Job stress and heart disease: evidence and strategies for prevention

A Population-Based Study of Job Stress in Mexican Americans, non-Hispanic Blacks, and non-Hispanic Whites

There is little known about the association between socioeconomic status and job stress in Mexican Americans. To address this issue, data were originated on a community level using personal interviews from working Mexican Americans using a multistage probability sample. In this study we described the population’s sociodemographic characteristics, health conditions, and job stress measures in Mexican Americans, non-Hispanic Whites, and non-Hispanic Blacks. Regression models were used to examine the associations of sociodemographic characteristics and health conditions for each job stress measure among 937 individuals. Our results indicate an association between low socioeconomic status and the perception of less job control, less job security, and less social support. Mexican Americans demonstrated more job security and social support in comparison to non-Hispanic Whites of similar socioeconomic status. We were able to define potential factors that may contribute to an individual’s perception of job stress.

Contemporary work characteristics, stress, and ill health

This study investigates the relationship between work and ill health resulting from stressors originating in the work environment. The association between work and health has been well-documented. Factors in the work environment leading to ill health have included generalized psychological stress and/or specific physical environmental characteristics. Data for this study come from a 1998 telephone survey, the Indiana Survey of Work in a Polarized Economy, under the auspices of the Center for Survey Research at Indiana University. The dependent variable is an index that measures ill health among workers; control variables include sociodemographic and lifestyle characteristics of these workers as well as their job characteristics; and the four key independent variables are occupational status, organizational disruption, layoff experience, and educational discordance of the workers. Multiple regression analysis on the entire sample (n = 919) demonstrates that occupational status is negatively associated with ill health, while organizational disruption, layoff experience, and educational discordance are positively associated with it. Separate analyses for male (n = 474) and female (n = 445) respondents find significant sex differences in the effects of the key variables: for males, organizational disruption is positively related to ill health while for women occupational status is negatively related and layoff experience and educational discordance are positively related to ill health. The findings from the present research provide insight into the interrelationship of occupational environment and health within the framework of evolutionary medicine.

The changing organization of work and the safety and health of working people: a commentary

Recent trends in the organization of work may affect worker health through a variety of pathways--by increasing the risk of stress-related illnesses, such as cardiovascular disease, musculoskeletal disorders, and psychological disorders, by increasing exposure to hazardous substances and violence on the job, or by affecting occupational health services and training programs. Much remains to be learned about the nature of changes in work organization, and how they affect worker health and safety. While available evidence is limited, such evidence suggests that recent trends in work organization may be increasing the risk of occupational illnesses. In a groundbreaking publication, the National Institute for Occupational Safety and Health has provided a concise summary of available knowledge and a detailed agenda for research and development.

A labor perspective of workplace violence prevention. Identifying research needs

BACKGROUND

During the past decade, labor unions have contributed to efforts to increase awareness of the importance of workplace violence as an occupational hazard. Research by the National Institute for Occupational Safety and Health and the U.S. Department of Justice have bolstered these efforts. This research revealed that workplace violence is the second leading cause of traumatic-injury death on the job for men, the leading cause of traumatic-injury death on the job for women, and accounts for some 2 million nonfatal injuries each year in the United States.

LABOR PERSPECTIVE

Ten years ago, the debate focused on whether workplace violence is an occupational hazard or strictly a police and criminal justice issue. Labor unions have joined with occupational safety and health professionals in recognizing that workplace violence is a serious occupational hazard that is often predictable and preventable. They have advocated that employers establish multidimensional violence-prevention programs.

CONCLUSION

Although the nature of workplace violence varies from industry to industry, implementation of the federal Occupational Safety and Health Administration (OSHA) Violence Prevention Guidelines for Health Care and Social Service Workers and for Late-Night Retail Establishments is a high priority to unions in the affected industries. Labor wants employers to invest in protecting workers from violence through voluntary programs and state legislation, and it supports the promulgation of a mandatory federal OSHA standard. To that end, intervention research can play a key role in demonstrating effective, technically and economically feasible prevention strategies

Community occupational structure, basic services, and coronary mortality in Washington state, 1980-1994

OBJECTIVE

Examine the association between county occupational structure, public expenditures, services availability, prevalence of risk factors, and coronary mortality rates, for 1980-1994, in Washington state.

DESIGN

Washington's 39 counties were classified into three occupational structure categories: counties with the lowest percentages of the labor force in managerial, professional, and technical occupations were classified in category I; counties with the highest percentages were in category III. Directly age-adjusted coronary heart disease (CHD) mortality rates, aged 35-64 years, (from vital statistics and Census data), per capita expenditures (Washington Department of Revenue data), per capita services (U.S. Statistical Abstracts data), and the prevalence of CHD risk factors (BRFSS data) were calculated for each occupational structure category.

RESULTS

CHD mortality rates and the prevalence of risk factors were inversely associated with occupational structure. Per capita expenditures for health, social, and employment services were 2.2 times, and for schools and recreation were 1.4 times higher in category III vs. I counties. Per capita numbers of child care, job training, employment services, exercise facilities, schools, and medical services were 1.5-6.4 times greater in category III vs. I counties.

