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Social Class

“Extensive research has documented that CVD is more common not only among people facing work stressors [11, 12], but also among people of lower social class or socioeconomic position (SEP), for example, lower levels of education, income, or occupational status (see chapter 3). One possible explanation for the social class differences in CVD is greater exposure to unhealthy working conditions among lower SEP groups. For example, job control was “the biggest factor contributing to the socioeconomic gradient” in heart disease “risk across civil service employment grade” in a major study of British civil servants [14, 15] (see Figure 2). The higher CVD risk among men and women in lower SEP groups, for example, blue-collar workers, began to appear in the 1950s [16-18] and has risen progressively since then [19]. Among U.S. men aged 25-64, in 1969-70, low SEP men had a 30% greater risk of dying of CVD than high SEP men of the same age. However, it had increased to an 80% greater risk by 1997-98 [19]. Differences between higher and lower SEP groups in new cases of CVD, whether fatal or not, are also increasing [20, 21].”

Taken from: Schnall PL, Dobson M, Rosskam E, Editors Unhealthy Work: Causes, Consequences, Cures. Baywood Publishing, 2009.

11. Karasek, R. and T. Theorell, Healthy Work: Stress, Productivity, and the Reconstruction of Working Life, Basic Books, New York, 1990.

12. Schnall, P., K. Belkic, P. A. Landsbergis, and D. E. Baker, The Workplace and Cardiovascular Disease, in Occupational Medicine: State-of-the-Art Reviews, Hanley and Belfus, Philadelphia, PA, 2000a.

14. Kawachi, I. and M. Marmot, What Can We Learn from Studies of Occupational Class and Cardiovascular Disease?, American Journal of Epidemiology, 148, pp. 160-163, 1998.

15. Marmot, M. G., H. Bosma, H. Hemingway, E. Brunner, and S. Stansfeld, Contribution of Job Control and Other Risk Factors to Social Variations in Coronary Heart Disease Incidence, Lancet, 350, pp. 235-239, 1997.

16. Gonzalez, M. A., F. R. Artalejo, and J. R. Calero, Relationship between Socioeconomic Status and Ischaemic Heart Disease in Cohort and Case-Control Studies: 1960-1993, International Journal of Epidemiology, 27:3, pp. 350-358, 1998.

17. Marmot, M., A. M. Adelstein, N. Robinson, et al., Changing Social Class Distribution of Heart Disease, British Medical Journal, 2, pp. 1109-1112, 1978.

18. Wing, S., P. Dargent-Molina, M. Casper, W. Riggan, C. G. Hayes, and H. A. Tyroler, Changing Association between Community Structure and Ischaemic Heart Disease Mortality in the United States, Lancet, 2:8567, pp. 1067-1070, 1987.

19. Singh, G. K. and M. Siahpush, Increasing Inequalities in All-Cause and Cardiovascular Mortality among US Adults Aged 25-64 Years by Area Socioeconomic Status, 1969-1998, International Journal of Epidemiology, 31, pp. 600-613, 2002.

20. Hallqvist, J., M. Lundberg, F. Diderichsen, and A. Ahlbom, Socioeconomic Differences in Risk of Myocardial Infarction 1971-1994 in Sweden: Time Trends, Relative Risks and Population Attributable Risks, International Journal of Epidemiology, 27, 
pp. 410-415, 1998.

21. Tuchsen, F. and L. A. Endahl, Increasing Inequality in Ischaemic Heart Disease Morbidity among Employed Men in Denmark 1981-1993: The Need for a New Preventive Policy, International Journal of Epidemiology, 28, pp. 640-644, 1999.

