Job, psychological factors and coronary heart disease. Swedish prospective findings and US prevalence findings using a new occupational inference method

Office Design's Impact on Psychosocial Work Environment and Emotional Health

This study explores the association between office design and (a) the psychosocial work environment and (b) the emotional health among 4352 employees in seven different office designs. A multivariate linear regression analysis was performed with adjustments for age and educational level for men and women separately. Results show that psychosocial factors and emotional exhaustion differ between both office designs and between genders, with best outcomes in cell offices, except for psychological demands that are rated the most favourable in shared-room offices. Cell offices and small open-plan offices show a strong beneficial association with emotional exhaustion in women. Among men, hot-desking is most problematic regarding psychosocial work environment and emotional exhaustion. Women rate the psychosocial environment low in combi-office and report emotional exhaustion in small open offices.

The Semmelweis Study: a longitudinal occupational cohort study within the framework of the Semmelweis Caring University Model Program for supporting healthy aging

The Semmelweis Study is a prospective occupational cohort study that seeks to enroll all employees of Semmelweis University (Budapest, Hungary) aged 25 years and older, with a population of 8866 people, 70.5% of whom are women. The study builds on the successful experiences of the Whitehall II study and aims to investigate the complex relationships between lifestyle, environmental, and occupational risk factors, and the development and progression of chronic age-associated diseases. An important goal of the Semmelweis Study is to identify groups of people who are aging unsuccessfully and therefore have an increased risk of developing age-associated diseases. To achieve this, the study takes a multidisciplinary approach, collecting economic, social, psychological, cognitive, health, and biological data. The Semmelweis Study comprises a baseline data collection with open healthcare data linkage, followed by repeated data collection waves every 5 years. Data are collected through computer-assisted self-completed questionnaires, followed by a physical health examination, physiological measurements, and the assessment of biomarkers. This article provides a comprehensive overview of the Semmelweis Study, including its origin, context, objectives, design, relevance, and expected contributions.

Benevolence - Associations With Stress, Mental Health, and Self-Compassion at the Workplace

Objective

Benevolence is an emerging concept in motivation theory and research as well as in on pro-social behavior, which has stimulated increasing interest in studying factors that impair or facilitate benevolence and effects thereof. This exploratory study examines the associations between benevolence, stress, mental health, self-compassion, and satisfaction with life in two workplace samples.

Methods

In the first study n = 522 (38% = female, median age = 42) participants answered questionnaires regarding self-reported stress symptoms (i.e., emotional exhaustion), depressive symptoms and benevolence. In the second study n = 49 (female = 96%) participants answered questionnaires regarding perceived stress, self-compassion, anxiety, depression symptoms, and benevolence.

Results

In study 1, measures of emotional exhaustion (r = −0.295) and depression (r = −0.190) were significantly negatively correlated with benevolence. In study 2, benevolence was significantly negatively correlated with stress (r = −0.392) and depression (r = −0.310), whereas self-compassion (0.401) was significantly positively correlated with benevolence. While correlations were in expected directions, benevolence was not significantly associated with Satisfaction with Life (r = 0.148) or anxiety (r = −0.199) in study 2.

Conclusion

Self-assessed benevolence is associated with levels of perceived stress, exhaustion, depression, and self-compassion. Future studies are warranted on how benevolence is related to stress and mental ill health such as depression and anxiety, and if benevolence can be trained in order to decrease stress and mental ill health such as depression and anxiety in workplace settings.

Development and Investigation of a New Model Explaining Job Performance and Uncertainty among Nurses and Physicians

The purpose of this paper is to develop and investigate a new theoretical model explaining variance in job performance and uncertainty among nurses and physicians. The study adopted a cross-sectional survey. Data was collected from 2946 nurses and 556 physicians employed at four public hospitals in Norway. We analysed data using descriptive statistics, correlations, Cronbach's alpha, confirmatory factor analyses and structural equation modelling. To explain job performance and uncertainty, two sets of explanatory variables were used: first, satisfactions of three psychological needs-namely autonomy, social support and competence development-and second, employee perceptions of hospital management quality (HMQ) and local leadership quality (LLQ). The results supported the theoretical model among nurses and physicians; (1) HMQ was positively associated with LLQ; (2) LLQ was positively associated with psychological needs; (3) the majority of psychological needs were positively associated with job performance and negatively associated with uncertainty, but more of these relations were significant among nurses than physicians. The results suggest that job performance and uncertainty among nurses and physicians can be improved by helping personnel meet their psychological needs. Improving job design and staff involvement will be important to strengthen need satisfaction. Results suggest enhancement of HMQ and LLQ will be positively related to need satisfaction among nurses and physicians and will strengthen job performance and reduce uncertainty.

