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Purpose To investigate the influence of poor health on job-search behavior and re-employment, and the mediating role of job-search cognitions and coping resources. Methods A prospective study was conducted among unemployed persons receiving social security benefits in the Netherlands (n = 510). Self-rated health, self-esteem, mastery, job-search cognitions, and the intention to search for a job were measured at baseline. Logistic regression analysis was used to investigate determinants of job-search behavior during a follow-up period of 6 months. Cox proportional hazards analysis was used to investigate the influence of health, job-search cognitions and coping resources on re-employment during a mean follow-up period of 23 months. Results Persons with poor health were less likely to search for paid employment (OR 0.58, 95 % CI 0.39-0.85) and were also less likely to find paid employment (HR 0.58, 95 % CI 0.39-0.89). Persons with a positive attitude toward job-search, high perceived social pressure to look for a job, high job-search self-efficacy and high job-search intention were more likely to search actively and also to actually find paid employment. Adjustment for job-search cognitions and coping reduced the influence of health on active search behavior by 50 % and on re-employment by 33 %. Conclusions Health-related differences in job-search behavior and re-employment can be partly explained by differences in coping, job-search attitude, self-efficacy, and subjective norms towards job-search behavior. Measures to reduce the negative impact of poor health on re-employment should address the interplay of health with job-search cognitions and coping resources. [ABSTRACT FROM AUTHOR]

Background The relationship between unemployment and poor health has been well established. Unemployment causes poor health, and poor health increases the probability of unemployment. Methods A prospective study with 6 months' followup was conducted among unemployed participants receiving social security benefits who were capable of full-time employment and were referred to a re-employment training centre. Re-employment was defined as ending social security benefits for at least 3 months because of starting with paid employment. Health-related quality of life was measured by the 36-Item Short-Form Health Survey. A Cox proportional hazards analysis was used to determine the factors that predicted re-employment during follow-up. The influence of re-employment on changes in perceived health was investigated with linear regression analysis. Results Unemployed participants with a poor health at baseline were less likely to return to paid employment during follow-up. Almost all dimensions of health at baseline had an influence on the likelihood of becoming employed. Among the re-employed participants, general health, physical functioning, social functioning, vitality, mental health, bodily pain and role limitations due to emotional or physical problems improved, with an effect size varying from 0.11 to 0.66. Conclusions This study provides evidence that re-employment leads to improvement of self-perceived health within a short time window. This suggests that labour force participation should be considered as therapeutic intervention within health promotion programmes among unemployed persons. [ABSTRACT FROM AUTHOR]

Background: Employment status is an important determinant of health inequalities. Among unemployed people, poor health decreases the likelihood of re-employment. Methods: A randomised controlled trial with 6 months' follow-up among unemployed people with health complaints receiving social security benefits from the city of Rotterdam, The Netherlands. In total, 456 people were assigned to the control group and 465 people to the intervention group. The intervention consisted of three sessions weekly over 12 weeks. One session a week was focused on education to enhance the ability to cope with (health) problems, and two weekly sessions consisted of physical activities. The primary outcome measures were perceived health, measured by the Short Form 36 Health Survey, and psychological measures mastery, self-esteem and pain-related fear of movement. Secondary outcome measures were work values, job search activities and re-employment. Results: Enrolment in the intervention programme was 65%, and 72% completed the programme with over 70% attendance at all sessions. The intervention had a good reach among subjects with lower education, but had no effect on mental and physical health, mastery, self-esteem and pain-related fear of movement. Participation in the programme had no influence on work values, job search activities or re-employment. Conclusion: This intervention programme aimed at the promotion of physical and mental health in unemployed people with health complaints did not show beneficial effects. The lack of integration into regular vocational rehabilitation activities may have interfered with these findings. This particular health programme cannot be recommended for implementation. [ABSTRACT FROM AUTHOR]

