Health Effects of Job Insecurity among Employees in Swiss General Population

Objectives. To investigate at national level the association between health and the social distress in which the whole employed population is plunged as a consequence of job insecurity. Design. Cross-sectional study. Setting. Switzerland. Subjects. Individuals working full or part time as employees drawn from a random sample (N=2024) of the Swiss general population interviewed by phone. Main outcome measures. Prevalence rates of ten self reported health and health related behaviour indicators according to three levels of perceived job insecurity (low, middle, high). Odds ratios estimated with logistic regression adjusted for relevant respondents characteristics (sex, age, education, having a chronic disease, working full or part-time and in public or private field). Results. One employee out of 10 experienced a high level of job insecurity, out of five a middle level while about 2/3 have no or a very low perception of job insecurity. The results clearly show that psychosocial stress induced in general employed population by fear of unemployment has a negative impact on the individual health and related health behaviour. A positive "dose-response" gradient was found between rise in job insecurity level's and the indicators investigated, suggesting a linear deterioration of health. In particular, employees in high insecurity group, compared to those in low one, have significantly higher odds ratios for seven indicators out of ten [not being in good health OR 1.6 (CI 1.0-2.7); high level of subjective stress OR 1.6 (CI 1.1-2.3); low self-esteem OR 2.9 (CI 1.5-5.7); daily or weekly consumption of tranquillisers OR 2.1 (CI 1.0-4.3); regular low-back pain OR 2.0 (CI 1.3-3.2); regular smoking OR 1.6 (CI 1.0-2.4); avoiding medical consultation or caring for themselves for fear of missing work OR 3.4 (CI 1.9-5.9)]. Employees with higher educational status seem to have more difficulties than less educated in coping with job insecurity. Conclusions. There is a positive association between health status and health related behaviour and social distress due to perception of job insecurity. Fear of unemployment seems to have stronger unfavourable effect in high educated employees than in less educated, probably because investment in career and in personal expectations are, in that group, generally higher. Although this cross-sectional study carried out at national level do not reach the "gold standard" represented by longitudinal ones, the results are fully consistent with those of few analysis on job insecurity carried out prospectively at firm level. Recommendations. In terms of concrete actions the main recommendations stemming from this study could be [i] to break the wall of silence generally erected around studies showing the positive relationship between job insecurity and deterioration of health, in order to promote a public and political consciousness in favour of less excluding and more solidary social and economic choices and [ii] to promote a systematic measure of health impact of policies and legislations with particular emphasis on those affecting labour market and work environment.economic development; labour market; unemployment; job insecurity; deprivation; health; public health; health impact assessment

Socioeconomic Indicators, Tobacco and Alcohol in the Aetiology of Digestive Tract Neoplasms

Ferraroni M {Institute of Medical Statistics, University of Milan, 20133 Milan, Italy), Negri E, La Vecchia C, D'Avanzo B and Franceschi S. Socioeconomic indicators, tobacco and alcohol in the aetiology of digestive tract neoplasms. International Journal of Epidemiology 1989, 18: 556-562. The relationship between education, social class, smoking habits, alcohol consumption and the risk of digestive tract neoplasms was analysed in a case-control study of 50 cases of cancer of the mouth or pharynx, 209 of the oesophagus, 397 of the stomach, 455 of the colon, 295 of the rectum, 151 of the liver, 214 of the pancreas, and a total of 1944 control subjects admitted for acute, non-neoplastic or digestive tract disorders. Cancers of the mouth or pharynx, oesophagus and stomach were inversely and strongly related to education, with risk estimates ranging between 0.2 and 0.4 for the highest education categories. Significant, but weaker inverse relations were evident for rectal and liver cancer, too, whereas the risk of colon cancer was elevated among more educated individuals. There was no relationship between education and pancreatic cancer. The pattern of risk was largely comparable when the head of the household's occupation was used as indicator of social class. There were strong direct associations between cigarette (as well as pipe or cigar) smoking and cancers of the mouth or pharynx and oesophagus, and a moderate one with pancreatic cancer, but none of the other sites considered was related to smoking habits. Cancers of the mouth or pharynx and oesophagus were independently and strongly related to alcohol consumption, too, while the associations between alcohol and liver or pancreatic cancer were moderate and not significant. Cancers of the stomach, colon and rectum were unrelated to measures of alcohol consumptio

