AMERICAN JOURNAL OF INDUSTRIAL MEDICINE 57:495–515 (2014)

Review Article

Work Organization, Job Insecurity, and

Occupational Health Disparities

Paul A. Landsbergis, PhD, MPH,1 Joseph G. Grzywacz, PhD,

2
and
Anthony D. LaMontagne, ScD, MA, MEd3

Background Changes in employment conditions in the global economy over the past
30 years have led to increased job insecurity and other work organization hazards.
These hazards may play a role in creating and sustaining occupational health dispar-
ities by socioeconomic position, gender, race, ethnicity, and immigration status.
Methods A conceptual model was developed to guide the review of 103 relevant
articles or chapters on the role of work organization and occupational health dispar-
ities identified through a comprehensive search conducted by NIOSH. A second review
was conducted of employment and workplace policies and programs designed to reduce
the health and safety risks due to job insecurity and other work organization hazards.
Results There is consistent evidence that workers in lower socioeconomic or social
class positions are exposed to greater job insecurity and other work organization
hazards than workers in higher socioeconomic positions. Likewise, racial and ethnic
minorities and immigrants are exposed to greater job insecurity. Limited research ex-
amining the effects of interventions targeting work organization hazards on disparities
has been conducted; nonetheless, intervention strategies are available and evidence
suggests they are effective.
Conclusions Job insecurity and work organization hazards play a role in creating and
sustaining occupational health disparities. Employment and workplace policies and
programs have the potential to reduce these hazards, and to reduce disparities. Am. J.
Ind. Med. 57:495–515, 2014. ß 2012 Wiley Periodicals, Inc.
KEY WORDS: work organization; job stress; job insecurity; health disparities;
occupational health disparities

1
State University of NewYork-Downstate School of Public Health, Brooklyn, NewYork
2
Oklahoma State University College of Human Sciences,Tulsa, Oklahoma
3
Melbourne School of Population Health, University of Melbourne, Melbourne, Victoria,
Australia
Contract grant sponsor: Australian National Health & Medical Research Council; Contract
grant number: 375196.
With contributions by: Carles Muntaner, University of Toronto Dalla Lana School of Public
Health; Joan Benach, Universitat Pompeu Fabra, Barcelona, Grup de Recerca en Desigual-
tats en Salut; Jane Lipscomb, University of Maryland School of Nursing, Baltimore; Jeffrey
Johnson, University of Maryland School of Nursing, Baltimore; Peter Schnall, University of
California, Irvine, Center for Occupational & Environmental Health; Kevin Riley, University
of California, Los Angeles, Labor Occupational Safety & Health Program; Ellen Rosskam,
Rosskam International Development Consulting, Geneva; Jennifer Zelnick, Touro College
Graduate School of Social Work, NewYork.
Disclosure Statement: The authors report no substantive conflicts of interest. The only
funding they received for the preparation of this manuscript were travel expenses paid
by the National Institute for Occupational Safety and Health (NIOSH) to attend a NIOSH-
sponsored conference on this topic in 2011and to present an earlier version of this paper at
the conference.
*Correspondence to: Paul A. Landsbergis, PhD, MPH, Associate Professor, Department
of Environmental and Occupational Health Sciences, School of Public Health, Room BSB
5-95, State University of New York-Downstate Medical Center, Box 43 450, Clarkson Ave.,
Brooklyn, NY11203. E-mail: paul.landsbergis@downstate.edu
Accepted 7 September 2012
DOI10.1002/ajim.22126. Published online16 October 2012 in Wiley Online Library
(wileyonlinelibrary.com).

ß 2012 Wiley Periodicals,Inc.

496 Landsbergis et al.
INTRODUCTION
The labor market and nature of work has changed
substantially in the past 30 years, as employers seek
to compete in the global economy [NIOSH, 2002]. Key
manifestations of these trends include increases in ‘‘pre-
carious’’ employment [Benach and Muntaner, 2007; Ferrie
et al., 2008], new production systems (e.g., lean produc-
tion), downsizing, outsourcing, privatization of public ser-
vices, and new occupations (e.g., information processing
and call center work) enabled by technological innovation
[Landsbergis et al., 2011b]. The proportion of U.S. work-
ers belonging to unions has declined [Kwon and Pontus-
son, 2006], and sweatshop work is reemerging [Bonacich
and Appelbaum, 2005]. These and other employment and
labor market conditions, and the way work is organized,
increase job insecurity and other psychosocial job stres-
sors, and the risk of occupational injuries and illnesses
[NIOSH, 2002]. Employment conditions, the organization
of work, and job insecurity can also create and exacerbate
occupational health disparities (inequalities) by socioeco-
nomic position or status (SES) and gender, as well as by
race, ethnicity, and immigration status [Ferrie et al., 2008;
Benach et al., 2010c; Siegrist et al., 2011].
