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OBJECTIVES: Low-quality and precarious employment have been associated with adverse mental health and wellbeing. More evidence is needed on how the quality of employment trajectories – including transitions in and out of unemployment, inactivity, and employment of varying quality – are associated with individuals’ mental health over time. This paper aimed to derive a typology of multidimensional employment trajectories and assess associations with mental health in the UK. METHODS: Data from waves 1–9 of the UK Household Longitudinal Study were used (2009–2019). Individuals aged 30–40 at baseline were included (N=1603). Using multichannel sequence and clustering analyses, we derived a typology of employment trajectories across employment statuses and four employment quality indicators. We assessed associations with subsequent psychological distress, accounting for baseline mental health. Changes in average General Health Questionnaire scores are described. RESULTS: A typology of five trajectory clusters highlighted stable and secure and precarious/low-quality trajectories for both men and women. Women who reported being economically inactive at most waves had higher odds of experiencing psychological distress than did women in ‘standard’ trajectories, regardless of baseline mental health. Women’s scores of psychological distress in the ‘precarious’ group on average increased along their trajectories characterized by instability and transitions in/out of unemployment, before a move into employment. Men who likely moved in and out of unemployment and economic inactivity, with low probability of paid employment, reported increased psychological distress at the end of follow-up. This may partly be due to pre-existing mental ill-health. CONCLUSION: This paper shows the importance of high-quality employment for individuals’ mental health over time. Researchers need to consider dynamic associations between employment quality and mental health across the life-course.

Abstract Background This study aims to identify the key factors that underlie the return to work (RTW) of head and neck cancer (HNC) patients in Belgium. Methods We used data from the EMPCAN database linking data from the Belgian Cancer Registry and the Crossroads Bank for Social Security. We selected HNC patients aged 18–60 at diagnosis who became inactive on the labour market during the follow-up time observed (n = 398). Fine-Gray regression models were used to examine associations between clinical, socio-demographical and work-related factors and RTW over a follow-up of almost 8 years (2004–2011). Results The overall RTW was 21.6%. Stage IV at diagnosis and the use of chemoradiation were associated with a decreased RTW probability but this effect was attenuated by age-adjusted analyses. Multivariate analysis shows that the probability of RTW decreases with age and depends on the household composition. Patients who live alone (SHR 2.2, 95% CI 1.0 – 4.5) and patients who live with another adult and child(ren) (SHR 2.1, 95% CI 1.1 – 4.0) are more likely to RTW than patients who live with another adult without children. Conclusions The cumulative incidence of RTW in HNC patients is associated with age and household composition but not with treatment modalities or stage. In future research, this model could be applied to larger cancer patient groups for more accurate estimations. These insights are of importance to better support patients and for informing tailored policy measures which should take into account the sociodemographic profile of HNC patients to tackle societal and health-related inequities and burden of work inactivity.

Introduction Living with a chronic disease impacts many aspects of life, including the ability to participate in activities that enable interactions with others in society, that is, social participation (SP). Despite efforts to monitor the quality of care and life of chronically ill people in Belgium, no disease-specific patient-reported measures (PRMs) have been used. These tools are essential to understand SP and to develop evidence-based recommendations to support its improvement. This protocol presents the phases for the disease-specific development of patient-reported outcome and experience measures to assess SP and its potential determinants among people living in Belgium with cancer, cystic fibrosis, diabetes, HIV or a neuromuscular disease.Methods and analysis This protocol applies the PROMIS Instrument Development and Validation Scientific Standards and COnsensus-based Standards for the selection of health Measurement INstruments to develop PRMs in a disease-specific manner to quantify the components of the International Classification of Functioning, Disability and Health (ICF). A mixed-method approach is used to create broad initial item pools based on patient (focus groups) and literature perspectives which are compared within ICF-standardised language by applying the refined ICF linking rules. An item set is first created based on this cross-matching exercise and then validated by multidisciplinary expert panels. Cognitive assessment and pilot testing are followed by the dissemination of the survey to a representative sample in Belgium. Advanced psychometric testing (classical test theory and item response theory) is applied to inform an item reduction strategy for the final measures and to develop scales for the ICF components.Ethics and dissemination Ethical approval was granted by the Ethics Committee of the Ghent University Hospital on 20 February 2023 to organise the patient focus groups (ONZ-2022-0470). Ethical approval for dissemination of the PRMs and psychometric testing will be sought at the Ghent University Hospital Ethics Committee at the start of Phase 6. Results will be disseminated through peer-reviewed journals and professional conferences.

