Incorporating home demands into models of job strain: findings from the work, family, and health network

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 associated with increases in ambulatory blood and pulse pressure during and after work hours among female hotel room cleaners

BACKGROUND

Previously documented elevated hypertension rates among Las Vegas hotel room cleaners are hypothesized to be associated with job strain.

METHODS

Job strain was assessed by questionnaire. Ambulatory blood pressure (ABP) was recorded among 419 female cleaners from five hotels during 18 waking hours. Multiple linear regression models assessed associations of job strain with ABP and pulse pressure for 18-h, work hours, and after work hours.

RESULTS

Higher job strain was associated with increased 18-h systolic ABP, after work hours systolic ABP, and ambulatory pulse pressure. Dependents at home but not social support at work attenuated effects. Among hypertensive workers, job strain effects were partially buffered by anti-hypertensive medication.

CONCLUSIONS

High job strain is positively associated with blood pressure among female hotel workers suggesting potential for primary prevention at work. Work organizational changes, stress management, and active ABP surveillance and hypertension management should be considered for integrated intervention programs.

Gender career divide and women's disadvantage in depressive symptoms and physical limitations in France

This study investigated the relationship between women's disadvantage in mental health and physical functioning and gender differences in career backgrounds. Sexual division of labor persists and key career characteristics are overrepresented in women: low-skilled first job, downward occupational trajectory, interruptions. These interrelated characteristics are usually linked to poor health. Their overrepresentation in women may be related to the female-male health gap; however, it may not if overrepresentation transposed into substantially weaker associations with poor health outcomes. To address this question, we used the French population survey "Health and Occupational Trajectories" (2006) and focused on 45-74 year-old individuals who ever worked (n=7537). Past career characteristics were qualified by retrospective information. Logistic regressions identified past characteristics related to current depressive symptoms and physical limitations. Non-linear decomposition showed whether these characteristics contributed to the gender health gap, through their different distribution and/or association with health. The overrepresentation of unskilled first jobs, current and past inactivity and unemployment in women contributed to their excess depressive symptoms. These contributions were only slightly reduced by the weaker mental health-relatedness of current inactivity in women and increased by the stronger relatedness of low-skilled and self-employed first jobs. Overrepresentation of current inactivity, past interruptions and downward trajectories also contributed positively to women's excess physical limitations. Gender-specific career backgrounds were significantly linked to women's disadvantage in mental health and physical functioning. We need to further explore whether equalization of opportunities, especially at the early stages and in terms of career continuity, could help to reduce women's mental and physical health disadvantage.

Work-related psychosocial stress and the risk of type 2 diabetes in later life

OBJECTIVES

Although work-related psychosocial stress and type 2 diabetes mellitus (T2DM) have been investigated, the association between lifelong work stress and T2DM in later life remains unclear. This study examined whether high work stress increased the risk of T2DM risk in later life, accounting also for other sources of stress outside work, such as burden from household chores.

METHODS

From the population-based prospective study SNAC-K, 2719 diabetes-free participants aged ≥60 years were identified and followed up for 6 years. T2DM was ascertained by glycated haemoglobin level, self-report, hypoglycaemic medication use and clinical records. Levels of job control and demands over the whole working life were assessed by a validated matrix. Household chores load was assessed by hours spent on such chores. Multivariate logistic regression models were used to estimate the association between job strain and T2DM.

RESULTS

During the 6-year follow-up, 154 incident cases of T2DM were identified. High job strain was associated with T2DM occurrence amongst the 60-year-old cohort (OR = 3.14, 95% CI: 1.27-7.77), and only amongst women (OR = 6.18, 95% CI: 1.22-31.26), but not in men. When taking into account household chores load, a more pronounced risk of T2DM was associated with high job strain in combination with heavy household chores load in women aged 60 years at baseline (OR = 9.45, 95% CI: 1.17-76.53).

CONCLUSION

Work-related psychosocial stress may increase the risk of T2DM only amongst women in their early 60s. The risk can be amplified by high household chores load.

