title: From insecure to secure employment: changes in work, health, health related behaviours, and sickness absence.
abstract: OBJECTIVE
  To determine whether change in employment status (from fixed term to permanent employment) is followed by changes in work, health, health related behaviours, and sickness absence.
  
  
  METHODS
  Prospective cohort study with four year follow up. Data from 4851 (710 male, 4141 female) hospital employees having a fixed term or permanent job contract on entry to the study were collected at baseline and follow up.
  
  
  RESULTS
  At baseline, compared to permanent employees, fixed term employees reported lower levels of workload, job security, and job satisfaction. They also reported greater work ability. All fixed term employees had a lower rate of medically certified sickness absence at baseline. Baseline rate ratios for those who remained fixed term were 0.64 (95% CI 0.55 to 0.75), and were 0.50 (95% CI 0.34 to 0.75) for those who later became permanent. Continuous fixed term employment was not associated with changes in the outcome measures. Change from fixed term to permanent employment was followed by an increase in job security, enduring job satisfaction, and increased medically certified sickness absence (compared to permanent workers rate ratio 0.96 (95% CI 0.80 to 1.16)). Other indicators of work, health, and health related behaviours remained unchanged.
  
  
  CONCLUSIONS
  Receiving a permanent job contract after fixed term employment is associated with favourable changes in job security and job satisfaction. The corresponding increase in sickness absence might be due to a reduction in presenteeism and the wearing off of health related selection.
authors.affiliation: Finnish Institute of Occupational Health, Department of Psychology, Topeliuksenkatu 41 a A, FIN-00250 Helsinki, Finland. marianna.virtanen@occuphealth.fi
authors.forename: M
authors.initials: M
authors.lastname: Virtanen
authors.forename: M
authors.initials: M
authors.lastname: Kivimäki
authors.forename: M
authors.initials: M
authors.lastname: Elovainio
authors.forename: J
authors.initials: J
authors.lastname: Vahtera
authors.forename: J E
authors.initials: JE
authors.lastname: Ferrie
mesh_terms: D000328:Adult; D004651:Employment / Q000523:psychology*; D005260:Female; D005387:Finland; D005500:Follow-Up Studies; D015438:Health Behavior; D006801:Humans; D007588:Job Satisfaction; D008297:Male; D008875:Middle Aged; D016272:Occupational Health / Q000706:statistics & numerical data*; D010559:Personnel Management; D010564:Personnel, Hospital / Q000523:psychology*; D011446:Prospective Studies; D018582:Sick Leave / Q000706:statistics & numerical data*