This review synthesizes what is known about the role
work organization plays in creating and exacerbating
occupational health disparities, and evaluates the effective-
ness of interventions that address work organization and
thus may reduce occupational health disparities. Job inse-
curity is a primary focus because it is a sentinel indicator
of the health and safety impact of current and future
trends in employment conditions and the way work is
organized. For this reason, NIOSH had requested that the
authors of this article specifically review work organiza-
tion, job insecurity and occupational health disparities, as
one of five articles to be presented at a NIOSH conference
on occupational health disparities: http://www.aoecdata.
org/conferences/healthdisparities/index.html. Separate reviews
of discrete domains (e.g., discrimination, harassment,
abuse, and bullying) were commissioned and prepared for
the conference. Thus, the current review did not address
those features of work organization.
A comprehensive review of the voluminous literature
on work organization (including job insecurity) and health
is beyond the scope of a single article. The foundations
for this review include books [Schnall et al., 2009; Benach
and Muntaner, 2010], major reports [Marmot, 2010],
and review articles, for example [Lipscomb et al., 2006;
Cummings and Kreiss, 2008; Ferrie et al., 2008; Quinlan
and Bohle, 2009; Clougherty et al., 2010; Benach
et al., 2010b; Muntaner et al., 2010b; Siegrist et al., 2011;
Landsbergis et al., 2011b]. This review complements
existing reviews by focusing on the role of job insecurity
and work organization in creating or exacerbating
occupational health disparities. A more detailed and
expansive version of this review is available on-line
[Landsbergis et al., 2011a], http://www.aoecdata.org/
conferences/healthdisparities/.
Conceptual Overview
The conceptual foundation for thinking about job in-
security, work organization, and occupational health dis-
parities is complex. Like the model developed by NIOSH
[NIOSH, 2002], our framework (Fig. 1) views the organi-
zation of work as nested: job-specific factors serve an in-
tervening role between organization-level factors and
occupational health outcomes. Likewise, organizational
factors (and subsequent job-specific factors) serve an inter-
vening role between external factors (employment condi-
tions) and occupational health outcomes.
Labor stratification, the division of the workforce into
groups with varying degrees of power, contributes to the
development and perpetuation of occupational health dis-
parities through two main processes. First, labor stratifica-
tion contributes to differential exposure to job insecurity
and other work organization hazards. Relative to managers
and professionals, worker groups with more limited
power have less opportunity to influence macro-level
employment policies, organization-specific employment
practices or job characteristics, thereby contributing to
greater exposure among the more powerless. Differential
exposure is represented in the model by the direct
lines from Labor Stratification to each box reflecting dis-
crete levels of work organization. Labor stratification also
contributes to differential vulnerability; that is, the health
and safety effects of job insecurity and work organization
differ across groups of workers. Differential vulnerability
is represented in the model by dashed lines and arrows
from Labor Stratification to the linkages among the dis-
crete levels of work organization and health outcomes:
these dashed lines suggest that each linkage depends
on where workers lie in the labor and socioeconomic
hierarchy.
Our conceptual framework considers occupational
health to be a multidimensional outcome incorporating
both positive (e.g., engagement, vitality) and negative
(e.g., illness, injury) manifestations. The model also posits
three primary mechanisms by which work organization
can affect occupational health outcomes: physiological
(e.g., sympathetic and parasympathetic responses to stress-
or exposure), psychological (e.g., feelings of fear, help-
lessness, or exhaustion), and behavioral (e.g., supervisory
safety practices, compliance with safety protocols, or life-
style factors such as physical activity and smoking). Final-
ly, our model highlights modifying factors based on
industry or occupational sector (e.g., explicit exemptions
for agricultural workers to protections provided by the
 Work Organization and Occupational Health Disparities
FIGURE 1. Conceptual overview of the role of work organization in the creation of occupational health disparities.
National Fair Labor Standards Act [Runyan, 2000]) that
bear on occupational health.
Definitions and Inter-Relationships
Job insecurity
Job insecurity has been defined in various subjective
and objective ways, and at various levels of Figure 1. It
can be defined as a psychosocial stressor at the job level,
caused by employment conditions and work organization,
and reflecting a worker’s perceptions of fear of job loss or
job instability. ‘‘Precarious’’ or ‘‘contingent’’ employment
conditions provide the clearest illustration of an objective
measure of job insecurity. ‘‘Precarious’’ employment rep-
resents the explicit or implicit absence of a permanent or
enduring employment contract. Workers in precarious
jobs face employment uncertainty; they generally lack
control over future work and income opportunities, and
they have fewer rights [Benach and Muntaner, 2007].
While a number of measures of precarious employment
and job insecurity exist, the most comprehensive measure
is the Employment Precariousness Scale, which assesses
six aspects of precarious work: temporariness, disempow-
erment, vulnerability, wages, rights (to benefits, such as
paid holidays, family leave, pension), and exercising rights
[Vives et al., 2010]. This measure highlights that objec-
tively insecure work can be harmful to health through
497
perceived or subjective job insecurity as well as through
other pathways. The U.S. Department of Labor defines
‘‘contingent’’ workers as those who do not expect their
jobs to last, and defines a separate category of workers in
‘‘alternative work arrangements,’’ such as independent
contractors, on-call workers, temporary agency, and con-
tract firm workers [Bureau of Labor Statistics, 2005].
