Effect of family responsibilities and job strain on ambulatory blood pressure among white-collar women

Financial responsibility, financial context, and ambulatory blood pressure in early middle-aged African-American women

BACKGROUND

African-American women have excess rates of elevated blood pressure (BP) and hypertension compared to women of all other racial/ethnic backgrounds. Several researchers have speculated that race and gender-related socioeconomic status (SES) stressors might play a role.

OBJECTIVE

To examine the association between a novel SES-related stressor highly salient among African-American women, financial responsibility for one's household, and 48-h ambulatory BP. We further examined whether aspects related to African-American women's financial context (e.g., single parenthood, household income, marital status) played a role.

METHODS

Participants were N = 345 employed, healthy African-American women aged 30-46 from diverse SES backgrounds who underwent 48-h ambulatory BP monitoring. Linear regression analyses were conducted to examine associations between self-reported financial responsibility and daytime and nighttime BP, adjusting for age, SES and other sociodemographics, cardiovascular risk factors, financial strain and depressive symptoms. Interactions between financial responsibility and single parenthood, household income, and marital/partnered status were tested.

RESULTS

In age-adjusted analyses, reporting financial responsibility was associated with higher daytime systolic (β = 4.42, S.E. = 1.36, p = 0.0013), and diastolic (β = 2.82, S.E. = 0.98, p = 0.004) BP. Associations persisted in fully adjusted models. Significant associations were also observed for nighttime systolic and diastolic BP. There were no significant interactions with single parenthood, household income, nor marital/partnered status.

CONCLUSION

Having primary responsibility for one's household may be an important driver of BP in early middle-aged African-American women, independent of SES, financial strain, and across a range of financial contexts. Future studies examining prospective associations are needed, and policy interventions targeting structural factors contributing to financial responsibility in African-American women may be warranted.

Child rearing or childbearing? Risk of cardiovascular diseases associated to parity and number of children

BACKGROUND

An increased risk of cardiovascular diseases (CVD) has been associated with women's parity, but whether or not this association reflects a direct pregnancy effect, or exposure to factors related to childrearing, still appears unclear. We assessed the CVD risk associated with number of children separately by gender and tested effect modification by socioeconomic position (SEP) and employment status, in order to elucidate the possible mechanisms underlying this association.

METHODS

The study population was composed of 20,904 men and 25,246 women who were interviewed in one of two National Health Surveys conducted in 2000 and 2005 in Italy. These subjects were followed for CVD incidence up to 2014 through record-linkage with national archives of mortality and hospitalisations. CVD risk was estimated by Cox regression models that were adjusted for socio-demographics, perceived health, lifestyles, biological CVD risk factors and for other potential confounders.

RESULTS

CVD incidence was significantly increased among men with 3 or more children (HR = 1.26, 95% CI: 1.02-1.56) and among women with 2 and with 3 or more children (HR = 1.42, 95% CI: 1.10-1.83; and HR = 1.39, 95% CI: 1.03-1.87, respectively) compared to subjects without children and no significant gender differences were observed. Subjects with lower SEP displayed stronger associations with parity and a higher number of children for both genders; by contrast, no modifying effect of employment status was observed.

CONCLUSIONS

Taken together, the significant association between higher parity and CVD risk in both genders, and the higher risk of CVD associated with higher parity among lower SEP parents, suggests that childrearing has a potential effect on the development of CVD that is more pronounced among disadvantaged families, although a concurrent effect of childbearing cannot be completely excluded.

Doing it all: Effects of Family Responsibilities and Marital Relationship Quality on Mothers' Ambulatory Blood Pressure

BACKGROUND

The shared provider responsibility between married couples does not translate to equally shared division of childcare (CC) and household labor. While some marriages contain highly positive aspects, marriages may also simultaneously contain both positive and negative aspects. The negativity in these relationships can negate the positivity and could potentially lead to the detriment of mothers' health.

PURPOSE

We examined mothers' ambulatory blood pressure (ABP) associated with their marital relationship quality and perceived equity with her spouse on CC and household tasks.

METHODS

We investigate these associations using a mixed multilevel model analysis on a sample of 224 mothers in heterosexual marriages, all of whom had children under the age of 18 years currently living in the home.

RESULTS

Mothers' perception of equity in the division of CC responsibilities contributed to lower ABP. Additionally, mothers in supportive marital relationships (low negativity and high positivity) had lower ABP than those in ambivalent relationships (both high negativity and positivity). There was a crossover interaction such that the effect of relationship quality on ABP was moderated by the perception of equity in the division of CC. For mothers who report doing all the CC, they had lower ABP if they had a supportive marital relationship compared with mothers in ambivalent relationships. Whereas mothers who report more equity in CC and have a supportive relationship have higher ABP compared with mothers in ambivalent relationships.

CONCLUSIONS

This study has implications related to dynamics within marital relationships. These results demonstrate important relational influences on mothers' ABP.

The role of sex and gender in hypertension

Hypertension (HTN) is a critical primary modifiable risk factor for the development of cardiovascular diseases, with recognized sex-based differences. While sex refers to one's biological genetic makeup and attributes, gender encompasses the individual's psycho-socio-cultural characteristics, including their environment and living conditions. The impact of each gendered variable may differ amongst men and women with respect to HTN. Applying a sex and gender-based lenses to inform our understanding of HTN has the potential to unveil important contributors of HTN-related cardiovascular outcomes. For instance, increased life stressors, work related anxiety and depression, typically have more pronounced effect on women than men with HTN. The impact of social surrounding including marital status and social support on HTN also differs amongst men and women. While married men are less likely to have higher blood pressure, single women, and those who never married are less likely to have HTN. Additionally, the beneficial role of social support is more pronounced in more historically marginalized cultural groups compared to majority. Finally, socioeconomic status, including education level and income have a linear and inverse relationship in blood pressure control in more resource-rich countries. The aim of this review is to summarize how sex and gender interact in shaping the clinical course of HTN demonstrating the importance of both sex and gender in HTN risk and its treatment. Hence, when investigating the role of gendered factors in HTN it is imperative to consider cultural, and social settings. In this narrative we found that employment and education play a significant role in manifestation and control of HTN particularly in women.

