Sara J. Cox

Relationship between work stress and body mass index among 45,810 female and male employees

Objective: The proportion of overweight and obese people has grown rapidly, and obesity has now been widely recognized as an important public health problem. At the same time, stress has increased in working life. The 2 problems could be connected if work stress promotes unhealthy eating habits and sedentary behavior and thereby contributes to weight gain. This study explored the association between work stress and body mass index (BMI; kg/m2). Methods: We used cross-sectional questionnaire data obtained from 45,810 female and male employees participating in the ongoing Finnish Public Sector Cohort Study. We constructed individual-level scores, as well as occupational- and organizational-level aggregated scores for work stress, as indicated by the demand/control model and the effort–reward imbalance model. Linear regression analyses were stratified by sex and socioeconomic status (SES) and adjusted for age, marital status, job contract, smoking, alcohol consumption, physical activity, and negative affectivity. Results: The results with the aggregated scores showed that lower job control, higher job strain, and higher effort–reward imbalance were associated with a higher BMI. In men, lower job demands were also associated with a higher BMI. These associations were not accounted for by SES, although an additional adjustment for SES attenuated the associations. The results obtained with the individual-level scores were in the same direction, but the relationships were weaker than those obtained with the aggregated scores. Conclusions: This study shows a weak association between work stress and BMI. BMI = body mass index; CHD = coronary heart disease; CRF = corticotropin-releasing factor; MET = metabolic equivalent task; SES = socioeconomic status.

Low workplace social capital as a predictor of depression - The Finnish public sector study

In a prospective cohort study of Finnish public sector employees, the authors examined the association between workplace social capital and depression. Data were obtained from 33,577 employees, who had no recent history of antidepressant treatment and who reported no history of physician-diagnosed depression at baseline in 2000-2002. Their risk of depression was measured with two indicators: recorded purchases of antidepressants until December 31, 2005, and self-reports of new-onset depression diagnosed by a physician in the follow-up survey in 2004-2005. Multilevel logistic regression analysis was used to explore whether self-reported and aggregate-level workplace social capital predicted indicators of depression at follow-up. The odds for antidepressant treatment and physician-diagnosed depression were 20-50% higher for employees with low self-reported social capital than for those reporting high social capital. These associations were not accounted for by sex, age, marital status, socioeconomic position, place of work, smoking, alcohol use, physical activity, and body mass index. The association between social capital and self-reported depression attenuated but remained significant after further adjustment for baseline psychological distress (a proxy for undiagnosed mental health problems). Aggregate-level social capital was not associated with subsequent depression.

Psychometric evaluation of a short measure of social capital at work

BackgroundPrior studies on social capital and health have assessed social capital in residential neighbourhoods and communities, but the question whether the concept should also be applicable in workplaces has been raised. The present study reports on the psychometric properties of an 8-item measure of social capital at work.MethodsData were derived from the Finnish Public Sector Study (N = 48,592) collected in 2000–2002. Based on face validity, an expert unfamiliar with the data selected 8 questionnaire items from the available items for a scale of social capital. Reliability analysis included tests of internal consistency, item-total correlations, and within-unit (interrater) agreement by rwgindex. The associations with theoretically related and unrelated constructs were examined to assess convergent and divergent validity (construct validity). Criterion-related validity was explored with respect to self-rated health using multilevel logistic regression models. The effects of individual level and work unit level social capital were modelled on self-rated health.ResultsThe internal consistency of the scale was good (Cronbachs alpha = 0.88). The rwgindex was 0.88, which indicates a significant within-unit agreement. The scale was associated with, but not redundant to, conceptually close constructs such as procedural justice, job control, and effort-reward imbalance. Its associations with conceptually more distant concepts, such as trait anxiety and magnitude of change in work, were weaker. In multilevel models, significantly elevated age adjusted odds ratios (ORs) of poor self-rated health (OR = 2.42, 95% confidence interval (CI): 2.24–2.61 for the women and OR = 2.99, 95% CI: 2.56–3.50 for the men) were observed for the employees in the lowest vs. highest quartile of individual level social capital. In addition, low social capital at the work unit level was associated with a higher likelihood of poor self-rated health.ConclusionPsychometric techniques show our 8-item measure of social capital to be a valid tool reflecting the construct and displaying the postulated links with other variables.

Job strain, effort-reward imbalance, and heavy drinking: A study in 40,851 employees

Objective: The objective of this study was to examine the relationship of the job strain model and the effort–reward imbalance model with heavy drinking. Methods: Questionnaire survey data were obtained from 32,352 women and 8499 men employed in the Finnish public sector (participation 67%). Logistic regression analyses for all employees and for separate subgroups were undertaken by sex, adjusted for age, education, occupational position, marital status, job contract, smoking, and negative affectivity. Different cutoff points of heavy drinking were used for men and women. Results: High job strain and high effort–reward imbalance as global constructs were not associated with heavy drinking. However, some components of these models were associated with heavy drinking but the relationships were not all in the expected direction and they varied by sex, age, and occupational position. Conclusions: Stressful work conditions are not consistently associated with heavy drinking.

