THE S C I ENCE OF HEALTH PROMOTION Stress Management Job Strain and Health Behaviors: Results of a Prospective Study Paul A. Landsbergis, Peter L. Schnall, Diane K. Deitz, Katherine Warren, Thomas G. Pickering, Joseph E. Schwartz Abstract INTRODUCTION Purpose. To assess the association between job demands,job decision latitude, and job strain (defined by Karasek as a combination of high demands and low decision latitude) and cardiovascular disease-related health behaviors such as cigarette smoking, alcohol use, lack of exercise, and overweight. Design. Cross-sectional and prospective. Setting. Nine NewYork City public and private sector worksites. Subjects. Two hundred eighty-five male employees, aged 30 to 60, in a wide variety of white-collar and blue-collar job titles. Measures. Medical examinations and surveys, which included demographic, health be- havi~,, and job characteristics data. Results. Prospectively, among 189 men, increase in job decision latitude over 3 years was associated with decrease in cigarette smoking, by analysis of covariance, controlling for age, race, education, marital status, and number of children at home (F (8,180) = 4.37, p = . 005). The largest increase in latitude occurred among the 13 menwho quit smok- ing. Howeveg, change in job characteristics was not associated with changein overweight or alcohol use. Cross-sectional analyses did not produce consistent associations. Conclusions. The effectiveness of smoking cessation may be aided by modification of structural features of the workenvironment, such as job decision latitude. This study is limited by the small number of subjects whowere engaged in high risk behaviors. (Am Health Promot 1998;1214]:237-245.) Key Words:Job Strain, Smoking, Alcohol, Exercise, Overweight Paul A. Landsbergis, Peter L. Schnall, Diane K. Deitz, Katherine Warren, Thomas G. Pick- ering, and Joseph E. Schwartz are at Cornell University Medical College, New York, New York. Diane K. Deitz is also at CSR Inc., Washington,D.C. Joseph E. Schwartz is also at State University of New York at Stony Brook, Stony Brook, New York. Send reprint requests to Paul Landsbergis, EdD, MPH, Assistant Professor of Epidemiology, CornellUni- versity Medical College,Start 416, 525 East 68 Street, New York, NY 10021; palands@med.cornell.edu. This manuscript was submitted for publication September 27, 1996; revisions were requested Februmy 19,1996; the manuscript was accepted for pufdication June 17, 199Z Am J Health Promot 1998;12(4) :237-245. Copyright © 1998 by American Journal of Health Promotion, Inc. 0890-1171/98/$5.00 ÷ 0 Health educators and behavioral specialists have become increasingly aware of the workplace as an inter- vention site where social change mechanisms can be mobilized to en- courage and support employees to improve their health? -~ The work- place has also been recognized as an important social environment that in- fluences health behaviors and risk of disease 4-6 through company policies and norms, 2&7 and possibly through the effects of job characteristics, such as job demands or job decision lati- tude.Z,5,s Occupational variables, e.g., occu- pational status and income, are com- ponents of socioeconomic status (SES), which is "among the most ro- bust variables" associated with pat- terns of disease. 9,a° For example, low- er SES has been consistently associat- ed with greater mortality and mor- bidity, including cardiovascular disease (CVD), ~-~ even after con- trolling for age, overweight, and smoking. ~4,~5 Lower SES is also associ- ated with unhealthy behaviors such as smoking ~6,t7 and sedentary behav- ior, ~3’ls and with lower job decision latitude. However, common use of global job-related SES categories (e.g., blue collar vs. white collar) often obscure significant variation in job character- istics within global categories and can lead to conflicting findings. ~u-’2~ As- sessment of detailed job characteris- tics in the past 15 years has proven to be a productive strategy in detect- ing occupational risk factors for hy- pertension, CVD, and some health- related behaviors. 4,5,~ March/April 1998, Vol. 12, No.4 237