Occupational risk factors for hypertension

The identification and characterization of the modifiable risk factors of hypertension is of great value for public health and clinical medicine to achieve primary prevention. A large amount of literature on the effects of occupational factors on blood pressure and hypertension has been published. In this review, I summarize current evidence regarding the role of occupational factors in hypertension. The results of this review suggest that there is sufficient evidence to support the association between increased risk of hypertension and job stress, shift work, occupational lead exposure, and noise exposure. The association of hypertension with physical inactivity, sedentary behavior, and occupational exposure to mercury, arsenic, cadmium, or carbon disulfide remains inconclusive, although several studies have reported this finding. This review will serve as a step toward future research and provide baseline information for developing strategic interventions to prevent hypertension in the working population.

Long working hours associated with elevated ambulatory blood pressure among female and male white-collar workers over a 2.5-year follow-up

Population-based strategies targeting modifiable risk factors are needed to improve the prevention of hypertension. Long working hours have been linked to high blood pressure (BP), but more longitudinal research is required. The objective of this study was to examine the effect of long working hours (≥41 h/week) on ambulatory BP mean over a 2.5-year follow-up. The effect modification of family responsibilities was also investigated. A repeated longitudinal design was used. Data collection was performed at three-time points over a 2.5-year follow-up among over 2000 white-collar workers. Working hours were self-reported assessed by questionnaire. BP was measured using Spacelabs 90207. The outcomes were systolic and diastolic BP mean. Cross-lagged GEE linear regressions were used to examine whether working hours were associated with BP means at the next measurement time. Women working long hours had a higher diastolic BP mean at follow-up compared to women working regular hours (+1.8 mm Hg (95% CI: 0.5-3.1)). In men, those working long hours had both higher systolic and diastolic BP means increases (systolic: +2.5 mm Hg (95% CI: 0.5-4.4)) and diastolic: +2.3 mm Hg (95% CI: 1.0-3.7)). This association was greater among workers having high family responsibilities. This longitudinal study showed that women and men working long hours had higher BP means when compared those working 35-40 h per week. These findings suggest that strategies that promote work weeks not exceeding 40 h might contribute to the primary prevention of hypertension, especially for workers with high family responsibilities.

Effectiveness of a workplace intervention reducing psychosocial stressors at work on blood pressure and hypertension

Objectives

To assess the effectiveness of a workplace intervention reducing psychosocial stressors at work in lowering blood pressure and hypertension prevalence.

Methods

The study design was a quasi-experimental pre–post study with an intervention group and a control group. Post-intervention measurements were collected 6 and 36 months after the midpoint of the intervention. Participants were all white-collar workers employed in three public organisations. At baseline, the intervention and the control groups were composed of 1088 and 1068 workers, respectively. The intervention was designed to reduce psychosocial stressors at work by implementing organisational changes. Adjusted changes in ambulatory blood pressure and hypertension prevalence were examined.

Results

Blood pressure and hypertension significantly decreased in the intervention group while no change was observed in the control group. The differential decrease in systolic blood pressure between the intervention and the control group was 2.0 mm Hg (95% CI: −3.0 to –1.0). The prevalence of hypertension decreased in the intervention group, when compared with the control group (prevalence ratio: 0.85 (95% CI: 0.74 to 0.98)).

Conclusions

Findings suggest that psychosocial stressors at work are relevant targets for the primary prevention of hypertension. At the population level, systolic blood pressure reductions such as those observed in the present study could prevent a significant number of premature deaths and disabling strokes.

Differences between women and men in the relationship between psychosocial stressors at work and work absence due to mental health problem

OBJECTIVES

Women have a higher incidence of mental health problems compared with men. Psychosocial stressors at work are associated with mental health problems. However, few prospective studies have examined the association between these stressors and objectively measured outcomes of mental health. Moreover, evidence regarding potential differences between women and men in this association is scarce and inconsistent. This study investigates whether psychosocial stressors at work are associated with the 7.5-year incidence of medically certified work absence due to a mental health problem, separately for women and men.

METHODS

Data from a prospective cohort of white-collar workers in Canada (n=7138; 47.3% women) were used. We performed Cox regression models to examine the prospective association between self-reported psychosocial stressors at work (job strain model) at baseline and the 7.5-year HR of medically certified work absence of ≥5 days due to a mental health problem.

RESULTS

During follow-up, 11.9% of participants had a certified work absence, with a twofold higher incidence among women. Women (HR 1.40, 95% CI 1.01 to 1.93) and men (HR 1.41, 95% CI 0.97 to 2.05) exposed to high strain (high demands and low control) had a higher incidence of work absence compared with those unexposed. Among women only, those exposed to an active job situation (high demands and high control) also had a higher risk (HR 1.82, 95% CI 1.29 to 2.56).

CONCLUSIONS

Prevention efforts aimed at reducing psychosocial stressors at work could help lower the risk of work absence for both women and men. However, important differences between women and men need to be further studied in order to orient these efforts.

Psychosocial work stressors, high family responsibilities, and psychological distress among women: A 5-year prospective study

BACKGROUND

Psychological distress is a strong and independent predictor of major depression. Assuming multiple roles (such as being both a mother and an employee) under stressful conditions may lead to psychological distress. This study evaluated, for the first time, the longitudinal effect of the simultaneous exposure to psychosocial work stressors and high family responsibilities on women's psychological distress.

METHODS

Women were assessed at baseline (N = 1307) and at 3- and 5-year follow-ups. Psychosocial work stressors of the demand-control and effort-reward imbalance models were measured with validated questionnaires. Family responsibilities were also self-reported and referred to the number of children and their age(s) as well as housework and childcare. Psychological distress was measured with the validated Psychiatric Symptoms Index questionnaire. Prevalence ratios (PR) of psychological distress were modeled with log-binomial regressions.

