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Job Strain and Ambulatory Blood Pressure: A Meta-Analysis and Systematic Review

Job Strain and Ambulatory Blood Pressure: A Meta-Analysis and Systematic Review

Paul A. Landsbergis, Marnie Dobson, George Koutsouras, and Peter Schnall.

American Journal of Public Health: March 2013, Vol. 103, No. 3, pp. e61-e71. doi: 10.2105/AJPH.2012.301153

Paul A. Landsbergis, PhD, MPH, Marnie Dobson, PhD, George Koutsouras, MPH, and Peter Schnall,MD, MPH Paul A. Landsbergis and George Koutsouras are with the School of Public Health, State University of New York–Downstate, Brooklyn.

Marnie Dobson and Peter Schnall are with the Center for Occupational and Environmental Health, University of California, Irvine. Paul A. Landsbergis, Marnie Dobson, and Peter Schnall are also with the Center for Social Epidemiology, Los Angeles, CA.

Reprints can be ordered at http://www.ajph.org by clicking the “Reprints” link.
We reviewed evidence of the relationship between job strain and ambulatory blood pressure (ABP) in 29 studies (1985–2012). We conducted a quantitative meta-analysis on 22 cross-sectional studies of a single exposure to job strain. We systematically reviewed 1 case–control study, 3 studies of cumulative exposure to job strain, and 3 longitudinal studies.
Single exposure to job strain in cross-sectional studies was associated with higher work systolic and diastolic ABP. Associations were stronger in men than women and in studies of broad-based populations than those with limited occupational variance. Biases toward the null were common, suggesting that our summary results underestimated the true association.
Job strain is a risk factor for blood pressure elevation. Workplace surveillance programs are needed to assess the prevalence of job strain and high ABP and to facilitate workplace cardiovascular risk reduction interventions.

Exploring Occupational and Health Behavioral Causes of Obesity in Firefighters: A Qualitative Study

The following manuscript – the result of collaboration between CSE staff and consultants with University of California Irvine – was published in the American Journal of Industrial Medicine “early view” on Jan 17, 2013.

Exploring occupational and health behavioral causes of firefighter obesity: A qualitative study

Marnie Dobson, Ph.D.1,2 BongKyoo Choi, Sc.D., MPHPeter L. Schnall, M.D., MPH 1,2 Erin Wigger, BA Javier Garcia, MALeslie Israel, DODean Baker, MD1

  1. (1) Center for Occupational and Environmental Health, University of California Irvine, USA
  2. (2) Center for Social Epidemiology, Los Angeles, CA


Background: Firefighters, as an occupational group, have one of the highest prevalence rates of obesity. A qualitative study investigated occupational and health behavioral determinants of obesity among firefighters.

Methods: Four focus groups were conducted with firefighters of every rank as Phase I of the FORWARD study which was designed to assess health behavioral and occupa- tional characteristics related to obesity in firefighters.

Results: Analysis revealed five main themes of central importance to firefighters: (1) fire station eating culture; (2) night calls and sleep interruption; (3) supervisor leadership and physical fitness; (4) sedentary work; and (5) age and generational influences.

Conclusion: The results showed a strong interrelationship between occupational and health behavioral causes of obesity in firefighters. The relevance of these qualitative findings are discussed along with the implications for future obesity interventions with firefighters. Am. J. Ind. Med. ” 2013 Wiley Periodicals, Inc.

KEY WORDS: obesity; firefighters; qualitative research; occupational health; health behaviors 

The full article can be downloaded here.

Surface Acting and Deep Acting: Emotional Labor and Burnout in Firefighters

For Submission to the APA NIOSH Work and Stress Conference, May 2011, Orlando Florida (October 11, 2010)

Marnie Dobson1,2, BongKyoo Choi1,2, Peter Schnall1,2, Leslie Israel1, Dean Baker1

1 Center for Occupational and Environmental Health, University of California Irvine, USA.
2 Center for Social Epidemiology, Los Angeles, California, USA

Objective: To investigate possible differential effects of two types of emotional labor such as surface acting and deep acting on burnout among firefighters.

Background: As first responders, firefighters must manage traumatic scenarios which require emotional labor, a psychosocial stressor known to be related to burnout in human service work. Emotional labor, a concept developed by sociologist Arlie Hochschild, refers to the regulation of emotions working people perform as part of their job or to promote organizational goals. There are several types of emotional labor potentially applicable to firefighters as human service workers. The literature suggests that professional human service workers, such as nurses, social workers, or firefighters/paramedics, are more likely to “deep act” when performing emotional labor since they internalize the appropriate display of emotion as part of their professional role. Those firefighters more likely to “surface act” are more likely to experience burnout, while “deep acting” may be associated with lower burnout. We will also investigate whether reporting specialized training as helpful to the management of emotions while in the field could modify the association between emotional labor and burnout.