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Work Stressors and Social Class (2004)

Jeffrey V. Johnson, PhD
University of Maryland


Social class position is a powerful predictor of illness and death from many forms of both chronic and infectious disease. Those in the upper class live longer and are healthier while doing so. Those in lower classes die at a younger age and are considerably less healthy over their entire life course (Evans, 1994). Moreover, numerous studies have found that a “gradient” exists along the social class continuum – with increasingly higher class position, health improves, and with descending class position health deteriorates (Marmot et al, 1978, Lynch & Kaplan, 2000). Although there continues to be a considerable discussion as to what explains this class gradient, there is an emerging consensus that social class is a “fundamental determinant” of population health. (Link & Phalen, 1995) Together with race and gender, class constitutes a core social structure (House & Williams, 2003). SSocial class is more than a property of individuals, rather, , it is more than a ‘position’ one occupies — it is also an expression of macro-societal forcessystem that “produces” stratified hierarchies within modern societies. As a societal structure social class is associated withpositions. It is a social structure that creates the enormous inequalities that we observe in nearly every aspect of human existence across the entire life course. Social class is also intimately bound up with work and the labor process (Johnson & Hall, 1995, Wright, 1988). It is through our work, and the work of our parents, that we enter into the life chances and circumstances of a particular social class.

Some of the pathways linking lower social class position to ill health include economic deprivation, lack of educational opportunities, and adverse exposures associated with differences in geographic and community environmental characteristics such as exposure to violence and to toxic substances like lead and carbon monoxide (Lynch & Kaplan, 2000, Evans & Kantrowitz, 2002). Other pathways involve class differences in consumption patterns including unhealthy foods, cigarettes, alcohol and illicit drug usage (Cockerham, 2000)usage. Social class position is also strongly associated with access (or lack there of) to social and public resources, informal social networks, institutional resources, and inter-generational resources. Still another pathway involves differences in the nature of the social and work environments, and includes the class differences in stress from adverse labor market experiences, including unemployment, underemployment and chronic exposure to stressful work organizations (House & Williams, 2003, Seigrist & Marmot, 2004). These specific pathways linking social class to health may change over time. New causal paths might emerge, others might be removed, yet as long as the society continues to have a social class structure it is almost certain there will continue to be health “disparities” (differences) between classes – this is what is meant when we say class is a “fundamental determinant” of health (Link & Phalen, 1995).

Social class position is frequently defined with respect to one’s occupation. Until recently skill levels have been used to distinguish different occupational class groups. Frequently a 5 occupational class scheme is used: 1st Class: Upper Level Managers and Professionals; 2nd Class: Medium Level Managers and Professionals; 3rd Class: Lower Level Office and Service Workers; 4th Class: Skilled Manual Workers; 5th Class: Unskilled Manual Workers. Critics have pointed out a number of problems with this definition of social class. Some have suggested that the degree to which the work has become routine is a more meaningful distinguishing characteristic today than skill. Others argue that the degree of control over the work process is the most important underlying element of social class (Marmot & Bartley, 2002).

There are, in fact, marked differences in a number of work organization characteristics across the different social class groups (Kristensen, 2002). The degree of control at work is strongly associated with social class position (Johnson & Hall, 1995). Social support at work, by contrast is only weakly (but [but positively?)] associated with social class. Other exposures tend to be much more present in certain class groups than others. Hazardous work exposures and heavy physical job demands are often present in lower level service and manual groups while being almost non-existent in managerial/professional class groups (Johnson & Hall, 1992). When examining patterns of multiple exposures across social class groups it becomes evident that Social Class 3 (the lower level office and service workers) is much more like Social Classes 4 and 5 (manual workers) than they are like Social Classes 1 and 2 (managerial/professional workers). The managerial/professional class tends to have high psychological job demands, high levels of work control, and very low levels of physical demands and low levels of hazardous exposure. They work longer work hours and their jobs require considerable flexibility (Johnson & Hall, 1992). Working class jobs by contrast have much less control, are more routine, and have fewer psychological job demands and considerable monotony. Working class jobs also have much higher physical demands and more hazardous exposures (Johnson & Hall, 1992). In addition, recent research findings using the two most prominent conceptual models of work stress have shown that those in lower social class positions are more likely to be exposed to high demands and low control as well as experience jobs with high demands for effort coupled with low rewards (Seigrist & Marmot, 2004). WWork environment exposure comes bundled by social class, and the most meaningful distinction is between a managerial/professional class on the one hand and a working class on the other. (Johnson & Hall, 1992, 1995).

