Make it a habit: how habit strength, goal importance and self-control predict hand washing behaviour over time during the COVID-19 pandemic.

OBJECTIVE: Hand washing has been at the core of recommendations and guidelines that aim to curb infectious diseases in general, and COVID-19 in particular. As hand washing comes down to an individual's behaviour, we aimed to study how individual psychological variables influence hand washing over time during the COVID-19 pandemic. DESIGN: Over the course of 20 weeks, participants answered questions about their hand washing behaviour, goal importance, habit strength and self-control. Participants from an experimental and a control condition completed a baseline and final measurement, and the experimental condition was invited to bi-weekly measurements through reminders. MAIN OUTCOME MEASURE: Hand washing behaviour over the past 14 days was assessed by self-report at baseline and final measurement, and additionally repeatedly over the course of 20 weeks in the experimental condition. RESULTS: Hand washing behaviour decreased over time, but this decrease was buffered by habit strength and goal importance. The decrease was smaller in the experimental condition that received reminders every 2 weeks. CONCLUSION: Sending personal reminders on hand washing behaviour contributes to hand washing behaviour. Moreover, taking habit strength and goal importance, and to a lesser extent self-control into account is important when designing interventions to promote hand washing behaviour.

How to Form Good Habits? A Longitudinal Field Study on the Role of Self-Control in Habit Formation.

When striving for long-term goals (e.g., healthy eating, saving money, reducing energy consumption, or maintaining interpersonal relationships), people often get in conflict with their short-term goals (e.g., enjoying tempting snacks, purchasing must-haves, getting warm, or watching YouTube video's). Previous research suggests that people who are successful in controlling their behavior in line with their long-term goals rely on effortless strategies, such as good habits. In the present study, we aimed to track how self-control capacity affects the development of good habits in real life over a period of 90 days. Results indicated that habit formation increased substantially over the course of three months, especially for participants who consistently performed the desired behavior during this time. Contrary to our expectations, however, self-control capacity did not seem to affect the habit formation process. Directions for future research on self-control and other potential moderators in the formation of good habits are discussed.

Positive Psychological Micro-Interventions to Improve the Work-Family Interface: Use Your Resources and Count Your Blessings.

The present study is designed to test the effectiveness of two positive psychological micro-interventions ("use your resources" and "count your blessings") aimed at improving the combination of work and family roles. Based on the Transactional Model of Stress (TMS), the Conservation of Resources (COR) Theory and the Work-Home Resources (WH-R) Model, it was expected that the interventions would result in a more positive cognitive appraisal of combining both roles as well as in less work-to-family and family-to-work conflict and more work-to-family and family-to-work enrichment. The hypotheses were tested in a field experiment with three conditions and three measurement waves. In total, 218 working mothers participated in the study. The "use your resources" intervention appeared effective in sorting positive effects on the work-family outcome variables. Participating in the "count your blessing" micro-intervention did not result in a better (appraisal of the) combination of work and family roles. Moreover, for generating positive effects it was important that the participants performed the exercises on a regular basis: the more days women performed the exercise, the stronger the effects. The implications of our findings for future interventions to improve work-family role combining are discussed.

Illness narratives and chronic patients' sustainable employability: The impact of positive work stories.

The number of workers with a chronic disease is steadily growing in industrialized countries. To cope with and to give meaning to their illness, patients construct illness narratives, which are widely shared across patient societies, personal networks and the media. This study investigates the influence of these shared illness narratives on patient's working lives, by examining the impact of reading a positive work story versus negative work story on patients' sustainable employability. We expected that this relationship would be mediated by positive emotions and the extent to which the story enhanced awareness of desires future selves, and moderated by identification with story character. An online field experiment with 166 people with Inflammatory Bowel Disease in The Netherlands showed that while reading a positive story of a patient with the same condition significantly increased positive emotions, these emotions did not influence sustainable employability. However, reading a positive story was related to higher sustainable employability when patients became more aware of their desired possible future work selves. Finally, identification with the story character moderated the impact of story type on sustainable employability. This study showed that personal engagement with a positive work story of a fellow patient is related to higher sustainable employability. Findings can be helpful for health professionals to empower employees with a chronic disease.

