Psychosocial job adversity and health in Australia: analysis of data from the HILDA Survey.

OBJECTIVE: This study examines measures of psychosocial job quality developed from the Household Income and Labour Dynamics in Australia (HILDA) Survey, and reports on associations with physical and mental health. METHODS: The study used seven waves of data from the HILDA Survey with 5,548 employed respondents. Longitudinal random-intercept regression models assessed the association of time-varying and between-person measures of psychosocial job quality job adversity with physical and mental health. RESULTS: Respondents' specific experience of psychosocial job adversity, except marketability, was associated with increased risk of mental health problems, whereas the association between psychosocial job adversity and physical health was largely driven by differences between people. CONCLUSIONS AND IMPLICATIONS: Moving into jobs with different psychosocial quality is associated with changes in mental health. In contrast, individuals with poor physical health show an increased propensity to work in poor-quality jobs but it seems that changes in physical health are not as strongly tied to changes in job quality. Differences in the relationship between physical and mental health and psychosocial job quality have implications for the design of employment, health and social policy. The HILDA Survey is an important resource for policy development in Australia, and the availability of valid measures of psychosocial of job quality will enhance its use to better understand this important determinant and correlate of health.

Time limits? Reflecting and responding to time barriers for healthy, active living in Australia.

Lack of time is the main reason people say they do not exercise or use public transport, so addressing time barriers is essential to achieving health promotion goals. Our aim was to investigate how time barriers are viewed by the people who develop programs to increase physical activity or use active transport. We studied five interventions and explored the interplay between views and strategies. Some views emphasized personal choice and attitudes, and strategies to address time barriers were focused on changing personal priorities or perceptions. Other views emphasized social-structural sources of time pressures, and provided pragmatic ideas to free up time. The most nuanced strategies to address time barriers were employed by programs that researched and solicited the views of potential participants. Two initiatives re-shaped their campaigns to incorporate ways to save time, and framed exercise or active transport as a means to achieve other, pressing, priorities. Time shortages also posed problems for one intervention that relied on the unpaid time of volunteers. Time-sensitive health and active transport interventions are needed, and the methods and approaches we describe could serve as useful, preliminary models.

Could better jobs improve mental health? A prospective study of change in work conditions and mental health in mid-aged adults.

OBJECTIVES: To investigate the extent improvement or deterioration in employee job security, control or workload is associated with a change in mental health. DESIGN: Self-report panel data (2000, 2004) on mental health (symptoms of depression and generalised anxiety) and job demands, control and insecurity. Changes in exposures and outcomes were calculated by subtracting wave 1 from wave 2 scores. Changes in mental health were regressed onto changes in work conditions, adjusting for confounders. Sensitivity analyses assessed reverse causation, floor and ceiling effects. SETTING: Two adjoining cities in south-east Australia. PARTICIPANTS: 1975 employees aged 40-48 years, 50% (n=995) male. RESULTS: Improvements and deterioration in each work condition were associated with corresponding improvements or deterioration in mental health. The association between changes in job insecurity and symptoms of depression was B=0.386 (95% CI 0.245 to 0.527) and with anxiety symptoms was B=0.434 (95% CI 0.267 to 0.601). Similarly, changes in job control were associated with changes in depressive (B=-0.548; 95% CI -0.791 to -0.304) and anxiety symptoms (B=-0.608; 95% CI -0.896 to -0.319) as were changes in job demands (B depression=0.386; 95% CI 0.245 to 0.527; B anxiety=0.434; 95% CI 0.267 to 0.601). Excluding people with severe symptoms at baseline did not alter the findings; however, path analyses indicated that depression may precede a worsening of work conditions. CONCLUSION: Among mid-aged employees, deteriorating work conditions may amplify population health burdens, especially anxiety. Furthermore, better quality jobs, combining an array of positive conditions, could alleviate major population health burdens.

The limitations of employment as a tool for social inclusion.

BACKGROUND: One 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. METHODS: This 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. RESULTS: Those 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. CONCLUSIONS: This evidence underlines the difficulty of moving from unemployment into good quality work and highlights the need for social inclusion policies to consider people's pre-existing health conditions and promote job quality.

Job quality and inequality: parents' jobs and children's emotional and behavioural difficulties.

In the context of high and rising rates of parental employment in Australia, we investigated whether poor quality jobs (without security, control, flexibility or paid family leave) could pose a health risk to employed parents' children. We examined the extent to which both mothers' and fathers' jobs matter, and whether disadvantaged children are more vulnerable than others. Multiple regression modelling was used to analyse cross-sectional data for 2004 from the Growing Up in Australia study, a nationally representative sample of 4-5 year old children and their families (N = 2373 employed mothers; 3026 employed fathers). Results revealed that when parents held poor quality jobs their children showed more emotional and behavioural difficulties. The associations with child difficulties were independent of income, parent education, family structure and work hours, and were evident for both mothers' and fathers' jobs. Further, the associations tended to be stronger for children in low-income households and lone-mother families. Thus job quality may be another mechanism underlying the intergenerational transmission of health inequality. Our findings also support the argument that a truly family-friendly job must not erode children's health.