Research on the career expectations of employees and the potential (mis)match with their lived reality is abundant, yet the research field has paid less attention to the expectation–reality gap of the self-employed. Self-employed people’s attitudes towards work are, however, important for determining business success and persistence. Therefore, research is needed to examine their expectations as well as how self-employed people’s expectations materialize in their experiences. By analyzing in-depth interviews with 19 self-employed workers without employees in Belgium, both desired and undesired career expectations were revealed. After becoming self-employed, these expectations sometimes materialized in reality, in both a positive (e.g., independence and doing what you love) and a negative (e.g., risk and insecurity) sense. Our results also imply that expectation–reality gaps going in two directions exist. We identified positive expectations being met by less-positive experiences (e.g., loneliness, increased responsibility, being unable to do what you like, overestimated financial success, and unavailable or expensive formal support), as well as negative expectations being met by better experiences (e.g., social support between self-employed colleagues). The study signals that the social environment of the solo self-employed (SSE) merits policy attention. Efforts need to be made to create self-employed networks, where professional and social ties can be formed.

Purpose: We describe the design and development of the European Platform to Promote health and wellbeing in the workplace (EMPOWER) digital intervention that provides an integrative user programme meeting the needs of employees and employers in addressing work stress. Results: A user-centred design process was followed from January 2020 until November 2021. A tailored algorithm was developed to provide support at the individual employee level and the company level. Each element of the digital intervention was developed in English and then translated in Spanish, English, Polish and Finnish. The digital intervention consists of a website and a mobile application (app) that provides algorithm-based personalised content after assessing a user's somatic and psychological symptoms, work functioning, and psychosocial risk factors for work stress. It has a public section and an employer portal that provides recommendations to reduce psychosocial risks in their company based upon clustered input from employees. Usability testing was conducted and showed high ease of use and completion of tasks by participants. Conclusion: The EMPOWER digital intervention is a tailored multimodal intervention addressing wellbeing, work stress, mental and physical health problems, and work productivity. This will be used in a planned RCT in four countries to evaluate its effectiveness.

Data repositories for the social sciences are facing some discipline-specific challenges. This essay provides an overview of the four key challenges. In addition, five suggestions are made to strengthen domain-specific online data repositories in the social sciences, supported by good practices. Using a user-centred approach, these suggestions aim to further open up the social sciences data landscape. The essay first addresses insights regarding the sharing of quantitative and qualitative data in light of the specific needs and issues regarding these two types of data. Thereafter, we suggest (i) ‘data labs’ for novice data re-users, (ii) advocate for the repository as an online meeting place for researchers, (iii&iv) argue for two concrete metadata approaches for quantitative and qualitative data separately, (v) provide ideas for handling epistemological challenges of data sharing, and (vi) introduce the data repository as a possible contact medium for research participants.

