Psychological variables in hypertension: relationship to casual or ambulatory blood pressure in men.

OBJECTIVE: The evidence linking hypertension with personality or psychological characteristics, such as anger, anxiety, or depression, remains equivocal. This may be due in part to limitations of personality theory, confounding by awareness of hypertension, and/or inherent difficulties in measuring blood pressure. This study was designed to investigate the association between mild hypertension as defined by both ambulatory and casual (clinic) blood pressure measurements and various measures of personality and psychological characteristics. METHODS: We examined this association in a population-based sample of 283 men between the ages of 30 and 60 years from eight work sites in New York City, using an ambulatory blood pressure monitor and controlling for age, race/ethnicity, and body mass index. RESULTS: We found no consistent difference between participants with mild hypertension and those with normal blood pressure on any of the psychological variables assessed, including Type A behavior pattern, state and trait anger, anger expression, anxiety, symptoms of psychological distress, locus of control, or attributional style. Results were not due to the use of antihypertensive medication by some of the participants with hypertension nor to the dichotomization of blood pressure into those with and without mild hypertension. This contrasts with previous findings from this study showing a sizable association of ambulatory blood pressure and hypertension with job strain (a situational measure), age, and body mass index. CONCLUSIONS: These null results suggest that situational, biological, and perhaps behavioral factors are the primary determinants of mild hypertension and that the predictive significance of psychological or dispositional factors is low or negligible in those without overt cardiovascular disease.

The impact of lean production and related new systems of work organization on worker health.

New systems of work organization, such as lean production and total quality management, have been introduced by employers throughout the industrialized world to improve productivity, quality, and profitability. However, few studies have examined the impact of such systems on occupational injuries or illnesses or on job characteristics related to job strain, which has been linked to hypertension and cardiovascular disease. The studies reviewed provide little evidence to support the hypothesis that lean production "empowers" auto workers. In fact, auto industry studies suggest that lean production creates intensified work pace and demands. Increases in decision authority and skill levels are modest or temporary, whereas decision latitude typically remains low. Thus, such work can be considered to have job strain. In jobs with ergonomic stressors, intensification of labor appears to lead to increases in musculoskeletal disorders. The evidence for adverse health effects remains inconclusive for related new work systems in other industries, such as modular manufacturing or patient-focused care.

A longitudinal study of job strain and ambulatory blood pressure: results from a three-year follow-up.

OBJECTIVE: This study was conducted to investigate the hypothesis that exposure to "job strain" is related to increased ambulatory blood pressure (ABP). METHOD: Participants were 195 men who wore an ABP monitor for 24 hours on two occasions 3 years apart. Job strain status, evaluated at each assessment, was used to identify four groups: those not having job strain at either assessment (N = 138), those having job strain at both times (N = 15), and two crossover groups. Regression analysis was used to examine the cross-sectional associations of ABP with job strain, controlling for other known risk factors. Repeated-measures analysis of variance was used to examine the association of ABP change with the category of job strain change. RESULTS: The cross-sectional analysis of the Time 2 data yielded almost identical, highly significant effects of job strain on ABP as was shown in our previously published Time 1 analysis. Those in high strain jobs at both times had systolic/diastolic ABPs at work and at home that were, on average, 11/7 mm Hg higher than those with no job strain at both times; the crossover groups had intermediate levels of ABP. The longitudinal analysis showed that those with a high strain job at Time 1, but not at Time 2, had a significant decrease in work and home ABP of approximately 5/3 mm Hg. CONCLUSIONS: The previously reported cross-sectional association between job strain and ABP was replicated at follow-up. The group repeatedly exposed to job strain had higher levels of ABP at Time 2 than either crossover group. Furthermore, change in job strain status partially predicted change in ABP. These results provide new evidence supporting the hypothesis that job strain is an occupational risk factor in the etiology of essential hypertension.

Job strain and health behaviors: results of a prospective study.

PURPOSE: To assess the association between job demands, job decision latitude, and job strain (defined by Karasek as a combination of high demands and low decision latitude) and cardiovascular disease-related health behaviors such as cigarette smoking, alcohol use, lack of exercise, and overweight. DESIGN: Cross-sectional and prospective. SETTING: Nine New York City public and private sector worksites. SUBJECTS: Two hundred eighty-five male employees, aged 30 to 60, in a wide variety of white-collar and blue-collar job titles. MEASURES: Medical examinations and surveys, which included demographic, health behavior, and job characteristics data. RESULTS: Prospectively, among 189 men, increase in job decision latitude over 3 years was associated with decrease in cigarette smoking, by analysis of covariance, controlling for age, race, education, marital status, and number of children at home (F (8, 180) = 4.37, p = .005). The largest increase in latitude occurred among the 13 men who quit smoking. However, change in job characteristics was not associated with change in overweight or alcohol use. Cross-sectional analyses did not produce consistent associations. CONCLUSIONS: The effectiveness of smoking cessation may be aided by modification of structural features of the work environment, such as job decision latitude. This study is limited by the small number of subjects who were engaged in high risk behaviors.