The impact of adverse work organization exposure also varies markedly by social class. For example, a number of studies have shown that the impact of Job Strain (high demand/low control jobs) and Iso-Strain (high demand/low control/low social support jobs) is significantly greater for individuals in working class occupations compared to those in managerial/professional jobs (Johnson & Hall, 1988; Johnson Hall & Theorell; 1989, Landsbergis et al, 2003). Moreover, research findings also indicate that class differences in adverse work organization exposure (particularly in job control, or lack thereof) may be an important causal mechanism that helps explain the relationship between social class position and health (Marmot & Theorell, 1988, Marmot et al, 1997). Recent findings from the European Science Foundation’s Study on Social Variation in Health Expectancy strongly suggest that workers in lower social class positions are more vulnerable to the impact of both Job Strain (high demands and low control) and effort/reward imbalance (Seigrist & Marmot, 2004). 

In addition to looking at differences in exposure between social class groups, it is important to examine how and why these kinds of disparities exist. Clearly there are great structural differences between classes in terms of the ownership of wealth and control over workplace institutions. The class structure of modern society is an expression of dynamic political and economic forces operating over time at macro-societal and increasingly global levels (Moody, 1997; Navarro, 2002). Although social classes have been present since the agricultural revolution and early urban settlement, their present form emerged with the industrial revolution and the growing centrality of the market economy as the predominant influence over the structure of society. It has been suggested that market economies today have three fundamental social classes: (1) a very small elite made up of the most wealthy and powerful members of the society who own and control large corporations and other powerful institutions, (2) an increasingly large working class whose members provide and care for the human energy that produces the goods and services that are bought and sold in the marketplace and (3) a third class made up of managers and professionals that share some of the characteristics of both the elite class and the working class, and hence are said to occupy a “contradictory class location” in that their work involves administering bureaucratic organizations in the interests of the elite, yet their personal history, work experience and professional training and ethics may lead them to identify with the working class (Wright, 1988; Moody, 1997; Perrucci & Wysong, 1999; ).

In order to survive in dynamic and competitive environments, corporations must continue to grow by increasing the rate at which profits are generated. Historically, one important way in which this has occurred is through managerial and technological innovations focused on increasing productivity – often by changes in work organization designed to reduce labor costs. ‘Scientific Management’ or ‘Taylorism’ is perhaps the most well known example of how this process can lead to a transformation in how work is organized. (Braverman, 1974). In the late 19th and early 20th Century F.redrick W.inslow Taylor, advocated a radical program of removing planning and decision-making authority from skilled workers on the shop floor, while, at the same time centralizing mental and conceptual work in the hands of a new managerial class. By fragmenting the work process into its simplest possible components, the proponents of “scientific management” hoped to both reduce labor costs by employing fewer skilled workers and to increase productivity through their newly won control over the pace, speed and intensity of the production process itself. Work environments that have been designed in this way implicitly embody class relations. To the extent that work is fragmented and deskilled for the working class, it becomes more manageable by the employing class (Braverman, 1974, Moody, 1997). The control over pace and intensity of work performance has historically been transferred from workers to owners for the purpose of increasing the profitability of the enterprise. The technical aspects of this work transformation have been implemented by the managerial/professional class, indeed, “Scientific management” techniques became the bedrock of industrial engineering, and they continue to dominate the ways in which jobs are designed even today (Kanigel, 1997).