Objective: This article describes the EMPOWER study, a controlled trial aiming to determine the effectiveness and cost-effectiveness of an eHealth intervention to prevent common health problems and reduce presenteeism and absenteeism in the workplace. Intervention: The EMPOWER intervention spans universal, secondary and tertiary prevention and consists of an eHealth platform delivered via a website and a smartphone app designed to guide employees throughout different modules according to their specific profiles. Design: A stepped-wedge cluster randomized trial will be implemented in four countries (Finland, Poland, Spain and UK) with employees from small and medium enterprises (SMEs) and public agencies. Companies will be randomly allocated in one of three groups with different times at which the intervention is implemented. The intervention will last 7 weeks. Employees will answer several questionnaires at baseline, pre- and post-intervention and follow-up. Outcome measures: The main outcome is presenteeism. Secondary outcomes include depression, anxiety, insomnia, stress levels, wellbeing and absenteeism. Analyses will be conducted at the individual level using the intention-to-treat approach and mixed models. Additional analyses will evaluate the intervention effects according to gender, country or type of company. Cost-effectiveness and cost-utility analyses [based on the use of quality-adjusted life-years (QALYS)] will consider a societal, employers’ and employees’ perspective.

Air pollution is a major global health threat. There is growing evidence for a negative effect of air pollution on health and well-being. Relationships between air pollution and health are mediated by health risk perceptions and play a crucial role in public response to it. Air pollution in the public’s mind is often different from air pollution defined by the scientific community. Therefore, in order to develop successful prevention and alleviation strategies, an understanding of public risk perceptions is key. The central question of this paper is: ‘How does “the public” (in Brussels) perceive air pollution?’ This research is an attempt to enrich the limited body of qualitative research in the field, approaching the topic of perception from 4 different, complementary angles: definition, association, categorisation and problematisation. About 51 interviews were conducted in the Brussels-Capital Region. Consistent with earlier research, this research illustrates that perceptions of air pollution are diverse, subjective, context-dependent and often deviate from conceptualisations and definitions in the scientific community. Respondents underestimate the potential harm and problematisation depends on comparative strategies and perceived avoidability. The novel aspect of this paper is the identification of 5 mental schemes by which specific elements are categorised as being air pollution: (1) the source of the element, (2) its health impact, (3) its climate impact, (4) its functionality and (5) sensory perceptions. The insights gained from this research contribute to the field of environmental epidemiology through a better understanding of how ‘the public’ perceives air pollution and in what way this may deviate from how it is perceived by experts. We hope to raise the awareness among experts and policy makers that air pollution perceptions are far from universal and consensual but on the contrary individual and contested.

OBJECTIVES: Evidence is growing that non-standard employment is associated with adverse health. However, little is known about the relationship between different non-standard employment arrangements and subsequent all-cause and cause-specific mortality. Using population-wide data, the present study investigated this link. METHODS: Data was derived from the 2001 Belgian census and a 13-year-long follow-up. The analyses comprised 1 454 033 healthy and disability-free employees aged 30–59 years at baseline. Cox regressions were fitted to analyze the mortality risks of those in non-standard employment forms (temporary agency, seasonal, fixed-term, causal work and employment program) compared to permanent employees. RESULTS: Several groups of workers in non-standard employment arrangements in 2001 exhibited a higher mortality risk relative to permanent employees during the follow-up after adjusting for socio-economic and work-related factors. This was especially the case among men. The relative mortality disadvantage was particularly elevated for male temporary agency workers. External causes of death played an important role in this association. CONCLUSIONS: A mortality gradient between the core and outer periphery of the Belgian labor market has been observed. This study also shows that the excess risk of death, previously attributed to non-permanent employment as a whole, hides inequalities between specific forms of non-standard work (eg, temporary agency, seasonal, fixed-term employment).

