The Relation Between Precarious Employment Arrangements and Social Precarity: Findings from the PREMIS Study in Stockholm,Sweden

Abstract

Precarious employment (PE) is a well-known social determinant of health and health inequalities. However, as most previous studies have focused on physical and mental well-being, less is known about the social-related outcomes (ie, social precarity) associated with precarious arrangements. This cross-sectional study aims to investigate whether PE is associated with social precarity in a working population of 401 nonstandard employed workers in Stockholm, Sweden (2016-2017). PE was assessed with the Swedish version of the Employment Precarious Scale (EPRES-Se) and analyzed in relation to social precarity related to working life (eg, task quality and job security) and living conditions (eg, restraint in social activities and financial constraints). We found positive adjusted associations between quartiles of EPRES-Se and social precarity related to working life (eg, being locked in an occupation [aPR_q4:1.33 [1.10-1.61]]) and living conditions (eg, inability to participate in social activities because of work [aPR_q4:1.27 [1.10-1.46]]). Our findings suggest that individuals in PE experience social precarity, stressing that PE may have negative effects on well-being. Further studies using multidimensional constructs of PE and larger samples should analyze these findings according to social and policy contexts in order to be able to inform policymakers.

Introduction

Precarious Employment

As a consequence of major social, economic, and political changes that took place in the mid-1970s, the overall quality of employment relationships has decreased over the past decades.¹ This gradual transformation of the so-called standard employment relationship (i.e., full-time, secure employment with collective bargaining power) into nonstandard and atypical employment has bolstered the rise of precarious employment (PE).² PE is commonly defined as an accumulation of unfavorable facets of employment quality, such as employment instability (eg, temporary employment, subcontracting, and multiple job holding), lack of power and rights (eg, asymmetric power relations and inability to exercise rights), and poor terms (eg, low wages and lack of benefits and/or training).^3,4

Usually, the population groups most affected by PE are women, young workers, immigrants, manual workers, and workers with low educational attainment.⁵ PE has multiple consequences, which include a higher likelihood of being exposed to work environment hazards (eg, psychosocial, ergonomic, and physical hazards), suffering from material deprivation (ie, inadequate resources to maintain living standards, poverty, and life insecurity), and experiencing low-quality employment arrangements (eg, boring or dissatisfying work, psychological perceptions of job insecurity).⁶

Employment Precarity and Social Precarity

PE is a well-known social determinant of health and health inequalities.^4–7 However, as most previous studies have focused on physical and mental well-being, less is known about the social-related outcomes (ie, social precarity) associated with PE arrangements. Social precarity, a concept previously used by other authors, can be defined as the factors related to higher risks of social exclusion and has two dimensions: living conditions (ie, poverty, financial resources, social connections, social isolation, and satisfaction with family life) and working life (ie, task quality, work pressure, skill development, and job security).⁸

Various forms of nonstandard employment arrangements and single dimensions of PE have been associated with a wide range of social precarity measures, such as a reduced likelihood of having children in the future,^9,10 poorer work–life balance, greater family conflicts,¹¹ poor household income situation,¹² and financial strain.¹³ It is important to note that studies exploring social consequences of PE measure PE through perceived job insecurity. However, job insecurity is actually a cognitive/affective phenomenon and a consequence of PE (experience of precariousness) rather than a characteristic of the quality of the employment relationship in itself.

The Need for a Multidimensional Perspective

Although the aforementioned studies provide useful information, it is relevant to consider that nonstandard employment arrangement is not synonymous with PE. Thus, a consideration of multiple dimensions of the employment arrangement is needed to correctly classify employment arrangements as precarious. Multidimensional measures of PE may capture better all the aspects of the employment relationship and its quality.^14,15 To our knowledge, only two Canadian studies have explored social precarity associated with PE using a multidimensional construct (the precarity index).¹⁶ These studies found that workers in PE are more likely to suffer social isolation, barriers for access to childcare (limiting the ability of both parents to work for pay), and poorer household well-being.

Precarious Employment in a Nordic Welfare State Regime

The potential effects of PE are dependent (modifiable) on the policy (ie, institutional and regulatory protection, welfare regime) and social context (ie, axes of inequality, and resources and social support).⁶ Interestingly, a qualitative study that recruited workers using a multidimensional concept of PE from different contexts (England, Sweden, and Italy) found that some workers in PE do not experience social precarity (financial strain and poor task quality). The authors argued that this finding was related to the policy and social context of the workers.¹⁷ Nordic welfare regimes (Sweden) are characterized by reliable social protection measures, whereas other welfare regimes, such as liberal (England) or southern (Italy) regimes, are characterized by weak or highly fragmented social protection regulations.¹⁸ Therefore, we believe it is necessary to explore the association of PE and social precarity in Sweden (policy and social Nordic context) using a multidimensional construct.

Aim

Against this background, this study aims to investigate whether PE (measured through a multidimensional construct) is associated with both dimensions of social precarity related to working life and living conditions in a working population of non-standard employed workers in Stockholm, Sweden.