Research on health and safety effects of job insecurity
has focused on three types of factors, which can be
considered ‘‘overlapping facets of the new flexible labor
market’’ [Ferrie et al., 2008, p. 105]: (1) temporary em-
ployment; (2) job instability (objective conditions, i.e.,
workforce reductions or workplace closure is expected or
occurring) and job insecurity (a worker’s perceptions of
fear of job loss or job instability) [Probst, 2005]; and (3)
downsizing, restructuring and outsourcing, including pri-
vatization of public services [Ferrie et al., 2008; Siegrist
et al., 2011].
Downsizing research has focused on workers who re-
main with their employer rather than those who have lost
jobs [Ferrie et al., 2008]. Downsizing can result in in-
creased workload, job insecurity, and physical hazards
[Kivimaki et al., 2000; Ferrie et al., 2007] and reduced job
control [Kivimaki et al., 2000; Rugulies et al., 2006] for
those who remain on the job.
‘‘Temporary work’’ may benefit workers when it
allows them to control their work time, sample job experi-
ences, use it as a ‘‘stepping stone’’ into permanent
498 Landsbergis et al.
employment [Ferrie et al., 2008] or supplement retirement
income after benefitting from earlier career standard
employment [Clarke et al., 2007]. However, temporary
workers are more likely to work at high speed,
make repetitive movements, have no control over the
pace of work, and have less training [Paoli and
Merllié, 2001]. Whatever task control they may have is
likely reduced when economic pressures force them
to work harder and longer [Quinlan et al., 2001].
Temporary workers have fewer opportunities for the
informal social networking and support at work that
enhance collective efforts to improve working conditions
[Richardson, 2008]. To the extent that temporary
workers are desperate to achieve targets that would
secure future work or permanent employment, their grow-
ing prevalence can undermine the resistance of permanent
workers to work intensification [Quinlan et al., 2001].
Many temporary workers are not protected by laws
designed to ensure proper pay and safe, healthful and
non-discriminatory workplaces, and many are not covered
by workers compensation [GAO, 2006]. In addition, the
development of extended national and international con-
tracting networks (supply chains) diffuse employer respon-
sibility and pose a serious threat to occupational health
and safety of temporary workers, many of whom are low-
wage, ethnic minority, and immigrant workers [Quinlan
and Sokas, 2009].
Work Organization and Job
Characteristics
Work organization research has focused primarily
on work schedule factors such as long work hours
[Johnson and Lipscomb, 2006] and evening or night
shift work [Bambra et al., 2008], and psychosocial job
stressors, such as job strain (high demand-low control
work) [Karasek and Theorell, 1990; Belkic et al., 2004],
lack of social support [Johnson, 1989; Richardson, 2008],
effort–reward imbalance (high efforts combined with
low rewards at work) [Siegrist et al., 2004], and job
insecurity [Ferrie et al., 2008]. Newer research has
examined organizational injustice, particularly, the
health effects of ‘‘procedural and relational injustice’’
[Elovainio et al., 2002, 2006], and workplace incivility
[Lim et al., 2008; Lim and Lee, 2011]. Additional
research has focused on threat-avoidant vigilant work,
which involves continuously maintaining a high level
of vigilance in order to avoid disaster, such as loss of
human life. Very little health research has studied produc-
tion and management systems, such as lean production
[Landsbergis et al., 1999], new public management
[Besosa, 2007], piece rate pay systems [Brisson et al.,
1989], or electronic performance monitoring [Smith et al.,
1992].
STATE OF THE EVIDENCE
Job Insecurity and Health and Safety
Temporary employment has been associated with psy-
chological distress [Virtanen et al., 2005] although null
studies also exist [Ferrie et al., 2008]. Studies of physical
health outcomes have produced mixed results, with associ-
ations seen with occupational injuries [Silverstein et al.,
1998; Mayhew and Quinlan, 1999; Meyer and Muntaner,
1999; Virtanen et al., 2005; Benavides et al., 2006; Ferrie
et al., 2008], including needlestick injuries [Aiken et al.,
1997], absenteeism, fatigue [Benach et al., 2004; Ferrie
et al., 2008], mortality [Kivimaki et al., 2003] and muscu-
loskeletal disorders [Silverstein et al., 2002; Benach et al.,
2004]. However, temporary work is sometimes related to
better health [Virtanen et al., 2003], perhaps reflecting dif-
fering national regulatory and social welfare systems, the
variety of circumstances which lead people to take on
temporary work [Siegrist et al., 2011] or the ‘‘healthy
worker effect’’ (most temporary workers are not entitled
to paid sick leave) [Ferrie et al., 2008].