RESULTS

Having high family responsibilities did not increase women's prevalence of psychological distress. However, being exposed to either job strain or effort-reward imbalance led to a higher prevalence of psychological distress at the 3- and 5-year follow-ups (PR of 1.25-1.62). Being simultaneous exposed to these psychosocial work stressors and high family responsibilities also increased the prevalence of psychological distress (PR of 1.44-1.87), but no interactions were observed between stressors and responsibilities.

CONCLUSIONS

In this 5-year prospective study, simultaneous exposure to psychosocial work stressors and high family responsibilities increased the prevalence of psychological distress among women. Work stressors were, however, driving most of the effect, which reinforces their importance as modifiable risk factors of women's mental health problems.

Job strain and the prevalence of uncontrolled hypertension among white-collar workers

To determine whether white-collar workers treated for hypertension who are exposed to psychosocial stressors at work have a higher prevalence of uncontrolled hypertension than unexposed workers, this study conducted three waves of data collection over a 5-year period (repeated cross-sectional design). The study sample was composed of 464 white-collar workers treated for hypertension. At each collection time, ambulatory blood pressure (ABP) was measured every 15 min during the workday. Uncontrolled hypertension was defined as a mean daytime systolic ABP ≥135 mmHg and/or diastolic ABP ≥85 mmHg for non-diabetic participants and systolic ABP ≥125 mmHg and/or diastolic ABP ≥75 mmHg for diabetic participants. Job strain was evaluated with Karasek's demand-latitude model using validated scales for psychological demands and decision latitude. Prevalence ratios (PR) and 95% confidence intervals (CI) were estimated using generalized estimating equations, adjusting for sociodemographic and lifestyle-related risk factors. Men with job strain (high demands and low latitude) and active jobs (high demands and high latitude) had a higher prevalence of uncontrolled hypertension (PR job strain = 1.46, 95% CI: 1.07-1.98 and PR active = 1.47, 95% CI: 1.12-1.94). When considered separately, high demands were associated with a higher prevalence of uncontrolled hypertension in both men (PR highest tertile = 1.60, 95% CI: 1.25-2.06) and women (PR highest tertile = 1.60, 95% CI: 1.03-2.47). Workers exposed to psychosocial stressors at work according to the demand-latitude model had a higher prevalence of uncontrolled hypertension. Reducing these frequent exposures could help to reduce the burden of uncontrolled hypertension.

The effects of age and ethnicity on the circadian variation of catecholamines and cortisol in employed women

Background

Women employed outside the home in urban settings must adapt to changing circadian microenvironments. The pattern and extent of vasoactive hormone responses to these changes may depend upon age and ethnic background. The purpose of this study was to evaluate the effects of age and ethnicity on the circadian variation of urinary norepinephrine, epinephrine, and cortisol excretion across work, home and sleep microenvironments.

Methods

The subjects of the study were 95 women (38 European-American, age = 35.4 ± 7.4; 28 African-American, age = 33.4 ± 7.9; 12 Asian-American, age = 36.7 ± 9.3 and 17 Hispanic-American age = 31.6 ± 10.9) employed as secretaries, lab technicians or office supervisors in New York City. Variation in the hormones across the microenvironments was evaluated using repeated measures ANCOVA with age group (18–29.9; 30–39.9; 40–49.9) and ethnicity as fixed factors.

Results

The results show that for norepinephrine and epinephrine, work excretion rates are substantially higher than sleep rates (p < .001), and for epinephrine home rates were higher than sleep rates (p < .001). Work and sleep cortisol excretion rates were also significantly higher than the rate at home, consistent with cortisol’s circadian rhythm. (p < .002). Women in their twenties had substantially lower norepinephrine excretion rates than women over 30 (p < .04). There were also ethnic differences in norepinephrine (p < .04) and epinephrine (p = .11) output with Asian-American women having the lowest and African-American women having the highest rates. This variation is likely related to the ethnic variation in weight. There was no significant variation in cortisol excretion with age or ethnicity.

Conclusion

The circadian rates of norepinephrine excretion differ by age and that of both catecholamines differ by ethnicity among women working outside the home. It is speculated that the age variation in norepinephrine may contribute to the development of vasomotor symptoms.

GENDER DIFFERENCES IN THE ASSOCIATION BETWEEN MARITAL STATUS AND HYPERTENSION IN GHANA

Hypertension is a significant contributor to the global burden of cardiovascular and related target organ diseases such as heart failure, coronary heart disease, stroke and kidney failure, and their associated premature morbidity, mortality and disability. Marital status is an important social characteristic known to predict a range of health outcomes including cardiovascular disease. However, little is known about its impact on hypertension in sub-Saharan Africa. This study explored the relationship between marital status and hypertension among women and men in Ghana. Drawing on data from the 2014 Ghana Demographic and Health Survey (GDHS), descriptive statistics and binary logistic regression models were used to analyse the link between marital status and hypertension. About 13% of women aged 15-49 and 15% of men aged 15-59 were found to be hypertensive. After controlling for lifestyle and socio-demographic covariates, the logistic regression models showed significantly higher odds of hypertension for married (OR=2.14, 95% CI=1.30-3.53), cohabiting (OR=1.94, 95% CI=1.16-3.23) and previously married (OR=2.23, 95% CI=1.29-3.84) women. In contrast, no significant association was found between any of the marital status cohorts and hypertension for men. Other significant predictors of hypertension were age, body mass index and wealth status. The results demonstrate that marital status is an independent risk factor for hypertension in Ghana for women, rather than men. This could have immediate and far-reaching consequences for cardiovascular health policy in Ghana. In particular, the findings could lead to better targeted public health interventions, including more effective risk factor assessment and patient education in clinical settings, which could lead to more effective patient management and improved cardiovascular outcomes.

