0010.1177/1403494816679555M. Vancea and M.

UtzetHow unemployment and precarious employment affect the health of young people
review-article2016

Scandinavian Journal of Public Health, 1–12

Review Article

How unemployment and precarious employment affect the health of

young people: A scoping study on social determinants

MIHAELA VANCEA1,2 & MIREIA UTZET1,3

1Department of Political and Social Sciences, Universitat Pompeu Fabra, Barcelona, Spain, 2Center for Scientific Research
and Technological Development in Social Sciences and Humanities, Universidad de la Frontera, Temuco, Chile, and
3Universitat Autònoma de Barcelona, Facultat de Medicina, GRAAL-Biostatistics Unit, Bellaterra, Spain

Abstract
Background: The impact of unemployment and precarious employment on the health of young people is not well understood.
However, according to social causation, higher socio-economic positions and thus better working conditions are beneficial to
health in general. We tried to synthesize the results of studies that test this hypothesis in the case of young people. Methods:
We conducted a scoping study mapping all the academic articles published in the period 2006–2016 in Europe. The
literature was searched in PubMed/Medline, Science Direct, Web of Science and Scopus. Results: We identified 1770 studies,
of which only 46 met the inclusion criteria. There are more studies that focus on the relationship between unemployment
and health than between precarious employment and health (28 and 16, respectively). The vast majority of the studies (44)
found support for the social causation hypothesis, the most common health outcomes being mental health disorders, health
risk behaviour, poor quality of life and occupational injuries. The causal mechanisms behind this association relied mainly
on the life-course perspective, the breadwinner model, and the lack of social and economic benefits provided by standard
employment. Conclusions: There is evidence that young people are especially vulnerable to health problems when
unemployed or working in precarious conditions. Active labour market and training programmes, inclusive
social security measures, improved working conditions and targeted health programmes are important for
addressing this vulnerability. Further research should strive to enhance the causal model by including a gender
perspective, longitudinal data, more indicators on precariousness and third factor explanations.

Key Words: unemployment, precarious employment, health, young people

Introduction
The current economic crisis, which began in Europe
between 2006 and 2010, has hit Southern European
countries particularly hard. The crisis has been char-
acterized by increasing unemployment rates and new
and growing forms of precarious employment, such
as flexible and temporary work, insecure and informal
jobs [1–3]. Precarious employment is understood to
be tightly linked to unemployment. High unemploy-
ment rates reduce workers’ bargaining power and
capacity to refuse poor employment and working
conditions, thus increasing the precariousness of
employment overall [4]. This new situation in the
labour market has been associated with increasing
psychosocial risks for the working population [5,6].
In the last three decades, in almost all European
countries, young adults have been exposed to pre-
carious and temporary jobs, and youth unemploy-
ment has been higher than general unemployment
rates [7]. Young adults are particularly vulnerable in
the labour market as they lack both work experience
and appropriate working opportunities [8]. From a
life-course perspective, young adulthood is a period

Correspondence: Mihaela Vancea, Department of Political and Social Sciences, Universitat Pompeu Fabra - Jaume I building, C/Ramon Trias Fargas no.
25, 08005 Barcelona, Spain. E-mail: mihaela.vancea@upf.edu

(Accepted 18 October 2016)