Work-related stress and blood pressure: current theoretical models and considerations from a behavioral medicine perspective.

There is extensive evidence that the prevalence of human hypertension is related to psychosocial factors, possibly including chronic exposure to stress. A tripartite model, consistent with the literature on stress and health, may help to define this relationship better. Its 3 components are environmental stressors, individual factors affecting the perception of stress, and the individual's physiological susceptibility. To date, researchers have looked at individual parts of this model, but rarely at all 3. Some models of work stress (e.g., the job strain, effort-reward, and person-environment fit models) focus on work-related stressors alone or in conjunction with individual characteristics. Other models (e.g., the defense-defeat, John Henryism, and reactivity models) focus on individual differences in response, with little attention paid to the nature of the stressors. The authors suggest that it is timely to integrate these approaches and to look for physiological mechanisms.

Psychosocial work stress and pregnancy-induced hypertension.

We examined the association between work during pregnancy and pregnancy-induced hypertension in a prospective cohort study of 717 women. We classified cases, whom we identified by uniform review of blood pressures and proteinuria in prenatal records, into two categories: gestational hypertension (N = 16, 2.5%) and preeclampsia (N = 11, 1.7%). All cases of pregnancy-induced hypertension occurred among the 575 subjects who worked during the first trimester of pregnancy. The association with employment was not explained by primiparity or other known risk factors, or by physical work demands, long work hours, or total hours of paid work, housework, and child care. Stressful job characteristics, however, did show associations with pregnancy-induced hypertension. In particular, gestational hypertension was associated with low decision latitude and low job complexity among women in lower-status jobs [standardized odds ratio (SOR) = 2.4 for low latitude, 95% confidence interval (CI) = 1.1-5.2; SOR = 2.1 for low complexity, 95% CI = 1.0-4.6]. Among women in higher-status jobs, gestational hypertension was associated with job pressures/low control (SOR = 3.6, 95% CI = 0.9-15.1). Psychosocial job stressors, not studied previously, might explain earlier reports of a raised risk of pregnancy-induced hypertension among pregnant workers.

Job strain among post office mailhandlers.

A sample of 4,018 U.S. Post Office mailhandlers nationwide completed a questionnaire assessing job demands, decision latitude, hazardous conditions, supervisory support, physical exertion, physical/psychological strain, sleeping problems, muscle strain, and job dissatisfaction. Scales were obtained from Karasek's Job Content Questionnaire. Comparative data were available from the U.S. Quality of Employment Surveys (for "mail carriers and handlers") and two samples of contemporary working populations. Hierarchical multiple regressions controlled for age, sex, education, length of postal service, Vietnam veteran status, and marital status. Mailhandlers reported significantly higher levels of negative job characteristics than both the national and contemporary samples, and their levels of job demands and decision latitude place them in the "high strain" quadrant of Karasek's model. Women not only reported higher strain, job dissatisfaction, and sleeping problems than men, but also higher levels of negative job characteristics. While other demographic variables, particularly Vietnam veteran status, were associated with stress-related outcomes, structural aspects of the work environment were more strongly associated with outcome. The authors conclude that postal mailhandlers face a highly stressful work environment.

Association between ambulatory blood pressure and alternative formulations of job strain.

OBJECTIVES: The goal of the study was to determine whether alternative formulations of Karasek & Theorell's job-strain construct are associated with ambulatory blood pressure and the risk of hypertension. METHODS: Full-time male employees (N = 262) in eight worksites completed a casual blood pressure screening, medical examinations, and questionnaires and wore an ambulatory blood pressure monitor for 24 h on a workday. Cases of hypertension were ascertained from casual blood pressure readings for a case-referent analysis. A cross-sectional analysis was also conducted, ambulatory (continuous) blood pressure measurements being used as the outcome. RESULTS: All formulations of job strain exhibited significant associations with systolic blood pressure at work and home, but not with diastolic blood pressure. Employees experiencing job strain had a systolic blood pressure that was 6.7 mm Hg (approximately 0.89 kPa) higher and a diastolic blood pressure that was 2.7 mm Hg (approximately 0.36 kPa) higher at work than other employees, and the odds of hypertension were increased [odds ratio (OR) 2.9, 95% confidence interval (95% CI) 1.3-6.6]. Using national means for decision latitude and demands to define job strain increased the systolic and diastolic blood pressure associations to 11.5 mm Hg (approximately 1.53 kPa) and 4.1 mm Hg (approximately 0.54 kPa), respectively. Adding organizational influence to the task-level decision latitude variable produced a stronger association for hypertension with job strain (OR 3.7, 95% CI 1.6-8.5). Adding social support to the job-strain model also slightly increased the hypertension risk. CONCLUSIONS: The impact of job strain, at least on systolic blood pressure, is consistent and robust across alternative formulations, more restrictive cut points tending to produce stronger effects.