Methods

Study Population and Data Collection

This cross-sectional study is based on data obtained from the PRecarious EMployment in Stockholm (PREMIS) study and the Longitudinal Integrated Database for Health Insurance and Labour Market Studies (LISA in the Swedish acronym) for the years 2016 to 2017. PREMIS is a study among nonpermanent workers (18-62 years) residing in Stockholm county between November 2016 and May 2017.¹⁹ The study recruited 483 individuals, but after exclusions, a total of 415 eligible individuals were included. The recruitment of participants and data collection was performed through web-based, respondent-driven sampling (non-probability sampling). An online survey included questions related to employment conditions (Swedish Employment Precariousness Scale [EPRES-Se]), work environment, health, life situation, and social networks. Details on PREMIS recruitment methods and study population can be found elsewhere.¹⁹ LISA is held by Statistics Sweden and integrates existing data from the labor market, sociodemographic characteristics, and so forth. Data collected with the PREMIS survey were linked to LISA by Statistics Sweden by means of the personal identification number unique to every person registered in Sweden and later de-identified.²⁰

For the present study, we excluded individuals with missing values in any dimension of the EPRES-Se (n = 14).

Study Variables

Exposure Variable: Precarious Employment

The level of PE was estimated using the Swedish EPRES-Se questionnaire,²¹ an adaption of the original Spanish EPRES-Es.²² The questionnaire included 23 items, grouped in six dimensions (temporariness, disempowerment, vulnerability, rights, the capacity to exercise rights, and wages). Each dimension was recoded to a 0 to 4 scale and thereafter its arithmetic mean was calculated. Next, we calculated the overall EPRES-Se mean score that could range from 0 (not precarious) to 4 (most precarious). The EPRES-Se score was used both as a continuous variable and divided into quartiles to estimate the level of PE. A separate overall EPRES-Se score was calculated to explore the financial constraint outcomes, excluding the “wages” dimension.

Outcome Variables: Social Precarity

The outcomes of this study are the two dimensions of social precarity related to working life and living conditions, measured through several variables.

Social precarity related to working life is measured through:

Being locked in a job (current job situation does not suit them [no/yes]);

Being locked in an occupation (prefer to work in something else [no/yes])²³;

Prefer to have permanent employment (no/yes);

Difficulties in piecing several jobs together (response categories “no [never]” and “yes [always, often, and sometimes”]).

Social precarity related to living conditions is measured through:

Restraint in social activities, including inability to participate in social activities because of work (no/yes) and avoiding talking about one's work situation in social contexts (no/yes);

Financial constraints, including difficulties in managing regular expenses in the past 12 months, with the response categories “no” and “yes (once, more than once),” and inability to afford social activities, with the response categories “no (never)” and “yes (always, often, and sometimes)”

Covariates

The sociodemographic variables were: sex, age (18–24, 25–29, 30–35, and 35–62 years old), educational level (high school, higher education of ≤2 years, and higher education of ≥3 years), country of birth (Sweden, non-Sweden), family composition (cohabiting with children, cohabiting without children, single with children, single without children), and family disposable income (categorized in quartiles). Past employment conditions were explored with the number of jobs in the previous three years (1, 2–4, 5 or more) and having been unemployed in the past three years (no/yes).

We constructed a Directed Acyclic Graph (DAG) for drawing the assumed associations between PE, outcomes, and covariates (see Figure S1, Supplemental Material) using “DAGitty”.²⁴ The minimal sufficient adjustment variables were sex, age, level of education, and country of birth.

Statistical Analysis

We calculated the mean values of the EPRES-Se score and percentages of EPRES-Se score quartiles with 95% confidence intervals (95% CI) by sociodemographic characteristics. We later constructed box plots of EPRES-Se scores for each outcome.

Further, we calculated the prevalence of the outcomes with their 95% CI by the EPRES-Se score quartiles. We used generalized linear models, with the Poisson family and robust variances, for estimating the crude and adjusted prevalence ratios (PR, aPR) of presenting an outcome according to the continuous EPRES-Se score values and also, according to the EPRES-Se score quartiles, having the quartile with lowest EPRES-Se score (quartile 1) as reference. When the absolute frequencies were <10 in quartile 1, quartile 4 was used as the reference quartile.

Further, as the sample was recruited with respondent-driven sampling (RDS),¹⁹ weighted analyses were conducted in addition to the unweighted analyses. RDSII weights were calculated in RDS Analyst 0.42 for Windows. We conducted the analysis using Stata 16.0 statistical software.

Ethical Considerations

The study was approved by the regional ethics board of Stockholm (dnr: 2016/1291-31/5). Written informed consent was attained by the respondent clicking “Yes” to the question “I understand the information given above and want to participate” after reading the study information. Personal identification numbers were replaced by serial numbers and stored separately after data collection.

Data was stored on password-protected, encrypted servers.

Results

This study included 401 individuals: 54% were women, 43.9% were between 25 and 29 years, 38.9% had lower levels of education, and 80% were born in Sweden.