Some Observations on Health and Socio economic Status

Health and socio-economic status are powerfully linked. This association cannot be attributed to social-selection effects, and the unequal distribution of behavioural risk factors, such as smoking, explains only a part of the variance. Differential exposure to physical hazards plays a role, but the persistence of health differentials into the better-off social strata and the significance of relative as well as absolute living standards suggest psychosocial factors also. We outline a conceptual model that regards the clustering of adverse physical and psychosocial factors over the life course as critical. Identifying the salient physical and psychosocial factors is a formidable research mission. In pursuing this mission we should not lose sight of the key fact that socio economic health differentials are intimately bound up with material differentials, and that remediation demands strategies that counter socio-economic disparity.

Gender, Job and Family Conditions, and Psychological Symptoms

This study examined the hypothesis that gender differences in psychological distress are mediated by job and family role conditions. Previous research has failed to directly test such mediational hypotheses but rather has inferred effects of role conditions from simple role-occupancy variables. The sample consisted of full-time employed married respondents including 161 women with full-time employed spouses, 142 men with nonemployed spouses, and 126 men with full-time employed spouses. Although the sample reported low psychological symptomatology overall, the women in dual-earner families reported more psychological symptomatology than did either group of men. Hierarchical regression equations indicated that work and family conditions fully attenuated this gender differential. Women in dual-earner families also reported less job enrichment, less time at work, and more household labor inequity than did either group of men. They also reported more childcare difficulty than did men with nonemployed spouses. Work-family interference predicted psychological symptomatology and partially accounted for its relationship with some job and family conditions. We discuss processes through which gender affects psychological distress.

Workplace psychosocial factors associated with work-related injury absence: a study from a nationally representative sample of Korean workers

BACKGROUND

Little is known about the association between psychosocial factors and injury absence in the workplace.

PURPOSE

This study aims to assess the association of comprehensive workplace psychosocial factors with work-related injury absence among Korean workers.

METHODS

The data (n = 7,856) were derived from the First Korean Working Conditions Survey conducted in 2006 with a representative sample (n = 10,043) of the Korean working population. The survey instrument contained questions about hours of work, physical risk factors, work organization, and the effect of work on health/injury. Work-related injury absence was indicated by a dichotomous variable with at least 1 day absence during the preceding 12 months. Logistic regression models were used to calculate odds ratio and confidence interval (CI). Incremental adjustments for sociodemographic, health behavior, and occupational confounding variables were employed in the models.

RESULTS

The overall 1-year prevalence of work-related injury absence in this study was 1.37 % (95 % CI, 1.11-1.63 %). Those who experienced violence at work (adjusted odds ratio (aOR), 7.05 (95 % CI, 2.69-18.5)), threat of violence at work (aOR, 4.25 (95 % CI, 1.32-13.64)), low job autonomy (aOR, 1.79 (95 % CI, 1.17-2.74)), and high job strain (aOR, 2.38 (95 % CI, 1.29-4.42) had an increased risk of injury absence, compared with their respective counterparts (p < 0.05). Among all job types, skilled workers in Korea were at a near fourfold risk of work absence due to occupational injuries, compared with managers in low-risk jobs.

CONCLUSION

Workplace violence and increased job strain were two key workplace psychosocial factors associated with work-related injury absence.

Early adversity and adult health outcomes

Adversity in childhood has effects on mental and physical health, not only in childhood but across the lifespan. A chief task of our research has been to define the pathways by which childhood experience has these surprising health outcomes, often decades later. The concept of allostatic load, which refers to dysregulations across major biological regulatory systems that have cumulative interacting adverse effects over time, provides a mechanism for understanding these relations and defining specific pathways. To chart these pathways, we examine early childhood socioeconomic status, family environment, and genetic predispositions as antecedents to socioemotional functioning/psychological distress; and neural responses to threat that have downstream effects on major stress regulatory systems, ultimately culminating in risks to mental and physical health outcomes. This integrative approach to investigating the impact of childhood experience on adult health outcomes illustrates the significance of multilevel integrative approaches to understanding developmental psychopathology more generally.

