COURSE REQUIREMENTS

It is recommended that students have completed a graduate level statistics/methods course and a course in epidemiology. The class will have 9 three-hour sessions (one Monday is the Memorial Day holiday) and will meet weekly.

The course while primarily didactic will include hands on use of psychosocial questionnaires as part of a midterm (1/3), a short paper (1/3) and a final exam (1/3). Class participation, reflecting an understanding of the course readings, will make up the remaining 10 percent of the grade. The take-home final exam will include the materials covered in lectures, the readings, and experiences derived from use of the questionnaires. Questions will be distributed at the last class session.

Required readings:

Schnall PL, Belkic K, Landsbergis PA, Baker D. (eds.) The Workplace and Cardiovascular Disease. Occupational Medicine: State of the Art Reviews. 2000; 15. (Available in health sciences bookstore.)

Additional articles (in a packet). Available at Course Reader Material 1141 Westwood Blvd. (310) 443-3303

OVERVIEW OF SESSIONS:

Session I: 4/01 Introduction to occupational health psychology: A social epidemiological approach to the workplace and health outcomes. Instructor - Peter Schnall

Session II: 4/08 Conceptual and theoretical models for occupational health psychology: Operationalization, measurement, and assessment. Instructor - Peter Schnall

Session III: 4/15 Taking a work history which includes psychosocial stressors: An approach informed by insights from cognitive ergonomics & brain research. Instructor - Peter Schnall

Session IV: 4/22 Psychosocial workplace factors and physiological mechanisms affecting the cardiovascular system. Instructor - Peter Schnall

Session V: 4/29 Women and Work. Instructor - Judith Siegel

Session VI: 5/06 Psychosocial workplace factors and health outcomes. Instructor - Paul Landsbergis and Peter Schnall

Session VII : 5/13 Cessation of work: Job loss and retirement. Instructor - Judith Siegel

Session VIII: 5/20 Stress Management at the Workplace Instructor - Judith Siegel

Session IX: 5/27 Memorial Day Holiday.

Session X: 6/03 Models for intervention: Primary and secondary prevention. Programs and policies for regulation of workplace stressors; Course wrap-up and conclusions. Instructor - Peter Schnall

DESCRIPTION OF SESSIONS

I. Introduction to occupational health psychology: A social epidemiological approach to the workplace and health outcomes. Instructor - Peter Schnall

Working people develop a wide variety of illnesses during their working lives, manifested in time lost from work, disability, physical incapacity, psychological distress and ultimately morbidity and mortality. How/whether these manifestations are connected to work is a critically important issue for those in the fields of medicine, occupational and public health. We will introduce the social epidemiologic approach, in which the workplace is viewed as a key determinant of a wide variety of behavioral and health outcomes. In other words, we focus upon the workplace as a relatively distal cause of these outcomes and view personality and individual factors as more proximal. Through viewing of a segment of Charlie Chaplin in the film Modern Times, we present two approaches to OHP, one of which focuses on individual coping and the other on the impact of the workplace on the individual. We present a brief overview of the field of stress research, and then examine in depth the historical origins of theoretical models of workplace psychosocial stressors which have been empirically validated, including the Demand-Control-Support (DCS) model and the Effort Reward Imbalance (ERI) model.

Practicum Packet which includes Job Content Questionnaire, Effort-Reward Imbalance and OSI.

Faculty contributors: Peter Schnall, Karen Belkic, Paul Landsbergis

Readings:

Schnall PL, Belkic K, Landsbergis PA, Baker D.A. Why the workplace and cardiovascular disease? In: Schnall PL, Belkic K, Landsbergis PA, Baker D. (eds.) The Workplace and Cardiovascular Disease. Occupational Medicine: State of the Art Reviews. 2000; 15: 1-5.

Stressors at the Workplace: Theoretical Models. In: Schnall PL, Belkic K, Landsbergis PA, Baker D (eds.) Occupational Medicine: State of the Art Review. The Workplace and Cardiovascular Disease. 2000; 15 (1): 69-105.

Health, Productivity and Work Life in Karasek RA, Theorell T. Healthy Work: Stress, productivity and the reconstruction of working life. New York. Basic Books, Inc., 1990. Pgs 1-31.