Table 1 shows the characteristics of the study participants by EPRES-Se score quartiles and EPRES-Se mean score. According to the sociodemographic characteristics, the most precarious employees—being those from the quartiles with the high EPRES-Se score (Q3 and Q4)—were men, young (18-24 years old), individuals with lower levels of education, born outside of Sweden, and had lower levels of family disposable income. Further, the most precarious employees had a history of multiple jobs and had been unemployed in the past three years.

Table 1.

Characteristics of the study participants by EPRES-Se score quartile and EPRES-Se mean score.

		Low precariousness (Q1: 0.09–1.54)	Medium-low precariousness (Q2: 1.55–1.90)	Medium-high precariousness (Q3: 1.91–2.25)	High precariousness (Q4: 2.26–3.07)	EPRES-Se mean
	n	% (95% CI)	% (95% CI)	% (95% CI)	% (95% CI)	Mean (95% CI)
Sex
Men	184	41.8 (32.4–51.9)	38.1 (28.9–48.2)	53.8 (44.2–63.1)	49 (39.3–58.8)	1.94 (1.87–2.02)
Women	217	58.2 (48.1–67.6)	61.8 (51.7–71)	46.2 (36.9–55.8)	51 (41.2–60.7)	1.89 (1.82–1.96)
Age
18 to 24	119	12.2 (7.05–20.4)	25.8 (17.9–35.4)	33 (24.7–42.6)	47 (37.4–56.8)	2.13 (2.05–2.21)
25 to 29	176	50 (40.1–59.8)	45.4 (35.7–55.4)	42.4 (33.3–52.1)	38 (28.9–47.9)	1.87 (1.79–1.94)
30 to 35	61	19.4 (12.7–28.5)	21.6 (14.5–31)	14.1 (8.7–22.2)	6 (2.7–12.8)	1.72 (1.61–1.83)
36 to 62	45	18.4 (11.8–27.4)	7.2 (3.4–14.4)	10.4 (5.8–17.8)	9 (4.7–16.5)	1.80 (1.63–1.98)
Education level
High school	156	31.9 (23.4–41.9)	37.9 (28.6–48.1)	41.7 (32.6–51.5)	49.5 (39.4–59.6)	1.98 (1.89–2.06)
Higher education ≤ 2 years	95	25.8 (17.9–35.4)	17.9 (11.4–27)	28.1 (20.3–37.7)	25.8 (17.9–35.7)	1.93 (1.83–2.03)
Higher education ≥ 3 years	137	42.3 (32.8–52.3)	44.2 (34.5–54.4)	30.1 (21.9–39.7)	24.7 (16.9–34.6)	1.80 (1.72–1.88)
Country of birth
Sweden	321	85.6 (77–91.3)	84.5 (75.8–90.5)	84.8 (76.5–90.5)	68.4 (58.4–76.8)	1.87 (1.82–1.93)
Non-Sweden	76	14.4 (8.7–22.9)	15.5 (9.5–24.2)	15.2 (9.5–23.5)	31.6 (23.1–41.5)	2.07 (1.95–2.20)
Family disposable income (yearly, 2016–2017, [SEK])
Q1 (7100 – 186 200)	95	22.7 (15.4–32.1)	22.1 (14.8–31.7)	21.1 (14.3–30.1)	31.9 (23.2–42.1)	1.99 (1.89–2.10)
Q2 (186 900 – 257 300)	100	22.6 (15.4–32.1)	28.4 (20.2–38.4)	25.9 (18.3–35.3)	25.5 (17.7–35.4)	1.94 (1.85–2.03)
Q3 (257 800 – 346 100)	97	34.1 (25.2–44.1)	21.1 (13.9–30.5)	25.9 (18.4–35.3)	18.1 (11.5–27.2)	1.79 (1.68–1.89)
Q4 (347 400 – 2 296 000)	98	20.6 (13.6–29.9)	28.4 (20.2–38.4)	26.9 (19.2–36.3)	24.5 (16.8–34.2)	1.90 (1.80–2.01)
Number of jobs in the past 3 years
1	106	32.6 (24.1–42.6)	30.9 (22.5–40.9)	19.8 (13.2–28.6)	23 (15.7–32.3)	1.81 (1.73–1.90)
Between 2 and 4	211	45.9 (36.2–55.9)	50.5 (40.6–60.4)	56.6 (46.9–65.8)	57 (47.1–66.4)	1.96 (1.89–2.02)
5 or more	84	21.4 (14.3–30.7)	18.5 (11.9–27.6)	23.6 (16.4–32.6)	20 (13.2–29.1)	1.94 (1.82–2.06)
Unemployed in the past 3 years
No	208	62.2 (52.2–71.3)	65.6 (55.5–74.5)	36.8 (28.1–46.4)	45 (35.5–54.9)	1.82 (1.75–1.89)
Yes	192	37.7 (28.7–47.8)	34.4 (25.5–44.5)	63.2 (53.6–71.9)	55 (45.1–64.5)	2.02 (1.95–2.08)

Abbreviations: PR, prevalence ratio; aPR, adjusted prevalence ratio; CI, confidence interval.