Hipertensão arterial em profissionais que atuam em serviços de atendimento pré-hospitalar

Avaliou-se a prevalência de hipertensão e variáveis relacionadas em 154 profissionais de serviço pré-hospitalar pela medida casual da pressão e monitorização ambulatorial da pressão. A prevalência de hipertensão na medida casual foi 33,1% e 26,6% na monitorização ambulatorial da pressão arterial. A presença de hipertensão se associou (odds ratio=OR): a) medida casual da pressão, com o HDL-c >40 mg/dL (OR=0,25); b) monitorização ambulatorial (24 h) com glicemia > 110 mg/dL (OR:9,98), sexo masculino (OR=2,71), trabalhar cansado raramente/nunca (OR=0,19) e às vezes (OR=0,17); c) monitorização ambulatorial (vigília) com glicemia > 110 mg/dL (OR=11,18), sexo masculino (OR=3,24), trabalhar cansado raramente/nunca (OR=0,14) e às vezes (OR=0,16), índice de massa corporal (OR=1,10), trabalhar cansado raramente/nunca (OR=0,14) e às vezes (OR=0,16); e d) monitorização ambulatorial (sono) com sono diurno (OR=0,14) e índice de massa corporal (OR=1,11). Foi elevada a prevalência de hipertensão e fatores de risco associados.

Subjective well-being mediates the effects of resilience and mastery on depression and anxiety in a large community sample of young and middle-aged adults

OBJECTIVE

The tripartite model of depression and anxiety hypothesizes that positive and negative affect is related to depression and anxiety. However, the specific role of cognitive or psychological well-being constructs like resilience and mastery within a tripartite context and throughout adulthood is unclear.

METHOD

Data was drawn from two longitudinal population-based cohorts, aged 20-24 and 40-44 based in Canberra, Australia (N = 3989). We sought to determine the interrelatedness of two affective measures of subjective well-being, positive and negative affect, with two cognitive measures of psychological well-being, resilience and mastery. We then tested their independent effects on depression and anxiety, and hypothesized, following the tripartite model, that subjective well-being would mediate the effects of the psychological well-being variables on mental health and that the psychological well-being variables would be more strongly related to positive subjective well-being.

RESULTS

Principal axis factoring delineated four affective and cognitive dimensions of well-being comprising positive and negative affect, resilience and mastery. Structural equation models identified the psychological well-being variables as significantly related to subjective well-being, which fully mediated the effects of resilience and partially mediated the effect of mastery on depression and anxiety. These findings were consistent throughout both young and middle adulthood.

CONCLUSIONS

Psychological well-being components are significant predictors of subjective well-being affect states that increase vulnerability to depression and anxiety.

Momentary Reports of Social-Evaluative Threat Predict Ambulatory Blood Pressure

Although laboratory research indicates that social-evaluative threat evokes a physical stress response, naturalistic studies of its situational determinants remain scarce. This work investigates the correlates of naturally occurring social-evaluative threats and tests the effects of situational control and social-evaluative threat on cardiovascular functioning. A total of 99 undergraduate students wore an ambulatory blood pressure monitor for 4 days. Following hourly activations of the monitor, participants described their activities at the time the monitor activated and rated situational control and social-evaluative threat. Hierarchical linear modeling analyses indicated relative elevations in systolic blood pressure and diastolic blood pressure at times when participants reported more social-evaluative threat. Increases in heart rate were observed in low control situations. Cardiovascular reactivity to social-evaluative threat was observed in a young healthy sample during real-life social interactions, suggesting that situation-specific reactivity to social-evaluative threat does occur and that social-evaluative threat may contribute to the development of cardiovascular disease.

Coping resources, coping processes, and mental health

Coping, defined as action-oriented and intrapsychic efforts to manage the demands created by stressful events, is coming to be recognized both for its significant impact on stress-related mental and physical health outcomes and for its intervention potential. We review coping resources that aid in this process, including individual differences in optimism, mastery, self-esteem, and social support, and examine appraisal and coping processes, especially those marked by approach or avoidance. We address the origins of coping resources and processes in genes, early life experience, and gene-environment interactions, and address neural underpinnings of coping that may shed light on evaluating coping interventions. We conclude by outlining possible intervention strategies for improving coping processes.

Psychosocial Factors in Musculoskeletal Disorders

Work-related musculoskeletal disorders (MSD) have a multifactorial etiology that includes not only physical stressors but also psychosocial risk factors, such as job strain, social support at work, and job dissatisfaction. Once an injury has occurred, psychosocial factors, such as depression and maladaptive pain responses, are pivotal in the transition from acute to chronic pain and the development of disability. Interventions to prevent MSD incidence and address psychosocial risk factors for delayed recovery are described.