The Health and Working Conditions of Women Employed in Child Care

Over one million women are employed in child care and are among the lowest wage workers in the US. The health and working conditions of 674 child care workers (118 administrators and 556 staff) from 74 centers is described using baseline data from a larger intervention trial. Participants were 39.9 (±13.0) years old; 55.4% African American, 37.1% Caucasian, and 5.3% of Hispanic ethnicity. Seventy-six percent reported having an Associate’s degree or less; 42% were classified as at or below poverty (<$20,000); and exhibited many health risks such as excess weight, insufficient activity, poor diet, and inadequate sleep. We investigated potential differences by income and job category. Lower income participants were significantly more likely to be current smokers (19.9% vs. 11.7%), drink more sweetened beverages (1.9 vs. 1.5), and report higher depressive symptoms (15.5 vs. 12.6). Administrators worked more hours weekly compared to staff (46.4 vs. 40.6), are less active (100 vs. 126 min/week), more sedentary (501 vs. 477 min/day), and reported higher job demands (13.3 vs. 12.5). Given the numerous health issues and challenging work conditions, we hope our results serve as a call to action for addressing low wages and the work environment as a means of influencing the health and well-being of child care workers.

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.

Effects on cigarette consumption of a work-family supportive organisational intervention: 6-month results from the work, family and health network study

BACKGROUND

Observational studies have linked work-family issues with cigarette consumption. This study examined the 6-month effects on cigarette consumption of a work-family supportive organisational intervention among nursing home workers.

METHODS

Group randomised controlled trial where 30 nursing homes across New England states were randomly assigned to either usual practice or to a 4-month intervention aimed at reducing work-family conflict via increased schedule control and family supportive supervisory behaviours (FSSB). Cigarette consumption was based on self-reported number of cigarettes per week, measured at the individual level.

RESULTS

A total of 1524 direct-care workers were enrolled in the trial. Cigarette consumption was prevalent in 30% of the sample, consuming an average of 77 cigarettes/week. Smokers at intervention sites reduced cigarette consumption by 7.12 cigarettes, while no reduction was observed among smokers at usual practice sites (b=-7.12, 95% CI -13.83 to -0.40, p<0.05) (d=-0.15). The majority of smokers were US-born White nursing assistants, and among this subgroup, the reduction in cigarette consumption was stronger (b=-12.77, 95% CI -22.31 to -3.22, p<0.05) (d=-0.27). Although the intervention prevented a decline in FSSB (d=0.08), effects on cigarette consumption were not mediated by FSSB.

CONCLUSIONS

Cigarette consumption was reduced among smokers at organisations where a work-family supportive intervention was implemented. This effect, however, was not explained by specific targets of the intervention, but other psychosocial pathways related to the work-family interface.

TRIAL REGISTRATION NUMBER

NCT02050204; results.

[Social inequalities in health less pronounced in women than in men: A question of measurements?]

Social inequalities in mortality are generally less pronounced for women than for men. Are women's health risks and behaviours more homogeneous, or does this pattern arise from a measurement issue inducing an under-estimation of these inequalities? This article reviews a number of studies covering different dimensions of health and different dimensions of social status. Their findings show that there are large social inequalities in health among women. The focus on the working careers, family histories and conciliation of multiple activities provides evidence of major social determinants of health to which women are widely exposed. This article highlights the need to broaden the notion of social inequality and to redefine the social categories, notably by considering the distinct trajectories of men and women and their different spheres of activity. It highlights that gender differences in health are themselves partly socially constructed, as suggested by the gender approaches in the social sciences.

The long-term mortality impact of combined job strain and family circumstances: A life course analysis of working American mothers

BACKGROUND

Work stress and family composition have been separately linked with later-life mortality among working women, but it is not known how combinations of these exposures impact mortality, particularly when exposure is assessed cumulatively over the life course. We tested whether, among US women, lifelong work stress and lifelong family circumstances would jointly predict mortality risk.

PROCEDURES

We studied formerly working mothers in the US Health and Retirement Study (HRS) born 1924-1957 (n = 7352). We used sequence analysis to determine five prototypical trajectories of marriage and parenthood in our sample. Using detailed information on occupation and industry of each woman's longest-held job, we assigned each respondent a score for job control and job demands. We calculated age-standardized mortality rates by combined job demands, job control, and family status, then modeled hazard ratios for death based on family constellation, job control tertiles, and their combination.

RESULTS

Married women who had children later in life had the lowest mortality risks (93/1000). The highest-risk family clusters were characterized by spells of single motherhood (132/1000). Generally, we observed linear relationships between job control and mortality hazard within each family trajectory. But while mortality risk was high for all long-term single mothers, we did not observe a job control-mortality gradient in this group. The highest-mortality subgroup was previously married women who became single mothers later in life and had low job control (HR 1.91, 95% CI 1.38,2.63).