Figure 1 shows the median values of the EPRES-Se score according to social precarity related to working life and living conditions. The individuals with any of these outcomes were also those with the highest median values of the EPRES-Se score.

Figure 1.

Median values of the EPRES-Se score according to social precarity related to working life and living conditions.

Table 2 shows the associations between social precarity and the EPRES-Se score quartiles. As EPRES-Se scores increase, so did the prevalence of declaring any experience of social precarity related to working life. This pattern was consistent in the crude and adjusted estimates; a high degree of PE was associated with preferring permanent employment (aPR_q4:1.10 [1.01–1.19]) and being locked in an occupation (aPR_q4:1.33 [1.10–1.61]). Regarding the restraints in social activities, we describe a steady pattern of higher prevalence of these as EPRES-Se scores increase. This pattern was consistent in the crude and adjusted estimates: inability to participate in social activities because of work (aPR_q4:1.36 [1.19–1.56]) and avoiding talking about their working situation in social contexts (aPR_q4:1.34 [1.09–1.65]). The associations of social precarity related to working life and restraint in social activities according to EPRES-Se score mean followed the same pattern (Table S1). As EPRES-Se scores increased, so did the prevalence of declaring financial constraints outcomes. These patterns were consistent in the crude and adjusted estimates: having difficulties in managing regular expenses (aPR_q4: 2.26 [1.55, 3.30]) and not being able to afford social activities (aPR_q4:1.27 [1.09, 1.48]). The associations of financial constraints outcomes according to EPRES-Se were also consistent with results using the score in a continuous manner (Table S1).

Table 2.

Associations between social precarity and the EPRES-Se score quartiles.

				Precarious employment (EPRES-Se score quartiles*)
			Overall	Low precariousness (Q1: 0.09-1.54)	Medium-low precariousness (Q2: 1.55-1.90)	Medium-high precariousness (Q3: 1.91-2.25)	High precariousness (Q4: 2.26-3.07)
Social precarity related to working life	Being locked-in a job	n(%)	56 (13.9%)	3 (3.1%)	10 (10.3%)	16 (15.1%)	27 (27%)
		PR (CI95%)	–	0.11 (0.03,0.36)	0.38 (0.19,0.75)	0.56 (0.32,0.97)	ref
		aPR (CI95%)	–	0.08 (0.03,0.27)	0.37 (0.18,0.72)	0.51 (0.29,0.90)	ref
	Being locked-in an occupation	n (%)	291 (73.1%)	58 (59.8%)	67 (69.8%)	82 (78.1%)	84 (84%)
		PR (CI95%)	–	ref	1.17 (0.95,1.44)	1.31 (1.08,1.58)	1.40 (1.17,1.69)
		aPR (CI95%)	–	ref	1.14 (0.92,1.41)	1.25 (1.03,1.52)	1.33 (1.10,1.61)
	Would rather have permanent employment	n (%)	370 (93.7%)	86 (90.5%)	85 (87.6%)	102 (98.1%)	97 (97.9%)
		PR (CI95%)	–	ref	0.97 (0.88,1.07)	1.08 (1.01,1.16)	1.08 (1.01,1.16)
		aPR (CI95%)	–	ref	0.97 (0.87,1.08)	1.09 (1.01,1.19)	1.10 (1.01,1.19)
	Difficult to piece several jobs together	n (%)	309 (77.2%)	67 (68.4%)	69 (71.1%)	84(80%)	89(89%)
		PR (CI95%)	–	ref	1.04 (0.86,1.25)	1.17 (0.99,1.38)	1.30 (1.12,1.51)
		aPR (CI95%)	–	ref	1.02 (0.85,1.23)	1.15 (0.97,1.36)	1.30 (1.12,1.51)
Social precarity related to living conditions	Restraint in social activities
	Cannot participate in social activities because of work	n (%)	348 (87%)	69 (70.4%)	82 (84.5%)	100 (95.2%)	97 (97%)
		PR (CI95%)	–	ref	1.21 (1.04,1.40)	1.27 (1.10,1.46)	1.30 (1.13,1.49)
		aPR (CI95%)	–	ref	1.20 (1.03,1.39)	1.25 (1.09,1.44)	1.36 (1.19,1.56)
	Avoids talking about work situation in social contexts	n(%)	270 (67.5%)	54 (55.1%)	56 (57.7%)	78 (74.2%)	82 (82%)
		PR (CI95%)	–	ref	1.04 (0.86,1.25)	1.17 (0.99,1.38)	1.30 (1.12,1.51)
		aPR (CI95%)	–	ref	1.03 (0.81,1.31)	1.25 (1.02, 1.55)	1.34 (1.09,1.65)
	Financial constraints*
	Difficulties in managing regular expenses	n (%)	151 (37.7%)	28 (27.7%)	27 (27.3%)	44 (43.6%)	52 (52%)
		PR (CI95%)	–	ref	0.98 (0.63,1.54)	1.57 (1.07,2.31)	1.87 (1.30,2.71)
		aPR (CI95%)	–	ref	1.07 (0.68,1.68)	1.72 (1.18,2.50)	2.26 (1.55,3.30)
	Inability to afford social activities	n(%)	334 (83.5%)	70 (69.3%)	83 (83.8%)	92 (91.1%)	89 (89.9%)
		PR (CI95%)	–	ref	1.21 (1.03,1.41)	1.31(1.14,1.52)	1.30 (1.12,1.50)
		aPR (CI95%)		ref	1.21 (1.04,1.42)	1.31(1.13,1.51)	1.27 (1.09,1.48)

Abbreviations: PR, prevalence ratio; aPR, adjusted prevalence ratio; CI95, 95% confidence interval; ref, reference value 1.

