Dorothy Broom

Work and health in a contemporary society: demands, control, and insecurity

Objective: To examine independent associations of job strain (high demands and low control) and job insecurity with mental and physical health outcomes. Design: Cross sectional general population study conducted in 2000 using a self completed questionnaire. Setting: Two adjoining cities in south east Australia. Subjects: 1188 employed professionals, aged 40–44 years, 55% (n = 655) male. Main outcome measures: Depression, anxiety, physical, and self rated health (SRH). Results: Adverse job conditions were relatively prevalent as 23% of the sample reported high job strain, while 7.3% and 23% reported high and moderate job insecurity respectively. Associations between job conditions and health persisted after adjustment for gender, education, marital status, employment status, major life events, and negative affectivity (personality). When adjusted for job strain, high job insecurity was independently associated with a greater than threefold increase in odds for poor SRH, depression and anxiety (OR (95% confidence intervals) poor SRH: 3.72 (1.97 to 7.04) depression: 3.49 (1.90 to 6.41), anxiety: 3.29 (1.71 to 6.33)), and a twofold increase for physical health 2.19 (1.21 to 3.95). High job strain also showed significant independent associations with depression: 2.54 (1.34 to.4.75) and anxiety: 3.15 (1.48 to 6.70). Conclusion: In this relatively privileged socioeconomic group, insecure employment and high job strain showed independent, consistent, and strong associations with physical and mental health. These adverse job conditions are on the increase, particularly insecure employment, and the influence of these two work conditions are an important focus for future public health research and their prevalence and impact should be examined in other occupations.

The psychosocial quality of work determines whether employment has benefits for mental health: results from a longitudinal national household panel survey

Objectives Although employment is associated with health benefits over unemployment, the psychosocial characteristics of work also influence health. We used longitudinal data to investigate whether the benefits of having a job depend on its psychosocial quality (levels of control, demands and complexity, job insecurity, and unfair pay), and whether poor quality jobs are associated with better mental health than unemployment. Method Analysis of seven waves of data from 7,155 respondents of working age (44,019 observations) from a national household panel survey. Longitudinal regression models evaluated the concurrent and prospective association between employment circumstances (unemployment and employment in jobs varying in psychosocial job quality) and mental health, assessed by the MHI-5. Results Overall, unemployed respondents had poorer mental health than those who were employed. However the mental health of those who were unemployed was comparable or superior to those in jobs of the poorest psychosocial quality. This pattern was evident in prospective models: those in the poorest quality jobs showed greater decline in mental health than those who were unemployed (B = 3.03, p<0.05). The health benefits of becoming employed were dependent on the quality of the job. Moving from unemployment into a high quality job led to improved mental health (mean change score of +3.3), however the transition from unemployment to a poor quality job was more detrimental to mental health than remaining unemployed (−5.6 vs −1.0). Conclusions Work of poor psychosocial quality does not bestow the same mental health benefits as employment in jobs with high psychosocial quality.

Women's understanding of abnormal cervical smear test results: a qualitative interview study.

Abstract Objective: To describe how women interpret their experiences of diagnosis and treatment of a cervical abnormality and how healthcare services for such women can be improved. Design: Qualitative study using detailed individual interviews. Setting: Australian gynaecology clinics. Subjects: 29 Women who had a cervical cytological abnormality and who attended a gynaecologist. Main outcome measures: Womens views on their diagnosis and their information needs. Results: Most women wanted to participate in decisions about their care but found it difficult to get the information they required from doctors because they were confused by what their doctors told them and felt unable to ask questions in the consultation. Medical terms such as wart virus and precancer were difficult to understand. Not being able to see their cervix also made it hard for women to understand what their abnormality meant and what treatment entailed. Most women tried to make sense of their abnormality in the context of their everyday lives. For some women their gynaecological care was not consistent with the way they understood their abnormality. Conclusions: The inherent power structure of medical practice combined with time pressures often make it difficult for doctors to give the detailed information and reassurance patients need when a diagnosis is distressing or when investigation and treatment are strange and upsetting. Key messages Women who have abnormalities detected on cervical smears are confused, afraid, and find it difficult to get the information they require In this study women often assumed that they had cancer because they did not know that smear tests detected precancerous lesions Women needed information about the seriousness of their abnormality, the rationale for treatment, and the precautions recommended after treatment Because the abnormality involved the cervix many women felt their femininity was undermined Women used explanations such as stress, the pill, or sexual activity to make sense of their condition and through these explanations identified things they could do to reduce their risk of cervical cancer

Does gender modify associations between self rated health and the social and economic characteristics of local environments