Mental stress and coronary artery disease: a multidisciplinary guide

Research suggests that acute and chronic stress are risk factors for the development and progression of coronary artery disease. Much of this work is multidisciplinary, using unfamiliar concepts deriving from disciplines other than cardiology and medicine. This article addresses and clarifies, for the cardiologist, some of the key concepts and issues in this area and provides an overview of evidence linking acute and chronic stress to cardiac pathology. Areas addressed include definitions and measurement of mental stress, methodological issues in stress research, and distinctions between stress and variables such as personality, emotion, and depression. Mental stress is a multifactorial process involving the environment, individual experiences and coping, and a set of neuroendocrine, autonomic, cardiovascular, and other systemic physiologic responses. There are difficulties identifying a single consensus physiologic stress measure because of individual differences in perceptions and physiologic response patterns. Nonetheless, important associations exist between mental stress and clinically relevant cardiovascular end points. As multidisciplinary research in this area continues, one major goal is the better integration of psychosocial knowledge and measures with cardiology research and practice.

Work hours and self-reported hypertension among working people in California

Among the risk factors for hypertension, stress, especially work stress, has drawn increasing attention. Another potential work-related risk factor for hypertension identified in the past few years is work hours. This article presents an analysis of work hours and self-reported hypertension among the working population in the state of California. The data set used for this study comes from the Public Use File of the 2001 California Health Interview Survey. The logistic regression analysis shows a positive association between hours worked per week and likelihood of having self-reported hypertension. Compared with those working between 11 and 39 hours per week, individuals working 40 hours per week were 14% (95% CI: 1.01 to 1.28) more likely to report hypertension, those who worked between 41 and 50 hours per week were 17% (95% CI: 1.04 to 1.33) more likely to report hypertension, and those who worked >or=51 hours per week were 29% (95% CI: 1.10 to 1.52) more likely to report hypertension after controlling for various potentially confounding variables, including demographic and biological risk factors and socioeconomic status. This analysis provides evidence of a positive association between work hours and hypertension in the California working population.

[Psychological approaches in hypertension management]

Stress factors, especially high levels of occupational stress, are associated with hypertension. Several so-called psychological techniques have been applied to hypertension: biofeedback, relaxation techniques (Schultz' autogenic training, Jacobson's progressive relaxation), transcendental meditation, and cognitive behavioral techniques for stress management. Randomized studies show that the best results come from cognitive behavioral methods, whether or not they include relaxation techniques. Other forms of psychotherapy (such as psychoanalysis) may be useful, although their benefits for blood pressure have not been tested in controlled trials. Patients should be informed about the personal benefits they may obtain from psychological treatment. Indications are hyperreactivity to stress, high levels of occupational stress, and difficulty in tolerating or complying with antihypertensive drugs.

Predictors of job satisfaction among doctors, nurses and auxiliaries in Norwegian hospitals: relevance for micro unit culture

OBJECTIVE

To explore what domains of work are important for job satisfaction among doctors, nurses and auxiliaries and to discuss differences between professional groups in the perspective of micro team culture.

DESIGN

Cross-sectional survey data from hospital staff working clinically at inpatient hospital wards in Norway in 2000.

MEASURES

Linear regression models predicting job satisfaction for the three professions were compared. First, five domains of hospital work were examined for general job satisfaction. Based on the result of the first regression, five items concerning local leadership were explored in a second regression.

RESULTS

A total of 1814 doctors, nurses and auxiliaries working at 11 Norwegian hospitals responded (overall response rate: 65%). The only domain of work that significantly predicted high job satisfaction important for all groups was positive evaluation of local leadership. Both steps of analyses suggested that professional development is most important for doctors. For registered nurses, experiencing support and feedback from the nearest superior was the main explanatory variable for job satisfaction. Job satisfaction of auxiliaries was equally predicted by professional development and local leadership. The results are discussed and interpreted as reflections of cultural values, loyalties and motivation.

CONCLUSION

The professional values of medicine, the organizational and holistic skills of nurses and the practical experience of auxiliaries should all be valued in the building of interdependent micro teams.

Prolonged stress-related cardiovascular activation: Is there any?

BACKGROUND

Prolonged physiological activation before or after stressors has gained recognition as a decisive element in theories that explain the link between stress and disease, specifically cardiovascular (CV) disease. This view is opposed to the conventional reactivity hypothesis that emphasizes responses during stressors.

PURPOSE

Prolonged activity has not often been an explicit research goal of real-life stress studies. Nevertheless, a growing number of these studies have provided evidence for prolonged activity, often as a secondary research goal.

METHODS

An overview of this evidence is lacking and is provided in this article.