Job instability and job insecurity have shown consis-
tent associations with psychological ill health, but weaker
evidence of association in cross-sectional studies of
physical health [Sverke et al., 2002; Ferrie et al., 2008].
However, chronic job insecurity appears to have a
dose–response relationship with self-reported health and
physical symptoms, and increases the risk of minor psy-
chiatric morbidity [Heaney et al., 1994; Dekker and
Schaufeli, 1995; Marmot et al., 2001; Ferrie et al., 2002;
Muntaner et al., 2008]. Some studies have shown associa-
tions with occupational injuries [Probst and Brubaker,
2001; Probst, 2002] and with poor self-rated health
[Laszlo et al., 2010]. A good organizational safety climate
may attenuate the relationship between job insecurity and
injuries [Probst, 2004].
Downsizing and restructuring: Downsizing ‘‘survi-
vors’’ have increased rates of sickness absence, musculo-
skeletal disorders, medical symptoms, psychological
distress, sleeping problems [Ferrie et al., 2008; Siegrist
et al., 2011], use of prescription psychotropic drugs
[Kivimaki et al., 2007], injury [Kelsh et al., 2004], and
exposure to workplace violence [Flannery et al., 1997].
One study of Finnish public employees showed elevated
cardiovascular mortality [Vahtera et al., 2004] among
downsizing survivors. However, another study of a long-
term follow-up of downsizing survivors in Finland did
not show increased mortality [Martikainen et al., 2008],
suggesting that long-term job stability may compensate
for the more temporary stress of downsizing [Siegrist
et al., 2011].
Privatization: One study of British civil servants,
whose agency was privatized, showed a 90% elevated risk
 Work Organization and Occupational Health Disparities
of work disability over 8 years of follow-up [Virtanen
et al., 2010]. Another study showed increases in body
mass index, ischemia, cholesterol, and, for women, blood
pressure, but little change in health behaviors over 5 years
of follow-up, compared to those who remained in the civil
service [Ferrie et al., 1998]. A systematic review of 11
studies found some evidence of increases in stress-related
ill health, but little evidence of increased injury rates
[Egan et al., 2007b]. A thorough review of research on the
health and safety implications of privatization and other
manifestations of job insecurity is beyond the scope of
this article.
Work Organization and Health and Safety
A substantial body of research exists linking long
work hours, shiftwork, job strain, effort–reward imbal-
ance, and threat-avoidant vigilance at work with illnesses
and injuries. More limited data are available suggesting
health and safety impacts of low workplace social
support, social isolation, organizational injustice, lean
production, piece rate pay systems, and electronic perfor-
mance monitoring [Schnall et al., 2000, 2009; Siegrist
and Rodel, 2006; Landsbergis et al., 2011b]. Typical out-
comes examined in these studies include cardiovascular
disease, hypertension, psychological disorders, musculo-
skeletal disorders, sickness absence, unhealthy behaviors,
and acute injuries. A thorough review of research on
work organization and health and safety is beyond the
scope of this article; readers are encouraged to consult
more comprehensive reviews [Lipscomb et al., 2006;
Cummings and Kreiss, 2008; Ferrie et al., 2008;
Quinlan and Bohle, 2009; Clougherty et al., 2010; Benach
et al., 2010b; Muntaner et al., 2010b; Siegrist et al., 2011;
Landsbergis et al., 2011b].
Work Organization, Job Insecurity, and
Occupational Health Disparities
NIOSH conducted a literature search in February
2011 in the following databases (PubMed, ABI/Inform,
Embase, Ergonomics Abstracts, Health & Safety Science
Abstracts, NIOSHTIC-2, Web of Science, and PsycNET)
for all studies published in English between 1990 and
2010 using the following search terms: (Workplace OR
Occupational Health OR Accidents OR Occupational
Diseases OR Occupational Exposure OR occupational
injury OR occupational injuries OR occupational illness)
AND (Health Disparities OR Minority OR minorities
OR Emigrants OR Immigrants OR Transients OR Migrants
OR Hispanic or Hispanics OR Asian Americans OR
Race Relations OR Socioeconomic Factors) AND ((job
insecurity OR job instability OR Downsizing OR restruc-
turing OR contingent OR precarious OR contracting OR
499
part time OR part-time OR temporary OR Labor Unions)
OR (Piece rate OR Piece-rate OR lean production OR
long work hours OR long working hours OR forced
overtime OR effort reward imbalance OR effort–reward
imbalance OR job strain OR job control OR Social
Isolation OR Social Support)). A total of 240 articles
were identified. The authors examined these articles
and 103 publications were found to meet inclusion criteria
for the current review; that is, studies of associations be-
tween job insecurity, work organization and health and
safety which provide information on differential exposures
or differential vulnerability among groups at high risk
of disparities. Relevant data from the articles were abstract-
ed and coded by the authors. In addition, we included in-
formation from recent review articles which addressed
work organization, job insecurity, and occupational health
disparities.
