Social Science & Medicine 54 (2002) 1589–1599 Change in job satisfaction, and its association with self- reported stress, cardiovascular risk factors and mortality Pauline Heslop a , George Davey Smith a, *, Chris Metcalfe a , John Macleod b , Carole Hart c a Department of Social Medicine, University of Bristol, Canynge Hall, Whiteladies Road, Bristol BS8 2PR, UK b The Medical School, University of Birmingham, UK c Department of Public Health, University of Glasgow, Scotland, UK Abstract Many studies have suggested that occupational stress may be related to the development of cardiovascular disease (CVD), independently of other known risk factors. Despite the recognition of job satisfaction as a particular form of stress, however, few studies have examined its association with CVD. Those studies that have explored the associations between job satisfaction and CVD risk factors, or job satisfaction and CVD mortality, have been largely cross-sectional in approach and report contradictory findings. This study revisits the associations between job satisfaction, self- reported stress, CVD risk factors and CVD mortality using longitudinal data from a cohort of working Scottish men and women recruited between 1970 and 1973. Approximately half of the cohort was screened for a second time, 4–7 yr after the baseline examination. Job satisfaction at baseline was strongly associated with low or moderate perceived stress at 2nd screening. Men and women reporting decreased satisfaction in their jobs between baseline and 2nd screening tended to report moderate or high perceived stress at 2nd screening. Job satisfaction was associated with own occupational class in different directions for men and women. Men in the manual social classes reported more satisfaction with their jobs than their peers, whilst it was women in the non-manual social classes who reported more satisfaction with their jobs than their peers. There was limited evidence of an association between job satisfaction and age-adjusted CVD risk factors (diastolic blood pressure; blood cholesterol; body mass index; forced expiratory volume in 1 s; amount of recreational exercise undertaken; cigarette smoking and alcohol consumption) for men, after adjustment for occupational class, but there was no evidence of any association for women. There was also no evidence to suggest that men or women reporting job dissatisfaction on one occasion or on two occasions several years apart, had a significantly greater risk of mortality from CVD. r 2002 Elsevier Science Ltd. All rights reserved. Keywords: Job satisfaction; Self-reported stress; Cardiovascular risk factors; Cardiovascular mortality; Scotland Introduction There is a large body of research which suggests that occupational stress may be related to the development of cardiovascular disease (CVD) independently of other known risk factors (Greenlund et al., 1995; Hassan, 1989; Kasl, 1984; House, 1974). However, such research has primarily focused on two models, one emphasising high job demands and low job control (Theorell et al., 1998; Peter et al., 1998; Bob ! ak, Hertzman, $ Skodov ! a, & Marmot, 1997; Alterman, Shekelle, Vernon, & Burau, 1994; Karasek & Theorell, 1990; Karasek et al., 1988; Karasek, Baker, Marxer, Ahlbom, & Theorell, 1981), and the other emphasising effort-reward imbalance (Siegrist, Peter, Junge, Cremer, & Seidel, 1990; Siegrist, 1996; Peter et al., 1998). Few studies have examined the association between job satisfaction and CVD mortality or other risk factors, despite its recognition as a *Corresponding author. Tel.: +44-117-928-7329; fax: +44- 117-928-7204. E-mail address: zetkin@bristol.ac.uk (G. Davey Smith). 0277-9536/02/$ - see front matter r 2002 Elsevier Science Ltd. All rights reserved. PII:S0277-9536(01)00138-1