OBJECTIVES: The aims of this position paper are to (i) summarize research on precarious employment (PE) in the context of occupational health; (ii) develop a theoretical framework that distinguishes PE from related concepts and delineates important contextual factors; and (iii) identify key methodological challenges and directions for future research on PE and health. METHODS: This position paper is the result of a working group consisting of researchers from the EU, Turkey and the USA, who have discussed the issue over the course of six months (October 2018–April 2019), meeting both online and face-to-face on several occasions. RESULTS: The lack of a common theoretical framework of PE hinders it from becoming an established part of occupational and public health research. There are also issues regarding operationalization in surveys and registers. Further, previous research on PE and health suffers from methodological limitations including inadequate study designs and biased assessments of exposure and outcomes. PE is highly dependent on contextual factors and cross-country comparison has proven very difficult. We also point to the uneven social distribution of PE, ie, higher prevalence among women, immigrants, young and low educated. We propose a theoretical framework for understanding precarious employment as a multidimensional construct. CONCLUSIONS: A generally accepted multidimensional definition of PE should be the highest priority. Future studies would benefit from improved exposure assessment, temporal resolution, and accounting for confounders, as well as testing possible mechanisms, eg, by adopting multi-level and intersectional analytical approaches in order to understand the complexity of PE and its relation to health.

Domestic cleaners have an increased risk of asthma-like and other respiratory symptoms and conditions. Uncertainty exists about which products are most hazardous. We aimed to investigate, among professional domestic cleaners, the associations of ocular/respiratory outcomes with using specific types of products at work and with the ability to choose their own products.Among domestic cleaners employed by “service vouchers” companies in Belgium, we administered an online questionnaire on ocular/respiratory symptoms (frequency and time relation to workdays), frequency of use of 40 types of products, and ability to choose one’s own products. Work-relatedness was defined as symptoms improving/disappearing on days off-work. We studied associations between frequency of product-use with work-related outcomes (eye irritation, rhinitis symptoms, sore throat, laryngeal symptoms, asthma symptoms, cough) and with chronic bronchitis, using multivariable logistic and elastic net regression. Adjusted odds ratios (OR) with 95%-confidence intervals were obtained per time a product was used per week.Among 1,586 domestic cleaners (99% women), the number of times sprays were used (median 13/week) was significantly associated with all outcomes (ORs between 1.012 and 1.024 per time sprays were used per week). Bleach/disinfectant-containing liquid products were associated with all outcomes, except for laryngeal symptoms (ORs 1.086 to 1.150); ammonia with work-related upper airway symptoms and chronic bronchitis. Cleaners able to choose their own products had fewer work-related eye symptoms (OR 0.728;0.556–0.954), rhinitis (OR 0.735;0.571–0.946) and cough (OR 0.671;0.520–0.865). Using elastic net regression, work-related rhinitis was most strongly associated with mould removal spray (OR 1.108;1.006–1.248), carpet/seat/curtain spray (OR 1.099;1.001–1.304) and ammonia (OR 1.081;1.002–1.372); work-related asthma with carpet/seat/curtain spray (OR 1.103;1.017–1.322), mould removal spray (OR 1.029;0.995–1.199) and drain cleaner (OR 1.023;0.979–1.302).In a large group of domestic cleaners, we documented that cleaning products have a range of adverse respiratory effects. Empowering cleaners to choose their products may reduce the burden of symptoms.

Background: Our living environment impacts on our health and wellbeing. The physical and mental benefits of interaction with nature and the ecosystem are well-established in literature. From a public health perspective, it is thus crucial that people make use of public green spaces (PGSs) in urban areas. Therefore, it is important to understand why they are potentially under-used.Methods: In this research, we identified social barriers that prevent the (full) use of PGSs in the Brussels Capital Region (BCR). We applied a qualitative research methodology. Insights were generated through 51 individual face-to-face in-depth interviews with a group of PGS users diversified in terms of age, gender, migration background, and socioeconomic situation. Questions were open-ended, and the interview guide was semi-structured.Results: Our research identified three social barriers for the use of available and accessible PGSs: (1) perceived dangers due to bad precedents, the presence of socially frightening elements, or a lack of social control, (2) not feeling in place because of the dominance of a specific group of users or because of community perceptions, and (3) not fulfilling one's social needs. These barriers were different in their manifestations (barriers to go—barriers to stay—barriers for integral use) and resulted in a differential degree of PSG-use. We distinguished three different dimensions of the completeness or integrality (understood as full or optimal use) by which PGSs are used; the spatial integrality (using all the different parts of the PGS), the temporal integrality (using PGSs at all moments of the day), and the social integrality of PGS use (without any restriction concerning social interaction).Conclusions: While there are many benefits associated with PGSs, a continuous social evaluation of these physical places might generate social barriers resulting in a decline of their use, a more superficial use, or even in complete avoidance. Both the social context and social needs of individuals result in specific social barriers.