Double Exposure to Adverse Psychosocial Work Factors and High Family Responsibilities as Related to Ambulatory Blood Pressure at Work: A 5-Year Prospective Study in Women With White-Collar Jobs

OBJECTIVE

Accumulating evidence shows that psychosocial work factors of the demand-control and effort-reward imbalance models may contribute to increase blood pressure (BP). Women are more likely to be exposed to these psychosocial factors than men. Moreover, women spend twice as much time per week performing family responsibilities than men. This study aimed to evaluate the longitudinal association of the double exposure to psychosocial work factors and high family responsibilities in women with BP for a 5-year follow-up.

METHODS

At baseline, the study sample was composed of 1215 working women. Psychosocial work factors were measured using validated scales. Family responsibilities were measured using items related to "the number of children and their age" and "housework and children care." Ambulatory BP measures were taken every 15 minutes during a working day. Associations between psychosocial measures and BP were examined using analyses of covariance.

RESULTS

Women with a double exposure to effort-reward imbalance and high family responsibilities had significantly higher BP means than women not exposed to these factors at baseline (diastolic: +2.75 mm Hg), at 3-year follow-up (systolic: +2.22 mm Hg and diastolic: +2.55 mm Hg), and at 5-year follow-up (systolic: +2.94 mm Hg and diastolic: + 3.10 mm Hg). No adverse effect on BP was observed for the double exposure to the psychosocial work factors of the demand-control model and high family responsibilities.

CONCLUSIONS

A double exposure to effort-reward imbalance at work and high family responsibilities might contribute to elevated ambulatory BP at work among women. BP elevations related to this double exposure may persist for several years.

Balancing work and family demands

Aims: The aim of this study is to analyse how increasing demands from work and family life affect the level of strain and whether there are any significant gender differences in this respect. This is be done by testing the following hypotheses: An increase in work and family demands causes (a) an increased risk of suffering from fatigue; (b) an increased need for working fewer hours. Methods: The hypotheses are analysed by using a longitudinal data set consisting of nearly 9,000 Swedish individuals. Results: Multiple demands increase the risk of suffering from fatigue among both women and men, but it is only among women that an increase in the percentage desiring a reduction in their working hours can be found. Conclusions: The results support the role stress theory, especially among women.

Transcultural adaptation to Brazilian Portuguese and reliability of the effort-reward imbalance in household and family work

OBJECTIVE

To describe the steps in the transcultural adaptation of the scale in the Effort-reward imbalance model to household and family work to the Brazilian context.

METHODS

We performed the translation, back-translation, and initial psychometric evaluation of the questionnaire that comprised three dimensions: (i) effort (eight items, emphasizing quantitative workload), (ii) reward (11 items that seek to capture the intrinsic value of family and household work, societal esteem, recognition from the spouse/partner, and affection from the children), and (iii) overcommitment (four items related to intrinsic effort). The scale was included in a sectional study conducted with 1,045 nursing workers. A subsample of 222 subjects answered the questionnaire for a second time, seven to 15 days thereafter. The data were collected between October 2012 and May 2013. The internal consistency of the scale was evaluated using Cronbach’s alpha and test-retest reliability analysis, square weighted kappa, prevalence and bias adjusted Kappa, and intraclass correlation coefficient.

RESULTS

Prevalence and bias-adjusted Kappa (k_a) of the scale dimensions ranged from 0.80-0.83 for overcommitment, 0.78-0.90 for effort, and 0.76-0.93 for reward. In most dimensions, the values of minimum and maximum scores, average, standard deviation, and Cronbach’s alpha were similar in test and retest scores. Only on societal esteem subdimension (reward) was there little variation in standard deviation (test score of 2.24 and retest score of 3.36) and in Cronbach’s alpha coefficient (test score of 0.38 and retest score of 0.59).

CONCLUSIONS

The Brazilian version of the scale was found to have proper reliability indices regarding time stability, which suggests adapting it to be used in population with characteristics that are similar to the one in this study.

Work organization, job insecurity, and occupational health disparities

BACKGROUND

Changes in employment conditions in the global economy over the past 30 years have led to increased job insecurity and other work organization hazards. These hazards may play a role in creating and sustaining occupational health disparities by socioeconomic position, gender, race, ethnicity, and immigration status.

METHODS

A conceptual model was developed to guide the review of 103 relevant articles or chapters on the role of work organization and occupational health disparities identified through a comprehensive search conducted by NIOSH. A second review was conducted of employment and workplace policies and programs designed to reduce the health and safety risks due to job insecurity and other work organization hazards.

RESULTS

There is consistent evidence that workers in lower socioeconomic or social class positions are exposed to greater job insecurity and other work organization hazards than workers in higher socioeconomic positions. Likewise, racial and ethnic minorities and immigrants are exposed to greater job insecurity. Limited research examining the effects of interventions targeting work organization hazards on disparities has been conducted; nonetheless, intervention strategies are available and evidence suggests they are effective.

CONCLUSIONS

Job insecurity and work organization hazards play a role in creating and sustaining occupational health disparities. Employment and workplace policies and programs have the potential to reduce these hazards, and to reduce disparities.

The influence of domestic overload on the association between job strain and ambulatory blood pressure among female nursing workers

Evidence suggests that the workplace plays an important etiologic role in blood pressure (BP) alterations. Associations in female samples are controversial, and the domestic environment is hypothesized to be an important factor in this relationship. This study assessed the association between job strain and BP within a sample of female nursing workers, considering the potential role of domestic overload. A cross-sectional study was conducted in a group of 175 daytime workers who wore an ambulatory BP monitor for 24 h during a working day. Mean systolic and diastolic BP were calculated. Job strain was evaluated using the Demand-Control Model. Domestic overload was based on the level of responsibility in relation to four household tasks and on the number of beneficiaries. After adjustments no significant association between high job strain and BP was detected. Stratified analyses revealed that women exposed to both domestic overload and high job strain had higher systolic BP at home. These results indicate a possible interaction between domestic overload and job strain on BP levels and revealed the importance of domestic work, which is rarely considered in studies of female workers.