Do working mothers raise couch potato kids? Maternal employment and children's lifestyle behaviours and weight in early childhood.

Alarm about the increasing prevalence of childhood obesity has focussed attention on individual lifestyle behaviours that may contribute to unhealthy weight. More distal predictors such as maternal employment may also be implicated since working mothers have less time to supervise children's daily activities. The research reported here used two waves of data from the Longitudinal Study of Australian Children to investigate whether mothers' hours in paid work shape young children's television viewing, snacking and physical activity, and through those lifestyle behaviours, children's weight at ages 4-5 years and 6-7 years. At both ages, children's lifestyle behaviours were interrelated and associated with weight status. Cross-sectional analysis confirmed small, direct associations between longer hours of maternal employment and child weight at age 4-5 years, but not with child's weight measured two years later. In both the cross-sectional and prospective analyses, the children of mothers who worked part-time watched less television and were less likely to be overweight than children of mothers who were not employed or who worked full-time. While associations were small, they remained significant after adjustment for maternal weight, household income and other factors. The combination of direct and indirect relationships between mothers' work hours and the weight status of their young children provides additional support to calls for family-friendly work policies as an important means for promoting healthy family lifestyles and early childhood wellbeing.

Fluctuating awareness of treatment goals among patients and their caregivers: a longitudinal study of a dynamic process.

BACKGROUND: Because increasing numbers of people now survive for months or years with advanced cancer, communication between patients, service providers, and family caregivers often continues over long periods. Hence, understanding of the goals of medical treatment may develop and change as time elapses and disease progresses. This understanding is closely related to the "awareness of dying," which has been studied in both qualitative and quantitative research. However, when both a patient and family caregiver are involved, the question of "awareness" becomes more complex. A recent longitudinal study reported on patient and caregiver knowledge of treatment goals, but no comparison of such knowledge using matched interview schedules and paired data analysis has been provided. This report examines patterns of awareness and factors associated with these patterns. MATERIALS AND METHODS: One hundred sixty-three patients with incurable cancer and their nominated principal family caregivers (136) were recruited from The Canberra Hospital Oncology Services. Participants' understanding of the treatment goals were measured by interview questions at weeks 1 and 12. RESULTS: One-third of both patients and caregivers understood that the treatment goal was not curative; however, not all patient and caregiver pairs had the same understanding. In 15% of pairs, both patient and caregiver believed that the goal of treatment was curative, while another 13% said that they did not know the aim of the treatment. Thirty-nine percent of pairs registered incongruent responses in which only one member of the pair understood that the treatment was not intended to cure the disease. Over time, a few respondents changed their perception of the treatment goals toward accurate clarification. Bivariate analysis using an awareness variable, constructed for the purpose, showed that in 6 months before death, at least one person in 89% of pairs understood that the treatment was noncurative. Time-to-death, gender, and place of residence were also important predictors of knowledge. CONCLUSIONS: Discrepancies between patients and their caregivers may complicate the delivery of effective care when patients are seriously ill. Misunderstanding or uncertainty about treatment goals will obstruct proper informed consent. Health professionals providing care for families dealing with advanced cancer must recognize that the discussion of treatment goals is a dynamic process, which may require them to extend their communication skills.

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. METHODS: We used cross-sectional survey data from 2,248 employees aged 40-44 years living in two cities of south-eastern Australia. Logistic regressions were used to compare the associations between job insecurity and demands among those with short (1-3 days) or long-term (> 3 days) sickness absence with those who had no sickness absence in the last four weeks. The mediating effects of mental and physical health were assessed by evaluating changes in the magnitude of the association between these work conditions and sickness absence. RESULTS: High job insecurity (OR = 3.28; 95% CI 1.54-6.95) and high work demands (OR = 1.62; 95% CI 1.13-2.30) were significantly associated with long-term, but not with short-term, sickness absence. These associations were unaffected by job control. Depression and anxiety explained 61% of the association between high work demands and long-term sickness absence and 30% of the association between job insecurity and long-term sickness absence. CONCLUSION: Difficult working conditions may reduce productivity by contributing to longer absences from work. IMPLICATIONS: Reforms intended to improve economic performance should address any potential health costs of insecurity or intensification, which could inadvertently decrease productivity, possibly through their impact on mental health.

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.

The lesser evil: bad jobs or unemployment? A survey of mid-aged Australians.