The work organizations created by “scientific management” are highly stressful jobs (Johnson, 1980). These workplaces produce high levels of “job strain” (see section 4A) because they have very high demands for performance and productivity and, at the same time, very low levels of control over meaningful decisions about how the work is to be performed. These principles of job design have also had an enormous influence over changes in work organizations in the health care and human service sector. Moreover, “lean production” methods (see section 2Biii) have led to an even more intensified form of Taylorism, referred to by some observers as a kind of “management by stress.” (Moody, 1997).

Managerial and technological innovations, though seemingly class-neutral, represent a kind of ‘social choice’ (Noble, 1977). The nature of specific character of these choices that have been made in the United Statesour country suggests a deep suspicion of and a fear directed toward the working class. Researchers have pointed out that the degree to which workers have been stripped of skills and authority in the workplace has far exceeded that which would in reality have been the most rational and efficient approach (Noble, 1984). This ‘irrationality’ has also been the case with the intense waves of downsizing and restructuring that have swept through work organizations over the last two decades – the health of firms, and their capacity to creatively produce has often been harmed by these types of extreme measures.

The globalization of work and the labor process has also taken on a class character. The transfer of many jobs to low wage countries, and perhaps even more importantly, the threat that this transfer might occur, has severed much of the social contract that existed in the U.S. between classes in the post wworld wwar ttwo era. In many ways, we have returned to the starker realities of the 19th century social landscape with an increasing polarization between society’s ‘winners’ and ‘losers’. Third World Workers have also become victims of a “downward leveling” – a “race to the bottom” where we see the working conditions for most of the working class being pulled in the direction of the most desperate and least empowered (Brecher & Costello, 1994; Moody, 1997) Yet, if at the most only 20% of the society can be considered ‘winners’ in the process of economic globalization, what will become of the remaining 80%? In the past century, social movements (such as the labor movement) developed to challenge economic and political inequalities . The same kind of social movements are being mobilized today, only now on a global level. These movements for economic and global justice may transform the politics of the 21st century and could improve work organization and working conditions and reduce job stress in both developed and developing countries (Teivainen T, 2002) .


References

Braverman H. Labor and Monopoly Capital. New York, Monthly Review Press, 1974.

Brecher J, Costello T. Global Village or Global Pillage. Boston, Mass: South End Press, 1994.

Cockerham WC. The Sociology of Health Behavior and Health Lifestyles. Pages 159-172 in Bird CE, Conrad P, Fremont AM (Eds.) Handbook of Medical Sociology. Upper Saddle River, NJ: Prentice Hall, 2000.

Evans GW, Kantrowitz E. Socioeconomic Status and Health: The Potential Role of Environmental Risk Exposure. Annual Review of Public Health 2002;23;303-31.

Evans RG. Chapter 1: Introduction. Pages 3-26 in Evans RG, Barer ML, Marmor TR (Eds.) Why Are Some People Healthy and Others Not? The Determinants of Health in Populations. New York: Aldine De Gruyter, 1994.

House JS, Williams DR. Understanding and Reducing Socioeconomic and Racial/Ethnic Disparities in Health. Pages 89-131 in Hofrichter R (Ed) Health and Social Justice. San Francisco, CA: Jossey-Bass, 2003.

Johnson JV. Work Fragmentation, Human Degradation and Occupational Stress. Washington DC, U.S. Department of Labor, Occupational Health and Safety Administration, 1980.

Johnson JV, Hall EM. Job Strain, Work Place Social Support, and Cardiovascular Disease: A Cross-Sectional Study of a Random Sample of the Swedish Working Population. American Journal of Public Health, 1988;78(10): 1336-1342.

Johnson JV, Hall EM, Theorell T. Combined effects of job strain and social isolation on cardiovascular disease morbidity and mortality in a random sample of the Swedish male working population. Scandinavian Journal of Work Environment and Health 1989;15;271-279.

Johnson JV, Hall EM. Towards an Understanding of the Interconnectedness of Class, Work and Health. Paper Prepared for Author’s Working Conference on Society and Health, Harvard University, October 1992.