Importance of tissue morphology relative to patient reports of symptoms and functional limitations resulting from median nerve pathology

Significant data exist for the personal, environmental, and occupational risk factors for carpal tunnel syndrome. Few data, however, explain the interrelationship of tissue morphology to these factors among patients with clinical presentation of median nerve pathology. Therefore, our primary objective was to examine the relationship of various risk factors that may be predictive of subjective reports of symptoms or functional deficits accounting for median nerve morphology. Using diagnostic ultrasonography, we observed real-time median nerve morphology among 88 participants with varying reports of symptoms or functional limitations resulting from median nerve pathology. Body mass index, educational level, and nerve morphology were the primary predictive factors. Monitoring median nerve morphology with ultrasonography may provide valuable information for clinicians treating patients with symptoms of median nerve pathology. Sonographic measurements may be a useful clinical tool for improving treatment planning and provision, documenting patient status, or measuring clinical outcomes of prevention and rehabilitation interventions.

Job strain and ambulatory blood pressure: a meta-analysis and systematic review

We reviewed evidence of the relationship between job strain and ambulatory blood pressure (ABP) in 29 studies (1985-2012). We conducted a quantitative meta-analysis on 22 cross-sectional studies of a single exposure to job strain. We systematically reviewed 1 case-control study, 3 studies of cumulative exposure to job strain, and 3 longitudinal studies. Single exposure to job strain in cross-sectional studies was associated with higher work systolic and diastolic ABP. Associations were stronger in men than women and in studies of broad-based populations than those with limited occupational variance. Biases toward the null were common, suggesting that our summary results underestimated the true association. Job strain is a risk factor for blood pressure elevation. Workplace surveillance programs are needed to assess the prevalence of job strain and high ABP and to facilitate workplace cardiovascular risk reduction interventions.

Comparing the risk associated with psychosocial work conditions and health behaviours on incident hypertension over a nine-year period in Ontario, Canada

OBJECTIVES

Hypertension is an increasingly important health concern in Canada. This paper examines the risks associated with psychosocial working conditions compared to health behaviours on the risk of hypertension over a 9-year period in Ontario, Canada.

METHODS

We used data from Ontario respondents to the 2000-01 Canadian Community Health Survey linked to the Ontario Health Information Plan database covering physician services and the Canadian Institute for Health Information database for hospital admissions. We focused on labour market participants aged 35 to 60, who had not been previously diagnosed with hypertension, were not self-employed, and were working more than 10 hours per week, more than 20 weeks in the previous 12 months (N = 6,611). Subjects were followed for a nine-year period to ascertain incidence of hypertension.

RESULTS

Low job control was associated with an increased risk of hypertension among men, but not among women. The population attributable fraction associated with low job control among males was 11.8% in our fully adjusted model. There was no consistent pattern of increased risk of hypertension across different levels of health behaviours.

CONCLUSION

Primary prevention efforts to reduce the incidence of hypertension predominantly target modifiable health behaviours. Evidence from this longitudinal cohort suggests that modifiable characteristics of the work environment should also be considered in the design of cardiovascular disease prevention programs, in particular for male labour market participants.

The effect of job strain on nighttime blood pressure dipping among men and women with high blood pressure

OBJECTIVES

Blunted nighttime blood pressure dipping is an established cardiovascular risk factor. This study examined the effect of job strain on nighttime blood pressure dipping among men and women with high blood pressure.

METHODS

The sample consisted of 122 blue- and white collar workers (men=72, women=50). The Job Content Questionnaire was used to measure job psychological demands, job control, and social support. The ratio of job demands to job control was used to assess job strain. Nighttime blood pressure dipping was evaluated from 24-hour ambulatory blood pressure monitoring performed on three workdays.

RESULTS

Men with high job strain had a 5.4 mm Hg higher sleep systolic blood pressure (P=0.03) and 3.5 mm Hg higher sleep pulse pressure (P=0.02) compared to men with low job strain. Men with high job strain had a smaller fall in systolic blood pressure and pulse pressure from awake to sleep state than those with low job strain (P<0.05). Hierarchical analyses showed that job strain was an independent determinant of systolic blood pressure dipping (P=0.03) among men after adjusting for ethnicity, body mass index, anxiety and depression symptoms, current smoking status, and alcohol consumption. Further exploratory analyses indicated that job control was the salient component of job strain associated with blood pressure dipping (P=0.03).

CONCLUSIONS

High job strain is associated with a blunting of the normal diurnal variation in blood pressure and pulse pressure, which may contribute to the relationship between job strain and cardiovascular disease.

The relationship between work-related stress and boundary-related stress within the clerical profession

The concepts of work-to-family conflict and family-to-work conflict have been studied extensively in recent years. We propose a different means of understanding clergy work and family stressors because the boundaries between family and work are blurred within the clerical profession. We suggest, therefore, that the stressors associated with ordained ministry can be better analyzed if separated into two related, but distinct categories: (1) stressors stemming from the demands of the work (work-related stress) and (2) stressors stemming from the way the work impinges upon clerical family boundaries (boundary-related stress). Utilizing the Pulpit and Pew Clergy Leadership Survey of 2001, we explore the association between these two forms of stress. Correlation analysis and simple and multiple regression models are used. A strong association between work-related stress and boundary-related stress is detected; length of time spent in the profession is related to reduced levels of boundary- and work-related stress.

Living life in the balance at midlife: lessons learned from mindfulness

The purpose of this qualitative study was to describe the perceived effects of a Mindfulness-Based Stress Reduction (MBSR) Program on stress and quality of life of women in midlife. A total of 20 nurses, aged 45 to 55 years, who participated in a stress reduction course were contacted for interviews. A total of 9 nurses agreed to be interviewed. Content analysis was used to analyze these interviews. The five themes that emerged from the analysis were as follows: strengthening of interpersonal communication through social support, increased personal awareness through becoming more mindful and reflective, a spiritual awakening, effective ways of dealing with stress, and living life in balance by taking hold of one's life. This study increased the authors' understanding of effects/benefits, adherence, and application of MBSR techniques for women in midlife. It is concluded that MBSR may be a useful intervention for nurses in midlife to develop successful strategies for dealing with stress and to improve their quality of life.