CONCLUSIONS

Strategies to improve community living conditions and decrease economic disparities between counties may be important to decrease geographic differences in premature CHD mortality.

Community occupational structure, medical and economic resources, and coronary mortality among U.S. blacks and whites, 1980-1988

PURPOSE

To examine the association between coronary heart disease (CHD) mortality, economic and medical resources, and county occupational structure.

METHODS

U.S. counties were classified into five occupational structure categories based on the percentage of workers in white-collar occupations. Directly age-adjusted CHD mortality rates (from vital statistics and Census data) and economic and medical care data (from Census and Area Resource File data) were calculated for each occupational structure category. Participants were black and white, men and women, aged 35-64 years, in the U.S. during 1980-88. CHD mortality rates and economic and medical care data were compared across occupational structure categories.

RESULTS

Among blacks, CDH rates were highest in counties with intermediate levels of occupational structure; rates among whites were inversely associated with occupational structure. Per capita levels of income and numbers of medical-care providers were positively associated with occupational structure.

CONCLUSION

Strategies to improve the resources of disadvantaged communities and the access of black workers to local occupational opportunities may be important for CHD prevention in high risk populations.

Job strain and health behaviors: results of a prospective study

PURPOSE

To assess the association between job demands, job decision latitude, and job strain (defined by Karasek as a combination of high demands and low decision latitude) and cardiovascular disease-related health behaviors such as cigarette smoking, alcohol use, lack of exercise, and overweight.

DESIGN

Cross-sectional and prospective.

SETTING

Nine New York City public and private sector worksites.

SUBJECTS

Two hundred eighty-five male employees, aged 30 to 60, in a wide variety of white-collar and blue-collar job titles.

MEASURES

Medical examinations and surveys, which included demographic, health behavior, and job characteristics data.

RESULTS

Prospectively, among 189 men, increase in job decision latitude over 3 years was associated with decrease in cigarette smoking, by analysis of covariance, controlling for age, race, education, marital status, and number of children at home (F (8, 180) = 4.37, p = .005). The largest increase in latitude occurred among the 13 men who quit smoking. However, change in job characteristics was not associated with change in overweight or alcohol use. Cross-sectional analyses did not produce consistent associations.

CONCLUSIONS

The effectiveness of smoking cessation may be aided by modification of structural features of the work environment, such as job decision latitude. This study is limited by the small number of subjects who were engaged in high risk behaviors.

Role of control and support in occupational stress: an integrated model

Drawing from the Demand-Control Model and the conceptual framework of the stress process developed by researchers at the University of Michigan's Institute for Social Research, this paper presents and tests an "integrated model" of occupational stress. The results indicate that control and social support are strongly correlated with negative job feelings. The effect of control on health was found to depend on the type of control and organizational level at which control is exercised. Specifically, the effect of participation on health outcomes was found to differ at the job and organizational levels, and participation without influence was associated with increased negative job feelings. The effect of social support was found to depend on the type of support and from whom the support was provided. Results also indicate that it is important to test for moderating, mediating, and direct effects of control on health, and underscore the complementary nature of qualitative and quantitative data in furthering knowledge and understanding.

The integrated model: implications for worksite health promotion and occupational health and safety practice

Within a single firm it is common to find both occupational safety and health and worksite health promotion interventions operating in isolation from one another, with different intervention targets, methods, and personnel. Overcoming the segmentation of the two fields will require, among other things, the promulgation of an overarching model of work and health. The purpose of this article is to describe an integrated model and to show how it can be applied to improve worksite health interventions for both occupational safety and health and worksite health promotion. Practice examples from both fields are used to illustrate interventions that focus on different areas of the model (individual behavior, psychosocial, organization, and contextual factors). It is argued that occupational safety and health and worksite health promotion practitioners need to develop more comprehensive interventions and rigorously evaluate these programs to determine if they are more effective than programs with a more narrow focus.

Cardiovascular Risk and Back-disorder Intervention Study of Mass Transit Operators

A prospective intervention study was conducted to evaluate an employer/union-sponsored physical and psychological health program, which was offered to 125 transit operators aged >45 years with >15 years of job seniority. The one-year, biweekly program included physical exercise, relaxation, back school, and work-related stress management and diet counseling. A control group (n = 26) was available for comparison. Twenty-seven operators dropped out of the study. WHO cardiovascular risk survey methods, ergometry, Minnesota ECG coding, standardized low-back tests, blood lipids, lead, and carboxyhemoglobin were measured. Before the intervention, the ten-year cardiovascular-disease risk of all study subjects (15.1%) was greater than that of the general reference population (14.0%). After the intervention it fell to 12.9%, but not significantly compared with that of a non-exercising control group, which also showed a reduction. The prevalence and the self-rated intensity of back problems were reduced after the intervention: 55.4% of low-back-pain sufferers reported substantial improvement, and only 12.3% reported substantial worsening. The multidisciplinary intervention program appeared to be effective for musculoskeletal conditions, but not for overall cardiovascular risk, compared with the controls.