Johnson JV, Hall EM. Class, Work, and Health. Pages 247-271 in Amick BC, Levine S, Tarlov, AR, Walsh DC (Eds.) Society and Health. New York: Oxford University Press, 1995.

Kanigel R. The One Best Way: Frederick Winslow Taylor and the Enigma of Efficiency. New York: Viking, 1997.

Kristensen TS, Borg V, Hannerz H. Socioeconomic Status and Psychosocial Work Environment: Results from a Danish National Study. Scand J Public Health. 2002;Suppl 59:41-8.

Landsbergis P, Schnall P, Pickering T, Warren K, Schwartz J. Lower socioeconomic status among men in relation to the association between job strain and blood pressure. Scandinavian Journal of Work, Environment and Health 2003;29(3):206-215.]

Link BG, Phelan JC. Social conditions as Fundamental Causes of Disease. Journal of Health and Social Behavior. Extra Issue. 80-94, 1995.

Lynch J, Kaplan G. Socioeconomic Postion. Pages 13-35 in Berkman LF, Kawachi I (Eds.) Social Epidemiology. New York: Oxford University Press, 2000.

Marmot MG, Rose G, Shipley M, Hamiltion PJS. Employment grade and coronary heart disease in British civil servants. J Epidemiol Community Health 32:244-9, 1978.

Marmot MG, Bosma H, Hemingway H, Brunner E, Stansfeld S. Contribution of job control and other risk factors to social variations in coronary heart disease incidence. Lancet 1997;350:235-9.

Marmot M, Bartley M. Social class and coronary heart disease. Pages 5-19 in SA Stansfeld & MG Marmot (Eds). Stress and the Heart. London: BMJ Books, 2002.

Marmot M, Theorell T. Social Class and Cardiovascular Disease: The Contribution of Work. International Journal of Health Services 1988; 18:659-74.

Moody, K. Workers in a Lean World. London: Verso, 1997.

Navarro V, Neoliberalism, “Globalization,” Unemployment, Inequalities, and the Welfare State. Pages 33-108 in Navarro V (Ed) The Political Economy of Social Inequalities: Consequences for Health and the Quality of Life. Amityville, New York: Baywood Publishing Company, 2002.

Noble, DF. America by Design. New York: Oxford University Press, 1977.

Noble DF, Forces of Production. New York: Alfred A. Knopf, 1984.

Perrucci R, Wysong. The New Class Society. New York: Rowman and Littlefield Publishers, Inc, 1999.

Siegrist J, Marmot M. Health Inequalities and the Psychosocial Environment – Two Scientific Challenges. Social Science and Medicine 2004;58(8):1463-73.

Teivainen T. The World Social Forum and Global Democratisation: Learning from Porto Alegre. Third World Quaterly 2002;23(4):621-632.

Wright EO. Classes. London: Verso, 1985.

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Social Inequality, Stress and Health

Joseph E. Schwartz Schwartz, J. E. (2001): Social inequality, stress, and health. In Blau, J. R. (Ed.) The Blackwell Companion to Sociology. Malden: Blackwell Publishers Inc.