Occupational stress and hypertension

Occupational stress, or job strain, resulting from a lack of balance between job demands and job control, is considered one of the frequent factors in the etiology of hypertension in modern society. Stress, with its multifactorial causes, is complex and difficult to analyze at the physiological and psychosocial levels. The possible relation between job strain and blood pressure levels has been extensively studied, but the literature is replete with conflicting results regarding the relationship between the two. Further analysis of this relationship, including the many facets of job strain, may lead to operative proposals at the individual and public health levels designed to reduce the effects on health and well-being. In this article, we review the literature on the subject, discussing the various methodologies, confounding variables, and suggested approaches for a healthier work environment.

Are there health effects of harassment in the workplace? A gender-sensitive study of the relationships between work and neck pain

The aim of this study was to identify workplace physical and psychosocial risk factors for neck pain among male and female workers and, in particular, to study the relationship between neck pain and intimidation and sexual harassment in the workplace in a representative sample of the Quebec working population. The study sample included 5405 men and 3987 women. In multiple logistic regression analyses, when taking into account individual and other workplace factors, neck pain was significantly associated with intimidation at work among both male (odds ratio (OR) 1.4 (1.01-1.8)) and female workers (OR 1.3 (1.01-1.8)). Among female workers, neck pain was alsosignificantly associated with unwanted sexual attention (OR 1.6 (1.1-2.4)). If confirmed in prospective studies, these results suggest that interventions to prevent harassment in the workplace may help reduce musculoskeletal disorders in the workplace and that workplace programmes to reduce harassment in the workplace should include prevention of sexual harassment.

PRACTITIONER SUMMARY

While taking into account relevant personal factors and previously identified workplace physical and psychosocial risk factors, this gender-based study identifies new work exposures associated with neck pain that have not previously been studied, including unwanted sexual attention, intimidation and difficult or tense situations with the public.

The impact of endothelin-1 genetic analysis and job strain on ambulatory blood pressure

OBJECTIVE

An interaction between the endothelin-1 gene (EDN1), blood pressure (BP) and social determinants has been previously found. Using a well-characterized cohort of participants, the impact of associations between genetic factors and job strain on BP was evaluated.

METHODS

A cross-sectional analysis of five polymorphisms covering the EDN1, of which 2 were previously reported to be associated with BP, was performed. Study subjects had previously completed a baseline evaluation including 24-h ambulatory BP monitoring and an assessment of job strain. This report presents the findings for 184 subjects who gave DNA samples for genetic analysis. One-way analysis of variance (ANOVA) was performed between each genetic marker and 24-h systolic blood pressure (SBP) and diastolic blood pressure (DBP), as well as two-way ANOVAs to test the interaction effect with job strain.

RESULTS

Trends for relationships were observed between SBP and two polymorphisms: rs10478694 and rs5369. An interaction between job strain and those heterozygous for two polymorphisms showed higher SBP (P=.029 and .008) and a tendency for higher DBP. All findings were more significant when analyses were confined to the 139 Caucasian subjects.

CONCLUSION

This is the first study to report an interaction between the EDN1 gene, job strain and BP, supporting previous evidence of a role of this gene in the interaction between environmental stress and ambulatory BP. Given the limited sample size, the results should be considered preliminary, and further studies are required.

Effort-reward imbalance at work and recurrent coronary heart disease events: a 4-year prospective study of post-myocardial infarction patients

OBJECTIVE

Prospective studies have shown that effort-reward imbalance (ERI) at work is associated with the incidence of a first coronary heart disease (CHD) event. However, it is unknown whether ERI at work increases the risk of recurrent CHD events. The objective of this study was to determine whether ERI at work and its components (effort and reward) increase the risk of recurrent CHD in post-myocardial infarction (post-MI) workers.

METHODS

We carried out a prospective cohort study of 669 men and 69 women who returned to work after a first MI. ERI at work was assessed by telephone interview using validated scales of reward and psychological demands. The outcome was a composite of fatal CHD, nonfatal MI, and unstable angina. CHD risk factors were documented in medical files and by interview. The participants were followed up for a mean period of 4.0 years (1998-2005).

RESULTS

During the follow-up, 96 CHD events were documented. High ERI and low reward were associated with recurrent CHD (respective adjusted hazard ratios [HRs] = 1.75, 95% confidence interval [CI] = 0.99-3.08, and HR = 1.77, 95% CI = 1.16-2.71). There was a gender interaction showing stronger effects among women (respective adjusted HRs for high ERI and low reward: HR = 3.95, 95% CI = 0.93-16.79, and HR = 9.53, 95% CI = 1.15-78.68).

CONCLUSIONS

Post-MI workers holding jobs that involved ERI or low reward had increased risk of recurrent CHD.

Does adding information on job strain improve risk prediction for coronary heart disease beyond the standard Framingham risk score? The Whitehall II study

BACKGROUND

Guidelines for coronary heart disease (CHD) prevention recommend using multifactorial risk prediction algorithms, particularly the Framingham risk score. We sought to examine whether adding information on job strain to the Framingham model improves its predictive power in a low-risk working population.

METHODS

Our analyses are based on data from the prospective Whitehall II cohort study, UK. Job strain among 5533 adults (mean age 48.9 years, 1666 women) was ascertained in Phases 1 (1985-88), 2 (1989-90) and 3 (1991-93). Variables comprising the Framingham score (blood lipids, blood pressure, diabetes and smoking) were measured at Phase 3. In men and women who were CHD free at baseline, CHD mortality and non-fatal myocardial infarction (MI) were ascertained from 5-yearly screenings and linkage to mortality and hospital records until Phase 7 (2002-04).

