider a period whe behaviour patters were beig established i a cohort subject to relatively high uemploymet levels soo after labour market etry. Because of the logitudial ature of this study we have bee able to examie the role of selectio i explaiig the associatio of poor health ad health behaviour with uemploymet. By cotrollig for socioecoomic backgroud, educatioal attaimet ad health behaviours which predated labour market etry (ad were thus ot iflueced by ay previous experiece of uemploymet) at age years, we were able to assess chages i these factors after the experiece of uemploymet. We were also able to examie both the cumulative effect of uemploymet ad the effect of recet uemploymet. Table 1 illustrates the timig of the measuremets of socioecoomic circumstaces, BMI ad health behaviours. It also idicates the uemploymet rate amogst me i this cohort betwee 1974 whe they were aged Dowloaded from by guest o Jauary 9, 20

2 EUROPEAN JOURNAL OF PUBLIC HEALTH VOL NO. 1 years ad 1991 whe they were aged years, 24 clearly showig the effect of the ecoomic recessio of the early 1980s. This paper is limited to me oly, as uemploymet i wome is difficult to iterpret durig these child-bearig years: may wome reported 'child or home care' as their mai activity durig a period of o-employmet, eve though they would have accepted a job if oe were offered. It was felt that the defiitio of uemploymet used for me would ot be appropriate for may wome. Me ad wome should also be treated separately as there is evidece that their reactios to uemploymet are sigificatly differet i terms of their health behaviour. 25 METHODS These data are from the Natioal Child Developmet Study (NCDS), 26 " 29 a ogoig atioal logitudial study of those livig i Great Britai who were bor betwee 3 ad 9 March There have bee six data collectio sweeps: at birth ad at ages 7, 11,, 23 ad years. The study has its origis i the Periatal Mortality Survey (PMS) which collected data about the births of 17,414 ifats to parets i Great Britai, represetig 98 of births i the target week. For the PMS, midwives completed questioaires ad iformatio was also take from medical records. The sweeps coducted at ages 7,11 ad years collected iformatio from parets, who were iterviewed by health visitors, from class teachers, who completed questioaires ad from medical examiatios coducted by school health services. The cohort members completed ability tests ad at age years filled i a self-completio questioaire. At ages 23 ad years data collectio icluded iterviews carried out by professioal survey research iterviewers ad cohort members also filled i self'completio questioaires. The target sample at age years was,455 ad a total of 86 of the target was traced. There were 11,407 cohort members iterviewed i 1991 at age years, 69 of the target populatio. The cohort has remaied largely represetative although the most disadvataged groups may be uder-represeted. 2 '" 30 A ivestigatio of o-resposes has idicated that the systematic loss to follow-up of the most disadvataged me has resulted i a coser- Table 1 Uemploymet rates betwee the ages of (1974) ad years (1991) amogst me i the Natioal Child Developmet Study (=4,999) ad measures used i the aalyses vative estimate of the prevalece of uemploymet ad hazardous health behaviours at age years ad possibly a coservative estimate of the associatio betwee uemploymet ad these behaviours. Whe NCDS me were bor, overall 10 of them had parets i social class V. I the aalyses performed here, oly 6.7 of the me were bor with their parets i social class V. Because of the kow associatio betwee paretal social class ad uemploymet i youg me, 31 this idicates some loss of me with a higher risk of uemploymet. A total of 5,588 me were iterviewed at age years, but, as cases with missig data were excluded, betwee 2,444 ad 2,887 me were used for these aalyses. The distributio of uemploymet i the group of me used for these aalyses was similar to that observed i the larger group of 5,588 me: 6.5 of the me had experieced over three years of accumulated uemploymet, betwee the first labour market etry ad age years, amogst the 5,588 me, while 5.4 had over three years of uemploymet amogst the smaller group. Because missig data resulted i the exclusio of a sigificat umber of me from the aalyses, the effect of their exclusio o the uivariate relatioships of uemploymet with the health behaviours is reported. Uemploymet Uemploymet was defied as beig out of employmet ad seekig work. A full history of uemploymet experiece was collected at ages 23 ad years coverig the period (ages - years). As the uemploymet history was collected at two poits i time, as well as a employmet history, it was possible to validate ad combie the uemploymet histories collected at both time poits. Two uemploymet variables were used i these aalyses. The