© Author(s) 2016
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DOI: 10.1177/1403494816679555
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2    M. Vancea and M. Utzet
of constant transition in labour market activity [3],
between short-lived employment periods and differ-
ent career paths and employers [9]. Although mod-
ern societies provide increasing and more equal
education opportunities, young people face fewer
possibilities for labour market participation due to
high unemployment rates, and more insecure and
deprived working conditions [10]. Moreover, unem-
ployed young people have an increased risk of expe-
riencing unemployment in the future [8].
Several studies have shown how unemployment
may influence the present and future health of young
people. Young unemployed adults seem to have poor
psychological health [11], poor quality of life [12,13]
and higher prevalence of risk behaviours, such as
smoking, excessive alcohol consumption and less-
healthy lifestyles [3]. It has been found that unem-
ployment at a young age is linked to later-in-life
sickness absence and disability pension. The negative
effects of unemployment tend to be exceptionally
harmful when the most disadvantaged young people
become unemployed [10]. Temporary employment,
job insecurity or poor employment protection also
seem to affect the quality of life and the life satisfac-
tion of young people, as well as increasing the prob-
ability of occupational injury risks, mental health
disorders and other physical health problems [14,15].
Two competing explanations have been developed
to account for the association between health and
socio-economic positions: the ‘health selection’
hypothesis, differences in health status lead to differ-
ences in socio-economic position; and the ‘social cau-
sation’ hypothesis, differences in socio-economic
circumstances imply differences in health status. In
accordance with the ‘social causation’ hypothesis,
Bartley [16] emphasizes four mechanisms by which
unemployment might affect health: (relative) poverty
and financial anxiety; social inactivity and lack of par-
ticipation; health-related behaviour; and the effect
that a spell of unemployment may have on subse-
quent risk of sickness absences (of more than 60
days). From the four mechanisms, the first one seems
to be directly linked to economic recession. Other
authors [17–20] have explained the relationship
between precarious employment and health based on
arguments such as material and social deprivation or
exposure to hazardous work environments. Finally
the life-course perspective [10] has also been used to
explain the association, portraying the transition from
youth to adulthood as more diversified and individu-
alized than before and unemployment as a life event
with (long-term) consequences such as health prob-
lems, marginalization and social exclusion.
In a context of high unemployment rates and a
prevalence of temporary and insecure jobs in the
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young population, the association between unem-
ployment/precarious employment and health repre-
sents an important scientific and also political issue.
Failure to mitigate high unemployment and eradicate
precarious employment among young adults might
incur substantial financial costs, in addition to health
and social costs, for contemporary welfare states
[8,21,22]. Therefore, and giving the significance and
complexity of this issue, a review and integration of
existent research studies in the above subject could be
useful to obtain a synthesis of key concepts and main
empirical evidence, and outline gaps in the existent
literature. The aim of the present scoping study is to
review the existing literature on the relationship
between youth unemployment/precarious employ-
ment and health, and to highlight research gaps.
The review follows the following specific objec-
tives. First, it aims to examine the relative importance
of the ‘social causation’ hypothesis in the literature
for the emergence of health inequalities: how this has
been portrayed, possible limitations and contribu-
tions. Identifying the contribution of social causation
to health inequalities is central to the promotion of
effective policy measures directed at the prevention
or reduction of social inequalities. Signalling the
causal limitations of studies testing this hypothesis
could contribute to refining future research in this
topic. Second, it attempts to identify research gaps in
the existing literature, make suggestions for improv-
ing comparability between studies and contribute to
the causal interpretation of research results while sig-
nalling future lines of research. Finally, it seeks to
explore how the relationship between unemploy-
ment/precarious employment and health in young
people has been portrayed in the literature before
and after the economic crisis.
Methods
Scoping studies generally aim to map the key concepts,
theories and gaps underpinning a research area and the
main sources and types of evidence available [23,24].
The main difference with systematic reviews is that
scoping studies do not necessarily focus on a well-
defined research question and thus an identifiable study
design. Scoping studies tend to address broader topics
where different research designs might be applicable,
are less likely to address very specific research questions
or to assess the quality of included studies [24].
We scoped published articles that examined the
relationship between unemployment/precarious
employment and health with the aim of identifying
research gaps in the literature. We actually followed
three steps in carrying out the scoping review: (1)
identifying the research question; (2) searching and
 How unemployment and precarious employment affect the health of young people   3
screening existent studies; (3) charting and analysing
the collected data (25)
Identifying the research question
Our research question was “What is known from the