The Influence of Multi-morbidity on the Work Ability of Ageing Employees and the Role of Coping Style.

Purpose With an ageing workforce, employees are increasingly confronted with multi-morbidity. Especially physical and mental health problems often occur together. This study aims to (i) explore the effect of multi-morbidity on work ability of ageing employees, more specifically the effects of the number of health problems and the combination of physical and mental health problems, and to (ii) explore to what extent the effects of physical and mental health problems on work ability are explained by applying differing coping styles. Methods A 1 year follow up study (2012-2013) was conducted among 7175 employees aged 45-64 years. Linear regression analyses were conducted to examine longitudinal relationships between multi-morbidity, coping styles and work ability. To determine whether coping styles mediate the effects of multi-morbidity on work ability, Sobel tests were conducted. Results A higher number of health problems was related to poorer work ability, but this negative effect stabilized from three health problems onwards. The combination of physical and mental health problem(s) was more strongly related to poorer work ability than only physical health problems. The negative relation between physical health problems and work ability was partly suppressed by active coping, while the negative relation between the combination of physical and mental health problem(s) on work ability was partly explained by avoidant coping. Conclusions Ageing employees with multi-morbidity have a reduced work ability, especially when mental health problems are present. The greater negative effects of the combination of physical and mental health problems on work ability are partially due to unfavorable coping styles.

The influence of chronic health problems and work-related factors on loss of paid employment among older workers.

BACKGROUND: With an ageing society and increasing retirement ages, it is important to understand how employability can be promoted in older workers with health problems. The current study aimed to determine whether (1) different chronic health problems predict transitions from paid employment to disability benefits, unemployment and early retirement, and (2) how work-related factors modify these associations. METHODS: Self-report questionnaire data was used from the Dutch longitudinal Study on Transitions in Employment, Ability and Motivation with 3 years of follow-up (2010-2013), among employees aged 45-64 years (N=8149). The influence of baseline chronic health problems and work-related factors on transitions from paid employment to disability benefits, unemployment and early retirement during follow-up was estimated in a competing risks proportional hazards model. Relative excess risk of transitions due to the interaction between chronic health problems and work-related factors was assessed. RESULTS: Severe headache, diabetes mellitus and musculoskeletal, respiratory, digestive and psychological health problems predicted an increased risk of disability benefits (HR range 1.78-2.79). Circulatory (HR=1.35) and psychological health problems (HR=2.58) predicted unemployment, and musculoskeletal (HR=1.23) and psychological health problems (HR=1.57) predicted early retirement. Work-related factors did not modify the influence of health problems on unemployment or early retirement. Psychosocial work-related factors, especially autonomy, modified the influence of health problems on disability benefits. Specifically, among workers with health problems, higher autonomy, higher support and lower psychological job demands reduced the risk of disability benefits by 82%, 49%, and 11%, respectively. CONCLUSIONS: All health problems affected disability benefits to a similar extent, but psychological health problems especially predicted unemployment and early retirement. For older workers with health problems, promoting an optimal work environment has the potential to contribute to sustainable employment.

The role of ability, motivation, and opportunity to work in the transition from work to early retirement--testing and optimizing the Early Retirement Model.

