Cross- -sectional Association of Job Strain and Systolic sectional - PowerPoint PPT Presentation

Cross- -sectional Association of Job Strain and Systolic sectional Association of Job Strain and Systolic Cross Blood Pressure, Framingham Offspring Study, 1985- -88 88 Blood Pressure, Framingham Offspring Study, 1985 Low status jobs High status jobs * 3.75 * 4 2.47 3 2 1 mm Hg 0 -0.46 -0.62 -1 -2 men (n=1452) women (n=1079) men (n=1452) women (n=1079) controlling for age, body mass index, alcohol use and education *p<.05 *p<.05 1

Why greater effect of job strain if low SES? Why greater effect of job strain if low SES? � In NYC BP study � smoking, BMI, job physical exertion, shiftwork controlled in analysis � Hazards faced by lower SES workers � cardiotoxic chemicals, noise � other job stressors: effort-reward imbalance, threat-avoidant vigilant work, job insecurity � life stressors: unemployment, crime, deteriorating urban physical and social environment, low & decreasing economic rewards � psychological effects of these stressors: anger, depression � unhealthy behaviors: less exercise � Resources, buffers available to higher SES workers � money, knowledge, power, prestige, social support, social network � exercise facilities, better housing, nutrition, and medical care Landsbergis P, Schnall P, Pickering T, Warren K, Schwartz J. Lower socioeconomic status among men in relation to the association 2 between job strain and blood pressure. Scandinavian Journal of Work, Environment and Health 2003;29(3):206-215.

Job demands- -control model: control model: Job demands predictions for illness and behavior predictions for illness and behavior 3

3- -Year Change in Smoking Year Change in Smoking 3 Prevalence and Job Decision Latitude Prevalence and Job Decision Latitude Change in Time 1 Time 2 (baseline) (3 years) Job Decision Latitude Yes (n=27) +1.5 Yes +4.0 No (n=13) Smoking Yes (n=7) -1.6 No F=4.37 (8,180) No (n=142) -0.3 p=.005 (controlling for age, race, education, marital status, and number of children at home) Landsbergis PA, Schnall PL, Deitz DK, Warren K, Pickering TG, Schwartz JE. Job strain and health 4 behaviors: results of a prospective study. American Journal of Health Promotion 1998;12(4), 237-245.

Job stressors and sedentary behavior Job stressors and sedentary behavior (Sweden population survey) (Sweden population survey) Men Women OR # OR # p p Psychological demands -- ns 1.38 .01 Monotonous work 1.31 .15 1.38 .11 Learning opportunities -1.51 .04 -1.95 .002 Work process control -1.25 .09 -1.24 .11 Social interaction -1.60 .001 -- ns # Top vs. bottom decile Odds Ratio, controlling for age and educat Top vs. bottom decile Odds Ratio, controlling for age and education ion Johansson G, Johnson JV, Hall EM. Social Science and Medicine Social Science and Medicine 1991;32(7):837 1991;32(7):837- -846 846 Johansson G, Johnson JV, Hall EM. 5

Effort- -reward imbalance (ERI) at work reward imbalance (ERI) at work Effort and co- -occurrence of lifestyle risk factors (RF) occurrence of lifestyle risk factors (RF) and co N=36,127 public employees in Finland N=36,127 public employees in Finland BMI ≥ 25, current smoking, heavy drinking, physical inactivity: ORs fully adjusted with ERI scores at organizational level women 1 vs. 0 RF 2 vs. 0 RF 3 vs. 0 RF women low ERI 1.00 1.00 1.00 intermediate 0.98 1.07 1.02 high ERI 1.07 1.25 1.44 1.25 1.44 men men low ERI 1.00 1.00 1.00 intermediate 0.99 0.99 1.00 high ERI 1.06 1.22 1.36 1.22 1.36 6 Source: A. Kouvonen et al. (2006), BMC Public Health, 6: 24.