Objectives: This study investigates the influence of onset of disease on exit from paid employment and whether this differs across diseases and sociodemographic groups., Methods: Register data from Statistics Netherlands on medication prescription was linked to information on employment status and demographics. Persons who were employed in 2009 and 2010 and who did not use medication for the selected disease in 2009 (N=5 889 036) were followed-up over nine years. Six diseases were identified based on medication prescription in 2010 and 2011: cardiovascular diseases, inflammatory diseases, diabetes mellitus, respiratory diseases, common mental disorders, and psychotic disorders. Four pathways out of paid employment were defined: disability benefits, unemployment, no income, and early retirement. Early exit from paid employment was defined as exiting paid employment before retirement age. Cause-specific Cox proportional hazards regression analyses were performed, with interaction terms for age, sex, and migration background., Results: Onset of disease increased the likelihood of exit from paid employment, with the strongest associations for psychotic disorders [hazard ratio (HR) 2.88, 95% confidence interval (CI) 2.78-2.98] and common mental disorders (HR 2.00, 95% CI 1.97-2.03). Onset of disease was most strongly associated with disability benefits, followed by unemployment. The influence of common mental and psychotic disorders on disability increased until around middle-age, after which it decreased. The influence of mental health problems on exit from paid employment was stronger for persons with a non-native Dutch background and males., Conclusion: Onset of diseases, especially mental health disorders, is a risk for exiting paid employment before the retirement age. Effective interventions are needed to enhance an inclusive workforce and prevent involuntary loss of paid employment.

Objectives: This study aims to estimate the influence of chronic diseases and poor working conditions - across educational levels - on working life expectancy (WLE) and working years lost (WYL) in the Dutch workforce after age 50., Methods: Information on demographics, chronic diseases, and working conditions from 11 800 Dutch workers aged 50-66 years participating in the Study on Transitions in Employment, Ability and Motivation (STREAM) from 2010/2015 was enriched with monthly information on employment status from Statistics Netherlands up to 2018. In a multistate model, transitions were calculated between paid employment and involuntary exit (disability benefits, unemployment) and voluntary exit (economic inactivity, early retirement) to estimate the impact of education, chronic diseases, and working conditions on WLE and WYL between age 50 and 66., Results: Workers with a chronic disease (up to 1.01 years) or unfavorable working conditions (up to 0.63 years) had more WYL due to involuntary pathways than workers with no chronic disease or favorable working conditions. The differences in WYL between workers with and without a chronic disease were slightly higher among workers with a lower education level (male: 0.85, female: 1.01 years) compared to workers with a high educational level (male: 0.72, female: 0.82 years). Given the higher prevalence of chronic diseases and unfavorable working conditions, WYL among lower educated workers were higher than among higher educated workers., Conclusions: The presence of a chronic disease or unfavorable working conditions, more prevalent among lower educated workers, contribute substantially to WYL among older workers. This will increase educational inequalities in working careers.eers.

Objectives: New legislation on youth care in the Netherlands led to the implementation of community-based support teams, providing integrated primary youth care. Important aims of the new Youth Act were more integrated, timely care and less use of intensive forms of care. Our aim was to study changes in youth care use in time and the role of newly introduced community-based support teams herein., Setting: Register data (2015-2018) on youth of a large city were linked and combined with administrative and aggregated data on team characteristics., Participants: Data on 126 095 youth (0-18 years) were available for analyses., Primary and Secondary Outcome Measures: Primary, specialised and residential youth care use were the primary outcomes., Results: Generalised estimating equations analyses adjusted for individual characteristics demonstrated that over 4 years, use of primary youth care increased from 2.2% to 8.5% (OR 1.70; 99% CI 1.67 to 1.73), specialised youth care decreased from 7.2% to 6.4% (OR 0.98; 99% CI 0.97 to 1.00) and residential youth care increased slightly (OR 1.04; 99% CI 1.01 to 1.06). Gender, age, family status, migrant background and educational level were all associated with the types of youth care use and also with some trends in time. Likelihood to receive care increased in time for preschool and younger children but did not improve for migrant children.Case load, team size, team turnover, team performance and transformational leadership showed significant associations with different types of youth care use but hardly with trends in time., Conclusion: Patterns of youth care use changed towards more locally provided primary youth care, slightly less specialised and slightly more residential youth care. Furthermore, youth care use among younger children increased in time. These trends are partly in line with the trends intended by the Youth Act. Little evidence was found for the role of specific team characteristics on changes in youth care use in time., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Objectives: The first objective of this study was to describe the age-specific prevalence of chronic diseases and multimorbidity among unemployed and employed persons. The second objective was to examine associations of employment status and sociodemographic characteristics with chronic diseases and multimorbidity., Design: Data linkage of cross-sectional nationwide registries on employment status, medication use and sociodemographic characteristics in 2016 was applied., Setting: Register-based data covering residents in the Netherlands., Participants: 5 074 227 persons aged 18-65 years were selected with information on employment status, medication use and sociodemographic characteristics., Outcome Measures: Multiple logistic regression analysis and descriptive statistics were performed to examine associations of employment and sociodemographic characteristics with the prevalence of chronic diseases and multimorbidity. The age-specific prevalence of six common chronic diseases was described, and Venn diagrams were applied for multimorbidity among unemployed and employed persons., Results: Unemployed persons had a higher prevalence of psychological disorders (18.3% vs 5.4%), cardiovascular diseases (20.1% vs 8.9%), inflammatory diseases (24.5% vs 15.8%) and respiratory diseases (11.7% vs 6.5%) than employed persons. Unemployed persons were more likely to have one (OR 1.30 (1.29-1.31)), two (OR 1.74 (1.73-1.76)) and at least three chronic diseases (OR 2.59 (2.56-2.61)) than employed persons. Among unemployed persons, psychological disorders and inflammatory conditions increased with age but declined from middle age onwards, whereas a slight increase was observed among employed persons. Older persons, women, lower educated persons and migrants were more likely to have chronic diseases., Conclusion: Large differences exist in the prevalence of chronic diseases and multimorbidity among unemployed and employed persons. The age-specific prevalence follows a different pattern among employed and unemployed persons, with a relatively high prevalence of psychological disorders and inflammatory conditions among middle-aged unemployed persons. Policy measures should focus more on promoting employment among unemployed persons with chronic diseases., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY. Published by BMJ.)