first comprised the total umber of moths of uemploymet betwee the ages of ad years, grouped ito four categories: o uemploymet ad 1-12, ad over 36 moths of uemploymet. The secod variable idetified recet uemploymet ad was defied as uemploymet experieced durig the year prior to the iterview at age years. A aalysis of recall bias revealed that spells of uemploymet with a duratio of less tha three moths were poorly remembered. Uemploymet periods of less tha three cosecutive moths were ot icluded i the aalyses used here, as these short spells teded oly to be reported if they occurred at a time immediately prior to a iterview. Dowloaded from by guest o Jauary 9, 20 Year Proportio uemployed Measures Age years: social class of parets, height, weight, drikig ad cigarette smokig behaviour Age years: height, weight, drikig ad cigarette smokig behaviour Cigarette smokig Me were classified as smokers or o-smokers at age years based o a self-report at age years of the umber of cigarettes smoked per day. For the earlier measure of smokig behaviour cohort members prospectively reported the umber of cigarettes they smoked per week at age years. Alcohol cosumptio The measures of alcohol cosumptio were based o the umber of uits cosumed durig the week prior to the

3 Uemploymet ad health behaviour i me iterview at ages ad years, as reported to the iterviewer. A uit was equivalet to half a pit of beer, a sigle measure of spirits or a glass of wie. The idicators for alcohol cosumptio used were o alcohol cosumed i the previous week ad the top fifth of the alcohol cosumptio distributio. The stadard CAGE questioaire 32 items were used to idetify those who had a drik problem (three or more positive resposes to the CAGE questioaire). This questioaire uses a series of questios (which were modified for British use) icludig the four which provide its ame: 'Have you ever felt that you should cut dow o your drikig?', 'Have people aoyed you by criticizig your drikig?', 'Have you ever felt bad or guilty about your drikig?', 'Have you ever had a drik first thig i the morig to steady your erves or get rid of a hag over (eye-opeer)?'. The istrumet, used i this way, has bee validated as a idicator of drikig problems. 32 BMJ The BMI at ages ad years was used as a idex of relative weight. The BMI was calculated as weight (kg) divided by height (m 2 ). Heights ad weights were measured without shoes. At age years heights ad weights were measured by a school medical officer. At age years heights ad weights were measured by professioal research iterviewers usig stadiometers ad electroic scales. Social class The Registrar Geeral's social class based o the father's occupatio whe the cohort member was years of age was used. Where the father was ot preset, the mother's social class was used. The Registrar Geeral's social class has bee described as measurig levels of prestige or skill. 3 ' 1 This measure of social class is divided ito six ordial categories (I, 11, III o-maual, III maual, IV ad V). Class I represets the highest level of prestige or skill ad class V the lowest. Qualificatios ad age at leavig full-time educatio Qualificatios were grouped ito 6 ordial categories idicatig the highest qualificatio achieved: o qualificatios, low-level qualificatios, 'O' level or equivalet qualificatios, 'A' level or equivalet qualificatios, other higher qualificatios below uiversity level ad uiversity degrees ad higher or equivalet qualificatios. The age at leavig full-time educatio was divided ito three groups: left at age years or before, left at age 17 to 18 years ad left at age 19 years or older. Regio The place of residece at age years was used to idicate the regio. Great Britai was divided ito 11 regios. Statistical aalysis All the aalyses were coducted usig SPSS. 35 The relatioships of cigarette smokig, alcohol cosumptio ad the BMI at ages ad years with the amout of uemploymet experieced ad recet uemploymet at age years were examied by cross tabulatio ad logistic regressio. Rather tha usig mea values, separate low ad high measures of alcohol cosumptio ad the BMI were aalysed, as uemploymet may be associated with both extremes of the distributios. Separate multiple logistic regressio models were used to ivestigate the health behaviour ad BMI outcome measures at age years, while ustig for cofoudig variables. Categorical variables were etered ito the logistic models as biary dummies. I order to model chages i a variable, such as a high BMI, betwee the ages of ad years, the variable at age years was modelled as the depedet variable. A detailed measure of the same behaviour or BMI at age years was icluded i the model as a explaatory variable, thus ustig for the effect of selectio. Such a approach is ofte referred to as coditioal chage modellig, as it coditios o iitial state by icludig it as a explaatory variable. 