Labor union programs to reduce or prevent occupational stress in the United States.

In the United States, most efforts to reduce occupational stress continue to focus primarily on personal stress management. However, there has been a growing awareness that personal coping techniques have limited effectiveness and that sources of stress in the work environment need to be altered. Research on workplace sources of stress has been spurred and guided by Karasek's "job strain" or "job demands-control" model, and the University of Michigan model of the stress process. In addition, a model of occupational stress interventions developed by Karasek provides a useful framework for stress prevention activities. U.S. labor unions have undertaken a variety of activities at all stages of the stress process described by this stress intervention model to reduce or prevent the health hazards associated with occupational stress. These programs and strategies include employee assistance programs, educational programs, stress surveys, medical studies, stress committees, collective bargaining, organizing and public awareness, and lobbying and political action. These programs are described and analyzed in relation to models of occupational stress, as well as to the economic context faced by labor unions today, and continuing obstacles to work environment reform.

The patterning of psychological attributes and distress by "job strain" and social support in a sample of working men.

As a test of the "job strain" (job demands-control) model, 297 healthy men aged 30-60 were recruited at eight New York City worksites. The association among job demands and control, social support, and psychological outcomes was tested using both ANCOVA and moderated multiple regression, controlling for demographic variables. The job strain model was supported by various psychological outcome measures, with workers in "active" jobs reporting the highest level of Type A behavior, job involvement, and positive attributional style, workers in "low-strain" jobs reporting the lowest job dissatisfaction and trait anxiety, workers in "passive" jobs reporting the most external locus of control and trait anxiety, and workers in "high-strain" jobs reporting the highest job dissatisfaction. Low social support was associated with greater symptomatology, and a significant three-way interaction (demands x control x support) for job dissatisfaction was observed. While selection of subjects into jobs may partially explain these findings, the results support the hypothesis that working conditions influence psychological attributes and distress.

Relation between job strain, alcohol, and ambulatory blood pressure.

"Job strain" (defined as high psychological demands and low decision latitude on the job) has been previously reported to be associated with increased risk of hypertension and increased left ventricular mass index (LVMI) in a case-control study of healthy employed men, aged 30-60 years, without evidence of coronary heart disease. We hypothesized that job strain would be associated with increased ambulatory blood pressure (AmBP). A total of 264 men at eight work sites wore an AmBP monitor for 24 hours on a working day. In an analysis of covariance model, job strain was associated with an increase in systolic AmBP of 6.8 mm Hg (p = 0.002) and diastolic AmBP of 2.8 mm Hg at work (p = 0.03) after adjusting for age, race, body mass index, Type A behavior, alcohol behavior, smoking, work site, 24-hour urine sodium, education, and physical demand level of the job. Alcohol use also had a significant effect on AmBP. However, among subjects not in high-strain jobs, alcohol had no apparent effect on AmBP at work. Instead, alcohol use and job strain interacted such that workers in high-strain jobs who drank regularly had significantly higher systolic AmBP at work (p = 0.007). Among the other risk factors, only age, body mass index, and smoking had significant effects on AmBP. Job strain also had significant effects on AmBP at home and during sleep as well as on LVMI.(ABSTRACT TRUNCATED AT 250 WORDS)

The impact of anticipation of job loss on psychological distress and worksite blood pressure.

The impact of occupational stressful life events on psychological distress and blood pressure was examined among employees of a major New York City brokerage firm undergoing massive layoffs. One hundred thirty-nine employees of the firm, who had participated in a blood pressure screening in 1986, were rescreened during the period of layoffs within their company in 1989. About two-thirds of the 139 employees reported being "somewhat" or "very" anxious or upset in 1989 during the period of layoffs, and psychological distress was significantly elevated among those employees reporting possible or definite layoff or job change and/or difficulty in obtaining a comparable job. However, we found no increase in overall blood pressure level, and no effect of anticipation of job loss on 1989 blood pressure when controlling for 1986 blood pressure level, age, body mass index, work hours, and other demographic variables. On the other hand, employment in a department sold to another employer on the day of screening, as well as employment in a clerical job title, were both associated with significant increases in diastolic blood pressure of about 5 mm Hg.

Demography of the hazardous waste industry.

This article attempts to characterize the workforce of the hazardous waste industry. The growth of the industry is discussed, including its deployment into various activity categories, and its size is estimated. Finally, demographics of the workforce are presented.