Research into the determinants of disease morbidity and mortality during most of the 20th century has been dominated by a biological model of disease as has the practice of medicine itself. Illnesses and other physical disorders were thought to be caused by harmful agents (e.g., bacteria or viruses causing infectious diseases, toxic chemicals, tobacco smoke, cholesterol, etc.) and/or a breakdown in one or more of the body’s organ systems. Consistent with this biomedical model, primary prevention of disease has focused on reducing the population’s exposure to toxic substances and procedures to control the spread of infections – for example, ensuring a clean water supply, quarantining infected individuals, and vaccinating individuals to make them immune to specific diseases.
It was not until 1977 that Engel published his seminal article setting forth the now widely accepted biopsychosocial model of disease. This article urged physicians and researchers to acknowledge and investigate the role of social, psychological, and behavioral factors in the prevention, etiology, and treatment of both physical and mental illnesses. Despite its wide acceptance, at least in principle, the vast majority of the medical literature ignores the role of psychological and sociological factors. A review of medical school curricula or the contents of leading journals (e.g. Journal of the American Medical Association or Lancet) suggests that the medical establishment remains skeptical about the relevance of psychosocial factors in the etiology of disease.
The above not withstanding, the subfield of “psychosomatic medicine,” historically dominated by psychiatrists, has a long tradition of emphasizing mind-body connections. Increasingly, a broader array of researchers have been investigating the impact of personality, behavior, and a variety of social factors on morbidity and mortality. While the majority are psychologists, there are also physicians, social epidemiologists, sociologists, anthropologists, and others. Many of these researchers identify themselves with one or more of the interdisciplinary fields of psychosomatic medicine, “behavioral medicine,” and “health psychology.”
In this chapter I review selected empirical findings and issues from behavioral medicine that are likely to interest sociologists. The first section is primarily descriptive, reviewing the fact that the risk of many diseases, and death itself, is socially patterned. Much of the emphasis is on mortality and cardiovascular disease, but the general point applies to other causes of death and many non-fatal diseases. Since, in my opinion, the subfield of social stratification lies at the core of sociology, and this section emphasizes the link between stratification and health. While many mechanisms surely contribute to this relationship, I am particularly interested in the effect that stress may have on health and the possibility that differential exposure to stress in the social environment partially accounts for social class differences in health. The latter part of the chapter presents select findings from studies of animals and humans pertaining to the impact of social stress on health.

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The MacArthur Research Network on Socioeconomic Status and Health is a multi-disciplinary collaboration comprising leading scholars from the fields of psychology, sociology, psychoneuroimmunology, medicine, epidemiology, neuroscience, biostatistics, and economics who have been working together for the last decade. The network research agenda is organized around an integrated conceptual model of the environmental and psychosocial pathways by which socioeconomic status alters the performance of biological systems, thereby affecting disease risk, disease progression, and ultimately mortality.

The network has enhanced understanding of the mechanisms by which socioeconomic factors affect the health of individuals and their communities through the development of innovative research methods, creation of significant new data sets, novel findings, and identification of new concepts, hypotheses and directions for research. Building on this work the network has contributed to discussions of economic and social policy to foster better health among individuals and communities across the socioeconomic spectrum.

http://www.macses.ucsf.edu/

Job Strain, Social Class and CVD

Cardiovascular disease

49. Johnson JV, Hall EM. Job strain, work place social support, and cardiovascular disease: A cross-sectional study of a random sample of the Swedish working population. Am J Public Health 1988;78:1336-42.

CVD – cross-sectional – stronger effect for Swedish blue-collar men

50. Johnson, J. V., Hall, E. M., Theorell, T. 1989. Combined effects of job strain and social isolation on cardiovascular disease morbidity and mortality in a random sample of the Swedish male working population. Scand J Work Eviron Health 15:271-79.

CVD – cohort – stronger effect for Swedish blue-collar men

54. Karasek RA, Baker D, Marxer F, Ahlbom A, Theorell T. Job decision latitude, job demands, and cardiovascular disease: A prospective study of Swedish men. Am J Public Health 1981;71:694-705.

CVD mortality – case-control – stronger effect for Swedish men
with less than high-school education

68. LaCroix AZ. High demand/low control work and the incidence of CHD in the Framingham Cohort. PhD Thesis. Univ. North Carolina, Chapel Hill, 1984.

CHD – cohort – stronger effect for Framingham clerical women

36. Hammar, N., Alfreddson, L., Theorell, T. Job characteristics and incidence of myocardial infarction: A study of men and women in Sweden, with particular reference to job strain. Int J Epidemiol 1994;23:277-284.

MI – case-control – slightly stronger effects among white- collar workers (Sweden)

new. Hall EM, Johnson JV, Tsou T-S. Women, occupation, and risk of cardiovascular morbidity and mortality. Occupational Medicine: State of the Art Reviews 1993;8:709-19.