PRACTICAL IMPLICATIONS

Studies of associations between psychosocial work characteristics and health might consider heterogeneity of effects by family circumstances. Worksite interventions simultaneously considering both work and family characteristics may be most effective in reducing health risks.

Work-Family Context and the Longevity Disadvantage of US Women

Female life expectancy is currently shorter in the United States than in most high-income countries. This study examines work-family context as a potential explanation. While work-family context changed similarly across high-income countries during the past half century, the United States has not implemented institutional supports, such as universally available childcare and family leave, to help Americans contend with these changes. We compare the United States to Finland-a country with similar trends in work-family life but generous institutional supports-and test two hypotheses to explain US women's longevity disadvantage: (1) US women may be less likely than Finnish women to combine employment with childrearing; and (2) US women's longevity may benefit less than Finnish women's longevity from combining employment with childrearing. We used data from women aged 30-60 years during 1988-2006 in the US National Health Interview Survey Linked Mortality File and harmonized it with data from Finnish national registers. We found stronger support for hypothesis 1, especially among low-educated women. Contrary to hypothesis 2, combining employment and childrearing was not less beneficial for US women's longevity. In a simulation exercise, more than 75 percent of US women's longevity disadvantage was eliminated by raising their employment levels to Finnish levels and reducing mortality rates of non-married/non-employed US women to Finnish rates.

Use of life course work-family profiles to predict mortality risk among US women

OBJECTIVES

We examined relationships between US women's exposure to midlife work-family demands and subsequent mortality risk.

METHODS

We used data from women born 1935 to 1956 in the Health and Retirement Study to calculate employment, marital, and parenthood statuses for each age between 16 and 50 years. We used sequence analysis to identify 7 prototypical work-family trajectories. We calculated age-standardized mortality rates and hazard ratios (HRs) for mortality associated with work-family sequences, with adjustment for covariates and potentially explanatory later-life factors.

RESULTS

Married women staying home with children briefly before reentering the workforce had the lowest mortality rates. In comparison, after adjustment for age, race/ethnicity, and education, HRs for mortality were 2.14 (95% confidence interval [CI] = 1.58, 2.90) among single nonworking mothers, 1.48 (95% CI = 1.06, 1.98) among single working mothers, and 1.36 (95% CI = 1.02, 1.80) among married nonworking mothers. Adjustment for later-life behavioral and economic factors partially attenuated risks.

CONCLUSIONS

Sequence analysis is a promising exposure assessment tool for life course research. This method permitted identification of certain lifetime work-family profiles associated with mortality risk before age 75 years.

Trends in Work-Family Context among U.S. Women by Education Level, 1976 to 2011

This study compares trends in work-family context by education level from 1976 to 2011 among U.S. women. The major aim is to assess whether differences in work-family context by education level widened, narrowed, or persisted. We used data from the 1976-2011 March Current Population Surveys on women aged 25-64 (n=1,597,914). We compare trends in four work-family forms by education level within three race/ethnic groups. The work-family forms reflect combinations of marital and employment status among women with children at home. Trends in the four work-family forms exhibited substantial heterogeneity by education and race/ethnicity. Educational differences in the work-family forms widened mainly among white women. Compared with more-educated peers, white women without a high school credential became increasingly less likely to be married, to be employed, to have children at home, and to combine these roles. In contrast, educational differences in the work-family forms generally narrowed among black women and were directionally mixed among Hispanic women. Only one form-unmarried and employed with children at home-became more strongly linked to a woman's education level within all three race/ethnic groups. This form carries an elevated risk of work-family conflict and its prevalence increased moderately during the 35-year period. Taken together, the trends underscore recent calls to elevate work-family policy on the national agenda.

Racial/ethnic disparities in short sleep duration by occupation: the contribution of immigrant status