Organisational justice and smoking: the Finnish public sector study

Objective: To examine the extent to which the justice of decision-making procedures and interpersonal relationships is associated with smoking. Setting: 10 municipalities and 21 hospitals in Finland. Design and participants: Cross-sectional data derived from the Finnish Public Sector Study were analysed with logistic regression analysis models with generalised estimating equations. Analyses of smoking status were based on data provided by 34 021 employees. Separate models for heavy smoking (⩾20 cigarettes/day) were calculated for 6295 current smokers. Results: After adjustment for age, education, socioeconomic position, marital status, job contract and negative affectivity, smokers who reported low procedural justice were about 1.4 times more likely to smoke ⩾20 cigarettes/day compared with their counterparts who reported high levels of justice. In a similar way, after adjustments, low levels of justice in interpersonal treatment was significantly associated with an increased prevalence of heavy smoking (OR 1.35, 95% CI 1.03 to 1.77 for men and OR 1.41, 95% CI 1.09 to 1.83 for women). Further adjustment for job strain and effort–reward imbalance had little effect on these results. No associations were observed between justice components and smoking status or ex-smoking. Conclusions: The extent to which employees are treated with justice in the workplace seems to be associated with smoking intensity independently of established stressors at work.

Relationship between job strain and smoking cessation: the Finnish Public Sector Study

Aims: To examine whether job strain (ie, excessive demands combined with low control) is related to smoking cessation. Methods: Prospective cohort study of 4928 Finnish employees who were baseline smokers. In addition to individual scores, coworker-assessed work unit level scores were calculated. A multilevel logistic regression analysis, with work units at the second level, was performed. Results: At follow-up, 21% of baseline smokers had quit smoking. After adjustment for sex, age, employer and marital status, elevated odds ratios (ORs) for smoking cessation were found for the lowest vs the highest quartile of work unit level job strain (OR 1.43, 95% CI 1.17 to 1.75) and for the highest vs the lowest quartile of work unit level job control (OR 1.61, 95% CI 1.31 to 1.96). After additional adjustment for health behaviours and trait anxiety, similar results were observed. Further adjustment for socioeconomic position slightly attenuated these associations, but an additional adjustment for individual strain/control had little effect on the results. The association between job strain and smoking cessation was slightly stronger in light than in moderate/heavy smokers. The results for individual job strain and job control were in the same direction as the work unit models, although these relationships became insignificant after adjustment for socioeconomic position. Job demands were not associated with smoking cessation. Conclusions: Smoking cessation may be less likely in workplaces with high strain and low control. Policies and programs addressing employee job strain and control might also contribute to the effectiveness of smoking cessation interventions.

Assessing the impact of stressful incidents in organizations: the development of an extended impact of events scale

Employers are becoming increasingly aware of the risks to employee wellbeing associated with the traumatic incidents that occur in the workplace. Despite this increased organizational awareness of the need to protect employees from the damaging effects of traumatic events, there has been little provision to help organizations to evaluate their management systems and post trauma interventions. This problem of a lack of evaluation has become more important as a growing body of evidence has provided evidence that suggests that trauma debriefing, the widely used approach to traumatic stress may be ineffective or damaging. The problem for an organization is to have a means of assessing the impact of a traumatic incident on exposed employees soon after the event and at regular intervals as a way of tracking the effectiveness of the treatment and rehabilitation programme. This paper examines the development and validation of a traumatic stress questionnaire designed to be used by trained practitioners working with traumatized employees. The extended impact of events scale (IES-E), took the 15 items from the impact of events scale (IES) and added eight new items which had been chosen on the basis of existing theory and clinical experience to represent the traumatic stress symptom of hyperarousal. Two studies are reported which examine the structure and reliability, and then the discriminant validity of the extended scale when used with a working population. The first study involved a factor analysis of the IES-E items using data collected from 105 subjects who had formally reported exposure to stressful work events to their employing organization. The second study then used the IES-E to compare employees self-reporting of the impact of either a major positive or a major negative life event. The results of the first study confirmed the presence of the re-experience and avoidance symptoms as a response to a traumatic event (as in the IES) but, in addition, identified a new factor, arousal and a new measurement model based on a single general factor. The reliability coefficients for all three scales and the general factor were found to be good. The second study showed that IES-E scores on re-experience, avoidance, arousal and the general factor could be used to discriminate between the subjects reporting major positive and negative life events. Two measurement models can therefore describe the impact of stressful events, the first based on three orthogonal factors, and the second based on a single general factor. The theoretical implications of these findings are explored.

Correction: psychometric evaluation of a short measure of social capital at work

In review of our article (Kouvonen et al: BMC Public Health 2006, 6:251) we found an error in the equation of our measurement of trait anxiety.

Psychometric evaluation of a short measure of social capital at work (vol 6, pg 251, 2006)

In review of our article (Kouvonen et al: BMC Public Health 2006, 6:251) we found an error in the equation of our measurement of trait anxiety.

Work-related reproductive health: A review

This paper reviews the literature concerning the impact of work on reproductive health. In doing so, it offers a framework model for guiding future research and practice. Contemporary models of occupational health usually identify at least two pathways linking exposure to workplace hazards to their effects on health. The study of work-related reproductive health has been largely restricted to the effects of the more tangible and physical hazards of work mediated by a largely physico-chemical pathway. However, the growth of research into the psycho-physiological influence of stress on reproductive health provides a new direction for research in this domain with the exploration of a complementary pathway. The extension of this new approach into the investigation of the effects of work design and management on reproductive health represents a potentially important and further development.