RESULTS

The combined data from the reviewed studies suggest that discrete and chronic stress sources, as well as negative emotional episodes and dispositions, are related to prolonged CV activity of various durations, including sleep periods. On the other hand, evidence supporting the assumption that prolonged stress-related activation predicts disease is still very modest.

CONCLUSIONS

In this article we suggest that future research of prolonged activation should give priority to (a) the establishment of clear beginnings and endings of stressful events, (b) the prediction of disease by prolonged activation, and (c) potential psychological mediators of stress-related prolonged activation. These mediators may include, for example, worry and rumination, or other processes characterized by perseverative cognition, including unconscious processes.

Food insufficiency and women's mental health: Findings from a 3-year panel of welfare recipients

Household food insufficiency is a significant problem in the United States, and has been associated with poor outcomes on mental health indicators among low-income women. However, it is difficult to disentangle the mental health consequences of household food insufficiency from poverty and other shared risk factors. Drawing on theories of the social production of health and disease, research evidence linking food insufficiency with poor mental health, and high rates of food insufficiency among welfare recipients, we examined whether a change in household food insufficiency is associated with a change in women's self-reported mental health in a sample of current and recent welfare recipients over a 3-year period of time, controlling for common risk factors. Data were obtained from a prospective survey of women who were welfare recipients in an urban Michigan county in February 1997 (n=753). We estimated fixed effect models for changes in mental health status that make use of information on household food insufficiency gathered in the fall of 1997, 1998, and 1999. The relationship between household food insufficiency and respondents' meeting the diagnostic screening criteria for major depression remained highly significant even when controlling for factors known to confer increased risk of depression and time invariant unobserved heterogeneity. These findings add to growing evidence that household food insufficiency has potentially serious consequences for low-income women's mental health. If confirmed by further research, they suggest that the public health burden of depression in welfare recipients and other low-income women could be reduced by policy-level interventions to reduce their exposure to household food insufficiency.

Health-related quality of life measured by the SF12 in working populations: associations with psychosocial work characteristics

This study investigated the contribution of psychosocial work characteristics (decision latitude, job demand, social support at work, and effort-reward imbalance) to health-related quality of life. Data were derived from 2 aircraft manufacturing plants (N=1,855) at the start of a longitudinal study. Regression analysis showed that work characteristics (1st model) explained 19% of the variance in the mental summary score of the Short Form-12 Health Survey. R2 change for work characteristics decreased to 13%, accounting for demographics, socioeconomic status, body mass index, and medical condition (5th model). Including health behavior and personality factors (full model), R2 change for work characteristics remained significant. Psychosocial work characteristics account for relevant proportions in the subjective perception of mental health beyond a wide array of medical variables and personality factors.

Psychosocial work conditions, social participation and social capital: a causal pathway investigated in a longitudinal study

Social capital is often claimed to be promoted by stable social structures such as low migration rates between neighbourhoods and social networks that remain stable over time. However, stable social structures may also inhibit the formation of social capital in the form of social networks and social participation. One example is psychosocial conditions at work, which may be determined by characteristics such as demand and control in the work situation. The study examines the active workforce subpopulation within the Swedish Malmö Shoulder Neck Study. A total of 7836 individuals aged 45-69 years, were interviewed at baseline between 1992 and 1994, and at a 1-year follow-up. Four groups of baseline psychosocial work conditions categories defined by the Karasek-Theorell model (jobstrain, passive, active, relaxed) were analysed according to 13 different social participation items during the past year reported at the 1-year follow-up. Odds ratios and 95% confidence intervals with the jobstrain group as a reference were estimated. A multivariate logistic regression model was used to assess differences in different aspects of social participation between the four psychosocial work conditions groups. The results show that the respondents within the active category in particular but also the relaxed category, have significantly higher participation in many of the 13 social participation items, even after multivariate adjustments. The results strongly suggest that psychosocial work conditions may be an important determinant of social capital measured as social participation, a finding of immediate public health relevance because of the well known positive association between social participation and health-related behaviours.

Job stress and cardiovascular risk factors in male workers

BACKGROUND

This study examined whether job stress (work demand and decision latitude) is associated with smoking, blood pressure, lipid level (total cholesterol, triglyceride, HDL cholesterol), and homocystein as risk factors for cardiovascular disease in Korean male workers.

METHODS

Study subjects of this study were recruited from a sample of 1,071 workers in 20 companies of W city and H counties, and they were grouped into four categories (high strain group, active group, passive group, and low strain group) based on the postulation of Karasek's Job Strain Model. Of them, we invited 160 male workers (40 people each subgroup) using a stratified sampling, and finally, 152 eligible participants were analyzed.