CVD morbidity – cross-sectional – similar (NS) effects for blue-collar vs white-collar Swedish women

CVD mortality – cohort – stronger effects for low work control
and low social support for white-collar vs blue-collar Swedish women

Ambulatory blood pressure

114. Theorell T, Perski A, Akerstedt T, Sigala F, Ahlberg-Hulten G, Svensson J, Eneroth P. Changes in job strain in relation to changes in physiological states. Scand J Work Eviron Health 1988;14:189-96.

Work Ambulatory SBP – cohort – stronger effect for low status
jobs (e.g., waiters) out of 6 job titles in Sweden

new. Landsbergis PA, Schnall PL, Schwartz JE, Warren K, Pickering TG. The association of ambulatory blood pressure with alternative formulations of job strain. Scandinavian Journal of Work, Environment and Health 1994;20:349-63.

Work Ambulatory Blood Pressure, Risk of hypertension – stronger effect for New York City men with 12 years or less of education


Studies of Job Strain and Cardiovascular Disease (Or CVD Risk Factors) Which Stratify by Age


(“new” indicates articles published since the Ann. Rev. Pub. Health article by Schnall et al., 1994, was published; reference numbers are from the review article)

Cardiovascular disease

50. Johnson, J. V., Hall, E. M., Theorell, T. 1989. Combined effects of job strain and social isolation on cardiovascular disease morbidity and mortality in a random sample of the Swedish male working population. Scand J Work Eviron Health 15:271-79.

CVD – cohort – stronger effect for older Swedish white-collar men

53. Karasek, R. A. 1990. Lower health risk with increased job control among white collar workers. J Organiza Behav 11:171-85.

CHD symptoms – cross-sectional – stronger effect for older Swedish white-collar workers

68. LaCroix, A. Z. 1984. High demand/low control work and the incidence of CHD in the Framingham Cohort. PhD Thesis. Univ. North Carolina, Chapel Hill.

CHD – cohort – stronger effect for older women

Ambulatory blood pressure

101. Schnall PL, Schwartz JE, Landsbergis PA, Warren K, Pickering TG. The relationship between job strain, alcohol and ambulatory blood pressure. Hypertension 1992;19:488-94.

Work Ambulatory SBP –
stronger effect for older New York City men


Studies of Job Strain and Cardiovascular Disease (Or CVD Risk Factors) Which Stratify by Social Support


(“new” indicates articles published since the Ann. Rev. Pub. Health article by Schnall et al., 1994, was published; reference numbers are from the review article)

Cardiovascular disease

49. Johnson, J. V., Hall, E. M. 1988. Job strain, work place social support, and cardiovascular disease: A cross-sectional study of a random sample of the Swedish working population. Am J Public Health 78:1336-42.

CVD – cross-sectional – stronger Job Strain effect if low social support

All-cause mortality

8. Astrand, N. E., Hanson, B. S., Isacson, S. O. 1989. Job demands, job decision latitude, job support, and social network factors as predictors of mortality in a Swedish pulp and paper company. Br J Ind Med 46:334-40.

Mortality – cohort – weaker high latitude effect if high social support

25. Falk, A., Hanson, B. S., Isacsson, S-O., Ostergren, P-O. 1992. Job strain and mortality in elderly men: Social network, support, and influence as buffers. Am J Public Health 82:1136-39.

Mortality – cohort – stronger Job Strain effect if low social support

Ambulatory blood pressure

new. Landsbergis PA, Schnall PL, Schwartz JE, Warren K, Pickering TG. The association of ambulatory blood pressure with alternative formulations of job strain. Scandinavian Journal of Work, Environment and Health 1994;20:349-63.