Socioeconomic Position (SEP)
Socioeconomic status (SES) refers to an individual’s
ability to produce and consume resources and is frequently
measured in terms of location along a continuum of
several attributes (e.g., income, educational level, occupa-
tional status). An alternative approach is to define a per-
son’s social class, their relationship to the production
of goods and services (e.g., an owner, self-employed,
worker, manager, supervisor, non-managerial employee).
These alternatives may show different associations with
health outcomes [Muntaner et al., 1998a]. Since research
contrasting such alternatives is beyond the scope of this
article, we primarily use the term ‘‘socioeconomic position
(SEP)’’ as a general term that includes both SES and
social class definitions [Muntaner et al., 2003, 2004].
Differential Exposure: Lower SEP is consistently
associated with job insecurity. Studies in Spain [Borrell
et al., 2004], France [Niedhammer et al., 2011],
Australia [Louie et al., 2006], and the U.S. [Hipple, 2001;
Robertson et al., 2006] report that temporary work con-
tracts are more common among workers in lower than
in higher occupational positions. Blue-collar workers
have less work predictability than white-collar workers
[Vaananen et al., 2008]. Perceived job insecurity is more
common among individuals with a high school education
or less compared to those with greater than a high school
education [Burgard et al., 2009], and more prevalent in
lower SES groups [Parslow et al., 2004; Vanroelen et al.,
2009; Moncada et al., 2010; Virtanen et al., 2011].
Workers in lower SEP are also disproportionately ex-
posed to other work organization hazards. Low job control
is inversely associated with educational level [Hintsa
et al., 2006; Huisman et al., 2008; Smith et al., 2008], and
is less common among workers in managerial and profes-
sional occupations relative to those in service or blue
500 Landsbergis et al.
collar occupations [Marmot et al., 1997; Gisselmann and
Hemstrom, 2008; Huisman et al., 2008; Vaananen et al.,
2008; Fujishiro et al., 2010]. Lower social class groups
have less job control [Borrell et al., 2004; Parslow et al.,
2004; Sekine et al., 2009; Vanroelen et al., 2009]. Expo-
sure to high psychological job demands tends to be great-
est among workers with higher SEP [Kuper and Marmot,
2003; Borrell et al., 2004; Sekine et al., 2009; Niedham-
mer et al., 2011], although null associations have been
reported [Hintsa et al., 2006]. Job strain is more common
among workers in lower SEPs in some studies [Bosma
et al., 1998; Malinauskiene et al., 2004; Hintsa et al.,
2006; LaMontagne et al., 2008], but not in others [Choi,
2006; Choi et al., 2008 (Suppl. 6)]. Lower SEP workers
report lower social support [Borrell et al., 2004; Moncada
et al., 2010; Niedhammer et al., 2011], and greater expo-
sure to effort–reward imbalance [Marmot et al., 1997;
Bosma et al., 1998; Kuper et al., 2002], organizational in-
justice [Kivimaki et al., 2005], threat-avoidant vigilant
work [Belkic et al., 1998], and shiftwork [Steenland,
2000; Karlsson et al., 2003].
Two Scandinavian studies [Gisselmann and Hem-
strom, 2008; Lahelma et al., 2009] and one British study
[Marmot et al., 1997] suggest that 20–60% of SEP health
disparities can be accounted for by work organization haz-
ards. Others report that work organization hazards are as-
sociated with poor health but they contribute little, if any,
explanatory power for understanding SEP disparities in
health [Huisman et al., 2008; Fujishiro et al., 2010].
Differential Vulnerability: Some evidence suggests
that employees in manual (blue-collar) jobs experience
greater strain due to perceived threats of unemployment
compared to employees in non-manual (white-collar) jobs
[Lynch et al., 1997; De Witte, 1999]. A study of Swedish
men found that high demand-low control work increased
risk for myocardial infarction, and that this risk was much
greater in manual than non-manual workers [Hallqvist
et al., 1998]. A stronger association among lower status
than higher status workers was also seen for effort–reward
imbalance and risk of heart disease [Kuper et al., 2002],
job strain and heart disease [Johnson and Hall, 1988;
Johnson et al., 1989], effort–reward imbalance and depres-
sion [Wege et al., 2008], and job strain and blood pressure
during working hours [Landsbergis et al., 2003]. However,
some studies have failed to find such interactions [Wege
et al., 2008] and, other studies suggest that higher status
individuals are more affected by job strain [Laflamme
et al., 1998; Virtanen et al., 2007].
Gender
Differential exposure: Several studies reported similar
levels of exposure among men and women to measures of
job insecurity [D’Souza et al., 2003; Burgard et al., 2009],
temporary jobs [Kouvonen et al., 2006] or downsizing
[Dragano et al., 2005]. However, others found greater ex-
posure among women to job insecurity [Wang et al.,
2008], temporary work [Borrell et al., 2004], non-standard
work [Kim et al., 2008], downsizing [Kivimaki et al.,
2007], or contingent work [Hipple, 2001].