RESULTS

A total of 160 coronary deaths and non-fatal MIs occurred during the mean follow-up period of 11.3 years. The addition of indicators of job strain to the Framingham score increased the C-statistics from 0.725 [95% confidence intervals (95% CIs): 0.575-0.854] to only 0.726 (0.577-0.855), corresponding to a net reclassification improvement of 0.7% (95% CIs: -4.2 to 5.6%). The findings were similar after inclusion of definite angina in the CHD outcome (352 total cases) and when using alternative operational definitions for job strain.

CONCLUSION

In this middle-aged low-risk working population, job strain was associated with an increased risk of CHD. However, when compared with the Framingham algorithm, adding job strain did not improve the model's predictive performance.

Religious support, motives for having large families, and psychological functioning among religious Jewish mothers

The effects of religious support, maternal motivations for having large families, and their interactions on psychological functioning were assessed in a sample of 79 religious Israeli Jewish mothers of six or more children. Religious support from religious leaders, community, and G-d--as well as faith-focused maternal motivation--were all positively related to adaptive psychological functioning. In contrast, self-focused maternal motivation was negatively related to adaptive functioning. Moreover, religious support and maternal motivation were both related to psychological functioning even after controlling for social support. Finally, several significant interactions between religious support and maternal motivation emerged and are also discussed.

Household responsibilities, income, and ambulatory blood pressure among working men and women

OBJECTIVE

To test the hypothesis that a greater perceived responsibility for household tasks and a greater number of hours spent doing these tasks would be associated with elevated ambulatory systolic (SBP) and diastolic blood pressure (DBP). The connection between job characteristics and cardiovascular outcomes has been widely studied. However, less is known about links between household work characteristics and cardiovascular health.

METHODS

A total of 113 employed unmedicated hypertensive men and women underwent 1 day of ambulatory blood pressure (ABP) monitoring. Participants provided information on 1) the number of hours spent doing; and 2) their degree of responsibility for seven household tasks (child care; pet care; caring for ill/elderly; household chores; house/car repair; yard work; finances). Associations between task hours and responsibility ratings in relation to SBP and DBP were estimated, using generalized estimating equations, with covariates age, race, gender, body mass index, location, and posture. Interactions with gender and socioeconomic position were assessed.

RESULTS

A greater perceived responsibility for household tasks, but not the hours spent doing these tasks, was associated with higher ambulatory SBP (b (95% confidence interval [CI]), 0.93 (0.29-1.56), p = .004) and DBP (b (95% CI), 0.30 (0.10-0.51), p = .003). Significant interactions with income indicated that associations between household responsibilities and ABP were most pronounced among low income participants (SBP: b (95% CI), 1.40 (0.58-2.21), p < .001; DBP: b (95% CI), 0.48 (0.18-0.78), p < .01). The task associated most strongly with BP was household chores. No interactions with gender were observed.

CONCLUSIONS

Greater perceived responsibility for household tasks was associated with elevated ABP, particularly for lower income participants. Household obligations may have important implications for cardiovascular health, meriting further empirical attention.

Job strain and masked hypertension

OBJECTIVES

To determine whether psychosocial work characteristics are associated with the prevalence of masked hypertension in a population of white collar workers.

METHODS

White-collar workers were recruited from three public organizations. Blood pressure (BP) was measured at the workplace for manual measurements (mean of the first three readings taken by a trained assistant) followed by ambulatory measurements (mean of all subsequent readings taken during the working day). Masked hypertension (MH) was defined as manual BP <140/90 mm Hg, and ambulatory BP ≥135/85 mm Hg. Job strain was evaluated, using the quadrant method for exposure assessment, as well as alternative formulations.

RESULTS

BP measurements were obtained from 2,357 workers (80% participation, 61% women; mean age, 44 years). For men, being in the active group (high psychological demands and high decision latitude) was associated with MH (adjusted odds ratio, 2.07; 95% confidence interval, 1.30-3.31). No significant association with a higher prevalence of MH was observed in women.

CONCLUSION

MH is associated with job strain in men. Workers in "active" job situations may be more likely to have the condition.

Gender and sex differences in job status and hypertension

OBJECTIVES

Studies have shown greater health risks associated with blue-collar manufacturing employment for women than men. It remains challenging, however, to distinguish gendered job status (affected by family composition and other personal characteristics) from sex-linked biological differences influencing physiological response to workplace physical hazards.

METHODS

We examined the effects of hourly (blue-collar) status on incident hypertension among men and women, using health claims data for 14, 618 white- and blue-collar aluminium manufacturing employees in eight US states. To explore gender differences in job status, we developed sex-stratified propensity score models identifying key socioeconomic predictors of hourly status for men and women. To examine the effects of hourly employment on hypertension risk, after adjusting for gender differences in job status, we applied time-weighted logistic regression models, stratified by propensity score, with additional adjustment for socioeconomic confounders.

RESULTS

Family structure (partnership, parity) influenced job status for both sexes; single mothers were more likely to hold hourly jobs (OR 2.02; 95% CI 1.37 to 2.97) and partnered men with children less likely (OR 0.68; 95% CI 0.56 to 0.83). Education, age at hire and race influenced job status for both sexes. The effect of hourly status on hypertension was significant only among women predicted to be hourly (OR 1.78; 95% CI 1.34 to 2.35).

CONCLUSIONS

Our results indicate significant risks of hypertension associated with hourly status for women, possibly exacerbated by sociodemographic factors predicting hourly status (eg, single parenthood, low education). Greater attention to gender differences in job status, and finer exploration of sex-linked biological differences influencing responsivity to workplace exposures, is warranted.

Psychosocial determinants of hypertension: laboratory and field models

Tom Pickering had a profound influence on the study of biobehavioral factors in the development, diagnosis, and misdiagnosis of hypertension. His contributions influenced several avenues of research, including ecological momentary assessments of the sources and causes of diurnal blood pressure variation, the evaluation and impact of job strain on blood pressure and cardiovascular disease, and the role of blood pressure reactivity and recovery to acute stress in hypertension development. This overview approaches these topics by examining the seminal role of the work by Tom et al. in the current understanding of how biobehavioral factors contribute to hypertension.