36 This approach is appropriate where marked chages i distributio are takig place betwee the two time poits. RESULTS Table 2 shows the distributio of uemploymet ad its relatioship to the potetial cofoudig variables. Overall, 59.0 reported o uemploymet while 5.8 Table 2 Accumulated uemploymet betwee the ages of ad years by paretal social class, age at leavig full-time educatio, highest qualificatio attaied ad uemploymet i the previous 12 moths at age years Paretal social class I ad 11 III o-maual III maual IV V Age at leavig full time educatio (years) >19 Highest qualificatio Noe Some 'O' level 'A 1 level Professioal Degree Uemployed i last year No Yes All , , , , Moths uemployed > Dowloaded from by guest o Jauary 9, 20

4 EUROPEAN JOURNAL OF PUBLIC HEALTH VOL NO. 1 had more tha three years of accumulated uemploymet betwee the ages of ad years. Of all the me 5.7 had experieced uemploymet i the year prior to the iterview at age years. Larger amouts of accumulated uemploymet were associated with a lower social class at age years ad lower levels of educatio. Smokig At age years, me who subsequetly experieced more tha three years of uemploymet were already more likely to smoke (50.0), tha those who experieced o uemploymet, of whom 31.6 were smokers (table 3). By age years this differece had grow to 51.2 of me who had accumulated over three years of uemploymet compared with 25.8 smokig amogst those who had ever bee uemployed, reflectig the greater tedecy for me who experiece less uemploymet to stop smokig. The recetly uemployed were also more likely to smoke at age years tha those who had ot bee recetly uemployed (53.9 ad 28.6 respectively). After ustmet for cofoudig variables, icludig the umber of cigarettes smoked per week at age years, the relative odds of smokig at age years were 2.11 (95 CI: ) i the group with more tha three years of uemploymet. Smokig at age years was also associated with recet uemploymet (usted RO 2.06,95 CI: ). Icludig both accumulated ad recet uemploymet i the same model suggested that both were idepedetly associated with smokig at age years. A uivariate aalysis (=5,242) to assess the effect of excludig cases with missig data idicated that the relatioship betwee uemploymet ad cigarette smokig at age years may have bee somewhat uderestimated: 55.6 of me who accumulated over three years of uemploymet ad 54.1 of recetly uemployed me were smokers. BMI Table 3 shows that the proportio of me i the bottom fifth of the BMI distributio (maximum BMI value 22.62, media 21.44) was greatest amogst those who experieced over three years of uemploymet, both at age years ad at age years whe the associatio was stroger (25.2 ad 30.5 respectively). At age years the usted relative odds for beig i the bottom fifth of the BMI distributio for me with over three years of uemploymet were 2.13 (95 CI: ). Iterestigly, the ustmet for cofouders, icludig the BMI at age years, did ot reduce the relative odds. This implies that the experiece of over three years of uemploymet was associated with a fall i the BMI rakig betwee the ages of ad years ad this was cofirmed i more detailed aalysis (data ot show). There Table 3 Smokig ad body mass idex (BMI top ad bottom fifths of the distributio) by amout of uemploymet betwee ages ad years, ad recet uemploymet Uemploym et (moths) >37 Uemploym et i last year No Yes 1, , SmokigI u RO 1.27 ( ) 1.95 ( ) 3.03 ( ) 2.92 ( ) RO a 1.30 ( ) 1.67 ( ) 2.11 ( ) 2.06 ( ) 1.24 (0.98- ) ( ) 1.79 ( ) ( ) 1, , LowBM I u RO 1. ( ) 1.06 ( ) 1.97 ( ) 1.40 ( ) RO a 1.24 ( ) 1.47) 2.13 ( ) 1.32 ( ) ( ) ( ) 2.11 ( ) ( ) 1, , High BMI u RO 0.87 ( ) 0.99 ( ) 1.28 ( ) 1.14 ( ) RO a 0.80 ( ) 0.94 ( ) ) 1.10 ( ) 0.80 ( ) 0.92 ( ) 1.14 ( ) 1.12 ( ) Dowloaded from by guest o Jauary 9, 20 Total 2,864 2,444 2,444 The odds are show with 95 cofidece itervals. Adjusted for social class, qualificatios, age at leavig full-time educatio, regio ad umber of cigarettes smoked at age years. The models for the BMI at age years were also usted for the BMI at age years ad.the umber of cigarettes smoked per day at age years. a: Accumulated ad recet uemploymet modelled separately b: Accumulated ad recet uemploymet usted for each other u RO: uusted RO; RO: usted RO