Turning to other work organization hazards, long paid
work hours are consistently more common in men
[McCurdy et al., 2003; Grosch et al., 2006; Louie et al.,
2006; Ostry et al., 2007; Artazcoz et al., 2009; Inoue
et al., 2010; Thomas and Power, 2010], while longer do-
mestic work hours are more common in women [Blau
et al., 2002; Borrell et al., 2004; Artazcoz et al., 2009].
Women also face a higher prevalence of job strain
[D’Souza et al., 2003; Ostry et al., 2007; Suominen et al.,
2007; LaMontagne et al., 2008; Rostila, 2008; Wang
et al., 2008, 2009; Inoue et al., 2010; Lopes et al., 2010],
low job control [Hemstrom, 1999; Kuper and Marmot,
2003; Vaananen et al., 2008; Gadinger et al., 2010;
Inoue et al., 2010; Thomas and Power, 2010], low job va-
riety [Matthews et al., 1998; Borrell et al., 2004], fewer
learning opportunities [Matthews et al., 1998], fewer
promotions [Adarga et al., 2010], access to flexible
work schedules [Golden, 2008], and workplace incivility
[Cortina et al., 2001]. However, four studies found compa-
rable levels of job strain [Greenlund et al., 2010], job con-
trol [Pikhart et al., 2004], job autonomy [Borrell et al.,
2004], or lack of control of pace or inflexible break times
[Matthews et al., 1998] for women and men.
Research focused on gender differences in other work
organization factors is mixed. Studies of psychological
workload demands find that, in some cases, men are
exposed to greater demands than women [Kuper and
Marmot, 2003; Inoue et al., 2010], whereas others find
greater demands among women [Gadinger et al., 2010],
and still others report no gender differences [Hemstrom,
1999; Borrell et al., 2004; Thomas and Power, 2010].
Likewise, studies of workplace social support sometimes
find that women have lower support than men [Hemstrom,
1999; Gadinger et al., 2010], whereas others find no gen-
der differences in support [Inoue et al., 2010] or working
alone [Borrell et al., 2004]. Effort–reward imbalance is
frequently found to be comparable among men and wom-
en [Pikhart et al., 2004; Dragano et al., 2005; Ostry et al.,
2007; Inoue et al., 2010]. However, some European sur-
veys showed higher efforts and higher rewards among
men [Siegrist et al., 2004]. Other studies showed no gen-
der differences in levels of organizational justice [Inoue
et al., 2010] and shiftwork [Ostry et al., 2007].
Differential vulnerability: The magnitude of associa-
tions between job insecurity and health and safety out-
comes tends to be similar for men and women [Dragano
et al., 2005; Ferrie et al., 2005; Virtanen et al., 2005; Kim
et al., 2008; Sousa et al., 2010]. However, stronger
 Work Organization and Occupational Health Disparities
associations for men than women between job insecurity
and mortality [Niedhammer et al., 2011], poor self-
reported health [Borrell et al., 2004], psychotropic pre-
scription use [Kivimaki et al., 2007], depression [Wang
et al., 2008], psychological distress [De Witte, 1999], and
musculoskeletal disorders [Kim et al., 2008] have been
documented. Other studies found stronger associations of
job insecurity with systolic blood pressure, smoking, BMI
[Muntaner et al., 1998b], and poor mental health [Kim
et al., 2008] among women than men. Still other studies
find no differential effects by gender in associations of job
insecurity with longstanding illness [Ferrie et al., 2005],
atherosclerosis (after risk factor adjustment) [Muntaner
et al., 1998b], cardiovascular disease [Kim et al., 2008], or
total mortality [Martikainen et al., 2008].
Research frequently finds differential effects of other
work organization factors on health outcomes by gender,
but the overall pattern is ambiguous. Stronger associations
were seen in men than women for job strain and sickness
absence [Suominen et al., 2007; Virtanen et al., 2007],
smoking [Radi et al., 2007] and psychological disorders
[Wang et al., 2008], for low job control and heart disease
[Kuper and Marmot, 2003], and for low skill discretion
and work injuries [Salminen et al., 2003]. Stronger associ-
ations were observed in women than men for low job con-
trol and systolic blood pressure, smoking, BMI [Muntaner
et al., 1998b], and psychosomatic complaints [Gadinger
et al., 2010], for workload and injuries [Salminen et al.,
2003] and for job demands and psychosomatic complaints
[Gadinger et al., 2010]. Nevertheless, gender comparable
health effects have been documented for long work
hours [Borrell et al., 2004; Ostry et al., 2007; Artazcoz
et al., 2009], job strain [Rostila, 2008; Wang et al., 2009;
Lopes et al., 2010], low job control [Bosma et al., 1997;
Westerberg and Theorell, 1997; Salminen et al., 2003;
Kouvonen et al., 2005], and job demands [Westerberg and
Theorell, 1997; Kuper and Marmot, 2003; Kouvonen
et al., 2005].