Work and its role in shaping the social gradient in health

Adults with better jobs enjoy better health: job title was, in fact, the social gradient metric first used to study the relationship between social class and chronic disease etiology, a core finding now replicated in most developed countries. What has been less well proved is whether this correlation is causal, and if so, through what mechanisms. During the past decade, much research has been directed at these issues. Best evidence in 2009 suggests that occupation does affect health. Most recent research on the relationship has been directed at disentangling the pathways through which lower-status work leads to adverse health outcomes. This review focuses on six areas of recent progress: (1) the role of status in a hierarchical occupational system; (2) the roles of psychosocial job stressors; (3) effects of workplace physical and chemical hazard exposures; (4) evidence that work organization matters as a contextual factor; (5) implications for the gradient of new forms of nonstandard or "precarious" employment such as contract and shift work; and (6) emerging evidence that women may be impacted differently by adverse working conditions, and possibly more strongly, than men.

If schools are closed, who will watch our kids? Family caregiving and other sources of role conflict among nurses during large-scale outbreaks

OBJECTIVES

The global impact of severe acute respiratory syndrome (SARS) brought attention to the role of healthcare professionals as "first receivers" during infectious disease outbreaks, a collateral aspect to their role as responders. This article records and reports concerns expressed by Canadian emergency and critical care nurses in terms of organizational and social supports required during infectious disease outbreaks. The nature of work-family and family-work conflict perceived and experienced by nurses during infectious disease outbreaks, as well as the supports needed to enable them to balance their social roles during this type of heightened stress, are explored.

METHODS

Five focus groups consisting of 100 nurses were conducted using a Structured Interview Matrix facilitation technique.

RESULTS

Four emergent themes included: (1) substantial personal/professional dilemmas; (2) assistance with child, elder, and/or pet care; (3) adequate resources and vaccinations to protect families; and (4) appropriate mechanisms to enable two-way communication between employees and their families under conditions of quarantine or long work hours.

CONCLUSIONS

Social and organizational supports are critical to help buffer the effects of stress for nurses and assist them in managing difficult role conflicts during infectious disease outbreaks. These supports are necessary to improve response capacity for bio-disasters.

Studying the relationship between low back pain and working postures among those who stand and those who sit most of the working day

A relationship between low back pain (LBP) and prolonged standing or prolonged sitting at work has not been clearly shown, despite its biological plausibility. Because sitting and standing postures vary as to duration and freedom to alternate postures, and standing postures vary as to mobility, associations between specific working postures and LBP were explored using multiple logistic regression. Associations between work factors and self-reported LBP during the previous 12 months that interfered with usual activities were examined among 4493 standing workers and 3237 sitting workers interviewed in the 1998 Quebec Health and Social Survey; 24.5% reported significant LBP. Since the same conditions can correspond to different physiological demands for sitting compared with standing workers, analyses were performed separately for the two groups. Standing without freedom to sit was associated with LBP. Different occupational physical and psychosocial factors were associated with LBP in sitting compared with standing populations.

Workplace status and risk of hypertension among hourly and salaried aluminum manufacturing employees

An inverse relationship between workplace status and morbidity is well established; higher job status has been associated with reduced risks of heart disease, hypertension, and injury. Most research on job status, however, has focused on salaried populations, and it remains unclear whether job status operates similarly among hourly workers. Our objectives were to examine whether hourly status itself influences risk of hypertension after adjustment for socioeconomic confounders, and to explore the role of fine-scale job grade on hypertension incidence within hourly and salaried groups. We examined data for 14,999 aluminum manufacturing employees in 11 plants across the U.S., using logistic regression with adjustment for age, sex, race/ethnicity and other individual characteristics. Propensity score restriction was used to identify comparable groups of hourly and salaried employees, reducing confounding by sociodemographic characteristics. Job grade (coded 1 through 30, within hourly and salaried groups) was examined as a more refined measure of job status. Hourly status was associated with an increased risk of hypertension, after propensity restriction and adjustment for confounders. The observed effect of hourly status was stronger among women, although the propensity-restricted cohort was disproportionately male (96%). Among salaried workers, higher job grade was not consistently associated with decreased risk; among hourly employees, however, there was a significant trend, with higher job grades more protective against hypertension. Increasing the stringency of hypertension case criteria also increased the risk of severe or persistent hypertension for hourly employees.

Associations between strain in domestic work and self-rated health: a study of employed women in Sweden

AIM

The aim of this study was to analyse the association between strain in domestic work and self-rated health among employed women in Sweden, using two different methods of measuring strain in domestic work.

METHODS

Questionnaire data were collected on health and living conditions in paid and unpaid work for employed women (n=1,417), aged 17-64 years. "Domestic job strain'' was an application of the demand-control model developed by Karasek and Theorell, and "Domestic work equity and marital satisfaction'' was measured by questions on the division of and responsibility for domestic work and relationship with spouse/cohabiter. Self-rated health was measured using the SF-36 Health Survey. Associations were analysed by bivariate and multivariate linear regression analyses, and reported as standardized regression coefficients.

RESULTS

Higher strain in domestic work was associated with lower self-rated health, also after controlling for potential confounders and according to both strain measures. "Domestic work equity and marital satisfaction'' showed for example negative associations with mental health beta -0.211 (p<0.001), vitality beta -0.195 (p<0.001), social function -0.132 (p<0.01) and physical role beta -0.115 (p<0.01). The highest associations between "Domestic job strain'' and SF-36 were found for vitality beta -0.156 (p<0.001), mental health beta -0.123 (p<0.001).

CONCLUSIONS

Strain in domestic work, including perceived inequity in the relationship and lack of a satisfactory relationship with a spouse/cohabiter, was associated with lower self-rated health in this cross-sectional study. Future research needs to address the specific importance of strain in domestic work as a contributory factor to women's ill-health.