How can we How can we do about this do about this problem? problem? 7

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Interventions: what is being changed? Interventions: what is being changed? Primary prevention Economic, political context Social change Organizational context Downsizing Organizational change Contingent work New systems of work organization Job characteristics Low job control High job demands Job redesign Social isolation Secondary prevention Stress response Physiological effects (e.g., BP) Individual coping Psychological effects (e.g., burnout) Health behaviors Tertiary prevention Illness Individual Tx, rehab 9

How do we go about changing it? How do we go about changing it? Legislation, regulation, Economic, political context workers compensation Organizational context Employer initiated policies, Downsizing programs, downsizing; Contingent work Collective bargaining New systems of work organization Job characteristics Employer initiated job redesign, Low job control supervisor training, High job demands participatory ergonomics, Social isolation Joint L-M S&H committees Stress response Physiological effects (e.g., BP) Health promotion, EAPs Psychological effects (e.g., burnout) Health behaviors Stress management Illness Tx, Rehabilitation 10

Why not solely stress management? Why not solely stress management? Benefits seen, but…. …. Benefits seen, but � Limited follow Limited follow- -up up (only 23% > 6 months) (only 23% > 6 months) � � Are benefits maintained? Are benefits maintained? � � Benefits seen also in control groups Benefits seen also in control groups � � Example: 20 BP studies: Avg. drop in systolic BP = Example: 20 BP studies: Avg. drop in systolic BP = � � 7.8 mm Hg (stress mgmt groups) 7.8 mm Hg (stress mgmt groups) � � 4.9 mm Hg (control groups) 4.9 mm Hg (control groups) � � About 1/3 of participants failed to learn techniques About 1/3 of participants failed to learn techniques � Murphy LR. Stress management in work settings: A critical review of the health effects. American Journal of Health 11 Promotion 1996;11:112-135.

How do we go about changing it? How do we go about changing it? Legislation, regulation, Economic, political context workers compensation Organizational context Employer initiated policies, Downsizing programs, downsizing; Contingent work Collective bargaining New systems of work organization Job characteristics Employer initiated job redesign, Low job control supervisor training, High job demands participatory ergonomics, Social isolation Joint L-M S&H committees Stress response Physiological effects (e.g., BP) Health promotion, EAPs Psychological effects (e.g., burnout) Health behaviors Stress management Illness Tx, Rehabilitation 12

Copenhagen Healthy Bus project Copenhagen Healthy Bus project � Action research project, 1999 Action research project, 1999- -2004 2004 � � >200 interventions to improve health, well >200 interventions to improve health, well- -being and being and � work environment of 3,500 Copenhagen bus drivers work environment of 3,500 Copenhagen bus drivers � Labor Labor- -management management- -researcher cooperation researcher cooperation � � Evaluation Evaluation � Quantitative and qualitative assessments � Quantitative and qualitative assessments � Improvements in stress measures, job characteristics, and � Improvements in stress measures, job characteristics, and � lifestyle lifestyle Typical problems such as stress and physical hazards � Typical problems such as stress and physical hazards � remain remain Tuchsen et al. Unpublished manuscript. 13

Copenhagen Healthy Bus project Copenhagen Healthy Bus project examples of interventions examples of interventions � Job characteristics/work organization Job characteristics/work organization � Test more flexible schedules � Test more flexible schedules � Meet drivers wishes on rotation, typical and holiday schedules � Meet drivers wishes on rotation, typical and holiday schedules � Better communication between management and drivers � Better communication between management and drivers � � Life style Life style � Smoking cessation, healthy diet courses � Smoking cessation, healthy diet courses � Fresh fruit available in garage � Fresh fruit available in garage � � Competence/education Competence/education � Education of managers in personnel mgmt and communication � Education of managers in personnel mgmt and communication � Courses on handling threats & violence; “know your bus” � Courses on handling threats & violence; “know your bus” � � Physical work environment Physical work environment � More resources for bus preventive maintenance � More resources for bus preventive maintenance � Joint labor- -management meetings management meetings � Joint labor � 14 Tuchsen et al. Unpublished manuscript.

Copenhagen Healthy Bus project: Copenhagen Healthy Bus project: changes from baseline (1999- -2000) to follow 2000) to follow- -up (2003 up (2003- -4) 4) changes from baseline (1999 Baseline Follow-up 80 72 70 66 60 55 53 50 43 43 40 40 % 33 30 29 28 30 20 19 20 12 10 0 Job stress Fatigue Can’t take Rush hour Managers Exercise Healthy full break time table do not >3.5 diet too tight treat drivers hrs/wk well Tuchsen et al. Unpublished manuscript. 15