Discussion

We describe positive associations between levels of PE and social precarity related to various aspects of working life and living conditions that remained after adjusting for sociodemographic factors.

In this study, the proportion of workers declaring an experience of social precarity related to working life was high on average. Furthermore, the reporting of experiences of social precarity related to working life was higher among the most precarious employees. These findings are in accordance with the current discourse on PE (measured through temporary contracts): Job dissatisfaction and job insecurity are higher among temporary workers than permanent workers in Australia and Europe.^25,26 Importantly, experiencing work–life precarity and restraints in social activities are hypothesized to be mechanisms by which PE affects health and quality of life.⁶ Therefore, the associations described in our study may have implications for the health and well-being of workers in PE. For example, working under undesired arrangements could produce feelings of guilt and a lack of control, which may impact the well-being of the PE workers.²⁷

An unexpected finding was the low prevalence (1 out of 10) of declaration of being locked in a job (the job they are in does not suit them). Intuitively, this finding appears contradictory to the high proportion (7 out of 10), who declared they are locked in an occupation (they prefer to work in something else) and a preference for permanent employment (9 out of 10). However, these opposing results could be due to how workers perceive the Swedish labor market. Workers in PE may think that they have to settle for whatever job is offered: either take a low-quality job or do not have a job at all, because of the limited job opportunities available.²⁷ Another explanation could be the way the question was framed; workers may respond based on different aspects of their job situation (employment arrangements, working hours, tasks, and workmates) rather than their overall experience.

We report a remarkably high prevalence of financial constraints and restraint in social activities among workers in PE, with higher rates with increasing PE. This lack of engagement in social activities may lead to social isolation.^8,28 Two previous cross-sectional studies conducted in Canada concluded that workers in PE (measured through a multidimensional index) earned lower wages and experienced social isolation.²⁸ Therefore, similar conclusions are obtained for individuals working in Canada and Sweden: PE could create barriers and restrict the social activities of workers. Social isolation affects physical and mental health and has been associated with increased all-cause mortality and with cardiovascular and mental disease.^29,30 Therefore, based on the social nature of humans, the associations found in this study may as well have implications for the well-being of the workers.

Further, we describe that 3 out of 10 precariously employed workers reported difficulties managing regular expenses. Material deprivation may directly affect the physical and mental health of the PE workers, such as poorer self-perceived health,³¹ stress, sleep disturbances, and depression-related symptoms.²⁷ Also, it may impact other social determinants of health, such as access to health care, adverse lifestyles, and unhealthy housing conditions.⁷

In our study, the majority of precarious employees were young, born outside of Sweden, and had a lower disposable family income. This finding is in accordance with European data highlighting that young and immigrant workers are most affected by PE.^5,32,33

Our results suggest that higher levels of PE are slightly more prevalent among men. Sex differences have been suggested in the PE discourse. For example, an empirically based study using data from the 2005 European Working Conditions Survey³² found that male and female workers experienced different forms of PE: Women were more prevalent in “precarious unsustainable” jobs (low employment quality characterized for involuntary part-time employment), whereas men were more prevalent in the “precarious intensive” jobs (low employment quality characterized for long working hours). However, due to this study's theoretically based approach for measuring multidimensional PE, we did not explore typologies of PE, which could explain the differences in the distributions among male and female workers. Further, a high proportion of workers included in our study were young. Previous studies have observed few differences between men and women at younger ages;⁵ so, this may also explain the proportion of PE according to sex described in our article.

Our findings of how PE is distributed across different sociodemographic characteristics (not gender) are consistent with previous literature, which suggests that the use of EPRES-Se for measuring PE in the Swedish population is consistent.

Furthermore, workers with higher levels of precariousness reported having had multiple jobs in the past and difficulties piecing several jobs together. Holding multiple jobs has been considered part of the PE definition by the International Labour Organization (ILO)³⁴ and was found to be associated with occupational injuries in a systematic review.³⁵ Multiple job holding is frequently understood as indicating insufficient income or employment instability and thus, although being debated,^36,37 our results could support the notion that multiple job holding should be considered when defining multidimensional PE.

This study has some limitations. First, we cannot rule out reverse causation for some of the outcomes, specifically for “having difficulties in managing regular expenses for the past 12 months.” For example, it is possible that some individuals had financial difficulties leading them into PE, or it could be the other way around: Because they were precarious employees, they then suffered from financial strain. Next, we cannot disregard the common method bias (self-reported exposure and outcomes measured at one time point). Despite this, our results agree with previous studies. Longitudinal studies are necessary to validate our findings and to understand the mechanisms and effects of multidimensional PE on social precarity and in various contexts.