Background: Individuals with lower socioeconomic status are at increased risk of involuntary exit from paid employment. To give sound advice for primary prevention in the workforce, insight is needed into the role of mediating factors between socioeconomic status and labour force participation. Therefore, it is aimed to investigate the influence of health status, lifestyle-related factors and work characteristics on educational differences in exit from paid employment., Methods: 14,708 Dutch employees participated in a ten-year follow-up study during 1999-2008. At baseline, education, self-perceived health, lifestyle (smoking, alcohol, sports, BMI) and psychosocial (demands, control, rewards) and physical work characteristics were measured by questionnaire. Employment status was ascertained monthly based on tax records. The relation between education, health, lifestyle, work-characteristics and exit from paid employment through disability benefits, unemployment, early retirement and economic inactivity was investigated by competing risks regression analyses. The mediating effects of these factors on educational differences in exit from paid employment were tested using a stepwise approach., Results: Lower educated workers were more likely to exit paid employment through disability benefits (SHR:1.84), unemployment (SHR:1.74), and economic inactivity (SHR:1.53) but not due to early retirement (SHR:0.92). Poor or moderate health, an unhealthy lifestyle, and unfavourable work characteristics were associated with disability benefits and unemployment, and an unhealthy lifestyle with economic inactivity. Educational differences in disability benefits were explained for 40% by health, 31% by lifestyle, and 12% by work characteristics. For economic inactivity and unemployment, up to 14% and 21% of the educational differences could be explained, particularly by lifestyle-related factors., Conclusions: There are educational differences in exit from paid employment, which are partly mediated by health, lifestyle and work characteristics, particularly for disability benefits. Health promotion and improving working conditions seem important measures to maintain a productive workforce, particularly among workers with a low education.

Objectives: The aim of this study was to investigate the effect of ill health and socioeconomic status on labor force exit due to unemployment, early retirement, disability pension, or becoming economically inactive. A secondary objective was to investigate the effect of ill health and socioeconomic status on return to work., Methods: A representative sample of the Dutch working population (N=15 152) was selected for a prospective study with ten years follow-up (93 917 person-years). Perceived health and individual and household characteristics were measured at baseline with the Permanent Quality of Life Survey (POLS) during 1999-2002. Statistics Netherlands ascertained employment status monthly from January 1999 to December 2008. Cox proportional hazards analyses were used to determine the factors that predicted labor force exit and return to work., Results: Ill health increased the likelihood of labor force exit into unemployment [hazard ratio (HR) 1.89], disability pension (HR 6.39), and early retirement (HR 1.20), but was not a determinant of becoming economically inactive (HR 1.07). Workers with low socioeconomic status were, even after adjusting for ill health, more likely to leave the labor force due to unemployment, disability pension, and economic inactivity. Workers with ill health at baseline were less likely to return to work after unemployment (HR 0.75) or disability pension (HR 0.62). Socioeconomic status did not influence re-employment., Conclusions: Ill health is an important determinant for entering and maintaining paid employment. Workers with lower education were at increased risk for health-based selection out of paid employment. Policies to improve labor force participation, especially among low socioeconomic level workers, should protect workers with health problems against exclusion from the labor force.

