Alcohol, tobacco and cannabis use are associated with job loss at follow-up: Findings from the CONSTANCES cohort
Alcohol, tobacco and cannabis use are associated with job loss at follow-up: Findings from the CONSTANCES cohort
复制标题
DOI：
10.1371/journal.pone.0222361
复制
发表时间：
2019-09-09
期刊：
影响因子：
3.7
通讯作者：
Zins, Marie
中科院分区：
文献类型：
--
作者：
Airagnes, Guillaume;Lemogne, Cedric;Zins, Marie
背景：与就业者相比，失业者中物质使用更为普遍。然而，根据物质使用来量化短期失业的风险，以及检查这种关联是否在各种社会人口统计学和先前与失业有关的职业职位中持续存在，仍然没有得到充分的研究。我们在考虑年龄、性别、总体健康状况和抑郁症状的情况下，在以人口为基础的大量男性和女性样本中，前瞻性地研究了酒精、烟草、大麻的使用及其组合。方法来自法国以人口为基础的constes队列，在2012年至2016年期间纳入了18,879名工作参与者。在基线时，根据酒精使用障碍识别测试（轻度、危险、有问题或依赖）、烟草（不吸烟者、前吸烟者、1- 9,10 -19、10-19支/天）和大麻使用（从不、不过去一年、每月少于一次、每月一次或更多）评估酒精使用障碍风险。一年内的就业状况（工作与不工作）是因变量。Logistic回归提供了一年后失业的优势比（OR(95%CI)），调整了年龄、性别、自我报告的健康状况和抑郁状态（用流行病学研究中心抑郁量表测量）。对受教育程度、职业等级、家庭收入、工作压力（以努力-回报不平衡衡量）、工作合同类型、工作时间类型和失业历史进行分层分析。在敏感性分析中，使用三年随访的就业状况作为因变量。结果酒精、烟草和大麻的使用与失业相关，从第二到最高的类别分别为1.46（95%CI:1.23-1.73）至1.92（95%CI:1.34-2.75）、1.26（95%CI: 1.09-1.46）至1.78（95%CI:1.26-2.54）和1.45（95%CI:1.27-1.66）至2.68(95%CI:2.10-3.42)，并具有剂量依赖关系（趋势均p < 0.001）。当同时引入时，三种物质的关联仍然显著，没有任何物质之间的相互作用。在对所有社会人口和职业因素进行调整后，几乎所有阶层和三年随访期间的关联仍然显著。结论酒精、烟草和大麻的使用与短期失业独立相关，且具有剂量依赖关系。这些知识将有助于完善信息和预防策略。重要的是，即使是适度的酒精、烟草或大麻使用也与短期失业有关，所有社会人口和职业职位都可能受到影响。
BackgroundSubstance use is more prevalent among unemployed subjects compared to employed ones. However, quantifying the risk subsequent of job loss at short-term according to substance use remains underexplored as well as examining if this association persist across various sociodemographic and occupational positions previously linked to job loss. We examined this issue prospectively for alcohol, tobacco, cannabis use and their combination, among a large population-based sample of men and women, while taking into account age, gender, overall health status and depressive symptoms.MethodsFrom the French population-based CONSTANCES cohort, 18,879 working participants were included between 2012 and 2016. At baseline, alcohol use disorder risk according to the Alcohol Use Disorders Identification Test (mild, dangerous, problematic or dependence), tobacco (non-smoker, former smoker, 1-9, 10-19, > 19 cigarettes/day) and cannabis use (never, not in past year, less than once a month, once a month or more) were assessed. Employment status at one-year (working versus not working) was the dependent variable. Logistic regressions provided Odds Ratios(OR(95%CI)) of job loss at one-year, adjusting for age, gender, self-reported health and depressive state (measured with the Center of Epidemiologic Studies Depression scale). Stratified analyses were performed for education, occupational grade, household income, job stress (measured with the Effort-Reward Imbalance), type of job contract, type of work time and history of unemployment. In sensitivity analyses, employment status over a three-year follow-up was used as dependent variable.ResultsAlcohol, tobacco and cannabis use were associated with job loss, from the second to the highest category: 1.46(95%CI:1.23-1.73) to 1.92(95%CI:1.34-2.75), 1.26(95%CI: 1.09-1.46) to 1.78(95%CI:1.26-2.54) and 1.45(95%CI:1.27-1.66) to 2.68(95%CI:2.10-3.42), respectively, and with dose-dependent relationships (all p for trend < 0.001). When introduced simultaneously, associations remained significant for the three substances without any between-substance interactions. Associations remained significant across almost all stratifications and over a three-year follow-up as well as after adjustment for all the sociodemographic and occupational factors.ConclusionsAlcohol, tobacco and cannabis use were independently associated with job loss at short-term, with dose-dependent relationships. This knowledge will help refining information and prevention strategies. Importantly, even moderate levels of alcohol, tobacco or cannabis use are associated with job loss at short-term and all sociodemographic and occupational positions are potentially concerned.