Health, school and family factors in adolescence and labour market integration problems in young adulthood : the HUNT study

Abstract

Background

In Norway and other western countries many young people experience labour market integration problems, as demonstrated by high rates of unemployment, sickness, disability and welfare dependence. Factors leading to such problems are complex and not well understood. In particular, there is a knowledge gap in how these problems are related to adolescent health and vulnerability, as such knowledge is needed for the understanding of mechanisms leading to non-inclusion or exclusion from work in young people and how this may be prevented. Many adolescents have chronic diseases, mental health problems and school problems, and their health and well-being is continuously influenced by their family and other close environments. Present knowledge indicates that these determinants are likely to influence adolescents’ risk of work integration problems.

Aims

The general objective of this thesis was to study work integration problems in young adulthood in relation to adolescent health and vulnerability, from a medical perspective and by the use of epidemiological methods. The objectives of the different papers were to study the prospective associations between selected health, school and family factors in adolescence (reading and writing difficulties, self-rated health, anxiety and depression symptoms, being a high-school dropout, parental anxiety and depression symptoms and parental benefit receipt and other family factors) and work integration problems in young adulthood, assessed by the receipt of long-term social insurance benefits.

Methods

The relationship between adolescent factors and work-related outcomes in young adulthood was explored by following a Norwegian population cohort (Young-HUNT1) of almost 9,000 subjects for more than 10 years – from adolescence to young adulthood – combining questionnaire data completed between ages 12 and 20 years in 1995-97 with information on the long-term receipt of social insurance benefits from 1998 to 2007/2008. Adolescent data was linked to register data from several national databases and to data on their biological parents, including parental data from the HUNT2 Survey (1995-97). The main study exposures were based on self-reported information by adolescents (reading and writing difficulties, self-rated health, anxiety and depression symptoms) and parents (parental anxiety and depression symptoms and parental health) and on register data on adolescents (high-school dropout) and parents (parental benefit receipt and socioeconomic status). The main outcome was the receipt of long-term social insurance benefits in young adulthood intended to replace income during unemployment or sickness. Medical benefits included disability benefits, rehabilitation benefits and long-term sickness benefits (received for at least 180 days/six months during one calendar year). All social benefits included medical benefits in addition to unemployment benefits and social assistance (received for at least 180 days/six months during one calendar year). Associations between main study exposures and benefit receipt were explored by descriptive statistics and various logistic regression models, including longitudinal assessments and sibling comparisons.

Results

In total, 2,396 (27%) individuals in the Young-HUNT 1 cohort (n=8907) received a long-term benefit during follow-up (all social benefits included) and 1,351(15%) individuals received a long-term medical benefit. Patterns of benefit receipt over time and associations with adolescent health measures depended on the type of benefit received (Thesis supplement). Sibling analyses indicated that benefit receipt was clustered within families (Thesis supplement). Self-reported reading and writing difficulties were associated with both medical benefits and all social benefits, including also after adjusting for mental health characteristics (Paper I). Self-rated health was associated with receiving both medical and non-medical benefits and dropping out of high school was strongly associated with receiving medical and non-medical benefits (Paper II). Anxiety and depression symptoms were associated with receiving medical benefits, but not with unemployment benefit (Paper III). Parental symptoms of anxiety and depression, however, were associated with adolescents’ risk of both receiving medical benefits and unemployment benefits (Paper III). Parental medical benefits were associated with an adolescent’s later risk of medical benefits, but the association was substantially reduced when adjusting for family health (Paper IV). Additional findings in Paper IV also indicated that family health, parental education, parental income, divorce, parental unemployment and parental social assistance were independent predictors of young adult medical benefits.

Conclusions

Work integration problems, assessed by the receipt of long-term social insurance benefits in young adulthood, were experienced at some time in their 20s by one out of four adolescents in the study cohort. Several specific health-related factors were demonstrated to increase adolescents’ vulnerability to experience such problems in the transition to adulthood. Moderate but consistent associations were found for adolescent self-reported reading and writing difficulties, self-rated health, anxiety and depression symptoms and most family factors, while a strong association was found for highschool drop-out. More research is needed on the causes and pathways of work integration problems in young people in order to reduce the magnitude of the problem, including research from other disciplines and research with other methodological approaches (e.g. qualitative methods and intervention studies). In addition, policy measures are needed to ensure that young people are given a fair chance to succeed in obtaining necessary qualifications and in working life.