II. Conceptual and theoretical models for occupational health psychology: Operationalization, measurement, and assessment. Instructor - Peter Schnall

Several theoretical models of workplace psychosocial stressors have been empirically validated, including the Demand-Control-Support (DCS) model and the Effort Reward Imbalance (ERI) model. Karasek's "job strain" model states that the greatest risk to physical and mental health from stress occurs to workers facing high psychological workload demands or pressures combined with low control or decision latitude in meeting those demands. Another broader model of work stress is Johannes Siegrist's "effort-reward imbalance" model. The model defines threatening job conditions as a "mismatch between high workload (high demand) and low control over long-term rewards" In comparison to the DCS model with its emphasis on moment-to-moment control over the work process (i.e. decision latitude), the ERI model provides an expanded concept, emphasizing macro-level, long-term control vis-à-vis rewards such as career opportunities, job security, esteem and income. The ERI model also integrates the exigencies and rewards of the job with the individual's input and coping style.

This session describes three main approaches for measurement of job characteristics: self-report questionnaires (e.g., Job Content Questionnaire, Effort-Reward Imbalance questionnaire, Occupational Stress Index); imputation of job characteristics scores based on aggregate data (e.g. national job title averages); and external assessment (e.g. supervisor or coworker ratings, job analysis by expert observers). Use of multiple methods of assessment of job characteristics allows for triangulation. We review important research results, highlight advantages and limitations of each method and discuss some issues to be resolved through future research. We recommend multi-method strategies, for convergent validation, using as many of these approaches as possible.

Faculty contributors: Peter Schnall, Karen Belkic, Paul Landsbergis

Questionnaire Practicum: Practicum: JCQ, ERI reviewed in detail

Readings:

Measurement of psychosocial workplace exposure variables. In: Schnall PL, Belkic K, Landsbergis PA, Baker D (eds.) Occupational Medicine: State of the Art Review. The Workplace and Cardiovascular Disease. 2000; 15(1): 163-188.

Johnson JV, Hall EM. Class, work, and health. In: Amick B, Levine S, Tarlov AR, Walsh DC (eds.): Society and Health. New York, Oxford University Press, 1995, pp. 247-271.

Karasek RA, Theorell T. Healthy Work: Stress, productivity and the reconstruction of working life. New York. Basic Books, Inc., 1990, pp.31-82.

Stressors at the Workplace: Theoretical Models. In: Schnall PL, Belkic K, Landsbergis PA, Baker D (eds.) Occupational Medicine: State of the Art Review. The Workplace and Cardiovascular Disease. 2000; 15 (1): 73-87.

III. How to take a work history which includes psychosocial stressors: An approach informed by insights from cognitive ergonomics and brain research. Instructor - Peter Schnall

Complementary to constructs such as the Job Strain Model (JSM) and Effort-Reward Imbalance, that are based heavily upon sociological theory, are approaches derived from cognitive ergonomics and brain research. These help describe, in more quantitative terms, the burden of work processes upon the central nervous system (CNS). Thus, e.g., when speaking of psychologically demanding work, we can go far beyond queries about "working hard" and "working fast, to analyze tasks in terms of allocation of mental resources. In the Occupational Stress Index (OSI), an additive burden model, we have sought to delineate work stressors relevant to the CV system, including psychological demands, in terms of how the CNS receives and processes information. Thus, we consider objective factors such as the nature and temporal density of incoming signals, the complexity and speed with which these are processed, inter alia, as well as how much control the worker has in modulating these, and other, demanding factors. From the vantage point of cognitive ergonomics, there is an inextricable coupling between the demand and the control dimensions: with sufficient decision-latitude, or control, a worker can modulate even a fairly onerous, though not overwhelming, psychological workload to meet his or her moment-to-moment needs and capacities. This approach helps us to better define, and thereby hopefully to protect the worker against exposure to overwhelming psychological demands. Cognitive ergonomics and brain research also point us to another dimension of stressful work: "disaster potential" or "symbolic aversiveness", a new dimension incorporated into the OSI. For survival reasons, our nervous systems are constructed to selectively allocate mental resources to threatening stimuli, even if the threat is only of a symbolic nature. The heaviest burden upon conscious attentional resources occurs when one continuously follows a barrage of signals to which he or she must be prepared to rapidly respond, such that momentary lapse, error or delay could have serious, or even fatal consequences; this is Threat Avoidant Vigilance. We provide practical information and instruction on how to utilize psychosocial stress questionnaires, including the JCQ, ERI and the OSI. OSI distributed.