OBJECTIVES: Determinants in the domains health, job characteristics, skills, and social and financial factors may influence early retirement through three central explanatory variables, namely, the ability, motivation, and opportunity to work. Based on the literature, we created the Early Retirement Model. This study aims to investigate whether data support the model and how it could be improved. METHODS: Employees aged 58-62 years (N=1862), who participated in the first three waves of the Dutch Study on Transitions in Employment, Ability and Motivation (STREAM) were included. Determinants were assessed at baseline, central explanatory variables after one year, and early retirement after two years. Structural equation modeling was applied. RESULTS: Testing the Early Retirement Model resulted in a model with good fit. Health, job characteristics, skills, and social and financial factors were related to the ability, motivation and/or opportunity to work (significant ß range: 0.05-0.31). Lower work ability (ß=-0.13) and less opportunity to work (attitude colleagues and supervisor about working until age 65: ß=-0.24) predicted early retirement, whereas the motivation to work (work engagement) did not. The model could be improved by adding direct effects of three determinants on early retirement, ie, support of colleagues and supervisor (ß=0.14), positive attitude of the partner with respect to early retirement (ß=0.15), and not having a partner (ß=-0.13). CONCLUSIONS: The Early Retirement Model was largely supported by the data but could be improved. The prolongation of working life might be promoted by work-related interventions focusing on health, work ability, the social work climate, social norms on prolonged careers, and the learning environment.

Associations of work-related factors and work engagement with mental and physical health: a 1-year follow-up study among older workers.

PURPOSE: The goals of this study were to determine whether, among older employees, unfavourable physical and psychosocial work-related factors were associated with poorer mental and physical health and whether high work engagement buffered the associations between unfavourable work-related factors and poorer health. METHODS: A 1-year longitudinal study with employed persons aged 45-64 was conducted within the Study on Transitions in Employment, Ability and Motivation (n = 8,837). Using an online questionnaire, work-related factors (physical: physical load; psychosocial: psychological job demands, autonomy, and support) and work engagement were measured at baseline and health at baseline and 1-year follow-up. General linear models were used to assess associations of work-related factors and work engagement with health. Tests of interaction terms assessed whether work engagement buffered the work-related factor-health associations. RESULTS: Unfavourable psychosocial work-related factors at baseline were associated with poorer mental health at follow-up. Higher physical load, higher psychological job demands, and lower autonomy at baseline were associated with poorer physical health at follow-up. Higher work engagement at baseline was related to better physical and especially better mental health during the 1-year follow-up. Work engagement had a small effect on the associations between work-related factors and health. CONCLUSIONS: Among older employees, especially the promotion of a high work engagement and, to a lesser extent, favourable work-related factors can be beneficial for mental health in particular.

The influence of chronic health problems on work ability and productivity at work: a longitudinal study among older employees.

OBJECTIVES: This study aimed to assess the influence of chronic health problems on work ability and productivity at work among older employees using different methodological approaches in the analysis of longitudinal studies. METHODS: Data from employees, aged 45-64, of the longitudinal Study on Transitions in Employment, Ability and Motivation was used (N=8411). Using three annual online questionnaires, we assessed the presence of seven chronic health problems, work ability (scale 0-10), and productivity at work (scale 0-10). Three linear regression generalized estimating equations were used. The time-lag model analyzed the relation of health problems with work ability and productivity at work after one year; the autoregressive model adjusted for work ability and productivity in the preceding year; and the third model assessed the relation of incidence and recovery with changes in work ability and productivity at work within the same year. RESULTS: Workers with health problems had lower work ability at one-year follow-up than workers without these health problems, varying from a 2.0% reduction with diabetes mellitus to a 9.5% reduction with psychological health problems relative to the overall mean (time-lag). Work ability of persons with health problems decreased slightly more during one-year follow-up than that of persons without these health problems, ranging from 1.4% with circulatory to 5.9% with psychological health problems (autoregressive). Incidence related to larger decreases in work ability, from 0.6% with diabetes mellitus to 19.0% with psychological health problems, than recovery related to changes in work ability, from a 1.8% decrease with circulatory to an 8.5% increase with psychological health problems (incidence-recovery). Only workers with musculoskeletal and psychological health problems had lower productivity at work at one-year follow-up than workers without those health problems (1.2% and 5.6%, respectively, time-lag). CONCLUSIONS: All methodological approaches indicated that chronic health problems were associated with decreased work ability and, to a much lesser extent, lower productivity at work. The choice for a particular methodological approach considerably influenced the strength of the associations, with the incidence of health problems resulting in the largest decreases in work ability and productivity at work.