Dietary Indicators of Oral and Pharyngeal Cancer

The relationship between frequency of consumption of a selected number of indicator foods and oral and oropharyngeal cancer risk was analysed in a case-control study conducted in Northern Italy on 105 cases of oral and pharyngeal cancer and 1169 controls in hospital for acute, non-neoplastic or digestive diseases. Besides significant and strong direct associations with tobacco (relative risk, RR = 11.0 for current versus never smokers) and alcohol (RR = 5.8 for upper versus lower consumption tertile), consumption of six food items (milk, meat, cheese, carrots, green vegetables and fruit) were inversely and significantly related to oral and pharyngeal cancer risk. The strongest protection was apparently related to frequent fruit consumption, with RRs of 0.8 and 0.2 in the two highest tertiles. Allowance for major potential confounding factors, including tobacco, alcohol and social class indicators explained only part of the dietary correlates observed. The two items remaining significant after multivariate analysis were fruit (RR = 0.3 for the upper tertile) and alcohol (RR = 3.8 for the upper tertile). The associations observed may simply reflect a generally poorer nutritional status in the cases, although the observation that fruit consumption appears to be a particularly important protective factor against oropharyngeal cencer is of potential interest, in terms of aetiological clues and preventive implication

Risk Factors for Gallstone Disease Requiring Surgery

Risk factors for cholelithiasis were investigated in a case-control study conducted in northern Italy on 195 incident cases of gallstone disease requiring surgery (119 females, 76 males) and 1122 controls in hospital for acute, nondigestive tract, non-neoplastic conditions. There was no consistent association with socio-demographic indicators, such as marital status, education and social class nor with smoking and coffee consumption. The relative risk of cholelithiasis decreased with increasing alcohol consumption: compared with non-drinkers, the odds ratio (OR) was 0.8 for one to three drinks per day and 0.5 for over three. A direct association was observed with measures of body weight: relative to leaner individuals, the multivariate ORs were 1.2, 2.1 and 2.4 for subsequent levels of body mass. These trends in risk were statistically significant, consistent in the two sexes, and not apparently modified by adjustment for major identified potential confounding factors. History of hepatitis and liver cirrhosis were reported more frequently by cases, but it is difficult to assess the role of recall bias on these risk factors. No association was found with diabetes, thyroid disease and several digestive tract disorders. For females, no consistent pattern of risk was observed up to four births, but women with five or more births had an OR of 2.9 (95% confidence interval (CI) = 1.1-7.3). The risk decreased with increasing age at first and last birth, both trends being statistically significant. Overweight and alcohol consumption were the most important risk and protective factors respectively for cholelithiasis requiring surgical intervention in this populatio

Women's perception of the benefits of mammography screening: population-based survey in four countries

Background Screening programmes are often actively promoted to achieve high coverage, which may result in unrealistic expectations. We examined women's understanding of the likely benefits of mammography screening. Methods Telephone survey of random samples of the female population aged ≥15 years in the US, UK, Italy, and Switzerland using three closed questions on the expected benefits of mammography screening. Results A total of 5964 women were contacted and 4140 women (69%) participated. Misconceptions were widespread: a majority of women believed that screening prevents or reduces the risk of contracting breast cancer (68%), that screening at least halves breast cancer mortality (62%), and that 10 years of regular screening will prevent 10 or more breast cancer deaths per 1000 women (75%). In multivariate analysis higher number of correct answers was positively associated with higher educational status (odds ratio [OR] = 1.44, 95% CI: 1.25, 1.66) and negatively with having had a mammography in the last 2 years (OR = 0.86, 95% CI: 0.73, 1.01). Compared with US women (reference group) and Swiss women (OR = 0.98, 95% CI: 0.82, 1.18) respondents in Italy (OR = 0.61, 95% CI: 0.50, 0.74) and the UK (OR = 0.73, 95% CI: 0.60, 0.88) gave fewer correct answers. Conclusion In the US and three European countries a high proportion of women overestimated the benefits that can be expected from screening mammography. This finding raises doubts on informed consent procedures within breast cancer screening programme

Understanding frailty:meanings and beliefs about screening and prevention across key stakeholder groups in Europe

Innovative methods to manage frailty are critical to managing the needs of an ageing population. Evidence suggests there are opportunities to reverse or prevent frailty through early intervention. However, little is known about older adults’, families’ and practitioners’ beliefs about the malleability of frailty. This study examined European stakeholders’ accounts of the acceptability and feasibility of frailty screening and prevention to inform future intervention development. Semi-structured focus groups and individual interviews were conducted in three European Union countries (Italy, Poland and the United Kingdom) with key stakeholders – frail and non-frail older adults, family care-givers, and health and social care professionals. Thematic analysis identified four themes: synchronicity between the physical and the psychological in frailty, living with frailty in the social world, the need for a new kind of care, and screening for and preventing frailty. Findings emphasised the need for a holistic approach to frailty care and early intervention. Integrated care services and advocacy were important in the organisation of care. Central to all stakeholders was the significance of the psychological and social alongside the physical elements of frailty and frailty prevention. Support and care for older adults and their family care-givers needs to be accessible and co-ordinated. Interventions to prevent frailty must encompass a social dimension to help older adults maintain a sense of self while building physical and psychological resilience