Faculty contributors: Karen Belkic, Peter Schnall

Readings:

Belkic K. Occupation-Specific versus General Self-Report Measures to Assess Psychosocial Workplace Exposures: Dilemmas and Potential Solutions to Bridge the Gap. Workshop on Psychosocial Work Environment Assessment Issues Conference on Occupational Assessment: June 12, 2001, Gothenburg, Sweden.

Cardiovascular evaluation of the work and workplace: A practical guide for clinicians. In: Schnall PL, Belkic K, Landsbergis PA, Baker D (eds.) Occupational Medicine: State of the Art Review. The Workplace and Cardiovascular Disease. 2000; 15 (1): 213-222.

Stressors at the Workplace: Theoretical Models. In: Schnall PL, Belkic K, Landsbergis PA, Baker D (eds.) Occupational Medicine: State of the Art Review. The Workplace and Cardiovascular Disease. 2000; 15 (1):87-98.

IV. Psychosocial workplace factors and physiological mechanisms affecting the cardiovascular system. Instructor - Peter Schnall

The deleterious physiological effects of different stressful work scenarios are reviewed, with a focus upon cardiovascular hemodynamic changes leading to the development of essential hypertension. Mechanisms by which long work hours and shift work as well as exacerbating physical stressors such as noise, glare, heavy lifting, vibration, cold and heat can impact upon the cardiovascular system as well as other target organs are discussed. Occupational groups exposed to a large number of these stressors are found to be at high risk for hypertension, myocardial infarction, stroke, peptic ulcer disease, as well as musculo-skeletal disorders interalia. We present an integrated view of epidemiologic, laboratory and field data from ambulatory monitoring for high-risk groups to illustrate how these mechanisms can operate in working life.

Lead Instructor: Karen Belkic, Peter Schnall

Psychosocial Practicum: Feedback to students on submitted questionnaires

Readings:

The central nervous system: Bridge between the external milieu and the cardiovascular system. In: Schnall PL, Belkic K, Landsbergis PA, Baker D (eds.) Occupational Medicine: State of the Art Review. The Workplace and Cardiovascular Disease. 2000; 15 (1):107-115.

Evidence for mediating econeurocardiologic mechanisms. In: Schnall PL, Belkic K, Landsbergis PA, Baker D (eds.) Occupational Medicine: State of the Art Review. The Workplace and Cardiovascular Disease. 2000; 15(1): 117-162.

V. Women and work. Instructor - Judith Siegel

One of the most dramatic changes in the 20th century is the increased labor force participation of women. This session concentrates on the relationship of paid work to the physical and mental health of women, with an emphasis on multiple roles and pay equity. For the latter, examples are drawn from studies of university settings.

Readings:

Weidner, G, Boughal, T, Connor, SL, Pieper, C, Mendell NR. Relationship of job strain to standard coronary risk factors and psychological characteristics in women and men of the Family Heart Study. Health Psychology 1997; 16:239-247.

Perry-Jenkins, M, Repetti, R, Crouter, AC. Work and family in the 1990's. Journal of Marriage and the Family 2000; 62:981-998.

Workplace factors and CVD outcomes. In: Schnall PL, Belkic K, Landsbergis PA, Baker D (eds.) Occupational Medicine: State of the Art Review. The Workplace and Cardiovascular Disease. 2000; 15 (1): 49-57. (Read Brisson section on Women, work, and cardiovascular disease.)

Midterm Distributed (return in one week at Session VI)

VI. Psychosocial workplace factors and health outcomes. Instructors - Paul Landsbergis and Peter Schnall

This session will focus upon international research studies, which reveal that a wide range of workplace conditions have been implicated as risk factors for a variety of health problems including cardiovascular disease (CVD), psychological distress and work?related musculoskeletal disorders. These workplace conditions include shift work, long work hours, and chemical, physical, and psychosocial conditions. The most consistent evidence is provided by sources of psychosocial stress at work.