RESULTS

In multivariate analyses, we found that decision latitude was associated with cholesterol, triglyceride, and homocystein and that work demand was related to smoking and systolic blood pressure. Job strain (the combination of high work demand with low decision latitude) was significantly related to higher levels of homocystein after controlling for age, BMI, smoking, and social support at workplace.

CONCLUSIONS

These results indicate that job stress is associated with cardiovascular risk factors and might contribute to the development of cardiovascular disease. Some considerations for the future research were discussed.

Psychosocial work conditions, social capital, and daily smoking: a population based study

OBJECTIVE

To investigate the associations between psychosocial conditions at work, social capital/social participation, and daily smoking.

DESIGN/SETTING/PARTICIPANTS/MEASUREMENTS

The 2000 public health survey in Scania is a cross sectional postal questionnaire study with a 59% participation rate. A total of 5180 persons aged 18-64 years that belonged to the work force and the unemployed were included in this study. Logistic regression models were used to investigate the associations between psychosocial factors at work/unemployment, social participation, and daily smoking. Psychosocial conditions at work were defined according to the Karasek-Theorell demand-control/decision latitudes into relaxed, active, passive, and jobstrain categories. The multivariate analyses included age, country of origin, education and economic stress.

RESULTS

17.2% proportion of all men and 21.9% of all women were daily smokers. The jobstrain (high demands/low control) and unemployed categories had significantly higher odds ratios of daily smoking among both men and women compared to the relaxed (low demands/high control) reference category. The passive (low demands/low control), jobstrain, and unemployed categories were also significantly associated with low social participation. Low social participation was significantly and positively associated with daily smoking within each of the psychosocial work conditions and unemployed categories.

CONCLUSIONS

The positive association between low social capital/low social participation and daily smoking is well known. However, both social participation and daily smoking are associated with psychosocial work conditions and unemployment. Psychosocial work conditions and unemployment may affect daily smoking both directly and through a pathway including social participation.

Heart and mind: (1) relationship between cardiovascular and psychiatric conditions

The relationship of our emotions and psyche to heart disease is intriguing. In this article we have reviewed the evidence linking cardiovascular and neuropsychiatric disorders and the possible mechanisms and pathophysiology of this association. This review is derived from Medline searches (1966-2002) using the relevant search terms (psychiatric disease, cardiovascular disease, depression, anxiety, and pathophysiology). Finally, the possible role of using mood enhancing therapies (mainly antidepressants) and their safety in patients with cardiovascular disorders is briefly discussed. In a companion paper, the therapeutic aspects of these two conditions is highlighted.

Work-related population health indicators

OBJECTIVE

To provide evidence-based recommendations for work-related population health indicators.

METHODS

Drawing on a framework of work-related experiences, we systematically reviewed studies that assess the association between these experiences and health and reviewed related measures at the population level that could be used as indicators.

RESULTS

We recommend (and grade the strength of evidence supporting our recommendation for) the following indicators for which data are already routinely collected: unemployment rate (strong), long-term unemployment rate (limited), and permanent lay-off rate (limited). As well, we recommend and grade our support for the following new indicators: insecurity associated with pending job loss (limited), with possible major organizational change (limited), and with actual major organizational change (limited); and job strain (medium).

CONCLUSION

These evidence-based indicators can be used to monitor work-related determinants of health and thus to inform the conceptualization, development, and evaluation of policies and programs related to these determinants.

Social psychophysiology, social circumstances, and health

Health varies markedly with social circumstances. While we are still without a comprehensive account of the mechanisms which underlie this variation, it is clear that psychological factors are involved and that key pathways may prove to be psychophysiological. Thus, social psychophysiological research of the kind illustrated in this Special Issue is ideally placed to help unravel some of the mechanisms by which social circumstances impact on health. Nevertheless, the success of this sort of social psychophysiological enterprise most likely depends on reconceptualizing psychophysiological reactivity as a situational, or psychological exposure, concept rather than as an individual difference concept. This shifts the research goal from one of identifying individuals at risk for disease to identifying the psychological exposures that put individuals and groups at risk.

African American women in the workplace: relationships between job conditions, racial bias at work, and perceived job quality

Although studies have described work processes among employed African American women, few have examined the influence of these processes on job outcomes. This study examined relationships between African American women's exposure to a range of occupational stressors, including two types of racial bias--institutional discrimination and interpersonal prejudice--and their evaluations of job quality. Findings indicated that institutional discrimination and interpersonal prejudice were more important predictors of job quality among these women than were other occupational stressors such as low task variety and decision authority, heavy workloads, and poor supervision. Racial bias in the workplace was most likely to be reported by workers in predominantly white work settings. In addition, Black women who worked in service, semiskilled, and unskilled occupations reported significantly more institutional discrimination, but not more interpersonal prejudice, than did women in professional, managerial, and technical occupations or those in sales and clerical occupations.

