Explaining employees' health care costs: a prospective examination of stressful job demands, personal control, and physiological reactivity.

The authors tested the ability of stressful demands and personal control in the workplace to predict employees' subsequent health care costs in a sample of 105 full-time nurses. Both subjective and objective measures of workload demands interacted with personal control perceptions in predicting the cumulative health care costs over the ensuing 5-year period. Tonic elevations in salivary cortisol, moreover, mediated the effects of demands and control on health care costs. Neither the job demands variables nor physiological reactivity measures, however, explained subsequent mental health. The results support findings from the epidemiological literature that demonstrate an important role for employees' control in explaining occupational inequalities in coronary heart disease and mortality. The authors argue that the results also encourage control-enhancing job design interventions by suggesting that their outcomes can benefit both organizations and their members.

Positive affectivity and negative outcomes: the role of tenure and job satisfaction.

In this study, the authors proposed and tested a 3-way interaction among positive affectivity (PA), job satisfaction, and tenure in predicting negative employee outcomes. Specifically, the authors predicted that the relationship between job satisfaction and negative outcomes would be stronger for high PAs and that this relationship would be more pronounced for longer tenured employees. Results support this 3-way interaction in predicting job search behavior, physical health complaints, and counterproductive employee behavior. In particular, the relationship between job satisfaction and negative outcomes was most strongly negative for high-PA individuals with longer tenure. The authors discuss the implications of these results and some directions for future research.

Effects of stressful job demands and control on physiological and attitudinal outcomes in a hospital setting.

We tested the job demands--job control model of stress with a group of 136 registered nurses. Significant interactions between subjective and objective measures of work load and a measure of perceived control predicting physiological and attitudinal outcomes indicated support for the model. In addition, objectively assessed job demands were significantly associated with blood pressure and cortisol levels. The model also predicted elevations in physiological responses after individuals left work, suggesting that potentially health-impairing reactions to jobs that have high demands and low controllability might carry over to home settings and thus pose a high risk of long-term health impairment. The results have implications for the role of personal control in occupational stress generally and for nurse-management practices specifically.

Chronic demands and responsivity to challenge.

Certain kinds of arousal in response to challenge situations reflect conditioning that makes one adaptive to task demands. A growing literature implicates chronic stress as a factor degenerating this conditioning. This study investigated the relation between objective occupational demands to which workers were classified for at least 2 years and various indicators of adaptive responsivity to challenge situations. There were consistently significant and negative relations between the occupational exposures and cardiovascular and skin temperature responsivity to the acute challenges administered in the laboratory, the corresponding speed of recovery to baseline after removal of the challenge stimulus, and peripheral catecholamine changes during a work shift.

Dispositional affect and work-related stress.

Trait negative affectivity (NA) has been asserted to be a factor that spuriously inflates relationships between self-reported stressors and self-reported strain outcomes. We tested this hypothesis with conventional work stress instrument responses and physiological assessments obtained from 311 fire and police department employees. Confirmatory factor analyses indicated that NA did not measure a factor in common with measures of subjective strain. Latent-variable structural equations analyses, however, found that estimating the effects of NA on strain significantly attenuated the effects of work stressors. NA had no correlation with physiological stress outcomes. Trait positive affectivity did not attenuate relationships between work stressors and either subjective or objective stress outcomes. Implications for work stress research methodology and recommendations are discussed.

The nomological validity of the Type A personality among employed adults.

The nomological validity of the Type A behavior pattern was explored. The Structured Interview (SI) and a battery of personality trait, physical health, and strain measures were administered to an occupationally diverse sample of 568 workers. Ss were also monitored for physiological reactivity and recovery (blood pressure, heart rate, skin temperature, and electrodermal response) to the SI and a subsequent Stroop Color-Word Conflict Task. A confirmatory factor analysis demonstrated that SI scores can be factored into three distinct dimensions. There was considerable overlap in the patterns of personality traits that characterized the Type A components, but only a Hostility dimension was significantly related to physiological reactivity and recovery. The results have implications for distinguishing coronary-proneness from the more traditional Type A conceptualization.

The impact of social support on mental and physical health.

Early research on life-stress grappled with the question of whether significant life-events bring about changes in health status. The emphasis has now shifted to the identification of factors that explain why some people seem to be so severely affected by life's adversities and others are not. From a class of what might be called 'vulnerability variables' (Kessler, 1979), support from one's social network has emerged as a significant factor that can account for at least some of the vulnerability differences between groups of stressed individuals. Since Cassel's (1974) review of the evidence linking social upheavals to adverse health consequences for both humans and animals, hundreds of empirical studies have been completed that assess the direct and indirect effects of social support on mental and physical health. This literature is so voluminous as to require several books devoted to reviews of various aspects of it (e.g. Cohen & Syme, 1985; Gottlieb, 1981; and Gottlieb, 1983). In this paper we will distil these as well as highlight some of the recent empirical developments, particularly in those areas that have received less attention in prior reviews. Social support has been defined as the presence of others, or the resources provided by them, prior to, during, and following a stressful event. While there is no general agreement on a single definition, the variety has spawned a number of typologies attempting to organize the literature (e.g. Cohen & Syme, 1985; Cohen & Wills, 1985; Gottlieb, 1983; House & Kahn, 1985). Most of these typologies initially distinguish between functional and structural operationalizations of social support.

Convergent validity of type A behavior pattern scales and their ability to predict physiological responsiveness in a sample of female public employees.

The purpose of this study was to assess the construct validity of the structured interview (SI), Jenkins Activity Survey (JAS), Thurstone Activity Scale, and Bortner Type A Scale in a sample of female employees from a government service agency. Criteria for validity assessment were physiological reactance to a mental stressor, psychological strains experienced at work, physical symptoms associated with work, and urinary catecholamine production at work. A continuous Type A SI scale demonstrated better convergent and construct validity than did the SI category scores. All of the SI Type A scales were reliable. Among the questionnaire measures only the Thurstone Activity Scale was reliable and showed the strongest construct validity. The SI measures of Type A tended to correlate with physiological responsiveness (changes in heart rate, skin temperature, and skin conductance), while the questionnaire measures correlated with self-reports of job strains (satisfaction, irritation, depression, physical symptoms), thus indicating the operation of measurement artifacts in validity assessment. No significant correlations were obtained between Type A and catecholamines. Comparison of correlation analysis with subgroup analysis revealed the former to be a more powerful test of the relationships that may exist between Type A behavior pattern and relevant criteria.