Skip to main content
Journal of Epidemiology and Community Health logoLink to Journal of Epidemiology and Community Health
. 2002 Apr;56(4):272–278. doi: 10.1136/jech.56.4.272

Employee control over working times: associations with subjective health and sickness absences

L Ala-Mursula 1, J Vahtera 1, M Kivimaki 1, M Kevin 1, J Pentti 1
PMCID: PMC1732125  PMID: 11896134

Abstract

Study objective: To investigate the impact of employees' worktime control on health, taking into account other aspects of job control.

Design: Analysis of questionnaire data in 1997 and register data on sickness absence during 1996–1998.

Setting: Eight towns in Finland.

Participants: 6442 municipal employees (1490 men and 4952 women) representing the staff of the towns studied. Follow up was 17 706 person years.

Main results: In women, poor health and psychological distress were more prevalent among those in the lowest quartile of worktime control than those in the highest (after adjustment for potential confounders including other aspects of job control, odds ratios and their 95% confidence intervals for poor health and psychological distress were 1.8 (1.5 to 2.3) and 1.6 (1.3 to 2.0), respectively). Correspondingly, the adjusted sickness absence rate was 1.2 (1.1 to 1.2) times higher in women with low worktime control than in women with high worktime control. In men, no significant associations between worktime control and health were found. These results, obtained from the total sample, were replicable within a homogeneous occupational group comprising women and men.

Conclusions: Exploration of specific aspects of job control provides new information about potentially reversible causes of health problems in a working population. Worktime control is an independent predictor of health in women but not in men. Dissimilarities in the distribution of occupations between men and women are not a probable explanation for this difference.