existing literature about the effects of unemploy-
ment/precarious employment on the health of young
people?”.
We first determined what aspects should be
included when applying the term “health” and decided
on physical and mental health problems as well as
health risk behaviour and quality-of-life indicators. We
then defined these four new terms, “physical prob-
lems”, “mental health problems”, “health risk behav-
iour” and “quality of life”. Under the term “physical
problems” we considered occupational accidents/inju-
ries or illnesses and chronic diseases like chronic aller-
gies, back pain and migraines, while the term “mental
health problems” was limited to conditions such as
anxiety, depression, insomnia, etc. The term “health
risk behaviour” included tobacco smoking, alcohol
consumption and being overweight, while the term
“quality of life” was limited to both subjective and
objective measures of life satisfaction and well-being.
Identifying relevant studies
After acknowledging the research question to be
addressed, we identified primary studies suitable for
answering the question. To achieve this, we adopted a
strategy that involved searching for research evidence
via different databases: Medline, Science Direct,
Scopus and Web of Science. We included only those
academic articles published between January 2006
and March 2016. The start date was chosen because
it was felt that this covered the period before 2008,
when most European countries started to experience
a generalised economic crisis.
We started by using search terms such as “unem-
ployment”, “precarious employment” and “health”
and applied the corresponding filters “young” and/or
“youth”. As familiarity with the literature increased, we
redefined search terms and undertook more sensitive
searches of the literature. The specific terms used were
“youth unemployment AND health”, “unemployment
AND health AND young”, “precarious employment
AND health”, “precariousness AND health”, “work-
related factors AND health AND young”, “working
conditions AND health AND young”.
Selecting the studies
An article was considered for inclusion in the study if
it met the following criteria: (1) it examined
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the relationship between health and employment/
working conditions; (2) it was a research study, both
quantitative or qualitative, that included a descrip-
tion of the methodology used; (3) the target group
was limited to or included young people between 18
and 35 years old;1 (4) it referred to European data;
(5) it was written in either English or Spanish; (6) it
was published in a peer-reviewed scientific journal.
We excluded theoretical and reviewing articles, con-
ference presentations or articles without an available
abstract. We also excluded articles related only with
health or with employment/working conditions that did
not look at the relationship between the two factors.
All articles were screened and assessed by a single
reviewer. A second reviewer double-checked the
inclusion choices. Disagreements about title, abstract
or full text were settled in discussions between the
two reviewers.
Charting the data
The next stage of the work involved “charting” [25]
key items of information obtained from the primary
research articles being reviewed. Following the princi-
ples of a scoping study, no systematic assessment of the
quality of evidence was sought. Our charting approach
was similar to a “narrative review” [26], used to cap-
ture dominant and important themes that emerged.
For each eligible study, two reviewers synthesised
the data using a data extraction form that we devel-
oped. We extracted and charted data on: (i) general
characteristics (author(s), title, year of publication
and journal); (ii) methodological aspects (study
design, main objective, reference population and
sample, study variables); (iii) results; (iv) practical/
theoretical implications; and (v) limitations and sug-
gestions for future research.
Analysis of the data
Having “charted” the information, we first elabo-
rated a basic numerical analysis of the extent, nature
and distributions of the studies indicated in the
review. We mapped the distribution of studies geo-
graphically and by time; the type of effects included
in the review; and the research methods adopted. We
were thus able to identify the main areas of interest,
and consequently the significant literature gaps.
Second, the literature was organized thematically,
according to the studied variables and, subsequently,
according to the different causal mechanisms explain-
ing the examined relationship. The results were then
resumed to emphasize consistent or contradictory
empirical evidence, or the lack of empirical evidence
in light of the hypothesized relationship. Finally, we
4    M. Vancea and M. Utzet
Figure 1  Flow chart of the literature search.
highlighted the political and research implications
included in the reviewed studies.
Results
Extent, nature and distribution of the studies
The database search retrieved 1770 articles. After
duplicates were removed, this left 1220 unique search
results. Of these unique search results, 1112 records
were excluded by title and abstract checks. From the
108 remaining articles, 64 were removed because
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they did not meet the eligibility criteria. This left 46
[12, 35-79] in the actual review (see Figure 1).
Common reasons for exclusion were lack of perti-
nence, not meeting the inclusion criteria and treating
unemployment as a dependant variable.
Of the 46 selected articles, only one used a qualita-
tive approach. We identified 20 cross-sectional stud-
ies, 24 longitudinal studies and 1 ecological study
(see Table I). The vast majority of the studies were
carried out in Western European countries (36 stud-
ies), of which 24 were performed in Nordic countries
 Table I.  Summary of the main characteristics of studies under review.

