Centre Maurice Halbwachs (EHESS, ENS, CNRS, PSL), INRAE, Paris, France.
Centre Maurice Halbwachs (EHESS, ENS, CNRS, PSL), Paris, France.
PLoS One. 2020 May 6;15(5):e0232262. doi: 10.1371/journal.pone.0232262. eCollection 2020.
Unemployment is associated with a high prevalence of risky health behaviors. Mortality increases with the number of co-occurring risky behaviors but whether these behaviors co-occur with a greater than expected frequency (clustering) among unemployed people is not known.
Differences according to unemployment status in co-occurrence and clustering of smoking, alcohol abuse, low leisure-time physical activity and unhealthy diet (marked by low fruit and vegetable intake) were assessed in 65,630 salaried workers, aged 18 to 65, who were participants in Constances, a French population-based cohort. Among them, 4573 (7.0%) were unemployed without (n = 3160, 4.8%) or with (n = 1413, 2.1%) past experience of unemployment.
Compared to the employed, unemployed participants without or with past experience of unemployment were similarly overexposed to each risky behavior (sex and age adjusted odds-ratios ranging from 1.38 to 2.19) except for low physical activity, resulting in higher rates of co-occurrence of two, three and four behaviors (relative risk ratios, RRR 1.20 to 3.74). Association between behavior co-occurrence and unemployment did not vary across gender, partnership status or income category. Risky behavior clustering, i.e., higher than expected co-occurrence rates based on the prevalence of each behavior, was similar across unemployment status. The same observations can be made in employed participants with past experience of unemployment, although overexposure to risky behaviors (ORs 1.15 to 1.38) and increased rates of co-occurrence (ORs 1.19 to 1.58) were not as pronounced as in the unemployed.
Co-occurrence of risky behaviors in currently and/or formerly unemployed workers is not worsened by behavior clustering. Engagement in each of these behaviors should be considered an engagement in distinct social practices, with consequences for preventive policies.
失业与高风险健康行为的普遍存在有关。死亡率随着同时存在的风险行为数量的增加而增加，但失业人群中这些行为是否同时发生的频率高于预期（聚类）尚不清楚。
在 65630 名年龄在 18 至 65 岁之间的薪俸工人中，评估了失业状况与吸烟、酗酒、低闲暇时间体力活动和不健康饮食（以低水果和蔬菜摄入量为标志）同时发生和聚类的差异，这些工人是法国基于人群的队列研究 Constances 的参与者。其中，4573 人（7.0%）失业，无（n = 3160，4.8%）或有（n = 1413，2.1%）失业经历。
与就业者相比，无或有失业经历的失业参与者同样过度暴露于每种风险行为（调整后的性别和年龄比值比为 1.38 至 2.19），除了低体力活动外，导致两种、三种和四种行为同时发生的比例更高（相对风险比，RRR 为 1.20 至 3.74）。行为同时发生与失业之间的关联在性别、伴侣状况或收入类别方面没有差异。风险行为聚类，即基于每种行为的流行程度，出现高于预期的同时发生率，在失业状况下是相似的。在有失业经历的就业参与者中也可以观察到同样的情况，尽管过度暴露于风险行为（比值比为 1.15 至 1.38）和同时发生的比例增加（比值比为 1.19 至 1.58）并不像失业者那样明显。
目前和/或以前失业的工人同时发生风险行为并不会因行为聚类而恶化。应该将参与这些行为中的每一种行为视为参与不同的社会实践，这对预防政策有影响。