Background: Understanding public health risk perceptions is essential in efficient environmental health management. In the light of the negative impact of air pollution on health and the direct and indirect mediation of this impact through risk perceptions, it is crucial to better understand the lay perceptions of air pollution. Since qualitative research methods are well suited for this aim, the central objective of this study is to present a review of qualitative research articles in the field of environmental epidemiology that investigate health risk perceptions of ambient air pollution since the 2000s. Methods: We followed the PRISMA-guidelines which resulted in a selection of 20 scientific articles published in peer-reviewed academic journals that used qualitative research methods and reported on health risk perceptions about ambient air pollution. Results: Qualitative research in the field of environmental epidemiology is still scarce. Most of the studies included in the review were based on face-to-face interviews and focus group discussions; a minority used a mixed-method approach. Interesting contributions were made with respect to both the perception of exposure to air pollution and the perception of the health effect associated with air pollution. Conclusions: The review suggests that data generated through qualitative research might complement the traditionally quantitative field of environmental epidemiology. Mixed method multidisciplinary research is likely to provide a more holistic explanation of environmental health patterns observed through quantitative research. These explanations are key in managing environmental health and in developing successful prevention, mitigation and communication strategies. Implementing qualitative research methods contribute to the field of environmental epidemiology as it i) allows for triangulation of findings; ii) generates nuanced findings and new research questions; iii) triggers in-depth understandings of quantitatively identified patterns; iv) leads to additional surprising and/or multifaceted responses; v) enhances relationships between researcher and respondent; vi) increases the awareness of important context-dependent dynamics or interactions that may generate biases and vii) grasps the local, contextual, situational and cultural elements that interact with health risk perceptions.

To fight the COVID-19 epidemic, many countries implemented containment measures that made physical distancing the norm and imposed restrictions on the use of public space. In countries where access to public green spaces (PGSs) was safeguarded, they were expected to partially counterbalance the negative health outcomes of these containment measures, as they offered a unique opportunity to meet others, to avoid isolation, and to move, play and relax at a safe distance. Research on PGS use and its objective association with health during the COVID-19 epidemic is rather limited and is based on quantitative research methodologies. Such methodologies are useful to detect objective associations between PGS use and health or between COVID-19 and PGS use, but fall short in explaining the observed associations. This qualitative research filled this gap by examining how PGS users perceived the health advantages of PGSs and how the use of PGSs changed during the epidemic in the Brussels-Capital Region, Belgium. In total, 23 individual face-to-face in-depth interviews were conducted in various PGSs. We found that while PGSs were initially perceived as a possible threat to health in the first period of the epidemic, they gradually became associated in users' minds with both improved physical and mental health. Although the mechanisms behind this association were also present prior to the epidemic, they became more tangible and more universal. We also found that the use of PGSs changed during the epidemic due to measures and restrictions and due to health risk perceptions. We distinguished five different health risk perception profiles in relation to COVID-19: the denier, the fatalist, the negotiator, the conformer and the worrier. These different health risk perceptions impacted on the use of and behaviour within PGSs. This research confirms the importance of PGSs during an epidemic and may inspire further research, offer pointers to policymakers for developing and implementing strategies related to the use of PGSs during epidemics, and assist them in providing available and accessible PGSs and in designing attractive, more epidemic-proof PGSs.