Objectives: To examine whether area level socioeconomic disadvantage and social capital have different relations with women’s and men’s self rated health. Methods: The study used data from 15 112 respondents to the 1998 Tasmanian (Australia) healthy communities study (60% response rate) nested within 41 statistical local areas. Gender stratified analyses were conducted of the associations between the index of relative socioeconomic disadvantage (IRSD) and social capital (neighbourhood integration, neighbourhood alienation, neighbourhood safety, political participation, social trust, trust in institutions) and individual level self rated health using multilevel logistic regression analysis before (age only) and after adjustment for individual level confounders (marital status, indigenous status, income, education, occupation, smoking). The study also tested for interactions between gender and area level variables. Results: IRSD was associated with poor self rated health for women (age adjusted p<0.001) and men (age adjusted p<0.001), however, the estimates attenuated when adjusted for individual level variables. Political participation and neighbourhood safety were protective for women’s self rated health but not for men’s. Interactions between gender and political participation (p = 0.010) and neighbourhood safety (p = 0.023) were significant. Conclusions: These finding suggest that women may benefit more than men from higher levels of area social capital.

Job Strain, Job Insecurity, and Health: Rethinking the Relationship

Job strain (high demands and low control) is a widely used measure of work stress. The authors introduce a new way of looking at work stress by combining job strain with job insecurity, a combination increasingly prevalent in contemporary economies, using data from a cross-sectional survey (N = 1,188) of mid-aged Australian managers and professionals. Those reporting both strain and insecurity showed markedly higher odds for mental and physical health problems (depression: odds ratio [OR] 13.88, 95% confidence interval [CI] 5.67-34.01; anxiety: OR 12.88, CI 5.12-32.39; physical health problems: OR 3.97, CI 1.72-9.16; and poor self-rated health: OR 7.12, CI 2.81-18.01). Job strain and insecurity showed synergistic associations with health, and employees experiencing both could be at heightened health risk.

Acts of Love (and Work): Gender Imbalance in Emotional Work and Women’s Psychological Distress

Family members do work to meet people’s emotional needs, improve their well-being, and maintain harmony. When emotional work is shared equally, both men and women have access to emotional resources in the family. However, like housework and child care, the distribution of emotional work is gendered. This study examines the psychological health consequences of gender divisions in emotional work. Quantitative and qualitative data from a sample of 102 couples with young children show that the gender imbalance affected women’s, but not men’s, experience of love and conflict in their marriage. Through this erosion of the marriage, the gender imbalance posed a health risk to women and helped explain gender differences in psychological distress. Couples preserved a sense of mutuality by accounting for the gender imbalance as something beyond men’s choice or control, or in terms of women’s excess emotional needs, thus entrenching gender differences in the performance and consequences of emotional work.

Reading Breast Cancer: Reflections on a Dangerous Intersection

Because breast is the most common female cancer, it is no surprise that it has prompted lobbying and extensive clinical research. Many women have written autobiographical accounts of their diagnosis and treatment, but there has been little effort to apply the perspectives of feminist or other social theory to our understandings of breast cancer. I propose that breast cancer is located at a meeting point between (at least) four sets of discourses and practices: those relevant to all life-threatening illness, those surrounding most or all cancers, those informing female-specific conditions and conditions of the breast specifically. This article considers how each of those domains defines and informs experiences of breast cancer and its treatment. I offer a reflection on that four-way intersection, and a move towards specifying how sociocultural fears about death, disease, sexuality and femininity converge to isolate and silence women who are diagnosed, to frame their choices and experiences, and to shape their stories.

Work demands, job insecurity and sickness absence from work. How productive is the new, flexible labour force?

Background: We investigate one aspect of productivity – sickness absence – and ask whether job insecurity and high work demands are associated with increased sickness absence and, if so, whether mental or physical health mediates this association. We further investigate if having control at work modifies these associations.

The limitations of employment as a tool for social inclusion

BackgroundOne important component of social inclusion is the improvement of well-being through encouraging participation in employment and work life. However, the ways that employment contributes to wellbeing are complex. This study investigates how poor health status might act as a barrier to gaining good quality work, and how good quality work is an important pre-requisite for positive health outcomes.MethodsThis study uses data from the PATH Through Life Project, analysing baseline and follow-up data on employment status, psychosocial job quality, and mental and physical health status from 4261 people in the Canberra and Queanbeyan region of south-eastern Australia. Longitudinal analyses conducted across the two time points investigated patterns of change in employment circumstances and associated changes in physical and mental health status.ResultsThose who were unemployed and those in poor quality jobs (characterised by insecurity, low marketability and job strain) were more likely to remain in these circumstances than to move to better working conditions. Poor quality jobs were associated with poorer physical and mental health status than better quality work, with the health of those in the poorest quality jobs comparable to that of the unemployed. For those who were unemployed at baseline, pre-existing health status predicted employment transition. Those respondents who moved from unemployment into poor quality work experienced an increase in depressive symptoms compared to those who moved into good quality work.ConclusionsThis evidence underlines the difficulty of moving from unemployment into good quality work and highlights the need for social inclusion policies to consider peoples pre-existing health conditions and promote job quality.

The health effects of jobs : Status, working conditions, or both?

Background: This study investigates whether the association of job strain and insecurity with health differs by status.