Health, job characteristics, skills, and social and financial factors in relation to early retirement--results from a longitudinal study in the Netherlands.

OBJECTIVES: This study aimed to investigate the relative contribution of health, job characteristics, skills and knowledge, and social and financial factors to the transition from work to (non-disability) early retirement. METHODS: Employees aged 59-63 years (N=2317) were selected from the Study on Transitions in Employment, Ability and Motivation in the Netherlands (STREAM). Individual characteristics, health, job characteristics, skills and knowledge, and social and financial factors were measured using a questionnaire at baseline. Information on early retirement was derived from the one-year follow-up questionnaire. Logistic regression analyses were used to identify predictors of early retirement. Population Attributable Fractions (PAF) were calculated. RESULTS: Older age [odds ratio (OR) 1.79], poor physical health (OR 1.78), a positive attitude of the partner with respect to early retirement (OR 3.85), and the financial possibility to stop working before the age of 65 (OR 10.2) predicted the transition to early retirement, whereas employees that reported high appreciation at work (OR 0.58) and higher focus on development of skills and knowledge (OR 0.54) were less likely to retire early. PAF were 0.75 for the financial possibility to stop working, 0.43 for a positive attitude of the partner with respect to early retirement, 0.27 for low appreciation at work, 0.23 for a low focus on development, and 0.21 for poor health. CONCLUSIONS: The financial possibility to stop working before the age of 65 importantly contributes to early retirement. In the context of rapidly diminishing financial opportunities to retire early in the Netherlands, the prolongation of working life might be promoted by workplace health promotion and disability management, and work-related interventions focusing on appreciation and the learning environment.

Differential effects of mental and physical health and coping style on work ability: a 1-year follow-up study among aging workers.

OBJECTIVE: This study examines whether mental and physical health relate differently to work ability and whether these associations vary with coping style. METHODS: A 1-year longitudinal study was conducted among 8842 employees aged 45 to 64 years from the Study on Transitions in Employment, Ability and Motivation. On-line questionnaires measured self-perceived mental and physical health at baseline and coping and work ability at follow-up. The data were analyzed using hierarchical regression analysis. RESULTS: Active coping and good mental and especially physical health predicted high work ability at follow-up. Avoidant coping was negatively related to work ability. Seeking support was unrelated to work ability. Interaction effects of coping and health on work ability were weak. CONCLUSIONS: Successful coping styles and good health predict high work ability, and thus, promoting such factors can help improve sustainable employability.

'All those things together made me retire': qualitative study on early retirement among Dutch employees.

BACKGROUND: Due to the aging of the population and subsequent higher pressure on public finances, there is a need for employees in many European countries to extend their working lives. One way in which this can be achieved is by employees refraining from retiring early. Factors predicting early retirement have been identified in quantitative research, but little is known on why and how these factors influence early retirement. The present qualitative study investigated which non-health related factors influence early retirement, and why and how these factors influence early retirement. METHODS: A qualitative study among 30 Dutch employees (60-64 years) who retired early, i.e. before the age of 65, was performed by means of face-to-face interviews. Participants were selected from the cohort Study on Transitions in Employment, Ability and Motivation (STREAM). RESULTS: For most employees, a combination of factors played a role in the transition from work to early retirement, and the specific factors involved differed between individuals. Participants reported various factors that pushed towards early retirement ('push factors'), including organizational changes at work, conflicts at work, high work pressure, high physical job demands, and insufficient use of their skills and knowledge by others in the organization. Employees who reported such push factors towards early retirement often felt unable to find another job. Factors attracting towards early retirement ('pull factors') included the wish to do other things outside of work, enjoy life, have more flexibility, spend more time with a spouse or grandchildren, and care for others. In addition, the financial opportunity to retire early played an important role. Factors influenced early retirement via changes in the motivation, ability and opportunity to continue working or retire early. CONCLUSION: To support the prolongation of working life, it seems important to improve the fit between the physical and psychosocial job characteristics on the one hand, and the abilities and wishes of the employee on the other hand. Alongside improvements in the work environment that enable and motivate employees to prolong their careers, a continuous dialogue between the employer and employee on the (future) person-job fit and tailored interventions might be helpful.