Since the 1980s, there has been a trend for businesses and public administrations to focus on their core activities, outsourcing tasks such as IT, security, catering and cleaning services. However, in recent years, many organisations have been reversing the trend by insourcing, or “backsourcing”, some of these activities. The aim of this article is to study the extent to which activities have been outsourced in the Brussels regional administrations, its impact on workers and organisations involved, and the attitudes of stakeholders towards a possible re-internalisation of low-skilled jobs. Based on a multidisciplinary BSI project for Talent.Brussels, our findings show that decisions about outsourcing and insourcing are complex and multidimensional, and that they should not be based solely on monetary cost considerations. Since the 1980s, there has been a trend for businesses and public administrations to focus on their core activities, outsourcing tasks such as IT, security, catering and cleaning services. However, in recent years, many organisations have been reversing the trend by insourcing, or “backsourcing”, some of these activities. The aim of this article is to study the extent to which activities have been outsourced in the Brussels regional administrations, its impact on workers and organisations involved, and the attitudes of stakeholders towards a possible re-internalisation of low-skilled jobs. Based on a multidisciplinary BSI project for Talent.Brussels, our findings show that decisions about outsourcing and insourcing are complex and multidimensional, and that they should not be based solely on monetary cost considerations.

Since the 1980s, there has been a trend for businesses and public administrations to focus on their core activities, outsourcing tasks such as IT, security, catering and cleaning services. However, in recent years, many organisations have been reversing the trend by insourcing, or “backsourcing”, some of these activities. The aim of this article is to study the extent to which activities have been outsourced in the Brussels regional administrations, its impact on workers and organisations involved, and the attitudes of stakeholders towards a possible re-internalisation of low-skilled jobs. Based on a multidisciplinary BSI project for Talent.Brussels, our findings show that decisions about outsourcing and insourcing are complex and multidimensional, and that they should not be based solely on monetary cost considerations.

Since the 1980s, there has been a trend for businesses and public administrations to focus on their core activities, outsourcing tasks such as IT, security, catering and cleaning services. However, in recent years, many organisations have been reversing the trend by insourcing, or “backsourcing”, some of these activities. The aim of this article is to study the extent to which activities have been outsourced in the Brussels regional administrations, its impact on workers and organisations involved, and the attitudes of stakeholders towards a possible re-internalisation of low-skilled jobs. Based on a multidisciplinary BSI project for Talent.Brussels, our findings show that decisions about outsourcing and insourcing are complex and multidimensional, and that they should not be based solely on monetary cost considerations.

Abstract Background In preventing the transfer of HIV to their children, the Ministry of Health in Mozambique recommends all couples follow medical advice prior to a pregnancy. However, little is known about how such women experience pregnancy, nor the values they adhere to when making childbearing decisions. This qualitative study explores perceptions and decision-making processes regarding pregnancy among HIV positive women in rural Maputo Province. Methods In-depth interviews and five focus group discussions with fifty-nine women who had recently become mothers were carried out. In addition, six semi-structured interviews were held with maternity and child health nurses. The ethnographic methods employed here were guided by Bourdieu’s practice theory. Results The study indicated that women often perceived pregnancy as a test of fertility and identity. It was not only viewed as a rite of passage from childhood to womanhood, but also as a duty for married women to have children. Most women did not follow recommended medical advice prior to gestation. This was primarily due to perceptions that decision-making about pregnancy was regarded as a private issue not requiring consultation with a healthcare provider. Additionally, stigmatisation of women living with HIV, lack of knowledge about the need to consult a healthcare provider prior to pregnancy, and unintended pregnancy due to inadequate use of contraceptive were crucial factors. Conclusion Women’s experiences and decisions regarding pregnancy are more influenced by social and cultural norms than medical advice. Therefore, education concerning sexual and reproductive health in relation to HIV/AIDS and childbearing is recommended. In particular, we recommend maternal and child healthcare nurses need to be sensitive to women’s perceptions and the cultural context of maternity when providing information about sexual and reproductive health.