Study Study design Country Sample Age groups Social Statistical analysis Gender stratified
size causation analysis

Aguilar-Palacios et al. (2015) [35] Cross-sectional Spain 3701 16 and 24 Yes Logistic regression. Yes
Akkermans et al. (2009) [36] Cross-sectional The Netherlands 1477 18 to 25 Yes ANOVA, linear regression analysis. No
Axelsson et al. (2007) [37] Cross-sectional Sweden 515 20 to 25 Yes Logistic regression models. Yes
Baggio et al. (2015) [38] Longitudinal Switzerland 4758 17 to 28 Yes Prevalence rates, cross-lagged panel models. No (*)
(baseline)
Bjorklund et al. (2015) [39] Descriptive Finland 15 18 to 27 Yes Manifest and latent qualitative content analysis. No (*)
Brydsten et al. (2015) [40] Longitudinal Sweden 962 16,18,21,43 Yes Multivariate linear regression, logistic regression. Yes
Chau et al. (2010) [41] Longitudinal France 164,814 18 to 64 Yes Negative binomial regression. No (*)
Ciairano et al. (2010) [42] Cross-sectional Italy 95 19 to 29 Yes Linear regression. No
Cordoba-Doña et al. (2014) [43] Cross-sectional Spain 24,380 15 to 64 Yes Linear regression models with fixed effects and Yes
adjusting for time trends.
Dalglish et al. (2015) [44] Cross-sectional France 1214 18 to 37 Yes Multiple logistic regression. No
Eek and Östergren (2009) [45] Longitudinal Sweden 99,125 18 to 80 No Stratified analysis for gender and age, ANOVA. Yes
Ek et al. (2008) [46] Cross-sectional Finland 5696 23 and 31 Yes Binary regression models. Yes
Fiori et al. (2016) [47] Cross-sectional Italy 47,404 18 to 39 Yes Linear regression models. Yes
Freyer-Adam et al. (2011) [48] Cross-sectional Germany 7906 18 to 64 Yes Multivariate logistic regression. Yes
Giraudo et al. (2016) [49] Longitudinal Italy 56,760 Under 30 Yes Cluster analysis, Injury rates per group and period. No
Goldman-Mellor et al. (2016) [50] Longitudinal UK 2232 Under 18 Yes Ordinary least-squares, Poisson and logistic No
(baseline) regression models.
Gustafsson et al. (2014) [51] Longitudinal Sweden 10,936 16 to 43 Yes Cox’s proportional hazards regression. No (**)
Gustafsson et al. (2014) [52] Longitudinal Sweden 45,567 20 to 64 Yes Cox’s proportional hazards regression. Yes
Hammarström et al. (2011) [53] Longitudinal Sweden 916 16 and 42 Yes Multivariate logistic regression. Yes
Helgesson et al. (2012) [54] Longitudinal Sweden 199,623 20 to 24 Yes Cox and logistic regressions. Yes
(baseline)

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Hultman and Hemlin (2008) [12] Cross-sectional Sweden 3810 18 to 24 Yes t-test, ANOVAs, logistic regressions. Yes
Janlert et al. (2014) [55] Longitudinal Sweden 1083 16,18,21,30 Yes Repeated regression models. Yes
Kosidou et al. (2012) [56] Cross-sectional Sweden 10,081 18 to 29 Yes Logistic regression analysis. Yes
Kottwitz et al. (2014) [57] Longitudinal Switzerland 57 22.5 (mean) Yes Multiple regression analyses. No (**)
Lallukka et al. (2008) [58] Longitudinal Finland 449 17 to 36 No Chi-square tests and t-test, Linear mixed model. Yes
(baseline)
(Continued)
How unemployment and precarious employment affect the health of young people   5
 Table I.  (Continued)