In addition, the included individuals may not be representative of the population of nonstandard workers in the Stockholm county. The PREMIS study, however, aimed to recruit individuals that are difficult to reach and not well-captured in other surveys, even at the expense of lower external validity. We also conducted analyses using the RDS weights (which account for oversampling of individuals included in large social networks) and no critical differences between the unweighted and weighted results were observed (data not shown).

Despite the temporariness dimension of EPRES-Se needing revision,²¹ a strength of the study is the use of a tool for measuring PE through a multidimensional approach. EPRES has been previously used in Spanish,³⁸ Catalan,³⁹ Chilean,⁴⁰ and a Swedish working population.²¹

Conclusions

To our knowledge, this is the first study in a Nordic welfare state exploring the social precarity associated with PE. Our findings suggest that workers in PE experience social precarity, stressing that PE may have negative effects on well-being. Further studies should analyze these findings in other contexts and explore the mediating effect of social precarity in the relation between PE, health, and well-being of workers.

Supplemental Material

sj-docx-1-joh-10.1177_00207314211051880 - Supplemental material for The Relation Between Precarious Employment Arrangements and Social Precarity: Findings from the PREMIS Study in Stockholm, Sweden

Supplemental material, sj-docx-1-joh-10.1177_00207314211051880 for The Relation Between Precarious Employment Arrangements and Social Precarity: Findings from the PREMIS Study in Stockholm, Sweden by Nuria Matilla-Santander, Johanna Jonsson, Bertina Kreshpaj, Cecilia Orellana, Joan Benach, Kathryn Badarin, Bo Burström, Alejandra Vives, Katarina Kjellberg, Susanne Strömdahl, Gun Johansson, Per-Olof Östergren and Theo Bodin in International Journal of Health Services

Footnotes

Acknowledgments

The authors thank the PREMIS project members and reference group members who provided valuable input during the formative work of the study.

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was supported by the Forskningsrådet om Hälsa, Arbetsliv och Välfärd (grant number 2015-00933).

Supplemental material

Supplemental material for this article is available online.

ORCID iDs

Nuria Matilla-Santander

Joan Benach

Author Biographies

Nuria Matilla-Santander, PhD, is a postdoctoral researcher in occupational and environmental medicine at Karolinska Institute in Sweden. Her background is in biomedical sciences, public health, and epidemiology. Her research interests are the health impact of employment and working conditions and new forms of work, such as platform work.

Johanna Jonsson is a doctoral student in occupational medicine with a background in psychology and public health/epidemiology. Her research is primarily focused on precarious employment, particularly health outcomes and exposure assessment methodology.

Bertina Kreshpaj, MPH with a focus on migration health and a PhD student in epidemiology at the Unit of Occupational Medicine at Karolinska Institute in Sweden, investigating precarious employment as a social determinant of health inequalities.

Cecilia Orellana Pozo, DVM, MPH, PhD, is an assistant professor in the Unit of Occupational Medicine, Institute of Environmental Medicine, Karolinska Institute, Sweden. She is a collaborative researcher in the Non-Standard and Precarious Employment Research Program.

Joan Benach, MD, PhD, is director of the Health Inequalities Research Group/Employment Conditions Network (GREDS-EMCONET, UPF), codirector of the JHU-UPF Public Policy Center, and senior researcher and full professor in the Department of Political and Social Sciences at the Pompeu Fabra University in Barcelona, Spain.

Kathryn Badarin is a PhD student in occupational medicine at Karolinska Institute, Sweden. Her current research explores associations between physical and psychosocial workplace hazards and marginalization from the workforce among workers with musculoskeletal disorders.

Bo Burström, MD, PhD, is a medical doctor, specialist in social medicine, professor at Karolinska Institute in Sweden, and senior consultant at the Centre for Epidemiology and Community Health, Region Stockholm. He leads the research group for equity and health policy and the unit for equity in health at Region Stockholm. His main focus is on equity in health, health care, and the social and economic consequences of disease and on health in disadvantaged groups.

Alejandra Vives, PhD, is an associate professor at the Pontificia Universidad Católica de Chile. Her background is in public health and epidemiology. Her primary areas of research are employment and work as social determinants of health and the relationship between urban spaces and health.

Katarina Kjellberg, PhD, is a researcher within the area of occupational medicine. Her research is focused on physical and psychosocial working conditions in relation to health outcomes and a sustainable working life. She studies exposures such as heavy lifting, uncomfortable working postures, and low job control, together with the primary outcomes of musculoskeletal disorders, work ability, and early exits from the labor market through long-term sick leave, disability pension, and other exit routes.