Although many governments actively stimulate self-employment, their work-related mental well-being remains understudied. The aim of current study is to investigate the mental well-being of different types of self-employed, testing whether mental well-being differences among self-employed are explained by the presence of work characteristics that are in accordance with the ideal-typical image of the “successful entrepreneur” (e.g. creativity, willingness to take risks, innovativeness, high intrinsic motivation, skilfulness and the ability of recognizing opportunities). Moreover, we investigate the relation of country-level “entrepreneurial climate” and the individual mental well-being of self-employed. For this purpose, data from the European Working Conditions Survey, round 6 (2015) was analysed, including 5448 cases, originating from the 28 EU-member states. Multilevel random intercepts modelling was used to investigate associations of both individual- and country-level characteristics with mental well-being. We found that motivation, the ability to recognize opportunities, and finding it easy to be self-employed positively influences the mental well-being of self-employed. Respondents with these characteristics are often medium-big employers, while farmers, dependent freelancers and own account workers generally have less of these features and tend to have lower levels of mental well-being. At the country-level, positive entrepreneurship perception relates to more advantageous mental health scores in self-employed. These results implicate that policies promoting self-employment should be (more) concerned with the work-related characteristics of (future) self-employed. Keywords: Self-employment, Mental well-being, Cross-national, Entrepreneurial characteristics, Entrepreneurial ecosystems, EU 28

Abstract Background This study focuses on the health impact of the labour market position, since recent research indicates that exposure to both unemployment and precarious employment causes serious harm to people’s health and well-being. An overview of general and mental health associations of different labour market positions in Belgium is provided. A distinction is made between employment and unemployment and in addition between different types of jobs among the employed, taking into account the quality of employment. Given the fact that precarious labour market positions tend to coincide with a precarious social environment, the latter is taken into consideration by including the composition and material living conditions of the household and the presence of social support. Methods Belgian data from the 1st Generations and Gender Survey are used. A Latent Class Cluster Analysis is performed to construct a typology of labour market positions that includes four different types of waged employment: standard jobs, instrumental jobs, precarious jobs and portfolio jobs, as well as self-employment and unemployment. Then, binary logistic regression analyses are performed in order to relate this typology to health, controlling for household situation and social support. Two health outcomes are included: self-perceived general health (good versus fair/bad) and self-rated mental health (good versus bad, based on 7 items from the Center for Epidemiologic Studies Depression Scale). Results Two labour market positions are consistently related to poor general and mental health in Belgium: unemployment and the precarious job type. The rather small gap in general and mental health between both labour market positions emphasises the importance of employment quality for the health and well-being of individuals in waged employment. Controlling for the household level context and social support illustrates that part of the reported health associations can be explained by the precarious social environment of individuals in unfavourable labour market positions. Conclusions The results from this study confirm that the labour market position and social environment of individuals are important health determinants in Belgium.

Abstract Background In the aftermath of the 2008 Great Recession, youth unemployment rates in the Brussels Capital Region (BCR) increased. The aim of this study is firstly to investigate the evolution of the mental health gap between employed and unemployed youth and secondly to examine the association of material and social resources with mental health of youth entering the labour market in the BCR. Methods Two data sources are used to answer the research questions: the Belgian Health Interview Survey (HIS) data (1997 to 2013; 18- to 29-year-olds; N = 5,562), and the authors’ own primary data collection among Brussels youth in the transition from education to employment (2015; 18- to 29-year-olds; N = 1,151; BCR-sample). Prevalence ratios, bivariate and multivariate logistic regression analyses are used to explore mental distress and possible mental disorder amongst this particular group of youth. Results The results show a consistent tendency towards increasing mental health problems for unemployed, compared to employed youth in the 1997–2013 period in the three Belgian Regions. Both social support and the living arrangements of men are related to mental distress and a possible mental disorder. The perception of a poor financial situation is related to a possible mental disorder. Our study also found that escape-avoidance behaviour is important in explaining both adverse mental health outcomes amongst women. Conclusions This study suggests that the mental health gap between employed and unemployed youth increases and demonstrates the importance of material and social resources for the mental health of unemployed youth. These results can contribute to discussions on unemployment policies targeting vulnerable youth.