Study Study design Country Sample Age groups Social Statistical analysis Gender stratified
size causation analysis
6    M. Vancea and M. Utzet

Laurijssen and Spruyt (2015) [59] Longitudinal Belgium 1.657 23 to 29 Yes Structural equation modelling, No
Legleye et al. (2010) [60] Cross-sectional France 4.075 18 to 30 Yes Logistic regression models (gender separately). Yes
Linander et al. (2014) [61] Longitudinal Sweden 1001 16,18,21,30,42 Yes Crude and multivariate logistic regression. Yes
Liukkonen et al. (2009) [62] Longitudinal Finland 9623 18 to 62 Yes General linear models. No
Lourenço et al. (2015) [63] Cross-sectional Portugal 650 21 Yes Logistic regression models. No
Lundin and Hansson (2014) [64] Ecological Sweden – – No Time series. Yes
Manocci et al. (2014) [65] Cross-sectional Italia 227 35.5 (mean) Yes Multivariate regression analysis. No
Melchior et al. (2015) [66] Cross-sectional France 1126 18 to 37 Yes Logistic regression analysis. No
Minelli et al. (2014) [67] Longitudinal Italy 37,782 15 to 64 Yes Fixed-effects ordered logit model. Yes
Nygren et al. (2015) [68] Longitudinal Sweden 927 16,18,21,43 Yes Univariate and Multivariate logistic regression. Yes
Pavlova and Silbereisen (2013) [69] Cross-sectional Germany 1636 18 to 42 Yes Regression equations. No
Reine et al. (2008) [70] Longitudinal Sweden 1044 16,18,21,30 Yes Logistic regression analysis. No
Reine et al. (2011) [71] Longitudinal Sweden 662 21 and 30 No Propensity score, Multivariate logistic regression. Yes
Reine et al. (2013) [72] Longitudinal Sweden 1044 16,18,21,30 Yes Logistic regression analysis. No
Reissner et al. (2014) [73] Cross-sectional Germany 265 16 to 24 Yes Chi-squared tests. No
Sellstrom et al. (2010) [74] Cross-sectional Sweden 13,480 20 to 24 Yes Multivariate logistic regression models. No
(baseline)
Strandh et al. (2014) [75] Longitudinal Sweden 1010 16,18,21,30,42 Yes Repeated-measures linear mixed models. No

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Strandth et al. (2015) [76] Longitudinal Sweden 1071 16,18,21,43 Yes Ordinal regressions. No
Virtanen et al. (2016) [77] Longitudinal Sweden 1687 21 to 25 Yes Binary logistic regression. No
Vives et al. (2011) [78] Cross-sectional Spain 6777 16 to 65 Yes Prevalence proportions and PAR%. Yes
Zolnierczyk-Zreda et al. (2012) [79] Cross-sectional Poland 306 19 to 62 Yes ANOVA. Yes

