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Measuring Job Stressors and Studying the Health Impact of the Work
Environment: An Epidemiologic Commentary
This document is copyrighted by the American Psychological Association or one of its allied publishers.
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
Stanislav V. Kasl
Yale University School of Medicine
This article provides a commentary on 5 articles in the special section that marshal a substantial
amount of information about 4 instruments for measuring work stress. The perspective is that of
psychosocial epidemiology and highlights the differences between the environmental and the
psychological traditions of studying stress and health. Several issues are addressed: (a) placing the
4 measures in a broader taxonomy of dimensions of work environment and evaluating the measures in that context, (b) discussing alternative strategies for measuring job strains, (c) analyzing
some of the issues in the triviality debate, and (d) reconsidering a number of issues in the ongoing
debate about "subjective" versus "objective" measurement approaches to work dimensions.
Correspondence concerning this article should be addressed to Stanislav V. Kasl, Department of Epidemiology
and Public Health, Yale University School of Medicine,
New Haven, Connecticut 06520-8034. Electronic mail may
be sent to stanislav.kasl@yale.edu.
390
391
host characteristics;
(p. 3).
tradition, their
outcomes.
The psychologic tradition to studying stress as a
risk
etiology.
This document is copyrighted by the American Psychological Association or one of its allied publishers.
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
of the
established
biomedical
elaboration of ...
relationship.
Epidemiologic methods have evolved as a strategy
for the study of risk factors for various diseases at the
population level. They are generally not suitable for
the additional study of the various mechanisms that
could be involved as intermediate links between the
exposure and the disease outcome. This leaves a
serious problem of the unopened "black box." In the
study of work stress and disease, the need to peer
inside the black box is particularly important because
the exposure variable may be an exceedingly complex
one, and learning about the intermediate steps may be
crucial to a full understanding of the etiologic
process.
Within classical occupational epidemiology, such
as that dealing
with carcinogens
in the work
environment, molecular biomarkers hold considerable promise of letting a person peer inside the black
box. McMichael (1994) outlined the ways in which
the biomarkers can strengthen the usual "bare bones"
strategy that designates certain work settings as high
differences
between the biomarkers and the psychologic tradition. The biomarkers are selected to be on the
mechanistic pathway to disease occurrence. The
psychological variables, on the other hand, may or
may not represent the intermediate steps in disease
etiology. Specifically, it needs to be documented,
rather than just theorized, that the effect of objective
exposures on disease is fully mediated by specific
appraisals, or that felt distress mediates between
exposure and disease outcome. Obviously, whether
one is studying mental health or physical health
outcomes will matter considerably in terms of how
well the psychological markers behave like the
biomarkers.
Johnson (1996) pointed out that while epidemiology has made useful contributions to occupational
health psychology, it is a limited contribution because
"it lacks a theory of human development" (p. 7). This
is felicitous phrasing because it points us in the
direction
to
which
classical
epidemiologic
ap-
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This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
392
KASL
This document is copyrighted by the American Psychological Association or one of its allied publishers.
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
393
This document is copyrighted by the American Psychological Association or one of its allied publishers.
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
394
KASL
This document is copyrighted by the American Psychological Association or one of its allied publishers.
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
395
of
depression,
tered will not yield useful information. And behavioral indicators, such as smoking or alcohol consump-
Occupational
Demands
and
statement
for
Safety
Worker
the
and Health
Health,
scales
the
measuring
study, Job
introductory
the job."
With physiological
such as
blood
biological adaptation.
For symptom checklists and other psychological
and behavioral indicators, the strategy of administering the same instruments in different settings and on
issues, such as respiratory symptoms in studies of
reasonably
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This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
396
KASL
397
This document is copyrighted by the American Psychological Association or one of its allied publishers.
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
dimensions
"objective"
perceptions of the work environment and on dysphoria), one would probably need contrasting job settings
crowding,
one
would want
some
kind
of
an
with
"based on
self-report" and objective with "not using selfreport." This hides many of the subtleties of the issues
facile equivalence.
demands).
other category of arguments against objective measures is a pragmatic one: Objective measures of job
This document is copyrighted by the American Psychological Association or one of its allied publishers.
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
398
KASL
Developing measurement strategies for the objective work environment is, indeed, a formidable task
(e.g., Hacker, 1993), and studies that have nationally
representative samples of employed individuals, or
even just include a large number of occupations in
their study, simply cannot commit to such an
approach. However, in studies of single occupations,
such as bus drivers (Greiner, Ragland, Krause, Syme,
& Fisher, 1997), developing relevant objective
dimensions need not be a daunting task. Also, when
one is working with such outcomes as cumulative
trauma disorders (Moon & Sauter, 1996), the
ergonomic perspective on man-machine interactions
needs to be fully represented.
There have been many published studies over the
years in which authors had at least one objective
measurethe job title or job classificationbut
failed to use it in their analysis and combined data
across jobs when examining stressors and strains.
Paying attention to job titles is a minimal strategy of
utilizing objective data and is often quite informative.
In the research on the job strain model using the JCQ,
two of the three primary dimensions are decision
latitude and (psychological) job demands. As described by Karasel and Theorell (1990), differences
between occupations explain about 35% of the
variance in latitude but only about 4% in demands
(the Karasek et al., 1998, article gives slightly
different estimates). Several questions might be
asked:
1. Are occupational titles too crude a classification
to pick up variation in job demands, or are job
demands a subjective reaction almost uncorrelated
with objective work conditions, so that a more refined
grouping of jobs would not increase the explained
variance? More of the variance is explained if age of
workers is taken into account as well, but this is a
person characteristic, not an additional job characteristic. It is clear that one needs to explore ways of
supplementing job titles with additional information
about the jobs to see if more variance could be
explained.
2. Does job demands measure psychological
reactions to objective work conditions, albeit with
enormous individual differences, or does it measure
mostly preexisting personal characteristics that would
manifest themselves in a similar way on different
jobs? It would seem that additional information is
needed on objective job characteristics to decide
which it is.
3. Is the health impact of the work setting most
appropriately understood as a link to the objective
work conditions, to the subjective measures, or to
399
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and impact.
Arguments in favor of a subjective measurement
across individuals.
2. Cognitive and emotional processing moderates
in methodological
evaluations of the
"tendency
to avoid
Conclusion
400
KASL
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This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
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