Objective: To assess differences in mortality rates between social security statuses in two independent samples of Belgian and Spanish male workers. Methods: Study of two retrospective cohorts (Belgium, n = 23,607; Spain, n = 44,385) of 50–60 year old male employees with 4 years of follow-up. Mortality rate ratios (MRR) were estimated using Poisson regression models. Results: Mortality for subjects with permanent disability was higher than for the employed, for both Belgium [MRR = 4.56 (95% CI: 2.88–7.21)] and Spain [MRR = 7.15 (95% CI: 5.37–9.51)]. For the unemployed/early retirees, mortality was higher in Spain [MRR = 1.64 (95% CI: 1.24–2.17)] than in Belgium [MRR = 0.88 (95% CI: 0.46–1.71)]. Conclusion: MRR differences between Belgium and Spain for unemployed workers could be partly explained because of differences between the two social security systems. Future studies should further explore mortality differences between countries with different social security systems.

Because of compositional effects (more highly educated unemployed) and differences in the vulnerability towards the health consequences of unemployment (i.e. disappointment paradox hypothesis and/or status inconsistency for highly educated unemployed), it is argued that indicators of educational attainment need to be included when investigating the social norm of unemployment. Data from the 2001 census linked to register data from 2001-2011 are used, selecting all Belgian employed and unemployed between 30 and 59-year-old at time of the census. Poisson multilevel modelling was used to account for clustering of respondents within sub-districts. For individuals with low education levels, the relative difference in mortality rate ratios between the unemployed and employed is smallest in those regions where aggregate unemployment levels are high. For highly educated, this social norm effect was not found. This study suggest that the social norm effect is stronger for workers with low education levels, while highly educated workers suffer from disappointment and status inconsistency.

Research into issues of deafness is characterised by the dominance of the medical model of disability. Although social and cultural-linguistic models have received increasing attention from scholars, they have been used mainly in theoretical debate. Empirical application has been limited. Based on our comprehensive research project into the care-related decisions of parents of congenitally deaf children in Flanders, Belgium, an explanatory model for care-related parental decisions was constructed, which transcends the specific findings generated by our studies. This model is presented and discussed in this paper. Illustrations are provided based on our empirical findings.

Background: This study investigates the association between forms of capital and mental health among unemployed youth, with a specific focus on the mediating role of feelings of deprivation and self-esteem as “mechanisms of embodiment”. Methods: The study is based on a primary data collection among unemployed Brussels youth in the transition from education to employment (2015; 18- to 29-year-olds; N = 1151). Multi-group Structural Equation Modeling (SEM) is used to explore the association between forms of capital, mechanisms of embodiment and mental health. Results: Our results show that different forms of capital are related to the mental health of unemployed youth. These associations are partly mediated by feelings of deprivation and self-esteem. Clear gender differences in these relations are found. Conclusions: The results of this study contribute to the body of knowledge regarding the mental health situation during the transition from education to employment, by showing how “subjective mechanisms” are explaining the relations between “objective resources” and mental health.

Domestic cleaners lack bargaining power, which can prevent them from being in control of their work quality. The ‘service voucher system’ is expected to change the power position of domestics. This is expected because the system is formalized by the Belgian government and organized through a triangular employment relationship between the domestic, the service voucher company (the employer), and the customers. This study draws on 42 interviews with immigrant and native service voucher cleaners. It probes into how the employment relationship with the company affects the domestics’ perceived power to bargain with customers about determinants of the work quality. Based on the results, policy recommendations are made to further empower domestic cleaners in the relationship with their customers and to help them safeguard their work quality.