Sleep duration, associated with increased morbidity/mortality, has been shown to vary by race and occupation. Few studies have examined the additional influence of immigrant status. Using a nationally-representative sample of 175,244 US adults from the National Health Interview Survey from 2004 to 2011, we estimated prevalence ratios (PRs) for short sleep duration (<7 h/per day) among US- and non-US born Blacks and Latinos by occupation compared to their White counterparts using adjusted Poisson regression models with robust variance. Non-US born participants' mean age was 46 years, 55% were men, 58% were Latino, and 65% lived in the US ≥ 15 years. Short sleep prevalence was highest among US- and non-US born Blacks in all occupations, and the prevalence generally increased with increasing professional/management roles in Blacks and Latinos while it decreased among Whites. Adjusted short sleep was more prevalent in US-born Blacks compared to Whites in professional/management (PR = 1.52 [95% confidence interval (CI): 1.42-1.63]), support services (PR = 1.31 [95% CI: 1.26-1.37]), and laborers (PR = 1.11 [95% CI: 1.06-1.16]). The Black-White comparison was even higher for non-US born Black laborers (PR = 1.50 [95% CI: 1.24-1.80]). Similar for non-US born Latinos, Latinos born in the US had a higher short sleep prevalence in professional/management (PR = 1.14 [95% CI: 1.04-1.24]) and support services (PR = 1.06 [95% CI: 1.01-1.11]), but a lower prevalence among laborers (PR = 0.77 [95% CI: 0.74-0.81]) compared to Whites. Short sleep varied within and between immigrant status for some ethnicities in particular occupations, further illuminating the need for tailored interventions to address sleep disparities among US workers.

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.

Job strain and incident metabolic syndrome over 5 years of follow-up: the coronary artery risk development in young adults study

BACKGROUND

Theories of stress-induced metabolic syndrome predict that job strain would increase risk. Few studies have evaluated this association.

OBJECTIVE

To evaluate the association between job strain and the risk of metabolic syndrome.

METHODS

We investigated associations between job strain and incident metabolic syndrome adjusted for sociodemographic factors, health behaviors, and depressive symptoms over 5 years among 2966 black and white men and women in the Coronary Artery Risk Development in Young Adults study. Job strain was categorized by Karasek's model: high demands/low control; high demands/high control; low demands/low control; and low demands/high control.

RESULTS

Compared with persons in low-strain jobs, men in active jobs (adjusted hazards ratio, 2.7; 95% confidence interval, 1.5 to 4.9) and women in high strain jobs (adjusted hazards ratio, 2.2; 95% confidence interval, 1.0 to 4.6) had significantly increased risk of metabolic syndrome.

CONCLUSION

Job strain may be a modifiable risk factor for metabolic syndrome and subsequent cardiovascular disease.

Healthy work revisited: do changes in time strain predict well-being?

Building on Karasek and Theorell (R. Karasek & T. Theorell, 1990, Healthy work: Stress, productivity, and the reconstruction of working life, New York, NY: Basic Books), we theorized and tested the relationship between time strain (work-time demands and control) and seven self-reported health outcomes. We drew on survey data from 550 employees fielded before and 6 months after the implementation of an organizational intervention, the results only work environment (ROWE) in a white-collar organization. Cross-sectional (wave 1) models showed psychological time demands and time control measures were related to health outcomes in expected directions. The ROWE intervention did not predict changes in psychological time demands by wave 2, but did predict increased time control (a sense of time adequacy and schedule control). Statistical models revealed increases in psychological time demands and time adequacy predicted changes in positive (energy, mastery, psychological well-being, self-assessed health) and negative (emotional exhaustion, somatic symptoms, psychological distress) outcomes in expected directions, net of job and home demands and covariates. This study demonstrates the value of including time strain in investigations of the health effects of job conditions. Results encourage longitudinal models of change in psychological time demands as well as time control, along with the development and testing of interventions aimed at reducing time strain in different populations of workers.

Team-level flexibility, work-home spillover, and health behavior

Drawing on two waves of survey data conducted six months apart in 2006, this study examined the impacts of a team-level flexibility initiative (ROWE--results only work environment) on changes in the work-home spillover and health behavior of employees at the Midwest headquarters of a large U.S. corporation. Using cluster analysis, we identified three distinct baseline spillover constellations: employees with high negative spillover, high positive spillover, and low overall spillover. Within-team spillover measures were highly intercorrelated, suggesting that work teams as well as individuals have identifiable patterns of spillover. Multilevel analyses showed ROWE reduced individual- and team-level negative work-home spillover but not positive work-home spillover or spillover from home-to-work. ROWE also promoted employees' health behaviors: increasing the odds of quitting smoking, decreasing smoking frequency, and promoting perceptions of adequate time for healthy meals. Trends suggest that ROWE also decreased the odds of excessive drinking and improved sleep adequacy and exercise frequency. Some health behavior effects were mediated via reduced individual-level negative work-home spillover (exercise frequency, adequate time for sleep) and reduced team-level negative work-home spillover (smoking frequency, exercise frequency, and adequate time for sleep). While we found no moderating effects of gender, ROWE especially improved the exercise frequency of singles and reduced the smoking frequency of employees with low overall spillover at baseline.

