The association between job skill discretion, decision authority and burnout

This paper reports on the relationship between dimensions of control (skill discretion and decision authority) and burnout (emotional exhaustion, depersonalization, and reduced personal accomplish-ment) among 164 human service workers. It examines the diVerential in ¯ uence of job demands, control (skill discretion and decision authority) and social support (supervisor, co-workers, others) on each burnout dimension. Then it examines the moderating eVects of higher skill discretion, higher decision authority, and higher social support on burnout. Low skill discretion was found to be associated with high emotional exhaustion and depersonalization and low personal accomplishment. The eVects of decision authority were not statistically signi ® cant. High job demands were associated with high emotional exhaustion only. Social support (supervisor, co-worker, and others) was not associated with burnout when demographic variables and job characteristics were controlled for. Neither dimension of control moderated the impact of high job demands on burnout. Social support did not moderate the impact of high demands, low skill discretion, or low decision authority on any burnout dimension. The full model explained 44 % of the variance in emotional exhaustion, 25 % in depersonalization, and 42 % in personal accomplishment. Despite its limitations, the study suggests that the Job Demand-Control model may provide a useful theoretical foundation for the study of burnout, but that the control dimensions need to be evaluated independently since they appear to be diVerentially related to the burnout dimensions. 1

Explaining racial/ethnic differences in all-cause mortality in the Multi-Ethnic Study of Atherosclerosis (MESA): Substantive complexity and hazardous working conditions as mediating factors

Research on racial/ethnic health disparities and socioeconomic position has not fully considered occupation. However, because occupations are racially patterned, certain occupational characteristics may explain racial/ethnic difference in health. This study examines the role of occupational characteristics in racial/ethnic disparities in all-cause mortality. Data are from a U.S. community-based cohort study (n=6342, median follow-up: 12.2 years), in which 893 deaths (14.1%) occurred. We estimated mortality hazard ratios (HRs) for African Americans, Hispanics, and Chinese Americans compared with whites. We also estimated the proportion of the HR mediated by each of two occupational characteristics, substantive complexity of work (e.g., problem solving, inductive/deductive reasoning on the job) and hazardous conditions (e.g., noise, extreme temperature, chemicals), derived from the Occupational Information Network database (O*NET). Analyses were adjusted for age, sex, nativity, working status at baseline, and study sites. African Americans had a higher rate of all-cause death (HR 1.41; 95% confidence interval [CI]: 1.19–1.66) than whites. Chinese-American ethnicity was protective (HR 0.59, CI: 0.40–0.85); Hispanic ethnicity was not significantly different from whites (HR 0.88; CI: 0.67–1.17). Substantive complexity of work mediated 30% of the higher rate of death for African Americans compared with whites. For other groups, mediation was not significant. Hazardous conditions did not significantly mediate mortality in any racial/ethnic group. Lower levels of substantive complexity of work mediate a substantial part of the health disadvantage in African Americans. This job characteristic may be an important factor in explaining racial health disparities

Job Strain, Occupational Category, Systolic Blood Pressure, and Hypertension Prevalence: The Multi-Ethnic Study of Atherosclerosis

Objective: To assess associations of occupational categories and job characteristics with prevalent hypertension. Methods: We analyzed 2517 Multi-Ethnic Study of Atherosclerosis participants, working 20+ hours per week, in 2002 to 2004. Results: Higher job decision latitude was associated with a lower prevalence of hypertension, prevalence ratio = 0.78 (95% confidence interval 0.66 to 0.91) for the top versus bottom quartile of job decision latitude. Associations, however, differed by occupation: decision latitude was associated with a higher prevalence of hypertension in health care support occupations (interaction P = 0.02). Occupation modified associations of sex with hypertension: a higher prevalence of hypertension in women (vs men) was observed in health care support and in blue-collar occupations (interaction P = 0.03). Conclusions: Lower job decision latitude is associated with hypertension prevalence in many occupations. Further research is needed to determine reasons for differential impact of decision latitude and sex on hypertension across occupations