5 Uemploymet ad health behaviour i me was o clear evidece that uemploymet of less tha three years was associated with a low BMI at age years, or was there ay clear evidece that a low BMI was associated with recet uemploymet. After ustmet for cofoudig variables, icludig the BMI at age years, either measure of uemploymet was associated with a high BMI (miimum BMI value 28.14, media 30.07) at age years. A uivariate aalysis (=5,177) to assess the effect of excludig cases with missig data idicated that the relatioship betwee uemploymet ad the BMI at age years may have somewhat uderestimated the associatio of uemploymet with a high BMI. Twety-six percet of me who had accumulated over three years of uemploymet ad 22.4 of recetly uemployed me had a high BMI. I me who had accumulated over three years of uemploymet ad i recetly uemployed me, 26.8 ad 24-8 respectively, had a low BMI. Alcohol cosumptio Me who wet o to experiece over three years of uemploymet were more likely to have druk o alcohol i the week prior to the iterview at age years (58.7), compared with me who would experiece o uemploymet (47.4), as show by table 4. At age years abstiece was also more commo amogst those with over three years of uemploymet (28.7) tha those who had ever bee uemployed (17.9). After ustmet for cofoudig variables icludig drikig at age years, the relative odds of ot drikig at age years were 1.52 (95 CI: ) i me with over three years of uemploymet. There was o suggestio that smaller amouts of accumulated uemploymet or recet uemploymet were related to abstiece. A high alcohol cosumptio at age years was ot related to subsequet experiece of uemploymet (table 4) A high alcohol cosumptio at age years (top fifth of the distributio, miimum 31 uits, media 44.00) was more commo amogst those with over three years of uemploymet (usted relative odds 1.47, 95 CI: ) ad sigificatly associated with recet uemploymet (usted relative odds 1.73, 95 CI: ). The iclusio of both accumulated ad recet uemploymet i the same model cofirmed that recet uemploymet was more clearly related to a higher alcohol cosumptio. A uivariate aalysis (=5,249) to assess the effect of excludig cases with missig data idicated that the relatioship betwee uemploymet ad alcohol cosumptio at age years may have somewhat uderestimated the associatio of o alcohol cosumptio i the week prior to the iterview ad uemploymet. Of me who had accumulated over three years of uemploymet ad recetly uemployed me 34-1 ad 26.6 respectively, had o alcohol i the week prior to iterview at age years. Of me who had accumulated over three Table 4 Alcohol cosumptio i the previous week (o alcohol ad the top fifth of the distributio) by amout of uemploymet betwee the ages of ad years ad recet uemploymet Uemploym et (moths) >37. Uemploym et i last year 0 1, No 2, Yes No alcohol u RO RO a ( ) 1.09 ( ) 1.86 ( ) 1.52 ( ) ( ) 1.01 ( ) 1.52 ( ) 1.14 ( ) ( ) ) 1.40 ( ) 1.27 ( ) 1, , High alcohol u RO RO a 1.17 ( ) 1.15 ( ) 1.60 ( ) 1.83 ( ) 1.13 ( ) 1.08 ( ) 1.47 ( ) 1.73 ( ) 1.07 ( ) 1.34) 1.22 ( ) 1.62 ( ) 1, , Problem drikig u RO RO a 1.62 ( ) 1.79 ( ) 2.10 ( ) 2.75 ( ) 1.63 ( ) 1.86 ( ) 2.15 ( ) 2.90 ( ) 1.50 ( ) 1.62 ( ) ( ) 2.26 ( ) Dowloaded from by guest o Jauary 9, 20 Total 2,887 2,887 2,887 The odds are show with 95 cofidece itervals. Adjusted for social class, qualificatios, age at leavig full-time educatio, regio ad umber of uits of alcohol cosumed i the week prior to iterview at age years, a: Accumulated ad recet uemploymet modelled separately b: Accumulated ad tecet uemploymet usted for each other u RO: uusted RO; RO: usted RO

6 EUROPEAN JOURNAL OF PUBLIC HEALTH VOL NO. 1 I years of uemploymet ad recetly employed me 18.2 ad 22.0 respectively, were i the top alcohol cosumptio group. Problem drikig, as idetified by the CAGE questioaire, was more prevalet amogst those who experieced uemploymet, with a slight positive gradiet with the icreasig amout of accumulated uemploymet (table 4) Recet uemploymet was particularly strogly associated with problem drikig, the relative odds after ustmet for cofoudig variables beig 2.90 (95 CI: ). Iterestigly, accumulated uemploymet remaied sigificatly associated with problem drikig eve after ustmet for recet uemploymet, which was clearly more strogly associated with problem drikig, with usted relative odds of 2.26 (95 CI: ). A uivariate aalysis (=5,248) to assess the effect of excludig cases with missig data idicated that the relatioship betwee uemploymet ad problem drikig at age years may have bee somewhat overestimated. Of me who had accumulated over three years of uemploymet ad recetly uemployed me 17.9 ad 26.6 respectively, had drikig problems at age years. DISCUSSION Whilst we foud evidece of selectio ito uemploymet for those with a worse health behaviour, we also observed that the experiece of uemploymet resulted i a further deterioratio of health behaviours. Ulike other studies, we have usted for the potetial cofoudig effects of socioecoomic backgroud factors as well as relevat measures of behaviour prior to labour market etry. Me who left full-time educatio at the earliest age were at risk of experiecig more uemploymet tha those who remaied i educatio for loger. However, this was ot the reaso for the associatio betwee the outcome measures ad uemploymet, as the ustmet for the age at leavig full-time educatio did ot sigificatly alter our fidigs (data ot show). Me who experieced uemploymet were more