Full Text

The Full Text of this article is available as a PDF (133.7 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Alfredsson L., Karasek R., Theorell T. Myocardial infarction risk and psychosocial work environment: an analysis of the male Swedish working force. Soc Sci Med. 1982;16(4):463–467. doi: 10.1016/0277-9536(82)90054-5. [DOI] [PubMed] [Google Scholar]
  2. Alfredsson L., Spetz C. L., Theorell T. Type of occupation and near-future hospitalization for myocardial infarction and some other diagnoses. Int J Epidemiol. 1985 Sep;14(3):378–388. doi: 10.1093/ije/14.3.378. [DOI] [PubMed] [Google Scholar]
  3. Amick B. C., 3rd, Kawachi I., Coakley E. H., Lerner D., Levine S., Colditz G. A. Relationship of job strain and iso-strain to health status in a cohort of women in the United States. Scand J Work Environ Health. 1998 Feb;24(1):54–61. doi: 10.5271/sjweh.278. [DOI] [PubMed] [Google Scholar]
  4. Aronsson G. Dimensions of control as related to work organization, stress, and health. Int J Health Serv. 1989;19(3):459–468. doi: 10.2190/N6KQ-HWA0-H7CJ-KUPQ. [DOI] [PubMed] [Google Scholar]
  5. Bobák M., Hertzman C., Skodová Z., Marmot M. Association between psychosocial factors at work and nonfatal myocardial infarction in a population-based case-control study in Czech men. Epidemiology. 1998 Jan;9(1):43–47. [PubMed] [Google Scholar]
  6. Bosma H., Peter R., Siegrist J., Marmot M. Two alternative job stress models and the risk of coronary heart disease. Am J Public Health. 1998 Jan;88(1):68–74. doi: 10.2105/ajph.88.1.68. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Cheng Y., Kawachi I., Coakley E. H., Schwartz J., Colditz G. Association between psychosocial work characteristics and health functioning in American women: prospective study. BMJ. 2000 May 27;320(7247):1432–1436. doi: 10.1136/bmj.320.7247.1432. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Frankenhaeuser M. Coping with stress at work. Int J Health Serv. 1981;11(4):491–510. doi: 10.2190/L7LK-4T4D-KLVV-A9P6. [DOI] [PubMed] [Google Scholar]
  9. Goldberg D. P., Gater R., Sartorius N., Ustun T. B., Piccinelli M., Gureje O., Rutter C. The validity of two versions of the GHQ in the WHO study of mental illness in general health care. Psychol Med. 1997 Jan;27(1):191–197. doi: 10.1017/s0033291796004242. [DOI] [PubMed] [Google Scholar]
  10. Hammar N., Alfredsson L., Theorell T. Job characteristics and the incidence of myocardial infarction. Int J Epidemiol. 1994 Apr;23(2):277–284. doi: 10.1093/ije/23.2.277. [DOI] [PubMed] [Google Scholar]
  11. Idler E. L., Angel R. J. Self-rated health and mortality in the NHANES-I Epidemiologic Follow-up Study. Am J Public Health. 1990 Apr;80(4):446–452. doi: 10.2105/ajph.80.4.446. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Johnson J. V., Stewart W., Hall E. M., Fredlund P., Theorell T. Long-term psychosocial work environment and cardiovascular mortality among Swedish men. Am J Public Health. 1996 Mar;86(3):324–331. doi: 10.2105/ajph.86.3.324. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Kaplan G. A., Goldberg D. E., Everson S. A., Cohen R. D., Salonen R., Tuomilehto J., Salonen J. Perceived health status and morbidity and mortality: evidence from the Kuopio ischaemic heart disease risk factor study. Int J Epidemiol. 1996 Apr;25(2):259–265. doi: 10.1093/ije/25.2.259. [DOI] [PubMed] [Google Scholar]
  14. Kaprio J., Koskenvuo M., Langinvainio H., Romanov K., Sarna S., Rose R. J. Genetic influences on use and abuse of alcohol: a study of 5638 adult Finnish twin brothers. Alcohol Clin Exp Res. 1987 Aug;11(4):349–356. doi: 10.1111/j.1530-0277.1987.tb01324.x. [DOI] [PubMed] [Google Scholar]
  15. Karasek R., Baker D., Marxer F., Ahlbom A., Theorell T. Job decision latitude, job demands, and cardiovascular disease: a prospective study of Swedish men. Am J Public Health. 1981 Jul;71(7):694–705. doi: 10.2105/ajph.71.7.694. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Kivimäki M., Vahtera J., Pentti J., Ferrie J. E. Factors underlying the effect of organisational downsizing on health of employees: longitudinal cohort study. BMJ. 2000 Apr 8;320(7240):971–975. doi: 10.1136/bmj.320.7240.971. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Kivimäki M., Vahtera J., Thomson L., Griffiths A., Cox T., Pentti J. Psychosocial factors predicting employee sickness absence during economic decline. J Appl Psychol. 1997 Dec;82(6):858–872. doi: 10.1037/0021-9010.82.6.858. [DOI] [PubMed] [Google Scholar]
  18. Knauth P. Innovative worktime arrangements. Scand J Work Environ Health. 1998;24 (Suppl 3):13–17. [PubMed] [Google Scholar]
  19. Kujala U. M., Kaprio J., Sarna S., Koskenvuo M. Relationship of leisure-time physical activity and mortality: the Finnish twin cohort. JAMA. 1998 Feb 11;279(6):440–444. doi: 10.1001/jama.279.6.440. [DOI] [PubMed] [Google Scholar]