Click here for a pdf of the full Abstract

Exploring Occupational and Behavioral Risk Factors for Obesity in Firefighters

Abstract submitted to the 2011 APA NIOSH Meeting

BongKyoo Choi (1), Peter Schnall (1), Marnie Dobson (1), Leslie Israel (1), Paul Landsbergis (2), Pietro Galassetti (3), Andria Pontello (4), Stacey Kojaku (1), Dean Baker (1)

(1) Center for Occupational and Environmental Health, University of California Irvine, USA.
(2) Department of Environmental and Occupational Health Science, State University of New York Downstate Medical Center, USA.
(3) Department of Pediatrics and Department of Pharmacology, University of California Irvine, USA.
(4) Institute for Clinical and Translational Science, University of California Irvine, USA.


Background: Obesity has been a serious public health issue in the general population and among workers in the United States (US) since at least the 1980s. Among 41 male-dominated occupations, firefighters have the third highest prevalence rate of obesity. Despite the high obesity prevalence rate among firefighters, epidemiological studies on firefighters and obesity have focused on the correlations between obesity (defined by body mass index (BMI)) and physiological covariates (e.g., blood pressures and lipid profiles). Few studies have examined the roles of working conditions and health behaviors of firefighters in obesity. The working 
conditions of firefighters are generally characterized by high mental and physical job demands, unpredictable fire fighting, relatively long calm periods of time between alarms, shift work (i.e., 24-hr shift), and frequent overtime work. These factors may increase the risk of obesity in firefighters directly or indirectly through promoting unhealthy behaviors (e.g., overeating and 
physical inactivity both at work and during leisure time). In addition, few validated instruments – a methodological prerequisite for obesity studies in firefighters – are available that specifically assess the unique working conditions and health behaviors of firefighters who work on a 24 hrshift system. Many firefighter wellness fitness (WEFIT) programs have focused on fitness training and periodic medical examinations. The WEFIT programs have never been intended to examine occupational or behavioral determinants of obesity and biological CVD risk factors.Furthermore, no study has explored differential relationships between BMI and skinfoldbased % fat by age and ethnicity (e.g., Latinos vs. Whites) and differential relationships of BMI and skinfold-based body fat % with other CVD risk factors (e.g., hypertension and blood lipid profiles) in firefighters.

Objectives: The main aims of this study are a) to develop and validate a firefighter-relevant work and health questionnaire using qualitative and quantitative methods in firefighters, b) to use this questionnaire in an epidemiological study to explore whether adverse working conditions and health behaviors are risk factors for obesity in firefighters, and c) to explore the interrelations between working conditions and health behaviors as they relate to obesity. A supplementary objective is to evaluate the strengths and weaknesses of BMI as a measurement (commonly used as a surveillance measure of obesity in many (WEFIT) programs for 
firefighters) in comparison with skinfold-based body fat %.

Methods: This study will be conducted in collaboration with a fire authority covering a county of Southern California. In order to facilitate and oversight the study, a research advisory committee will be created with members from the fire authority management, International Association of Fire Fighters (IAFF) local union, WEFIT coordinators, and researchers at a university. This study involves the following steps in chronological order: a) focus groups of firefighters by rank (captains vs. firefighters/engineers) will review and revise the domains and items in a questionnaire about working conditions and heath behaviors (dietary quality, eating behaviors, and physical activity) of firefighters; b) a final version of the questionnaire will be introduced to firefighters (n ≥ 357) who will visit an occupational health clinic as part of a firefighter WEFIT program on a regular basis. For analyses, the questionnaire information will be linked to the records of the WEFIT medical and fitness exams (BMI, body fat %, VO2 max, blood pressures, and blood lipid profiles) of the survey participants; c) a sub-sample (n ≥ 80) of the survey participants will be recruited to test the validity of the self-reported questionnaire information on working conditions and health behaviors. They will be asked to wear a waist physical activity monitor for 72 hrs (24 hrs at a work day and 48 hrs at non-work days), to complete a 3-day food 
diary, and to fill out the questionnaire again in one week after completing the survey for a 1-week test-retest reliability, and d) focus groups of firefighters will assess and evaluate study findings in order to develop recommendations for reducing weight and obesity in firefighters.

Results: This study is a 2-year project, funded by the Center for Disease Control and Prevention (CDC)/National Institute for Occupational and Environmental Health (NIOSH) from 2010 to 2012 (Grant #: 1R21OH009911-01). From a study design perspective, the overall study plan will be presented at the APA/NIOSH 2011 conference. In addition, the findings from the 
focus groups of firefighters for developing a firefighter-relevant work and health questionnaire (to be completed before the conference) will be presented in detail with focus on firefighters’ insights and contributions.

Brief Summary: Identify occupational and behavioral risk factors for obesity in firefighters is an essential first step for establishing effective intervention programs for obesity in almost 1.1 million professional and voluntary firefighters in the US.

For correspondence: BongKyoo Choi, Center for Occupational and Environmental Health, 
University of California Irvine, 5210 California Avenue, Suite 100, Irvine, CA, 92617. Tel. 1-949-
824-8641, Fax 1-949-824-2345, E-mail: b.choi@uci.edu

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