Social environment, health cognition, and health behavior: how individuals with non-fixed employment end up with adverse health outcomes in China under the era of VUCA?-findings from PLS-SEM and fsQCA.

Objectives: This article studied the single-factor causal relationships between the social environment, health cognition, and health behavior of the individuals with non-fixed employment and their adverse health outcomes, as well as the complex causal relationships of multiple factors on these outcomes. Methods: Partial Least Squares Structural Equation Modeling (PLS-SEM) and Fuzzy-Set Qualitative Comparative Analysis (fsQCA) are employed. Data is collected from the results of an open questionnaire Results: PLS-SEM analysis reveals that health risk behaviors and cognition play a mediating role in impact of the social environment on adverse health outcomes, indicating that individuals with non-fixed employment susceptible to adverse health outcomes. fsQCA analysis identifies that weak social support is a core condition leading to outcomes of depression and anxiety. There are shared configurations and causal pathways between the outcomes of physical health and depression. Conclusion: The study supports the social determinants theory of health and suggests that the fundamental reason for people being trapped in adverse health outcomes is the health inequality caused by social stratification, and the external shock of uncertainty in the era of VUCA (Volatility, Uncertainty, Complexity, and Ambiguity).