Pathways through which health influences early retirement: a qualitative study.

BACKGROUND: Due to the aging of the population, there is a societal need for workers to prolong their working lives. In the Netherlands, many employees still leave the workforce before the official retirement age of 65. Previous quantitative research showed that poor self-perceived health is a risk factor of (non-disability) early retirement. However, little is known on how poor health may lead to early retirement, and why poor health leads to early retirement in some employees, but not in others. Therefore, the present qualitative study aims to identify in which ways health influences early retirement. METHODS: Face-to-face semi-structured interviews were conducted with 30 employees (60-64 years) who retired before the official retirement age of 65. Participants were selected from the Study on Transitions in Employment, Ability and Motivation. The interviews were transcribed verbatim, a summary was made including a timeline, and the interviews were open coded. RESULTS: In 15 of the 30 persons, health played a role in early retirement. Both poor and good health influenced early retirement. For poor health, four pathways were identified. First, employees felt unable to work at all due to health problems. Second, health problems resulted in a self-perceived (future) decline in the ability to work, and employees chose to retire early. Third, employees with health problems were afraid of a further decline in health, and chose to retire early. Fourth, employees with poor health retired early because they felt pushed out by their employer, although they themselves did not experience a reduced work ability. A good health influenced early retirement, since persons wanted to enjoy life while their health still allowed to do so. The financial opportunity to retire sometimes triggered the influence of poor health on early retirement, and often triggered the influence of good health. Employees and employers barely discussed opportunities to prolong working life. CONCLUSIONS: Poor and good health influence early retirement via several different pathways. To prolong working life, a dialogue between employers and employees and tailored work-related interventions may be helpful.

Do work factors modify the association between chronic health problems and sickness absence among older employees?

OBJECTIVES: The aim of this study was to (i) assess how common chronic health problems and work-related factors predict sickness absence and (ii) explore whether work-related factors modify the effects of health problems on sickness absence. METHODS: A one-year longitudinal study was conducted among employed persons aged 45-64 years from the Study on Transitions in Employment, Ability and Motivation (N = 8984). The presence of common chronic health problems and work-related factors was determined at baseline and self-reported sickness absence at one-year follow-up by questionnaire. Multinomial multivariate logistic regression analyses were conducted to assess associations between health, work factors, and sickness absence, and relative excess risk due to interaction (RERI) techniques were used to test effect modification. RESULTS: Common health problems were related to follow-up sickness absence, most strongly to high cumulative sickness absence (> 9 days per year). Baseline psychological health problems were strongly related to high sickness absence at follow-up [odds ratio (OR) 3.67, 95% confidence interval (95% CI) 2.80-4.82]. Higher job demands at baseline increased the likelihood of high sickness absence at follow-up among workers with severe headaches [RERI 1.35 (95% CI 0.45-2.25)] and psychological health problems [RERI 3.51 (95% CI 0.67-6.34)] at baseline. Lower autonomy at baseline increased the likelihood of high sickness absence at follow-up among those with musculoskeletal [RERI 0.57 (95% CI 0.05-1.08)], circulatory [RERI 0.82 (95% CI 0.00-1.63)], and psychological health problems [RERI 2.94 (95% CI 0.17-5.70)] at baseline. CONCLUSIONS: Lower autonomy and higher job demands increased the association of an array of common chronic health problems with sickness absence, and thus focus should be placed on altering these factors in order to reduce sickness absence and essentially promote sustainable employability.

