Abstract
BackgroundIn occupational life, a mismatch between high expenditure of effort and receiving few rewards may promote the co-occurrence of lifestyle risk factors, however, there is insufficient evidence to support or refute this hypothesis. The aim of this study is to examine the extent to which the dimensions of the Effort-Reward Imbalance (ERI) model – effort, rewards and ERI – are associated with the co-occurrence of lifestyle risk factors.MethodsBased on data from the Finnish Public Sector Study, cross-sectional analyses were performed for 28,894 women and 7233 men. ERI was conceptualized as a ratio of effort and rewards. To control for individual differences in response styles, such as a personal disposition to answer negatively to questionnaires, occupational and organizational -level ecological ERI scores were constructed in addition to individual-level ERI scores. Risk factors included current smoking, heavy drinking, body mass index ≥25 kg/m2, and physical inactivity. Multinomial logistic regression models were used to estimate the likelihood of having one risk factor, two risk factors, and three or four risk factors. The associations between ERI and single risk factors were explored using binary logistic regression models.ResultsAfter adjustment for age, socioeconomic position, marital status, and type of job contract, women and men with high ecological ERI were 40% more likely to have simultaneously ≥3 lifestyle risk factors (vs. 0 risk factors) compared with their counterparts with low ERI. When examined separately, both low ecological effort and low ecological rewards were also associated with an elevated prevalence of risk factor co-occurrence. The results obtained with the individual-level scores were in the same direction. The associations of ecological ERI with single risk factors were generally less marked than the associations with the co-occurrence of risk factors.ConclusionThis study suggests that a high ratio of occupational efforts relative to rewards may be associated with an elevated risk of having multiple lifestyle risk factors. However, an unexpected association between low effort and a higher likelihood of risk factor co-occurrence as well as the absence of data on overcommitment (and thereby a lack of full test of the ERI model) warrant caution in regard to the extent to which the entire ERI model is supported by our evidence.
Highlights
In occupational life, a mismatch between high expenditure of effort and receiving few rewards may promote the co-occurrence of lifestyle risk factors, there is insufficient evidence to support or refute this hypothesis
We examined the relationship of Effort-Reward Imbalance (ERI) and its components to the co-occurrence of lifestyle risk factors in a sample of Finnish public sector employees
The proportion of women with none of the four risk factors was 38%, and the corresponding figure for the men was 24%. In both women and men, the mean number of risk factors was significantly higher among older people, manual workers, permanent employees, and among participants living without a partner. (p < 0.001 in all cases.)
Summary
A mismatch between high expenditure of effort and receiving few rewards may promote the co-occurrence of lifestyle risk factors, there is insufficient evidence to support or refute this hypothesis. The Effort-Reward Imbalance (ERI) model, a recent model of occupational stress, focuses on a negative trade-off between experienced 'costs' and 'gains' at work In this model, high ratio of occupational effort spent relative to rewards received in turn in terms of money, esteem, job security, and career opportunities, elicits sustained stress responses and ill health [1,2,3,4]. High ratio of occupational effort spent relative to rewards received in turn in terms of money, esteem, job security, and career opportunities, elicits sustained stress responses and ill health [1,2,3,4] This contractual reciprocity is frequent in cases where people have no alternative choice in the labor market or where they are exposed to heavy competition [5]. There is some evidence suggesting a relation of high ERI or some of its components with smoking [8,9,10], alcohol consumption or dependence [11,12], and higher body mass index (BMI) [13]
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