likely to smoke, have a low BMI, ad cosume less alcohol at age years. However, eve after ustmet for behaviour at age years ad the other potetial cofoudig factors, we have observed sigificat associatios of body weight ad a deterioratio of health behaviour with recet ad accumulated uemploymet at age years. While a relatively small proportio of our sample had experieced recet uemploymet at age years (5.7) or over three years of uemploymet sice labour market etry (5.8), this is probably a coservative estimate i populatio terms, as the most disadvataged me (who are at greater risk of uemploymet) are more likely to have bee lost from the NCDS. 27 " 30 Youth uemploymet has bee associated with a deterioratio i health behaviours, icludig smokig, 37 ad the me i this study who had accumulated more uemploymet were less likely to give up cigarette smokig ad slightly more likely to have take it up. Both accumulated ad recet uemploymet were associated with a higher rate of cigarette smokig idepedetly of each other. Neither recet uemploymet or the amout of uemploymet were sigificatly associated with a high BMI. This is ot too surprisig, as o social class gradiet for obesity i me betwee the ages of ad 44 years was observed i the 1993 Health Survey for Eglad.- 38 The o-sigificat relatioship betwee a higher BMI ad greater amouts of uemploymet may idicate the begiig of a tedecy to obesity amogst log-term uemployed me i middle age, as observed i the Regioal Heart Study. 21 The relatively high prevalece of a low BMI amogst me who had bee uemployed was uexpected ad the circumstaces surroudig this pheomeo deserve further ivestigatio. Smokig is kow to be associated with a low BMI, but as we usted for this, it is ulikely to explai the relatioship betwee a low BMI ad uemploymet. A combiatio of behavioural ad other factors, icludig heavy drikig, may be resposible for the relatioship. Further aalysis idicated that the associatio betwee low weight ad accumulated uemploymet was partly due to weight loss betwee age 23 ad years (data ot show), but it was ot possible to determie if this occurred at a time of uemploymet. Both a high alcohol cosumptio ad a high CAGE score were sigificatly associated with recet uemploymet. The risk of havig a high CAGE score icreased with the accumulatio of uemploymet. Oe explaatio for this is that me with a drik problem fid it harder to obtai ad keep a job because of the drikig problem itself. Exposure to uemploymet may also cause or exacerbate a drikig problem. Both recet ad accumulated uemploymet are likely to have resulted i a greater risk of fiacial hardship ad this may have a direct effect o health ad health behaviour. Uemploymet i Britai i the late 1980s owards has bee associated with multiple deprivatio ad social polarizatio, idicatig that ay experiece of uemploymet is associated with a sigificat risk of cotiuig fiacial hardship. Because a low icome is associated with previous uemploymet' 10 as well as curret uemploymet, more work to ivestigate the mediatig role of fiacial hardship i the relatioship of uemploymet with health ad health behaviours is desirable. We have foud that both recet ad accumulated uemploymet are associated with deterioratio of health behaviours, but were uable to look at the potetially damagig effects of aticipatig job loss, 41 which may also accout for some deterioratio i health ad health behaviour amogst me who suffer labour market disadvatage. While uemploymet may have a acute effect, previous studies have show that metal well-beig amogst the uemployed may improve i those who are satisfactorily employed, 18 ' 42 " 44 ad this may also have positive cosequeces for health behaviour. However, whether such a resolutio is likely to take place i me who have a drikig problem is uclear. Dowloaded from by guest o Jauary 9, 20

7 Uemploymet ad health behaviour i me CONCLUSION Despite evidece that the health behaviour of me who would go o to experiece uemploymet was already differet prior to labour market etry, uemploymet appeared to have further chroic ad acute effects o health behaviour. As this is a study of youg me, for whom patters of health behaviour were still beig established, it provides evidece that uemploymet may play a sigificat part i establishig life-log patters of hazardous behaviour i terms of alcohol cosumptio ad cigarette smokig. This paper forms part of a project fuded by the British Ecoomic ad Social Research Coucil Grat No. R Thaks are due to the Staff of the Social Statistics Research Uit, City Uiversity, who provided the data used here. We are grateful to Oli Harris for his perseverace i retypig the tables. 1 Cook DG, Cummis RO, Bartley MJ, Shaper AG. Health of uemployed middle aged me i Great Britai. Lacet 1982;i: Daiel WW, Stilgoe E. Where are they ow? 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