Manager support for work-family issues and its impact on employee-reported pain in the extended care setting

OBJECTIVE

Supervisor-level policies and the presence of a manager engaged in an employee's need to achieve work-family balance, or "supervisory support," may benefit employee health, including self-reported pain.

METHODS

We conducted a census of employees at four selected extended care facilities in the Boston metropolitan region (n = 368). Supervisory support was assessed through interviews with managers and pain was reported by employees.

RESULTS

Our multilevel logistic models indicate that employees with managers who report the lowest levels of support for work-family balance experience twice as much overall pain as employees with managers who report high levels of support.

CONCLUSIONS

Low supervisory support for work-family balance is associated with an increased prevalence of employee-reported pain in extended care facilities. We recommend that manager-level policies and practices receive additional attention as a potential risk factor for poor health in this setting.

Design of psychosocial factors questionnaires: a systematic measurement approach

BACKGROUND

Evaluation of psychosocial factors requires instruments that measure dynamic complexities. This study explains the design of a set of questionnaires to evaluate work and non-work psychosocial risk factors for stress-related illnesses.

METHODS

The measurement model was based on a review of literature. Content validity was performed by experts and cognitive interviews. Pilot testing was carried out with a convenience sample of 132 workers. Cronbach's alpha evaluated internal consistency and concurrent validity was estimated by Spearman correlation coefficients.

RESULTS

Three questionnaires were constructed to evaluate exposure to work and non-work risk factors. Content validity improved the questionnaires coherence with the measurement model. Internal consistency was adequate (α = 0.85-0.95). Concurrent validity resulted in moderate correlations of psychosocial factors with stress symptoms.

CONCLUSIONS

Questionnaires' content reflected a wide spectrum of psychosocial factors sources. Cognitive interviews improved understanding of questions and dimensions. The structure of the measurement model was confirmed.

Assessing the relationship between work-family conflict and smoking

OBJECTIVES

We examined the relationship between smoking and work-family conflict among a sample of New England long-term-care facility workers.

METHODS

To collect data, we conducted in-person, structured interviews with workers in 4 extended-care facilities.

RESULTS

There was a strong association between smoking likelihood and work-family conflict. Workers who experienced both stress at home from work issues (i.e., work-to-home conflict) and stress at work from personal issues (i.e., home-to-work conflict) had 3.1 times higher odds of smoking than those who did not experience these types of conflict. Workers who experienced home-to-work conflict had an odds of 2.3 compared with those who did not experience this type of conflict, and workers who experienced work-to-home conflict had an odds of 1.6 compared with workers who did not experience this type of conflict.

CONCLUSIONS

The results of this study indicate that there is a robust relationship between work-family conflict and smoking, but that this relationship is dependent upon the total amount of conflict experienced and the direction of the conflict.

Racial disparities in job strain among American and immigrant long-term care workers

BACKGROUND

Nursing homes are occupational settings, with an increasing minority and immigrant workforce where several psychosocial stressors intersect.

AIM

This study aimed to examine racial/ethnic differences in job strain between Black (n = 127) and White (n = 110) immigrant and American direct-care workers at nursing homes (total n = 237).

METHODS

Cross-sectional study with data collected at four nursing homes in Massachusetts during 2006-2007. We contrasted Black and White workers within higher-skilled occupations such as registered nurses or licensed practical nurses (n = 82) and lower-skilled staff such as certified nursing assistants (CNAs, n = 155).

RESULTS

Almost all Black workers (96%) were immigrants. After adjusting for demographic and occupational characteristics, Black employees were more likely to report job strain, compared with Whites [relative risk (RR): 2.9, 95% confidence interval (CI) 1.3 to 6.6]. Analyses stratified by occupation showed that Black CNAs were more likely to report job strain, compared with White CNAs (RR: 3.1, 95% CI: 1.0 to 9.4). Black workers were also more likely to report low control (RR: 2.1, 95% CI: 1.1 to 4.0). Additionally, Black workers earned $2.58 less per hour and worked 7.1 more hours per week on average, controlling for potential confounders.

CONCLUSION

Black immigrant workers were 2.9 times more likely to report job strain than White workers, with greater differences among CNAs. These findings may reflect differential organizational or individual characteristics but also interpersonal or institutional racial/ethnic discrimination. Further research should consider the role of race/ethnicity in shaping patterns of occupational stress.