Paid work is related to health in complex ways, posing both risks and benefits. Unemployment is associated with poor health, but some jobs may still be worse than no job at all. This research investigates that possibility. We used cross-sectional survey data from Australians aged 40-44 (N = 2497). Health measures were depression, physical health, self-rated health, and general practitioner visits. Employees were classified according to their job quality (strain, perceived job insecurity and marketability). Employee health was compared to people who were unemployed, and to people who were not in the labour force. We found that unemployed people reported worse health when compared to all employees. However, distinguishing in terms of employee's job quality revealed a more complex pattern. Poor quality jobs (characterized by insecurity, low marketability and job strain) were associated with worse health when compared to jobs with fewer or no stressors. Furthermore, people in jobs with three or more of the psychosocial stressors report health that is no better than the unemployed. In conclusion, paid work confers health benefits, but poor quality jobs which combine several psychosocial stressors could be as bad for health as being unemployed. Thus, workplace and industrial relations policies that diminish worker autonomy and security may generate short-term economic gains, but place longer-term burdens on the health of employees and the health-care system.

Impact of saliva collection methods on sIgA and cortisol assays and acceptability to participants.

In community-based studies of stress and immunity, saliva samples offer a non-intrusive way of gathering biological data. Cotton-based devices are widely used in cortisol research, but some may affect assay results. We compared assay reliability and perceived acceptability of three saliva collection methods: passive, cotton 'salivettes' and cellulose-cotton tip 'eyespears'. Compared to passive collection, salivettes reduced the concentration of cortisol (p = .001) and sIgA (p = .002). Eyespears did not reduce cortisol or sIgA concentration, and showed less interference in the rank ordering of cortisol (r(eyespear with passive) = .90) and sIgA scores (r(eyespear with passive) = .96) compared to salivettes (r cortisol(salivette with passive) = .79; r sIgA(salivette with passive) = .66). The comfort and acceptability of both cotton-based devices were rated positively. Cotton-cellulose eyespears could offer methodological advantages for collecting saliva to measure cortisol and sIgA levels, and, because they can be held during sampling, may be useful for research with children and the frail elderly.

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. METHODS: A cross-sectional study of 2,249 employed workers aged 40-44 years conducted in two regions in south-east Australia in 2000 used a self-completed questionnaire to collect data. Multivariate analyses were used to compare depression, anxiety, physical health and general practitioner (GP) visits over 12 months across categories of job strain and insecurity for three status groups (high, middle and low). RESULTS: High job strain and job insecurity were independently associated with poor mental health, poor physical health and visits to the GP for all status groups when adjusted for confounders. High job strain was associated with depression (OR = 2.46, 95% CI 1.96-3.07), anxiety (OR = 2.56, 95% Cl 2.05-3.20), lower mean physical health scores (-1.11, 95% CI -1.98 - -0.23), and more visits to the GP (IRR = 1.20, 95% CI 1.05-1.37). High job insecurity also showed significant associations with depression (OR = 3.03, 95% Cl 2.03-4.53), anxiety (OR = 2.66, 95% CI 1.81-3.91), and GP visits (IRR = 1.27, 95% CI 1.01-1.60). There were no significant differences by status in the associations of job strain and insecurity with outcomes. CONCLUSION: High-status workers were just as likely as low-status workers to be exposed to adverse work conditions and both status groups showed similar health effects. IMPLICATIONS: Exposure to insecure and high-strain jobs is likely to rise as economies and labour markets respond to globalisation and political change. High status may not protect employees from either exposure or impact, thus widening the population health consequences of adverse work conditions.

The impact of employee level and work stress on mental health and GP service use: an analysis of a sample of Australian government employees.

BACKGROUND: This study sought to identify the extent to which employee level and work stressors were associated with mental health problems experienced by Australian government employees, and with their use of primary care services. METHODS: 806 government employees aged between 40 and 44 years were surveyed as part of an epidemiological study conducted in Australia. Data collected from participants included sociodemographic attributes, physical health, psychological measures and work stressors relating to job control, job demands, job security and skills discretion at work. For 88% of these participants, information on visits made to general practitioners (GPs) for the six months before and after their survey interview was obtained from health insurance records. RESULTS: When work stress and personal factors were taken into account, men at more junior levels reported better mental health, more positive affect and used fewer GP services. Women at middle-management levels obtained less GP care than their more senior counterparts. Both men and women who reported higher levels of work stress were found to have poorer mental health and well-being. The impact of such stressors on GP service use, however, differed for men and women. CONCLUSION: Measures of work stress and not employee level affect the mental health and well-being of government employees. For governments with responsibility for funding health care services, reducing work stress experienced by their own employees offers potential benefits by improving the health of their workforce and reducing outlays for such services.

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.

Around-the-clock: parent work schedules and children's well-being in a 24-h economy.