Susanne Strömdahl, PhD, is a researcher within the Global Health, human immunodeficiency virus (HIV), and Sexual and Reproductive Health and Rights (SRHR) Group at the Department of Public Health Sciences at Karolinska Institute in Sweden. Her research focus is on HIV epidemiology and effective HIV/sexually transmitted infections (STI) interventions among key populations for HIV. In addition, Susanne focuses on sampling methods for populations without a sampling frame, particularly respondent-driven sampling and web-based methods.

Gun Johansson, PhD, is an epidemiologist at the Center for Occupational and Environmental Medicine, Stockholm County Council, and a researcher at the Institute for Environmental Medicine at the Karolinska Institute. Her research focuses on sick leave and return to work from a working life and labor market perspective.

Per-Olof Östergren, MD, PhD, is a senior professor in social medicine at Lund University, Sweden. His primary research interests concern social determinants of health with a focus on work and labor market issues and health systems, especially regarding outcomes such as mental health and sexual and reproductive health and rights.

Theo Bodin, MD, PhD, is an associate professor and resident physician in occupational and environmental medicine. He is the head of the New World of Work research group at Karolinska Institute in Sweden and director of the Center for Occupational and Environmental Medicine, Stockholm Region. His primary research focus is nonstandard employment arrangements and health.

References

Kawachi

Globalization and workers’ health. Ind Health. 2008;46(5):421–423. doi:10.2486/indhealth.46.421

Bosch

. Towards a new standard employment relationship in Western Europe. Br J Ind Relations. 2004;42(4):617–636. doi:10.1111/j.1467-8543.2004.00333.x

Kreshpaj

Orellana

Burström

, et al. What is precarious employment? A systematic review of definitions and operationalizations from quantitative and qualitative studies. Scand J Work Environ Health. 2020;46(3):235–247 doi:10.5271/sjweh.3875

Benach

Vives

Tarafa

Delclos

Muntaner

. What should we know about precarious employment and health in 2025? Framing the agenda for the next decade of research. Int J Epidemiol. 2016;45(1):232–238. doi:10.1093/ije/dyv342

Julià

Vanroelen

Bosmans

Van Aerden

Benach

. Precarious employment and quality of employment in relation to health and well-being in Europe. Int J Heal Serv. 2017;47(3):389–409. doi:10.1177/0020731417707491

Bodin

Caglayan

Garde

, et al. Precarious employment in occupational health- an OMEGA-NET working group position paper. Scand J Work Environ Heal. 2019;46(3):321–329. doi:10.5271/sjweh.3860

Benach

Vives

Amable

Vanroelen

Tarafa

Muntaner

. Precarious employment: understanding an emerging social determinant of health. Annu Rev Public Health. 2014;35:229–253. doi:10.1146/annurev-publhealth-032013-182500

Gallie

Paugam

. Social Precarity and Social Integration. Report for the European Commission. Based on Eurobarometer 56.1. Luxembourg: Office for Official Publications of the European Communities, 2003.

Steele

Giles

Davies

Moore

. Is precarious employment associated with women remaining childless until age 35 yearsResults from an Australian birth cohort study. Hum Reprod. 2017;29(1):155–160. doi:10.1093/humrep/det407

10.

Bobek

Pembroke

Wickham

. Living With Uncertainty: The Social Implications of Precarious Work. Brussels, Belgium: Foundation for European Progressive Studies; 2018. https://www.tasc.ie/publications/living-with-uncertainty-the-social-implications-o/

11.

Mcnamara

Bohle

Quinlan

. Precarious employment, working hours, work-life conflict and health in hotel work. Appl Ergon. 2011;42(2):225–232. doi:10.1016/j.apergo.2010.06.013

12.

Scherer

. The Social Consequences of Insecure Jobs. Soc Indic Res. 2009;93:527–547. doi:10.1007/s11205-008-9431-4

13.

Buchler

Haynes

Baxter

. Casual employment in Australia. The influence of employment contract on financial well-being. J Sociol. 2009;45(3):271–289. doi:10.1177/1440783309335648

14.

Vives

Gonzalez Lopez

Benach

. Measuring precarious employment: type of contract can lead to serious misclassification error. Ann Work Expo Heal. 2020;64(9):1035–1038. doi:10.1093/annweh/wxaa089

15.

Peckham

Seixas

. What’s casual? What’s causal? Advancing research on employment relationships and health. Occup Environ Med. 2021;78(1):1035–1038. doi:10.1093/annweh/wxaa089

16.

Poverty and Employment Precarity in Southern Ontario Research Group. The Precarity Penalty. The Impact of Employment Precarity on Individuals, Households and Communities and What to Do about It; 2015.

17.

Antonucci

. Not all experiences of precarious work lead to precarity: the case study of young people at university and their welfare mixes. J Youth Stud. 2018;21(7):888–904. doi:10.1080/13676261.2017.1421749

18.

Dragano

Siegrist

Wahrendorf

. Welfare regimes, labour policies and unhealthy psychosocial working conditions: a comparative study with 9917 older employees from 12 European countries. J Epidemiol Community Heal. 2010;65(9):793–800. doi:10.1136/jech.2009.098541

19.

Jonsson

Stein

Johansson

Bodin

. A performance assessment of web-based respondent driven sampling among workers with precarious employment in Sweden. PLoS One. 2019;14(1):e0210183.