*Only men.
**Only women.
ANOVA, analysis of variance; PAR%, population attributable risk.
 How unemployment and precarious employment affect the health of young people   7
Table II.  Causal explanations employed in each study.
Independent variable Dependent variable
Unemployment Mental health disorders
Self-rated health
Health risk behaviour
Physical health
Quality of Life
Precarious employment Mental health disorders
or working conditions
Physical health
(9 analysed the same Swedish cohort), and 12 in
countries such as Germany, Switzerland, France,
England or Holland. Only nine studies focused on
Southern Europe (Italy, Spain and Portugal) and just
one on Eastern Europe, specifically on Poland. No
more than five studies were published before the end
of 2008, when the current economic crisis started to
take hold throughout Europe. Seventeen articles were
published between 2009 and 2013. From 2014, the
scientific publications in this line of research have
considerably increased: 10 in 2014; 10 in 2015; and
four so far in 2016. There are 27 studies that stratified
their results by gender.
Unemployment and precarious employment,
and different health outcomes
We have structured the analysis of results on the
independent variables and highlighted the different
health outcomes (see Table II). The independent fac-
tors were summarised through two conceptual con-
structs: unemployment status (employed/
unemployed) or length of unemployment (28 arti-
cles); and working conditions or precariousness (psy-
chosocial risks, working hours or type of contract)
(16 articles). Only two articles analysed both of these
constructs. The reported outcomes were: mental
health problems (27 articles, of which four were on
suicide attempts), measured with a variety of instru-
ments including GHQ-12, DSM and IMHS; self-
rated health (six articles); occupational injuries (five
articles); quality of life (four articles); behaviour risk
factors such as alcohol consumption, tobacco smok-
ing or being overweight (four articles).
For each study, we assessed whether or not the
authors found support for social causation. There are
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Causal explanations
Breadwinner model [39, 43, 53, 71]
Life-course perspective [40, 43, 56, 60, 75, 77]
Lack of economic and social benefits [44, 46, 50, 76]
Breadwinner model [55, 72]
Breadwinner model [53]
Lack of economic and social benefits [55, 66]
Physiological link [57]
Life-course perspective [66]
Life-course perspective [12]
Lack of economic and social benefits [69]
Third factor explanation [12]
Breadwinner model [48]
Life-course perspective [62, 67]
Lack of economic and social benefits [36, 42, 48, 67, 70, 79]
Third factor explanation [42]
Lack of economic and social benefits [49]
two studies that found no association between unem-
ployment and health outcomes. However, both arti-
cles present clear methodological limitations. One
uses a small sample while the other employs aggregate
data, so their results must be interpreted with caution.
Two studies found a very weak association between
working conditions/precariousness and risk behaviour,
as they looked at a very specific health outcome (being
overweight), in which case, other individual character-
istics might intervene in the explanation. All of the
other studies found support for social causation.
From the articles that examined the effect of
unemployment status and/or length of unemploy-
ment, the most common health outcomes, for both
men and women, were: mental health disorders (six
studies), health risk behaviour (three studies) and
poor quality of life (two studies). Two studies offered
evidence of a strong association between being a
NEET (youth Not in Employment, Education or
Training) and mental health or health risk behaviour.
Some studies highlighted health risk behaviour and
mental health outcomes only in men. Others found
an association with mental health, self-rated health
and health risk behaviour, only in women.
Some of the studies that examined the impact of
working conditions and precariousness found asso-
ciation with mental health disorders (four studies),
suicide ideation (one study) and occupational inju-
ries outcomes (one study), for both men and women.
Others found an association with mental health and
occupational injuries (two studies) or with general
health (one study), only for men. Just one study,
which focused only on women, found an association
with health risk behaviour.
As shown in Table II, most studies (29 studies)
exposed a wide range of causal mechanisms explaining
8    M. Vancea and M. Utzet
the relationship between the studied variables, while
some (17 studies) do not provide an explicit account
for it. Those studies that analysed the impact of unem-
ployment relied mostly on explanations such as the
life-course perspective (eight studies), the breadwinner
model (seven studies), the lack of economic and social
benefits when unemployed (six studies), and on a com-
bination of life-course perspective and third factor
explanations (one study). The studies that analysed the
effect of working conditions and precariousness made
use of the lack of economic and social benefits, when
working in precarious conditions (eight studies), the
life-course perspective (two studies), the breadwinner
model (one study) and a combination of lack of eco-
nomic and social benefits and third factor explanations
(one study) to account for the association.
Only four studies, particularly from Spain, Italy
