CME AVAILABLE FOR THIS ARTICLE AT ACOEM.ORG Work Performance Decrements Are Associated With Australian Working Conditions, Particularly the Demand to Work Longer Hours Libby Holden, MPH, Paul A. Scuffham, PhD, Michael F. Hilton, PhD, Nerina N. Vecchio, PhD, and Harvey A. Whiteford, MBBS, MPH Objectives: To demonstrate the importance of including a range of working conditions in models exploring the association between health- and work- related performance. Methods: The Australian Work Outcomes Research Cost-benefit study cross-sectional screening data set was used to explore health-related absenteeism and work performance losses on a sample of approximately 78,000 working Australians, including available demo- graphic and working condition factors. Data collected using the World Health Organization Health and Productivity Questionnaire were analyzed with negative binomial logistic regression and multinomial logistic regres- sions for absenteeism and work performance, respectively. Results: Hours expected to work, annual wage, and job insecurity play a vital role in the association between health- and work-related performance for both work attendance and self-reported work performance. Conclusions: Australian working conditions are contributing to both absenteeism and low work performance, regardless of health status. N ew technologies, globalization, industrial relations, and regu- latory reforms are all impacting on Australian workers. 1,2 During the last decade the increased pressure on industries to be more competitive has seen an increase in the number of employees engaged in shiftwork, working irregular and longer hours, and has often been associated with increased job complexity and work intensification. 3 Concurrently, there have been changes in industrial relations. In Australia, these changes date back to the 1993 enter- prise bargaining agreements, to the more contentious Australian Workplace agreements introduced in 2005. 4 Although somewhat modified now, these are still receiving critical review. Emerging risks associated with these workplace changes include increased pace of work, longer hours, greater cognitive demands, and job insecurity. 2 A range of working conditions has been found to negatively impact on productivity. Studies both overseas and in Australia have found that adverse working conditions result in both productivity decrements (through absenteeism) 5–19 and health decrements. 19 –27 Adverse working conditions have also been associated with depres- sion and stress. 2,27–39 Therefore, it is important to include these factors, where possible, in studies exploring the relationship be- tween health and productivity. The following working conditions are associated with productivity or health decrements or both: job security, 27,29,33,40 – 44 job strain/high demand, 12,19,20,26,29,45– 48 coworker/social support, 12,14,38,39,42,43,45,47,49 working hours, 6,10,39,50 job autonomy, 13,14,19,42,45 effort reward balance, 6,16 shiftwork, 47,51 issues with management, 14,16,20,40 demand/control, 47,52 or- ganization restructure, 15,53–55 work-family conflict, 39,43,56 workplace bul- lying, 55,57 and role conflict/clarification. 16,54 Nevertheless, few studies exploring the relationship between health and productivity adjust for working conditions in their models, 58 – 60 usually only adjust for one or two factors, such as occupation grade, and/or limit the sample to one organization. The effect of working conditions on productivity is usually measured with absenteeism as the outcome measure. 5–19 Few stud- ies report associations between working conditions and presentee- ism. 61– 64 Recent studies exploring the effects of health conditions on productivity indicate that presenteeism accounts for a greater proportion of the productivity loss than absenteeism. 51,59 More information on the association between working conditions and presenteeism is needed. Our study uses a range of available work- ing conditions and demographic characteristics in modeling the association between health and productivity, measured in both absenteeism and presenteeism. MATERIALS AND METHODS Study Design The Australian-based Work Outcomes Research Cost-benefit project provides a large cross-sectional data set of approximately 78,000 working Australians to explore associations between health and work performance, including attendance. Study Sample Employees of 58 large Australian-based companies were invited to participate in the Work Outcomes Research Cost-benefit study. The surveys were received between October 2004 and December 2005. The response rate was 24.7% (90,279 employees). From the School of Medicine (Ms Holden, Dr Scuffham, Dr Vecchio), Griffith University, Brisbane, Australia; Centre for Mental Health Research (Dr Hilton, Dr Whiteford), Queensland Health, Australia; and School of Popu- lation Health (Dr Hilton, Dr Whiteford), University of Queensland, Herston, Australia. Libby Holden and coauthors Paul A. Scuffham, Michael F. Hilton, Nerina N. Vecchio, and Harvey A. Whiteford have no financial interest in this research. The JOEM Editorial Board and planners have no financial interest related to this research. Address correspondence to: Libby Holden, MPH, School of Medicine, Griffith University, University Drive, Meadowbrook, Q4131; E-mail: l.holden@griffith.edu.au or Libby.Holden@student.griffith.edu.au. Copyright © 2010 by American College of Occupational and Environmental Medicine DOI: 10.1097/JOM.0b013e3181d1cdbb Learning Objectives Y Become familiar with previous studies showing the negative impact of working conditions on productivity and/or health, including the emerging risks associated with recent trends affecting the workplace. Y Review the new findings on how expected work hours and other working conditions affect the association between health and work-related performance. Y Discuss the implications for industrial relations policy and for companies seeking to increase productivity. JOEM • Volume 52, Number 3, March 2010 281