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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.

Repeated Job Strain and the Risk of Depression: Longitudinal Analyses From the Whitehall II Study

A new article has been published by the APHA on the powerful impact of job strain on mental health outcomes such as depression (see Abstract below).
Stephen A. Stansfeld, PhD, Martin J. Shipley, MSc, Jenny Head, MSc, and Rebecca Fuhrer, PhD

Stephen A. Stansfeld is with the Centre for Psychiatry, Wolfson Institute of Preventive Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary, University of London, UK. Martin J. Shipley and Jenny Head are with the Department of Epidemiology and Public Health, University College London Medical School, London. Rebecca Fuhrer is with the Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada.
S. A. Stansfeld conceptualized and designed the study, interpreted the data, and wrote the first draft of the article. M. J. Shipley carried out the analyses and contributed to their interpretation. Jenny Head contributed to the analyses and to their interpretation. Rebecca Fuhrer codesigned the study and contributed to the analyses and the interpretation of the data. All authors contributed to writing the article.


Objectives. We addressed whether repeated job strain and low work social support increase the risk of major depressive disorder (MDD).
Methods. We used work characteristics from Karasek’s Job Strain model, measured on 3 occasions over 10 years in a cohort of 7732 British civil servants, to predict subsequent onset of MDD with the Composite International Diagnostic Interview.
Results. Repeated job strain was associated with increased risk of MDD (odds ratio [OR] = 2.19; 95% confidence interval [CI] = 1.48, 3.26; high job strain on 2 of 3 occasions vs none) in a fully adjusted model. Repeated low work social support was associated with MDD (OR = 1.61; 95% CI = 1.10, 2.37; low work social support on 2 of 3 occasions vs none). Repeated job strain remained associated with MDD after adjustment for earlier psychological distress.
Conclusions. Demonstration of an increased association for repeated job strain adds to the evidence that job strain is a risk factor for depression. Recognition and alleviation of job strain through work reorganization and staff training could reduce depression in employees.


Work stress linked to heart attack risk in older men


Here  is a short article from Personnel Today (January 2013) which discusses the impact of job strain on the cardiovascular health of older male workers. The original article published in Occupational Medicine can be found here: Age, job characteristics and coronary health.

Work stress linked to heart attack risk in older men

Older men with stressful jobs and little power to make decisions are more likely to suffer with heart disease than their peers with less job strain, according to a study published in Occupational Medicine, the journal of the Society of Occupational Medicine.

The researchers from University College Cork found that older male workers who had had a heart attack or had unstable angina were four times as likely to have high job strain as those that did not.

Job strain, or the combination of high job demands and low control at work, has long been associated with coronary heart disease, but this latest research looked specifically at its effects in the older workforce.

Intriguingly, it found there was a clear difference between younger and older workers – the association was not found in younger people.

Lead author Vera McCarthy said: “This study is important as it provides information on older workers necessary to inform policy-makers, clinicians, OH physicians and employers.”

The society argued that as the UK’s working population ages, employers will need to make work more attractive and feasible for older workers, implementing changes that enable them to work up to and beyond state pension age.

To this end, investing in OH services will become increasingly important in keeping people economically active and helping to ensure that older workers remain healthy and fit, it added.

“Employers need to ensure that they are looking after the health of their older employees, making the necessary adjustments and being flexible about the jobs they do and their working practices,” said society president Dr Richard Heron.

Tips for working moms with higher stress hormones

By Laurie Tarkan

Read more: http://www.foxnews.com/health/2012/08/30/tips-for-working-moms-with-higher-stress-hormones/#ixzz259kiCtxj

It’s not just the mad rush to get the kids fed, dressed and out the door that can stress out a working mom.

If she also has a high level of work-related stress, it can add an extra level of tension to weekday mornings.

A new study, published in the Journal of Family Psychology, found that working moms with high parenting stress tended to have higher levels of cortisol (indicating more stress) on weekday mornings than on weekends. Not a huge surprise. 

But the study also found that those women who reported high job strain and high parenting stress had significantly higher cortisol levels on workdays.

Job Stress Prevention & Control: Developing Best Practice

Contributed by Tony LaMontagne, ScD, MA, MEd, from the McCaughey Centre, Melbourne School of Population Health, University of Melbourne (AUSTRALIA).

This edition of News & Views highlights a recently-published open-access resource for policy-makers and practitioners that summarises the evidence on job stress and its impacts on human and organizational health as well as international best practice in job stress prevention and control.The current report builds on two previous job stress reports, all published open-access by the (Australian) Victorian Health Promotion Foundation.2,3

How stress influences disease: Research reveals inflammation as the culprit

How stress influences disease: Research reveals inflammation as the culprit .

April 2nd, 2012 in Immunology http://medicalxpress.com/news/2012-04-stress-disease-reveals-inflammation-culprit.html 

Stress wreaks havoc on the mind and body. For example, psychological stress is associated with greater risk for depression, heart disease and infectious diseases. But, until now, it has not been clear exactly how stress influences disease and health. A research team led by Carnegie Mellon University’s Sheldon Cohen has found that chronic psychological stress is associated with the body losing its ability to regulate the inflammatory response. Published in the Proceedings of the National Academy of Sciences, the research shows for the first time that the effects of psychological stress on the body’s ability to regulate inflammation can promote the development and progression of disease. 

A Consensus Method for Updating Psychosocial Measures Used in NIOSH Health Hazard Evaluations

Douglas M. Wiegand, PhD, Peter Y. Chen, PhD, Joseph J. Hurrell Jr, PhD, Steve Jex, PhD, Akinori Nakata, PhD, Jeannie A. Nigam, MS, Michelle Robertson, PhD, CPE, and Lois E. Tetrick, PhD

Here is the March 2012 report from NIOSH of the workplace questions and constructs recommended by NIOSH for studies of the workplace intended to evaluate psychosocial health hazards.

Click here to download a pdf of the report.

Eating less salt doesn’t cut heart risks: study I Reuters

Is nothing sacred? For 100 years now it has been gospel that salt plays an important role in the etiology of ESSENTIAL Hypertension, despite the fact that the evidence for the role of salt has always been contradictory (e.g., feeding people unlimited amounts of salt doesn’t increase bp as our bodies have enormous ability to excrete salt in the urine). This article provides further evidence that the role in sodium in the etiology and treatment of hypertension is even more problematic than previously thought.  The key sentence from below of their results  “participants with the lowest salt intake had the highest rate of death from heart disease during the follow up (4 percent), and people who ate the most salt had the lowest (less than 1 percent).”

Dr. Peter Schnall
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