and France analysed the impact of economic reces-
sion on the association, and reached different con-
clusions. Three of them compared two
cross-sectional surveys before and after the begin-
ning of the economic crisis: one study found a
worsening of mental health disorders and a stronger
association with unemployment rates after the
onset of the crisis; a second found an increase in
suicide attempts after the crisis that, in men, seems
to be related with increasing unemployment rates; a
third one found that mental health improved dur-
ing the crisis, but it was still associated with unem-
ployment. Finally, the fourth study found that
unemployment and precariousness were associated
with suicide risk in young adults, an age group
severely hit by the economic crisis.
Implications and future lines of research
The implications for policy and research that were
identified in the reviewed studies were grouped into
three categories. The first highlights the need to
invest in public policies or governmental programmes
to reduce long-term youth unemployment (eight
articles), improve the transition from education to
the labour market (seven articles) promote better
education programmes (three articles) and enhance
the psychosocial resources of young adults (three
articles). The second emphasizes the need to enhance
working conditions and promote employment stabil-
ity and security (10 articles). The third suggests
increased access to primary care and improved men-
tal health services (seven articles).
Future lines of research were also identified in
the reviewed studies. They basically consisted of
more studies examining the impact of precarious
employment (six articles). These included gender
stratified analyses (five articles), conducting
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cultural, economic and country-related contextual
analyses (seven articles), exploring the effectiveness
of social security systems (unemployment benefits
and active labour-market programmes) and of spe-
cific behaviour change and mental health interven-
tions (four articles). All cross-sectional studies (20
studies) highlighted the importance of longitudinal
studies to establish the directionality of the causal
relationship between unemployment/precarious
employment and health.
Discussion
This study aimed to review the effects of unemploy-
ment and precarious employment on the health sta-
tus of young people. As a scoping study, it does not
include a quality assessment of the reviewed articles,
and thus does not provide a definitive analysis of the
strengths/weaknesses of the examined association. It
does, however, account for the scale of association
and the main explanations provided.
After reviewing the literature, we can say that
social causation seems to play a significant role in
engendering health inequalities. Most studies found
support for this hypothesis, in particular with respect
to mental health effects and health risk behaviours.
The most common explanations for the link between
unemployment/precarious employment and health
were the lack of economic and social benefits when
unemployed or working in precarious conditions, the
life-course perspective that emphasises the need for
educational and economic incentives in the transi-
tion process to adulthood, and the changing social
roles in present societies, particularly in respect to
the male breadwinner role [43]. The male breadwin-
ner model refers to an ideal of the family in which
men earn a family wage and provide, while wives do
domestic labour and care for family members. In
today’s society these roles have become more equili-
brated and even started to get re-inverted, mainly
due to the increasing incorporation of women in the
labour market.
Complementary to these, the reviewed literature
highlighted the physiological link for health risk
behaviour and the need to take into account third
factor explanations such as personality traits, job and
family history, work–family relation and country-
related contextual variables (five articles). The physi-
ological link refers to the biological mechanisms
behind the relationship between unemployment and
health risk behaviour. A third factor, also known as a
confounding or mediator variable, can adversely
affect the relation between our independent and
dependent variables. This may lead to incorrect anal-
yses of results as the results may show a false
 How unemployment and precarious employment affect the health of young people   9
correlation. A third factor, not measured, may influ-
ence both independent and dependent variables.
In terms of methodology, further research should
aim to incorporate a gender perspective into the analy-
sis. In spite of the labour market’s gender segmenta-
tion, especially in Southern European countries [27],
the high prevalence of unemployment and work flexi-
bility among women [28], and gender inequalities in
health related to unemployment, precarious employ-
ment and working conditions [29–31], only half of the
reviewed articles took this variable into account. Other
social stratification variables such as cultural/ethnic
origin, social class, education and age could also affect
the relationship between unemployment/precarious
employment and health. More longitudinal studies are
needed to confirm the social causation hypothesis as
well as qualitative studies to better understand the
mechanisms explaining the association.
Further research should also aim to include more
indicators on precarious employment. The current