  20. Lerner D. J., Levine S., Malspeis S., D'Agostino R. B. Job strain and health-related quality of life in a national sample. Am J Public Health. 1994 Oct;84(10):1580–1585. doi: 10.2105/ajph.84.10.1580. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Lundberg U., Frankenhaeuser M. Stress and workload of men and women in high-ranking positions. J Occup Health Psychol. 1999 Apr;4(2):142–151. doi: 10.1037//1076-8998.4.2.142. [DOI] [PubMed] [Google Scholar]
  22. Lundberg U., Mårdberg B., Frankenhaeuser M. The total workload of male and female white collar workers as related to age, occupational level, and number of children. Scand J Psychol. 1994 Dec;35(4):315–327. doi: 10.1111/j.1467-9450.1994.tb00956.x. [DOI] [PubMed] [Google Scholar]
  23. Marmot M. G., Bosma H., Hemingway H., Brunner E., Stansfeld S. Contribution of job control and other risk factors to social variations in coronary heart disease incidence. Lancet. 1997 Jul 26;350(9073):235–239. doi: 10.1016/s0140-6736(97)04244-x. [DOI] [PubMed] [Google Scholar]
  24. Marmot M., Feeney A., Shipley M., North F., Syme S. L. Sickness absence as a measure of health status and functioning: from the UK Whitehall II study. J Epidemiol Community Health. 1995 Apr;49(2):124–130. doi: 10.1136/jech.49.2.124. [DOI] [PMC free article] [PubMed] [Google Scholar]
  25. Matthews S., Hertzman C., Ostry A., Power C. Gender, work roles and psychosocial work characteristics as determinants of health. Soc Sci Med. 1998 Jun;46(11):1417–1424. doi: 10.1016/s0277-9536(97)10141-1. [DOI] [PubMed] [Google Scholar]
  26. Melamed S., Ben-Avi I., Luz J., Green M. S. Objective and subjective work monotony: effects on job satisfaction, psychological distress, and absenteeism in blue-collar workers. J Appl Psychol. 1995 Feb;80(1):29–42. doi: 10.1037/0021-9010.80.1.29. [DOI] [PubMed] [Google Scholar]
  27. Miilunpalo S., Vuori I., Oja P., Pasanen M., Urponen H. Self-rated health status as a health measure: the predictive value of self-reported health status on the use of physician services and on mortality in the working-age population. J Clin Epidemiol. 1997 May;50(5):517–528. doi: 10.1016/s0895-4356(97)00045-0. [DOI] [PubMed] [Google Scholar]
  28. North F. M., Syme S. L., Feeney A., Shipley M., Marmot M. Psychosocial work environment and sickness absence among British civil servants: the Whitehall II study. Am J Public Health. 1996 Mar;86(3):332–340. doi: 10.2105/ajph.86.3.332. [DOI] [PMC free article] [PubMed] [Google Scholar]
  29. North F., Syme S. L., Feeney A., Head J., Shipley M. J., Marmot M. G. Explaining socioeconomic differences in sickness absence: the Whitehall II Study. BMJ. 1993 Feb 6;306(6874):361–366. doi: 10.1136/bmj.306.6874.361. [DOI] [PMC free article] [PubMed] [Google Scholar]
  30. Rimm E. B., Williams P., Fosher K., Criqui M., Stampfer M. J. Moderate alcohol intake and lower risk of coronary heart disease: meta-analysis of effects on lipids and haemostatic factors. BMJ. 1999 Dec 11;319(7224):1523–1528. doi: 10.1136/bmj.319.7224.1523. [DOI] [PMC free article] [PubMed] [Google Scholar]
  31. Stansfeld S. A., Bosma H., Hemingway H., Marmot M. G. Psychosocial work characteristics and social support as predictors of SF-36 health functioning: the Whitehall II study. Psychosom Med. 1998 May-Jun;60(3):247–255. doi: 10.1097/00006842-199805000-00004. [DOI] [PubMed] [Google Scholar]
  32. Steptoe A., Fieldman G., Evans O., Perry L. Control over work pace, job strain and cardiovascular responses in middle-aged men. J Hypertens. 1993 Jul;11(7):751–759. doi: 10.1097/00004872-199307000-00011. [DOI] [PubMed] [Google Scholar]
  33. Theorell T., Tsutsumi A., Hallquist J., Reuterwall C., Hogstedt C., Fredlund P., Emlund N., Johnson J. V. Decision latitude, job strain, and myocardial infarction: a study of working men in Stockholm. The SHEEP Study Group. Stockholm Heart epidemiology Program. Am J Public Health. 1998 Mar;88(3):382–388. doi: 10.2105/ajph.88.3.382. [DOI] [PMC free article] [PubMed] [Google Scholar]
  34. Vahtera J., Kivimäki M., Pentti J. Effect of organisational downsizing on health of employees. Lancet. 1997 Oct 18;350(9085):1124–1128. doi: 10.1016/S0140-6736(97)03216-9. [DOI] [PubMed] [Google Scholar]
  35. Vahtera J., Kivimäki M., Pentti J., Theorell T. Effect of change in the psychosocial work environment on sickness absence: a seven year follow up of initially healthy employees. J Epidemiol Community Health. 2000 Jul;54(7):484–493. doi: 10.1136/jech.54.7.484. [DOI] [PMC free article] [PubMed] [Google Scholar]

Articles from Journal of Epidemiology and Community Health are provided here courtesy of BMJ Publishing Group

RESOURCES