Family life in developed economies has undergone a fundamental change--shifting from single-breadwinner households (typical of the post war decades) to families where both parents are employed. Equally dramatic has been the emergence of around-the-clock economies, altering the way work is organised, especially working time. Many more children now live in households where one or both parents work non-standard hours (evenings, nights or on weekends). Are there any implications for children's well-being when parents work non-standard schedules? There has been virtually no investigation of how children are faring in these around-the-clock households, despite evidence that non-standard work times affect family functioning and are stressful for parents. Using data from a representative sample of 4433 dual-earner Canadian families and their 2--11-year-old children (N children=6361), we compared families where both parents worked standard hours, with families where one or both worked non-standard times (evenings, nights or weekends). In nearly three-quarters of the families one or both parents regularly worked non-standard times. We found associations between children's well-being and parent work schedules, with higher odds ratios for child difficulties when parents worked non-standard times. These associations persisted after adjusting for several confounding factors including socio-economic status, parent part-time or full-time work, and childcare use, and were evident whether mothers, fathers or both parents worked non-standard times. The findings raise questions about the implications for children of the 24-h economy.

General practitioner management of intimate partner abuse and the whole family: qualitative study.

OBJECTIVE: To explore management by general practitioners of victimised female patients, male partners who abuse, and children in the family. DESIGN: Triangulated qualitative study comparing doctors' reported management with current recommendations in the literature. PARTICIPANTS: 28 general practitioners attending continuing medical education about management of domestic violence. RESULTS: Doctors perceived partner abuse in diverse ways. Their gender, perceptions, and attitudes could all affect identification and management of this difficult problem. A few doctors practised in recommended ways, but many showed stress and aversion, difficulties in resolving the tensions involved in managing all family members, and neglect of the risks to children. Some doctors used contraindicated practices, such as breaking confidentiality and undertaking or referring for couple counselling. Doctors who were not familiar with community based agencies were reluctant to use them. A lack of expertise and support could have a negative impact on doctors themselves. CONCLUSIONS: General practitioners managing partner abuse need to be more familiar with and apply the central principles of confidentiality and safety of women and children. Recommended guidelines for managing the whole family should be developed. Doctors should consider referring one partner elsewhere and avoid couple counselling; always ask about and act on the children's welfare; refer to specialist family violence agencies; and seek training, supervision, and support for the inherent stress. Medical education and administration should ensure comprehensive training and support for doctors undertaking this difficult work.

Familiarity breeds neglect? Unanticipated benefits of discontinuous primary care.

BACKGROUND: Continuity of medical care is generally considered to be beneficial to patients. OBJECTIVE: The aim of this study was to investigate the possibility that familiarity with patients may sometimes discourage case finding. METHODS: Extensive qualitative interviews were carried out with a sample of Australian adults with type 2 diabetes, focusing in particular on their experience of diagnosis. RESULTS: Interviews were conducted with 119 participants, 75% of whom supplied sufficient information to enable the coding of whether diagnosis occurred under circumstances of discontinuity. Half of all participants (two-thirds of the coded subsample) had a diagnosis that could be categorized as resulting from discontinuous primary care: hospital admission, change of doctor, patient initiative and/or diabetic emergency. CONCLUSION: The same circumstances that enhance the management of chronic disease can at times hinder its diagnosis. Primary care service providers may need to instigate more active methods of case finding in order to avoid this paradoxical effect of familiarity with the patient.

The health of the Australian workforce: 1998-2001.

OBJECTIVE: To describe the health of the Australian workforce in relation to occupational status. METHODS: Data on 9,167 workers, collected between 1998 and 2001, were obtained from the Campbell National Health Monitor, a cross-sectional national, health survey. Professional, white-collar and blue-collar workers were compared on five health outcomes: self-rated health, long-and short-term conditions, reduced activity days and work absences. RESULTS: One in 10 workers (M:11%; F:10%) rated their health as poor. Two-thirds (M: 60%; F: 64%) reported long-term conditions with four in five (M:77%; F: 83%) reporting short-term conditions. Smaller proportions took health-related actions, with 21% of men and 28% of women reducing their activity, and 17% of men and 20% of women taking time off work in a given month. Occupational inequalities in self-rated health were evident for both men and women, with professionals reporting the best health and blue-collar workers the worst (p < 0.001). Male, but not female, white- and blue-collar workers also had higher rates of short-term conditions (OR 1.25, 1.06-1.50 and 1.25, 1.07-1.46, respectively) and reduced activity days due to health (OR 1.43, 1.20-1.71 and 1.25, 1.07-1.47, respectively) compared with professionals. However, blue-collar workers reporting health problems were the least likely to take time off work (poor health: p = 0.043; short-term conditions: p = 0.001; long-term conditions: p = 0.003). CONCLUSIONS AND IMPLICATIONS: Blue-collar workers are the least healthy occupational grouping. They are also the most likely to present to work unwell. With employment conditions rapidly changing, better understanding of the impact of these changes on workers' health is vital.