Household food insufficiency, financial strain, work-family spillover, and depressive symptoms in the working class: the Work, Family, and Health Network study

OBJECTIVES

We evaluated the association of household-level stressors with depressive symptoms among low-wage nursing home employees.

METHODS

Data were collected in 2006 and 2007 from 452 multiethnic primary and nonprimary wage earners in 4 facilities in Massachusetts. We used logistic regression to estimate the association of depressive symptoms with household financial strain, food insufficiency, and work-family spillover (preoccupation with work-related concerns while at home and vice versa).

RESULTS

Depressive symptoms were significantly associated with household financial strain (odds ratio [OR] = 1.82; 95% confidence interval [CI] = 1.03, 3.21) and food insufficiency (OR = 2.10; 95% CI = 1.10, 4.18). Among primary earners, stratified analyses showed that food insufficiency was associated with depressive symptoms (OR = 3.60; 95% CI = 1.42, 9.11) but financial strain was not. Among nonprimary wage earners, depressive symptoms correlated with financial strain (OR = 3.65; 95% CI = 1.48, 9.01) and work-family spillover (OR = 3.22; 95% CI = 1.11, 9.35).

CONCLUSIONS

Household financial strain, food insufficiency, and work-family spillover are pervasive problems for working populations, but associations vary by primary wage earner status. The prevalence of food insufficiency among full-time employees was striking and might have a detrimental influence on depressive symptoms and the health of working-class families.

The role of psychosocial stress at work for the development of cardiovascular diseases: a systematic review

PURPOSE

A systematic review was carried out to assess evidence for the association between different models of stress at work, and cardiovascular morbidity and mortality.

METHODS

A literature search was conducted using five databases (MEDLINE, Cochrane Library, EMBASE, PSYNDEX and PsycINFO). Inclusion criteria for studies were the following: self-reported stress for individual workplaces, prospective study design and incident disease (myocardial infarction, stroke, angina pectoris, high blood pressure). Evaluation, according to the criteria of the Scottish Intercollegiate Guidelines Network, was done by two readers. In case of disagreement, a third reader was involved.

RESULTS

Twenty-six publications were included, describing 40 analyses out of 20 cohorts. The risk estimates for work stress were associated with a statistically significant increased risk of cardiovascular disease in 13 out of the 20 cohorts. Associations were significant for 7 out of 13 cohorts applying the demand-control model, all three cohorts using the effort-reward model and 3 out of 6 cohorts investigating other models. Most significant results came from analyses considering only men. Results for the association between job stress and cardiovascular diseases in women were not clear. Associations were weaker in participants above the age of 55.

CONCLUSIONS

In accordance with other systematic reviews, this review stresses the importance of psychosocial factors at work in the aetiology of cardiovascular diseases. Besides individual measures to manage stress and to cope with demanding work situations, organisational changes at the workplace need to be considered to find options to reduce occupational risk factors for cardiovascular diseases.

Depressive symptoms in extended-care employees: children, social support, and work-family conditions

To examine the relation between having a child aged 18 years and under in the home and employee depressive symptoms, we analyzed cross-sectional data from four extended care facilities in Boston, MA (n = 376 employees). Results show that having a child is associated with slightly higher depressive symptoms. The strength of this relationship in our models is attenuated with the inclusion of social support at home (β = 1.08 and β = 0.85, with and without support, respectively) and may differ by gender. We recommend that future research examine the role of parenting and social support in predicting employee mental health.

Workplace Discrimination and Depressive Symptoms: A Study of Multi-Ethnic Hospital Employees

Workplace discrimination reports have recently increased in the U.S. Few studies have examined racial/ethnic differences and the mental health consequences of this exposure. We examined the association between self-reported workplace discrimination and depressive symptoms among a multi-ethnic sample of hospital employees. Data came from the prospective case-control Gradients of Occupational Health in Hospital Workers (GROW) study (N = 664). We used the Center for Epidemiological Studies Depression Scale (CES-D) to assess depressive symptoms and measured the occurrence, types, and frequency of workplace discrimination. African Americans were more likely than other racial/ethnic employees to report frequent and multiple types of discrimination exposure. Multivariate relationships were examined while controlling for socio-demographic factors, job strain, and general social stressors. After adjustment, workplace discrimination occurrence and frequency were positively associated with depressive symptoms. The positive association between workplace discrimination and depressive symptoms was similar across racial and ethnic groups. Reducing workplace discrimination may improve psychosocial functioning among racial/ethnic minority hospital employees at greatest risk of exposure.