20.

Statistics Sweden. Longitudinal integrated database for health insurance and labour market studies (LISA).

21.

Jonsson

Vives

Benach

, et al. Measuring precarious employment in Sweden: translation, adaptation and psychometric properties of the Employment Precariousness Scale (EPRES). 2019. doi:10.1136/bmjopen-2019-029577

22.

Vives

Amable

Moncada

, et al. The Employment Precariousness Scale (EPRES): psychometric properties of a new tool for epidemiological studies among waged and salaried workers. Occup Environ Med. 2010;67(8):548–555. doi:10.1136/oem.2009.048967

23.

Stengård

Bernhard-Oettel

Berntson

Leineweber

Aronsson

. Stuck in a job: being “locked-in” or at risk of becoming locked-in at the workplace and well-being over time. Work Stress. 2016;30(2):152–172. doi:10.1080/02678373.2016.1163804

24.

Textor

Hardt

Knüppel

. DAGitty: a graphical tool for analyzing causal diagrams. Epidemiology. 2011;22(5):745. doi:10.1097/EDE.0b013e318225c2be

25.

Keuskamp

Ziersch

Baum

LaMontagne

. Precarious employment, psychosocial working conditions, and health: cross-sectional associations in a population-based sample of working Australians. Am J Ind Med. 2013;56(8):838–844. doi:10.1002/ajim.22176

26.

Benavides

Benach

Diez-Roux

Roman

. How do types of employment relate to health indicators? Findings from the second European survey on working conditions. J Epidemiol Community Health. 2000;54(7):494–501. doi:10.1136/jech.54.7.494

27.

Toivanen

Tarantino

Emmelin

Östergren

. Diverting blame to stay sane - Young people’s strategies for dealing with the mental health effects of precarious employment: a grounded theory study. BMC Public Health. 2020;20(571):1–12. doi:10.1186/s12889-020-08626-4

28.

Lewchuk

Laflèche

Procyk

, et al. The precarity penalty: how insecure employment disadvantages workers and their families. Altern Routes A J Crit Soc Res. 2015;27:87–108.

29.

Leigh-Hunt

Bagguley

Bash

, et al. An overview of systematic reviews on the public health consequences of social isolation and loneliness. Public Health. 2017;152:157–171. doi:10.1016/j.puhe.2017.07.035

30.

Holt-Lunstad

. Why social relationships are important for physical health: a systems approach to understanding and modifying risk and protection. Annu Rev Psychol. 2018;69:1–22. https://doi.org/10.1146/annurev-psych-122216-011902

31.

Bacci

Pigini

Seracini

Minelli

. Employment condition, economic deprivation and self-evaluated health in Europe: evidence from. Int J Environ Res Public Health. 2017;14(143):1–19. doi:10.3390/ijerph14020143

32.

Van Aerden

Moors

Levecque

Vanroelen

. Measuring employment arrangements in the European labour force: a typological approach. Soc Indic Res. 2014;116(3):771–791. doi:10.1007/s11205-013-0312-0

33.

Porthé

Ahonen

Vázquez

, et al. Extending a model of precarious employment: a qualitative study of immigrant workers in Spain. Am J Ind Med. 2010;53(4):417–424. doi:10.1002/ajim.20781

34.

International Labour Organization. From Precarious Work to Decent Work; 2011.

35.

Koranyi

Jonsson

Rönnblad

Stockfelt

Bodin

. Precarious employment and occupational accidents and injuries – a systematic review. Scand J Work Environ Heal. 2018;44(4):341–350. doi:10.5271/sjweh.3720

36.

Stef

Geuskens

van der Beek

Boot

. Multiple-job holding is not a type of precarious employment. Scand J Work Environ Heal. 2019;45(1):98–99. doi:10.5271/sjweh.3782

37.

Koranyi

Jonsson

Rönnblad

Stockfelt

Bodin

. Authors’ response to “Multiple-job holding is not a type of precarious employment.” Scand J Work Environ Heal. 2019;45(1):2018–2019. doi:10.5271/sjweh.3789

38.

Vives

González

Moncada

Llorens

Benach

. Measuring precarious employment in times of crisis: the revised Employment Precariousness Scale (EPRES) in Spain. Gac Sanit. 2015;29(5):379–382. doi:10.1016/j.gaceta.2015.06.008

39.

Benach

Julià

Tarafa

Mir

Molinero

Vives

. La precariedad laboral medida de forma multidimensional: distribución social y asociación con la salud en Cataluña [Multidimensional measurement of precarious employment: social distribution and its association with health in Catalonia (Spain)]. Gac Sanit. 2015;29(5):375–378. doi:10.1016/j.gaceta.2015.04.002

40.

Vives-Vergara

González-López

Solar

Bernales-Baksai

González

Benach

. Precarious employment in Chile: psychometric properties of the Chilean version of Employment Precariousness Scale in private sector workers. Cad Saude Publica. 2017;33(3):1–13. doi:10.1590/0102-311X00156215

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