We also discuss current models of the complex pathways through which social conditions produce stress and influence behavior and risk of disease which progresses from general macro social conditions down to micro level processes in individual persons. These models describe how social structure (e.g., socioeconomic status or social class, race, gender) shapes the immediate social environment (e.g., working conditions, housing, neighborhood, access to services), which influences lifestyle behaviors (e.g., smoking, diet, exercise), personality and psychological characteristics (e.g., hostility, self-efficacy, depression, Type A behavior, individual coping), and physiological risk factors for disease (e.g., blood pressure, cholesterol, overweight). In the context of these models, research findings linking personality/psychological characteristics, social conditions, job conditions and disease states are discussed. In addition, emphasis will be placed on recent research on the job demand-control model and the influence of job characteristics on behaviors, psychological characteristics and physiological responses to stress. This includes studies on the effects of "passive" (low demand-low control) jobs on reducing self-efficacy and increasing passive behavior, external locus of control, feelings of depression and learned helplessness; and the effects of "active" (high demand-high control) jobs on increasing active learning, internal locus of control, a broader range of coping strategies, and intellectual flexibility.

Faculty contributors: Peter Schnall, Paul Landsbergis

Psychosocial Practicum: Turn in self scored questionnaires

Readings:

Workplace factors and CVD outcomes. In: Schnall PL, Belkic K, Landsbergis PA, Baker D (eds.) Occupational Medicine: State of the Art Review. The Workplace and Cardiovascular Disease. 2000; 15 (1): 7-68.

Karasek RA, Theorell T. Healthy Work: Stress, productivity and the reconstruction of working life. New York. Basic Books, Inc., 1990, pp.89-103.

Landsbergis PA, Schnall PL, Dietz DK, Warren K, Pickering TG, Schwartz JE. Job strain, health behaviors and cardiovascular risk factors: Results of a prospective study. American Journal of Health Promotion 1998; 12(4):237-245.

Midterm Due

VII. Cessation of work: Job loss and retirement. Instructor - Judith Siegel

This session will focus on separation from one's primary paid employment, both via job loss and via retirement. For job loss, consideration will be given to selection factors, anticipatory phase, reemployment, and the impact of unemployment on both physical and mental health. Topics relevant to retirement include timing, voluntary nature of retirement, associated stressors, the social status of retired persons, and post retirement mental and physical health. In both areas, cross-cultural studies will be emphasized.

Lead Instructor: Judith Siegel

Readings:

Calasanti, T. Gender and life satisfaction in retirement: An assessment of the male model. Journal of Gerontology: Social Sciences. 1996; 51B: S18-S29.

Dooley, D., Prause, J., Ham?Rowbottom, K. A. Underemployment and depression: Longitudinal relationships. Journal of Health and Social Behavior. 2000; 41: 421-436.

Reitzes, DC, Mutran, EJ, Fernandez, ME Does retirement hurt well-being? Factors influencing self-esteem and depression among retirees and workers. The Gerontologist 1996; 36: 649-656.

Turner, J. B. Economic context and the health effects of unemployment. Journal of Health and Social Behavior. 1995; 36: 213-229.

VIII. Stress management and organizational change in the work place. Instructor - Judith Siegel

Stressful working conditions are associated with increased absenteeism, tardiness, and intentions by workers to quit their jobs - all of which have a negative effect on the economic soundness of a work organization. As we've discussed earlier this quarter, stress plays an important role in several types of chronic health problems, especially cardiovascular disease, musculoskeletal disorders, and psychological disorders. Furthermore, mood and sleep disturbances, upset stomach and headache, and disturbed relationships with family and friends are symptoms of job stress which have been commonly found in research studies. Two primary strategies have been utilized to manage stress at work: stress management programs and organizational change strategies. Stress management programs teach workers about the nature and sources of stress, the effects of stress on health, and personal skills to reduce stress. Organizational change involves the identification of stressful aspects of work (e.g., excessive workload, conflicting expectations) and the design of strategies to reduce or eliminate the identified stressors.