Gender and Socioeconomic Position
Some evidence suggests ‘‘greater health differentials
associated with blue-collar (relative to white-collar) work
for women than men’’ [Clougherty et al., 2010, p. 116].
For example, among U.S. aluminum manufacturing
employees ‘‘Women in hourly jobs tended to be from
lower SES backgrounds, have greater financial need (e.g.,
single mothers), and were more likely to hold lower-grade
(e.g., lower-skilled) hourly jobs, than were hourly men’’
[Clougherty et al., 2010, p. 116]. Hourly work was associ-
ated with a greater risk of hypertension among women
than men, adjusted for demographics. Blue-collar women
are also more likely to experience harassment and discrim-
ination [Clougherty et al., 2010], higher injury rates and
501
injury severity (controlling for job tasks) [Pollack et al.,
2007], and longer time to return to work after illness and
absenteeism [Hill et al., 2008] than blue-collar men.
However, Framingham, MA women in high demand-
high control (high SEP) jobs had a higher risk of heart
disease than women in high strain (high demand-low
control) jobs. With baseline data collected from 1984 to
1987, this finding may reflect a period of changing social
roles—increasing labor force participation among women,
including higher SEP jobs—yet with residual discrimina-
tion, de facto limited authority and wage disparities [Eaker
et al., 2004].
An Australian study found that, among men, depres-
sion attributed to job strain decreases step-wise as SEP
increases, whereas for women, job strain-attributable de-
pression did not vary consistently by SEP [LaMontagne
et al., 2008]. Work organization factors and job insecurity
explained a larger proportion of socioeconomic inequal-
ities in health among men than women in three studies
[Borrell et al., 2004; Sekine et al., 2009; Niedhammer
et al., 2011]. In one of these studies, material well-being
at home and amount of household labor played a larger
role in women’s class differences in health [Borrell et al.,
2004] Thus, further research is needed on the moderating
role of gender in assessing the role of work organization
hazards in socioeconomic inequalities in health.
Race, Ethnicity, and Immigration Status
Differential Exposure: Job insecurity varies by race,
ethnicity, and immigration status. In two nationally
representative U.S. samples, more Blacks than non-Blacks
experienced perceived job insecurity [Burgard et al.,
2009]. Contingent workers in the U.S. are more likely to
be Black or Hispanic [Hipple, 2001]. Other research indi-
cates that concern about possible job loss is greater among
Hispanics than Blacks and Whites [Delp et al., 2010] and
that Blacks have greater perceived insecurity than non-
Blacks [Wilson et al., 2006]. Evidence from the National
Longitudinal Study of Youth indicated that minority work-
ers are more likely than non-minority workers to experi-
ence an involuntary job loss [Park and Sandefur, 2003].
Immigrant women in Sweden were more likely work in
temporary jobs than native born women [Akhavan et al.,
2007].
Some research provides direct evidence that exposure
to work organization hazards systemically vary by race,
ethnicity, and immigration status. Workplace discrimina-
tion occurs more frequently for racial and ethnic minority
workers [Krieger et al., 2006], although ‘‘incivility’’ in the
workplace, defined as subtle mistreatment by customers,
may not differ by race or ethnicity [Kern and Grandey,
2009]. However, cultural variation in what is perceived as
allowable customer behavior may mask real variation in
502 Landsbergis et al.
incivility [Gong et al., 2009]. Immigrants tend to find
themselves in jobs that have less opportunity to use
high-level skills [Fischbacher et al., 2005] than non-
immigrants, although differences by immigration status
in other work organization factors such as psychological
demand, control, or social support are reported to be mod-
est [Sundquist et al., 2003]. Immigrant day laborers are
exposed to more occupational hazards than non-immigrant
day laborers [Seixas et al., 2008].
Other studies provide indirect evidence of variation in
work organization factors by race, ethnicity or immigra-
tion status. Hispanics are disproportionately employed
in dangerous sectors like agriculture [Carroll et al.,
2005] and construction [Brunette, 2004; Bureau of Labor
Statistics, 2010]. Black and Hispanic workers and immi-
grants are increasingly concentrated in poultry processing
jobs [Government Accountability Office, 2005]; these are
jobs with low social support and decision authority, high
job strain, and elevated isometric load [Grzywacz et al.,
2007; Lipscomb et al., 2007]. Three-quarters of Latino
poultry processing workers report that their employer has
minimal concern for employee safety, and is primarily in-
terested in getting the job done as cheaply as possible
[Quandt et al., 2006]. Consistent with these observations,
Toh and Quinlan [2009] argue that immigrant workers
have substantially greater difficulty accessing occupational
safety and health rights and entitlements [Chibnall and
Tait, 2005].