The Black Report and beyond: what are the issues?

This paper provides an overview of the Black Report, published in Britain in 1980. It outlines its place in the history of British concern about socio-economic differentials in death rates since the mid-19th century, and suggests continuities in suggested explanations for these, a particularly persistent thread being debates between environmentalists, hereditarians, and those emphasising personal ignorance or irresponsibility. It introduces a distinction between "hard" "soft" versions of the Black Report's four explanatory models for inequalities in health (artefact, selection, behavioural and materialist), points out that the working group rejected the "hard" rather than the "soft" versions of the first three and espoused the "soft" version of the last, and suggests that the rather polarised debate about these explanations that followed can be understood in the light of the contemporary political context and a tendency to confuse the "hard" and "soft" versions. Methodological and empirical developments since the report are summarised, attention being drawn to seven themes which raise important issues for future research: the ubiquity of socio-economic differentials across industrialised countries, continuing or increasing differentials, stepwise gradients, interest in psychosocial mechanisms, the hypothesis of biological programming in utero or infancy, controls for behaviour, and evaluations of interventions. The overall conclusion is that we need more detailed studies of the mechanisms which generate and maintain social inequalities in health, and of interventions to reduce such inequalities.

Social class and race disparities in premature stroke mortality among men in North Carolina

The purpose of this work was to examine the association between social class and premature stroke mortality among blacks and whites. For black men and white men in North Carolina, aged 35-54 years, mortality data from vital statistics files and population data from Census Public Use Microdata Sample files were matched according to social class for the years 1984-1993. Four categories of social class were defined based upon a two-dimensional classification scheme of occupations. For each category of social class, race-specific age-adjusted stroke mortality rates were calculated, and race-specific prevalences of income, wealth, education, unemployment, and disability were estimated. Women were excluded because comparable information on social class was not available from the mortality and population data sources. For both black men and white men, the highest rates of premature stroke mortality were observed among the lowest social classes. The rate ratios (RR) between the lowest and highest social class were 2.8 for black men and 2.3 for white men. Within each social class, black men had substantially higher rates of premature stroke mortality than white men (black-to-white RR ranged from 4.0 to 4.9). Among both black men and white men, the highest social class consistently had the most favorable levels of income, wealth, education, and employment. The inverse association between social class and stroke mortality for both black men and white men supports the need for stroke prevention efforts that address the structural inequalities in economic and social conditions.

A test of the psychosocial vulnerability and health behavior models of hostility: results from an 11-year follow-up study of Mexican Americans

Previous research has shown that interpersonal conflict and depression are cross-sectionally associated with hostility. Our objective was to determine whether hostility is longitudinally predictive of interpersonal distress and depression and to replicate previous research that suggests that hostility is a risk factor for other health behaviors (e.g., smoking and excessive alcohol use) and psychosocial health problems. We use data from the youngest generation of a three-generation, 11-year follow-up study of Mexican Americans, that represent 251 Mexican Americans between the ages of 18 and 42 years. Our indicator of hostility was the irritability subscale from the Buss-Durkee Hostility Inventory. After statistically controlling for marital status, language acculturation, education, age, and sex, irritability was found to predict subsequent heavy drinking, somatic symptoms associated with depression, psychosomatic symptoms, infectious disease, divorce, marital separation, ending a serious nonmarital relationship, not being married at the follow-up, and more negative feelings associated with divorce, marital separation, and ending a serious relationship. Our research supports theory and research suggesting that hostility is predictive of physical symptoms, poor health habits, and interpersonal conflict.