How do older employees with health problems remain productive at work?: a qualitative study.

PURPOSE: The goal of this qualitative study was to gain insight into how older employees remain productive at work in spite of health problems. METHODS: Twenty-six semi-structured telephone interviews were conducted with older employees, 46-63 years of age, who reported a poor health in the Study on Transitions in Employment, Ability, and Motivation. Demographic, health, and work information was gathered, followed by information on adjustments made in response to health problems. Inductive and deductive analyses were done independently by two researchers. RESULTS: Four pathways through which poor health could influence productivity were identified: (1) poor health did not influence productivity; (2) poor health created a temporary imbalance in demands and external and internal resources after which adjustments were made and productivity was maintained; (3) adjustments were made in response to an imbalance, but productivity remained reduced; and (4) no adjustments were made and productivity was reduced. Whether and which adjustments occurred was influenced by factors in various domains, such as: visibility of the problem (health), autonomy (work-related), support (relational), and the ability to ask for help (personal). Sustainable productivity was influenced by internal factors that enhanced or hindered the creation of a balance, and by whether appropriate adjustments were made. CONCLUSIONS: The influence that health can have on productivity depends on the individuals' unique imbalance and personal disposition. Helpful a priori work place characteristics and personal well-being should be promoted so that a balance between demands and resources can be found in times of poor health.

Predictors of the willingness and the ability to continue working until the age of 65 years.

OBJECTIVE: To identify predictors of the willingness and ability of older workers to continue working until the age of 65. METHODS: In this longitudinal study, 4937 employees aged 45 to 63 years included in the Netherlands Working Conditions Cohort Study were studied. Logistic regression analyses were applied. RESULTS: Employees who experienced emotional exhaustion and bullying or harassment by colleagues/supervisor were less often willing to continue working, whereas employees sometimes using force were more often willing to continue working. Emotional exhaustion, a work handicap, higher physical and emotional demands, lower supervisor's support, and intermediate satisfaction with salary predicted a lower likelihood to be able to continue working. CONCLUSION: Prevention of emotional exhaustion and promotion of a healthy social work climate may support both the willingness and ability to work until the age of 65 years.

Investigating the associations among overtime work, health behaviors, and health: a longitudinal study among full-time employees.

BACKGROUND: It has often been suggested that high levels of overtime lead to adverse health outcomes. One mechanism that may account for this association is that working overtime leads to elevated levels of stress, which could affect worker's behavioral decisions or habits (such as smoking and lack of physical activity). In turn, this could lead to adverse health. PURPOSE: The present study examined this reasoning in a prospective longitudinal design. Data from the prospective 2-year Study on Health at Work (N = 649) were used to test our hypotheses. METHODS: Structural equation analysis was used to examine the relationships among overtime, beneficial (exercising, intake of fruit and vegetables) and risky (smoking and drinking) health behaviors, and health indicators (BMI and subjective health). RESULTS: Working overtime was longitudinally related with adverse subjective health, but not with body mass. Moreover, working overtime was associated with lower levels of physical activity and intake of fruit and vegetables, but not with smoking and drinking. Finally, higher levels of risky and lower levels of beneficial health behaviors were longitudinally associated with ill health. CONCLUSIONS: The relation between overtime and ill health is partly accounted for by the unhealthy lifestyle in which overworkers tend to engage. However, a direct longitudinal effect of overtime on health suggested that the effects of overtime on health may also partly be due to the sustained physiological activation that results from working overtime. Whereas working a moderate amount of overtime does not usually entail major health risks, these will increase with increasing overtime.

Return-to-work of sick-listed workers without an employment contract--what works?