Readings:

Murphy, L. R. (1996). Stress management in work settings: A critical review of health effects. American Journal of Health Promotion, 11, 112-135.

Van Dierendonck, D., Schaufeli, W. B., & Buunk, B. P. (1998). The evaluation of an individual burnout intervention program: The role of inequity and social support. Journal of Applied Psychology, 83, 392-407.

Munz, D. C., Kohler, J. M., & Greenberg, C. I. (2001). Effectiveness of a comprehensive worksite stress management program: Combining organizational and individual interventions. International Journal of Stress Management, 8, 49?62. Available online at: http://www.kluweronline.com. (Type in journal title and then go to volume 8, issue 1.)

IX. Memorial Day holiday (no class).

Health educators, health psychologists, behavioral specialists and occupational health specialists have become increasingly aware of the workplace as a critical social environment that influences health behaviors. Therefore, primary prevention interventions, aimed at redesigning jobs, work organization and employer policies, will be the focus. We will also discuss programs that are complementary to these efforts (secondary prevention strategies), such as individual stress management and health promotion. Examples will be provided of programs that integrate workplace health promotion and occupational health.

The first half of this session will review the variety of legal and legislative measures that have been instituted to reduce employee exposure to workplace stressors. These include legislation (and accompanying regulations) and collective bargaining by labor unions and employers, both of which are designed to reduce exposure to workplace chemical, physical, ergonomic and psychosocial hazards. The costs of workers' compensation for work-related disease may also provide an incentive to reduce workplace exposure to these stressors. The state of legislation (and regulations) in Europe, the United States and Japan is briefly reviewed. In addition, the use of workers' compensation and collective bargaining as prevention strategies in the United States will be discussed.

The second half of this session will allow for a discussion that reviews the major themes of the course. The empirical (epidemiologic), theoretical, and biological evidence presented in this course provides convergent validation that the relationship between workplace stressors and a number of adverse health outcomes is causal. In other words, the empirical findings are consistent with and predicted by the theoretical models, while the linkage between the theoretical models and empirical evidence is demonstrated to be plausible by considering biological mechanisms and experimental research. Based upon these conclusions, new strategies are explored for enhanced prevention and clinical management, work place interventions, and social policy to reduce the impact of disease, psychological distress and unhealthy behaviors that result from stressful working conditions. These strategies acquire an urgent public health dimension, given the magnitude of the epidemic of stress?related diseases and widespread psychological/behavioral effects, and the current deterioration in conditions of working life. Creating a healthy work environment is a high priority, and would entail the full participation of working people in the decision?making processes surrounding the organization of work.

Lead Instructor: Peter Schnall

Faculty contributors: Peter Schnall, Karen Belkic, Paul Landsbergis

Readings:

Kristensen, TG. Workplace intervention studies. In: Schnall PL, Belkic K, Landsbergis PA, Baker D. (eds.) The Workplace and Cardiovascular Disease. Occupational Medicine: State of the Art Reviews. 2000; 15: 293-305.

Landsbergis PA, Cahill J, Schnall PL. The impact of lean production and related new systems of work organization on worker health. J Occup Health Psychol 1999; 4: 1-23.

The Tokyo Declaration on Work-Related Stress and Health in Three Post-Industrial Settings - EU, Japan and USA. J Tokyo Med Univ 1998; 56: 760-767.

Belkic K, Schnall P, Landsbergis P, Baker D. The workplace and cardiovascular health: Conclusions and thoughts for a future agenda. In: Schnall PL, Belkic K, Landsbergis PA, Baker D (eds.) Occupational Medicine: State of the Art Review. The Workplace and Cardiovascular Disease. 2000; 15 (1): 307-321.

Gardell B. Worker participation and autonomy: a multilevel approach to democracy at the workplace. In: Johnson JV, Johansson G. (Eds.) The Psychosocial Work Environment: Work Organization, Democratization and Health. Essays in Memory of Bertil Gardell. Baywood Publishing Co., Inc., Amityville, 1991, pp. 193-223.