Musculoskeletal disorders among visual display terminal users in a telecommunications company

The relationship between workplace factors and work-related upper extremity musculoskeletal disorders (UE disorders) was assessed in a cross-sectional study of 533 telecommunication employees utilizing video display terminals (VDTs). Cases of UE disorders were defined using symptom questionnaires and physical examinations. Data on demographics, individual factors (medical conditions and recreational activities), work organization and practices, and psychosocial aspects of work, including electronic performance monitoring (EPM), were obtained by questionnaire. Associations between workplace factors and UE disorders were assessed by multiple logistic models generated for each of the four UE areas (neck, shoulder, elbow, hand/wrists). One-hundred and eleven (22%) participants met our case definition for UE disorders. Probable tendon-related disorders were the most common (15% of participants). Probable nerve entrapment syndromes were found in 4% of participants. The hand/wrist was the area most affected, 12% of participants. The following variables had associations in the final models (p < 0.05) with at least one of the four UE disorders, although the strength of these associations were modest. Non-white race, a diagnosis of a thyroid condition (self-reported) use of bifocals at work, and seven psychosocial variables (fear of being replaced by computers, increasing work pressure, surges in workload, routine work lacking decision-making opportunities, high information processing demands, jobs which required a variety of tasks and lack of a production standard) were associated with UE disorders. This study indicates that work-related UE musculoskeletal disorders are relatively common among telecommunication workers who use VDTs, and adds to the evidence that the psychosocial work environment is related to the occurrence of these disorders.

[Diastolic blood pressure associated with accumulated work time among drivers and collectors]

The relationship between diastolic blood pressure and the variables "total cumulative working time" and "age" was examined by regression analysis. The study was carried out among 839 bus drivers and conductors, users of an occupational health center in Campinas, S. Paulo State, Brazil. The main results were a positive association between diastolic blood pressure and cumulative working time, as well as an interaction between this variable and the bus worker's age.

[Occupation and hypertension]

Scientific reports on Arterial Blood Hypertension for the period from 1970 to 1989 are reviewed, with special reference to its epidemiological focusing among workers. The knowledge gained and the theoretical and methodological advances associated with it are assessed.

Job strain and prevalence of hypertension in a biracial population of urban bus drivers

OBJECTIVES

In this study we tested the association between occupational stress--as measured by job demands, decision latitude, and job strain--and hypertension in a population of 1396 Black and White bus drivers.

METHODS

Height, weight, blood pressure, and medical history were assessed by physical exam. Drivers completed a questionnaire assessing their work schedules, personal habits, and self-perceptions about job demands and decision latitude.

RESULTS

Univariate analyses revealed significant inverse associations; lower levels of job demands and job strain were associated with a higher prevalence of hypertension for Blacks and Whites. After 12 confounding variables were controlled for, the association between these two measures of occupational stress and hypertension became nonsignificant. Decision latitude was also not significantly associated with hypertension.

CONCLUSIONS

Our findings are inconsistent with previous studies' findings of a positive association between job strain and chronic diseases. The difference in results may be explained by our incorporation of individuals' perceptions in the measurement of occupational stressors and our use of individuals from a single occupation with comparable job responsibilities and income, thus controlling for potential confounding by social class.

Double exposure: the combined impact of the home and work environments on psychosomatic strain in Swedish women and men

This study investigates the relative distribution of home responsibilities and psychosocial work environment characteristics and their associations with psychosomatic strain in a random sample of the female and male working population of Sweden (N = 12,772). Occupational variables investigated were psychological and physical demands, job control, social support, and job hazards. Home characteristics included measures of household work, number and age of children, and child care resources. A sex-pooled logistic regression analysis was performed to detect sex differences in the effects of the variables upon strain. Gender was no longer associated with psychosomatic strain after adjusting for work and home characteristics and their interactions, and while there were some similarities between the sexes with respect to the main effects of the home and work characteristics, in 52 of 60 combined effect comparisons women had a greater combined odds ratio for strain than men.

Sickness absence and work strain among Danish slaughterhouse workers: an analysis of absence from work regarded as coping behaviour

This paper comprises two parts: a theoretical part in which a number of theoretical and methodological recommendations about research on absence are made on the basis of a review of selected literature, and an empirical part that contains analyses of absence from work in the Danish slaughterhouse industry. In the theoretical part it is asserted that sickness absence cannot be understood if it is viewed as a simple function of ill health or other individual factors, such as job dissatisfaction. Absence should rather be regarded as a coping behaviour that reflects an individual's perception of his/her health (illness) and is a function of a number of factors at different levels, primarily the combination of job demands and coping possibilities at the job (job strain). Several ideal methodological requirements regarding absence research are formulated on this basis. The empirical part presents an analysis of absence from work in the Danish slaughterhouse industry based on a study of 4407 slaughterhouse workers. It is shown that a number of factors at the company level, the job level and the individual level are associated with an individual's absence from work over a 12-month period. It is further shown that people with high job strain have a significantly higher absence rate, that there is a clear association between sickness absence and perceived health and that absence is part of a pattern along with other coping strategies which are directed against stressing working conditions and perceived ill health. Lastly, it is discussed whether absence from work is a functional coping strategy.