Objective: The aim of the study is to evaluate whether health inequalities associated with unemployment are comparable across different ethnic groups., Method: A random sample of inhabitants of the city of Rotterdam filled out a questionnaire on health and its determinants, with a response of 55.4% (n = 2,057). In a cross-sectional design the associations of unemployment, ethnicity, and individual characteristics with a perceived poor health were investigated with logistic regression analysis. The associations of these determinants with physical and mental health, measured by the Short Form 36 Health Survey, were evaluated with linear regression analyses. Interactions between ethnicity and unemployment were investigated to determine whether associations of unemployment and health differed across ethnic groups., Results: Ill health was more common among unemployed persons [odds ratio (OR) 2.6; 95% CI 1.7-3.8] than workers in paid employment. Health inequalities between employed and unemployed persons were largest among native Dutch persons (OR = 3.2) and Surinamese/Antillean persons (OR = 2.6), and smaller in Turkish/Moroccan persons (OR = 1.6) and overseas refugees (OR = 1.6). The proportions of persons with poor health that could be attributed to unemployment were 14, 26, 14, and 13%, respectively., Conclusions: Differences in ill health between employed and unemployed persons were less profound in ethnic groups compared to the majority population, but the prevalence of unemployment was much higher in ethnic groups. The population attributable fractions varied between 14 and 28%, supporting the argument that policies for health equity should pay more attention to measures that include persons in the labour market and that prevent workers with ill health from dropping out of the workforce.

Background: The relationship between poor health and unemployment is well established. Health promotion among unemployed persons may improve their health. The aims of this study were to investigate characteristics of non-participants and drop-outs in a multidisciplinary health promotion programme for long-term unemployed persons with health complaints, to evaluate changes in physical health among participants, and to investigate determinants of improvement in physical health., Methods: A longitudinal, non-controlled design was used. The programme consisted of two weekly exercise sessions and one weekly cognitive session during 12 weeks. The main outcome measures were body mass index, blood pressure, cardiorespiratory fitness, abdominal muscle strength, and low back and hamstring flexibility. Potential determinants of change in physical health were demographic variables, psychological variables (self-esteem, mastery, and kinesiophobia), and self-perceived health., Results: The initial response was 73% and 252 persons had complete data collection at baseline. In total, 36 subjects were lost during follow-up. Participants were predominantly low educated, long-term unemployed, and in poor health. Participation in the programme was not influenced by demographic and psychological factors or by self-reported health. Drop-outs were younger and had a lower body mass index at baseline than subjects who completed the programme. At post-test, participants' cardiorespiratory fitness, abdominal muscle strength, and flexibility had increased by 6.8%-51.0%, whereas diastolic and systolic blood pressures had decreased by 2.2%-2.5%. The effect sizes ranges from 0.17-0.68., Conclusion: Participants with the poorest physical health benefited most from the programme and gender differences in improvement were observed. Physical health of unemployed persons with health complaints improved after participation in this health promotion programme, but not sufficiently, considering their poor physical health at baseline.

Objective: A collective labour agreement concerning extended rest periods during long-distance shuttle bus trips of Dutch long-distance coach drivers was established in 1997. The main purpose of this study was to evaluate the extent to which top-down implementation of these health regulations, with respect to rest times and subjective health complaints in the private passenger-transport sector, succeeded in the year 2002., Methods: A questionnaire study was carried out on 440 coach drivers and 97 of their employers. The questionnaire for coach drivers focused on the frequency they received the required rest times and on their health status. The questionnaire for employers focused on the number of rest hours that their companies scheduled for long-distance shuttle bus trips for their drivers. Motives for not scheduling the required rest hours were noted as well., Results: Almost every employer (93%) and three-quarters of the drivers (72%) reported at least 12 h rest time before a long-distance shuttle bus trip, as required. Approximately half of the employers (57%) reported planning the required rest during and after these bus trips. Fewer than one-quarter of the drivers (24%) received at least 10 h rest at their destination and fewer than half of the coach drivers (42%) always receive the required 24 h rest after the trip. In addition, the significant results are indicative of a positive relationship between the duration of the rest period during and after the long-distance shuttle bus trip and the level of health complaints of the coach drivers., Conclusions: Top-down implementation of health regulations with respect to rest times resulted in successful implementation after 5 years in approximately half of the companies. Longer rest times during the high season of 2002 were associated with less health complaints at the end of that season.