BACKGROUND: In the past decade flexible labour market arrangements have emerged as a significant change in the European Union labour market. Studies suggest that these new types of labour arrangements may be linked to ill health, an increased risk for work disability, and inadequate vocational rehabilitation. Therefore, the objectives of this study were: 1. to examine demographic characteristics of workers without an employment contract sick-listed for at least 13 weeks, 2. to describe the content and frequency of occupational health care (OHC) interventions for these sick-listed workers, and 3. to examine OHC interventions as possible determinants for return-to-work (RTW) of these workers. METHODS: A cohort of 1077 sick-listed workers without an employment contract were included at baseline, i.e. 13 weeks after reporting sick. Demographic variables were available at baseline. Measurement of cross-sectional data took place 4-6 months after inclusion. Primary outcome measures were: frequency of OHC interventions and RTW-rates. Measured confounding variables were: gender, age, type of worker (temporary agency worker, unemployed worker, or remaining worker without employment contract), level of education, reason for absenteeism (diagnosis), and perceived health. The association between OHC interventions and RTW was analysed with a logistic multiple regression analysis. RESULTS: At 7-9 months after the first day of reporting sick only 19% of the workers had (partially or completely) returned to work, and most workers perceived their health as fairly poor or poor. The most frequently reported (49%) intervention was 'the OHC professional discussed RTW'. However, the intervention 'OHC professional made and discussed a RTW action plan' was reported by only 19% of the respondents. The logistic multiple regression analysis showed a significant positive association between RTW and the interventions: 'OHC professional discussed RTW'; and 'OHC professional made and discussed a RTW action plan'. The intervention 'OHC professional referred sick-listed worker to a vocational rehabilitation agency' was significantly associated with no RTW. CONCLUSION: This is the first time that characteristics of a large cohort of sick-listed workers without an employment contract were examined. An experimental or prospective study is needed to explore the causal nature of the associations found between OHC interventions and RTW.

The double whammy of a work handicap (differential) effects of health on working conditions and outcomes.

OBJECTIVE: To determine the effect of health on working conditions and outcomes. METHODS: Data were collected in the longitudinal Study on Health at Work (n = 1597 employees), using multiple regression analyses and focusing on three groups of employees: 1) healthy, 2) chronic health complaints without a work handicap, and 3) chronic health complaints with a work handicap. RESULTS: 1) Employees with a work handicap experienced less favorable working conditions and outcomes than other employees. 2) Employees with a work handicap experienced less favorable working conditions and outcomes over time. 3) Employees with chronic health complaints were more vulnerable to the influence of working conditions on outcomes, whereas employees with a work handicap, unexpectedly, benefited from high work pressure and low autonomy. CONCLUSION: 1) Employees with a work handicap differ considerably from employees with chronic health complaints. 2) Employees with a work handicap drift into less favorable working conditions and outcomes. 3) Healthy employees, employees with chronic health complaints, and employees with a work handicap, all are vulnerable to different working conditions.

Employment contracts: cross-sectional and longitudinal relations with quality of working life, health and well-being.

OBJECTIVES: The aim of this study was to enhance (i) insight in the relationship between different types of employment contract and the quality of working life, health and well-being, and (ii) our causal understanding of these relationships by comparing employees whose contract type changes across time. METHODS: Analyses were based on a two-year prospective cohort study. Cross-sectional analyses were based upon a sample of 2,454 Dutch employees (2004). Longitudinal data were available for 1,865 respondents (2004-2006). We distinguished among 5 contract types, and subgroups of 'Upward' (i.e., towards permanent employment) and 'Downward' (towards temporary employment) movers across time. Data were analysed with analysis of variance and cross table analysis. RESULTS: Cross-sectionally, we found differences between contract types in quality of working life: generally permanent employees had better jobs, whereas temporary agency workers and on call workers had more 'bad work characteristics'. We also found a difference in health behaviour (smoking) and that psychological health was worst among temporary agency workers. In longitudinal analyses we found some evidence that a positive change in employment contract was associated with a better quality of working life and better psychological health, whereas the opposite was true for a negative contract change. CONCLUSIONS: The quality of working life, health and well-being are unequally distributed over employment contract groups. Temporary agency workers and on-call workers deserve special attention in terms of job design and human resource management.