Dietary Indicators of Oral and Pharyngeal Cancer

The relationship between frequency of consumption of a selected number of indicator foods and oral and oropharyngeal cancer risk was analysed in a case-control study conducted in Northern Italy on 105 cases of oral and pharyngeal cancer and 1169 controls in hospital for acute, non-neoplastic or digestive diseases. Besides significant and strong direct associations with tobacco (relative risk, RR = 11.0 for current versus never smokers) and alcohol (RR = 5.8 for upper versus lower consumption tertile), consumption of six food items (milk, meat, cheese, carrots, green vegetables and fruit) were inversely and significantly related to oral and pharyngeal cancer risk. The strongest protection was apparently related to frequent fruit consumption, with RRs of 0.8 and 0.2 in the two highest tertiles. Allowance for major potential confounding factors, including tobacco, alcohol and social class indicators explained only part of the dietary correlates observed. The two items remaining significant after multivariate analysis were fruit (RR = 0.3 for the upper tertile) and alcohol (RR = 3.8 for the upper tertile). The associations observed may simply reflect a generally poorer nutritional status in the cases, although the observation that fruit consumption appears to be a particularly important protective factor against oropharyngeal cancer is of potential interest, in terms of aetiological clues and preventive implications

Socioeconomic Indicators, Tobacco and Alcohol in the Aetiology of Digestive Tract Neoplasms

The relationship between education, social class, smoking habits, alcohol consumption and the risk of digestive tract neoplasms was analysed in a case-control study of 50 cases of cancer of the mouth or pharynx, 209 of the oesophagus, 397 of the stomach, 455 of the colon, 295 of the rectum, 151 of the liver, 214 of the pancreas, and a total of 1944 control subjects admitted for acute, non-neoplastic or digestive tract disorders. Cancers of the mouth or pharynx, oesophagus and stomach were inversely and strongly related to education, with risk estimates ranging between 0.2 and 0.4 for the highest education categories. Significant, but weaker inverse relations were evident for rectal and liver cancer, too, whereas the risk of colon cancer was elevated among more educated individuals. There was no relationship between education and pancreatic cancer. The pattern of risk was largely comparable when the head of the household's occupation was used as indicator of social class. There were strong direct associations between cigarette (as well as pipe or cigar) smoking and cancers of the mouth or pharynx and oesophagus, and a moderate one with pancreatic cancer, but none of the other sites considered was related to smoking habits. Cancers of the mouth or pharynx and oesophagus were independently and strongly related to alcohol consumption, too, while the associations between alcohol and liver or pancreatic cancer were moderate and not significant. Cancers of the stomach, colon and rectum were unrelated to measures of alcohol consumption

Risk Factors for Gallstone Disease Requiring Surgery

Risk factors for cholelithiasis were investigated in a case-control study conducted in northern Italy on 195 incident cases of gallstone disease requiring surgery (119 females, 76 males) and 1122 controls in hospital for acute, non-digestive tract, non-neoplastic conditions. There was no consistent association with socio-demographic indicators, such as marital status, education and social class nor with smoking and coffee consumption. The relative risk of cholelithiasis decreased with increasing alcohol consumption: compared with non-drinkers, the odds ratio (OR) was 0.8 for one to three drinks per day and 0.5 for over three. A direct association was observed with measures of body weight: relative to leaner individuals, the multivariate ORs were 1.2, 2.1 and 2.4 for subsequent levels of body mass. These trends in risk were statistically significant, consistent in the two sexes, and not apparently modified by adjustment for major identified potential confounding factors. History of hepatitis and liver cirrhosis were reported more frequently by cases, but it is difficult to assess the role of recall bias on these risk factors. No association was found with diabetes, thyroid disease and several digestive tract disorders. For females, no consistent pattern of risk was observed up to four births, but women with five or more births had an OR of 2.9 (95% confidence interval (Cl) = 1.1-7.3). The risk decreased with increasing age at first and last birth, both trends being statistically significant. Overweight and alcohol consumption were the most important risk and protective factors respectively for cholelithiasis requiring surgical intervention in this population