Work and Home Ambulatory DBP – stronger effect for New York City men with lower social support


Studies of Job Strain and Cardiovascular Disease (Or CVD Risk Factors) Which Stratify by Gender


(“new” indicates articles published since the Ann. Rev. Pub. Health review article by Schnall et al., 1994 was published; reference numbers are from the review article)

Cardiovascular disease

68. LaCroix AZ. High demand/low control work and the incidence of CHD in the Framingham Cohort. PhD Thesis. Univ. North Carolina, Chapel Hill, 1984.

CHD – cohort – stronger effect for women (Framingham, U.S.)

5. Alfredsson L, Spetz CL, Theorell T. Type of occupation and near-future hospitalization for myocardial infarction and some other diagnoses. Int J Epidemiol 1985;14:378-88.

MI (hospitalizations) – cohort – similar effects for men and women (Sweden)

33. Haan MN. Job strain and ischaemic heart disease: An epidemiological study of metal workers. Ann Clin Res 1988;20:143-45.

CHD – cohort – similar effects for men and women (Finland)

36. 36. Hammar N, Alfreddson L, Theorell T. Job characteristics and incidence of myocardial infarction: A study of men and women in Sweden, with particular reference to job strain. Int J Epidemiol 1994;23:277-284.

CHD – case-control – similar effects for men and women (Sweden)

55. Karasek RA, Gardell B, Lindell J. Work and non-work correlates of illness and behaviour in male and female Swedish white collar workers. J Occup Behav 1987;8:187-207.

CHD symptoms – cross-sectional – similar effects for men and women (Sweden)

53. Karasek RA. Lower health risk with increased job control among white collar workers. J Organiza Behav 1990;11:171-85.

CHD symptoms – cross-sectional – similar effects for men and women (Sweden)

Ambulatory blood pressure

75. Light KC, Turner JR, Hinderliter AL. Job strain and ambulatory work blood pressure in healthy young men and women. Hypertension 1992;20:214-18.

cross-sectional – job strain associated with AmBP only for men (North Carolina)

new. Landsbergis PA, Schnall PL, Schwartz JE, Warren K, Pickering T. Job strain, hypertension, and cardiovascular disease. In: Sauter SL, Murphy LR (eds.) Organizational Risk Factors for Job Stress. Washington, DC: American Psychological Association;1995:97-112.

cross-sectional – job strain associated with AmBP only for men (New York City)

116. Van Egeren LF. The relationship between job strain and blood pressure at work, at home, and during sleep. Psychosom Med 1992;54:337-43.

cross-sectional – job strain associated with AmBP for both women and men (North Carolina)

114. Theorell T, Perski A, Akerstedt T, Sigala F, Ahlberg-Hulten G, Svensson J, Eneroth P. Changes in job strain in relation to changes in physiological states. Scand J Work Eviron Health 1988;14:189-96.

cohort – similar magnitude of association with systolic AmBP for both women and men, p-value >.05 since only 18 women vs 40 men in study (Sweden)

108. Theorell TPG, Ahlberg-Hulten G, Jodko M, Sigala F, Soderholm M, de la Torre B. Influence of job strain and emotion on blood pressure in female hospital personnel during work hours. Scand J Work Environ Health 1993;19:313-318.

cross-sectional – job strain associated with AmBP for women
[note: while this study did not include males, it is noted since it is one of the 3 studies that have found associations between job strain and AmBP among women]

Smoking

81. Mensch BS, Kandel DB. Do job conditions influence the use of drugs. J Health Soc Behav 1988;29:169-84.

cross-sectional – similar effects for men and women

new. Johansson G, Johnson JV, Hall EM. Smoking and sedentary behavior as related to work organization. Soc Sci Med 1991;32:837-846.

cross-sectional – shift-work and piece-work associated with smoking only among men (Sweden)

Sedentary behavior

new. Johansson G, Johnson JV, Hall EM. Smoking and sedentary behavior as related to work organization. Soc Sci Med 1991;32:837-846.

cross-sectional – lack of learning opportunities associated with sedentary behavior for both men and women – psychological work demands associated with sedentary beahvior only among women (Sweden)

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