labour market is characterized by frequent transition
from unemployment to precarious and informal
employment and vice versa, especially among young
adults. Thus, a more in-depth analysis of precarious
and informal employment is required in order to
know its impact on health and health inequalities
[32] and especially in the case of young people. Some
studies leave serious doubts about the causal inter-
pretation of their results. It is thus crucial to address
problems of third factor explanations, measurement
errors, the subjectivity of self-reported measures,
missing values and simultaneous estimation of recip-
rocal and bidirectional causal paths.
As youth unemployment has become an impor-
tant policy issue all over Europe, studies examining
the social determinants of health for this population
segment should develop explicit policy implications
and recommendations to help alleviate this situation.
Examples of such policy measures include: active
labour market programmes to prevent long periods
of unemployment (one article); training programmes
(two articles); enhancing young people’s psychoso-
cial resources (three articles); extensive social secu-
rity measures to offset the economic consequences of
unemployment (two articles); work re-design to
reduce social stressors at work and increase job con-
trol, social support and autonomy (three articles);
specific health programmes and services to cope with
inequalities in health (three articles); and support for
youth career initiatives (one article).
More comparative studies are also needed to fur-
ther explore the impact of the economic crisis on the
health of young people, as only four of the studies,
three of which were from Southern Europe, attempted
to give an account of this.
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Strengths and limitations of the scoping study
The main strength of this scoping study is its focus
on an important academic and political issue, namely
the impact of unemployment/precarious employ-
ment on the health of young people. As far as we are
aware, this is the first study analysing the existing lit-
erature about this relationship. Overall, the study
aimed to map the key concepts and empirical evi-
dence in this research subject, and to identify gaps in
the literature.
When considering possible sources of bias, it
should be noted that nine studies were made using
the same cohort [33] for the analysis of the causal
relationship between unemployment and health in
young people. This might give the false impression
of valid results from different studies, although the
data are more or less the same and the results are
not totally independent. Regarding the limits for
generalization of the reviewed studies due to their
sampling design, it should be noted that the coun-
tries and regions in which the studies were con-
ducted were primarily in Northern Europe, probably
because of the availability of longitudinal datasets.
Therefore, further research needs to consider care-
fully whether the results from our study can be gen-
eralized to different contexts (other welfare systems,
labour market regulations, health care provision or
economic situations).
Another possible limitation of our study is its focus
on peer-reviewed articles since our aim was to give
an overview of the academic research from 2006
onwards. Articles that were not published in peer-
reviewed journals or other grey literature such as
reports by specialized agencies or non-governmental
organizations were not included in the study. Although
we are fully aware of the relevance of this type of lit-
erature, we decided not to include it mainly because
of the absence of peer-review and the difficulty to
verify the information derived from these sources.
Another limitation might be that only one reviewer
excluded all thematically irrelevant studies and
assessed the full text of the remaining articles accord-
ing to the inclusion criteria. Nevertheless, the second
reviewer double-checked the inclusion choices by
reviewing the abstracts and disagreements were set-
tled in discussion between the two reviewers.
Keypoints
- Young people are especially vulnerable to health
problems when unemployed or working in pre-
carious conditions.
- Active labour market and training programmes,
inclusive social security measures, improved
working conditions and targeted health
10    M. Vancea and M. Utzet
programmes are important for addressing this
vulnerability.
- Further research should strive to enhance the
causal model by including a gender perspec-
tive, longitudinal data, more indicators on pre-
cariousness and third factor explanations.
Acknowledgements
This paper is an outcome of the EU-funded collabo-
rative research project CUPESSE (Cultural Pathways
to Economic Self-Sufficiency and Entrepreneurship;
Grant Agreement No. 613257; www.cupesse.eu).
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of
interest with respect to the research, authorship,
and/or publication of this article.
Funding
The author(s) disclosed receipt of the following
financial support for the research, authorship, and/or
publication of this article: The research leading to
these results has received funding from the European
Union Seventh Framework Programme under grant
agreement n° 613257.
Note
1. We decided to focus on the 18–35 age group as
recent data on unemployment and underem-
ployment in Europe suggest a growing tendency
to extended periods of transition to adulthood,
beyond the age of 25 (see [34]).
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