Differential Vulnerability: There is some evidence that
perceived job insecurity is associated with greater thick-
ness of plaque in the carotid artery for Blacks than for
Whites, but these associations may be attributed to racial
variation in clinical cardiovascular disease risk factors
[Muntaner et al., 1998b]. Muntaner et al. [1998b] conclud-
ed that the putative explanatory value of work organiza-
tion factors for cardiovascular disease may be stronger for
Whites than for Blacks, due to racial discrimination. Other
data suggest that, if an occupational injury occurs, Latinos
may experience worse outcomes. Specifically, one study
TABLE I. Summary of Research on Job Insecurity and Work Organization Hazards Contributing to Variation in Health and Safety Outcomes by Various
Bases of Labor Stratification
Lower socioeconomic position
Differential exposure
Job insecurity þ þ
Workorganization þ 
Differential vulnerability
Job insecurity þ 
Workorganization þ 
The symbols refer to consistency (þ) or inconsistency () of findings.
Shaded areas represent areas of limited research inquiry (four or fewer studies).
found that Latinos are more likely to have moderate or
severe occupational injuries, they are less likely to have
insurance to cover care for that injury, and they have
greater difficulty than whites resolving workers’ compen-
sation claims [Nicholson et al., 2008].
Summary of Findings
Table I provides a summary of the state of the
evidence regarding differential exposure and differential
vulnerability to job insecurity and other work organization
hazards by SEP, gender, race, ethnicity, and immigration
status. Our review finds consistent evidence that job inse-
curity is more common among workers in lower SEPs,
racial and ethnic minorities, and immigrants. Further, five
of the nine reviewed studies found women to be more
exposed to job insecurity. Thus, there is good evidence of
differential exposure to job insecurity.
There is general consistency that individuals with
lower SEPs are more likely to be exposed to work organi-
zation hazards. There is no discernible pattern of effects
for gender internationally. The small amount of research
on differential exposure by race/ethnicity and immigration
status does not allow firm conclusions. Limited research
suggests that work organization hazards have a greater
impact on the health of lower (vs. higher) SEP workers.
However, there is no clear pattern of results to conclude
that other groups of workers are systematically more
vulnerable to the health effects of job insecurity or other
work organization hazards.
STATE OF THE EVIDENCE—
INTERVENTIONS TO REDUCE
OCCUPATIONAL HEALTH DISPARITIES
Interventions to reduce occupational health disparities
can be directed towards reducing differential exposure, re-
ducing differential vulnerability, or both (Table II). A wide
range of macro- and micro-level strategies can be applied
Female gender Racial and ethnic minorities/immigrants
þ
þ


TABLE II. Intervention Strategies for Reducing Occupational Health Disparities ArisingThrough Work Organization and Job Insecurity
Goal
Reduce differential exposure topoor
psychosocial working conditions
Reduce differential vulnerability to Strengthen worker ability towithstand stressors
health impacts ofpoorpsychosocial
working conditions
Effective treatment,rehabilitation and return to workof
. . .differentially prioritizing at risk workgroups and
Objective/targets
Reduce exposure to poor workorganization/improve
psychosocial job quality (primaryprevention). . .
. . .differentially prioritizing at risk workgroups and
contexts,including:
Workers in lower socioeconomic positions
Workingwomen
Immigrant workers
Racial and ethnic minority workers
Precariously employed workers
(secondary prevention) and . . .
workers adversely affectedbypoor workorganization
(tertiary prevention). . .
contexts,including:
Workers in lower socioeconomic positions
Workingwomen
Immigrants workers
Racial and ethnic minority workers
Precariously employed workers
Micro-level intervention strategies (examples) Macro-level intervention strategies (examples)
Awareness-raisingeducationalinterventionsatpopulation, OH&S regulatory intervention
industry,organizational,or workgroup levels
Union advocacy & education programs Voluntary OH&S policy intervention
Environment-directed interventions (e.g.,work time, Strengtheninglabor standards,includingraising minimum
organizational context) employment conditions,unfairdismissal provisions,job
security, and job quality standards
Task-directed interventions (e.g.,workload,job autonomy) National/local/organization-level job skills training
programs
Social relationship-directed (e.g.,communication,social Legislatingwage premiums (higher pay) on temporary or
support) precarious jobs
Management trainingprograms Creatingfederalrecommendationsonthereductionofwork
organization hazards,with incorporation into national
public health initiatives such as‘‘Healthy People’’
Tax-based intervention structured either as‘‘carrots’’ (e.g.,
multi-year taxcredits) or ‘‘sticks’’ (e.g.,penalties) to
incentivize employers to build theircorps ofpermanent
employees while reducingreliance on temporary
employees
Strengtheninghumanrightsandequalopportunitylaw(e.g.,
toreducediscrimination based onrace,gender,age,etc.)
Integrated workplace health promotion programs (addres- Strengtheningworkers’compensationsystems,including
singboth health behaviors and working conditions) anti-poverty support for injured or ill workers and their
dependents
Time management,coping skills development trainingto Universal healthcare coverage
strengthen workercapacity towithstand stressors
Special retrainingprograms atorganizationallevel to assist Special retrainingprograms at national/state policy level to
returnto work from injuryor illness,or to assist assist return to work frominjuryor illness,or to assist
employment reentry from disability employment reentry from disability
Raising minimum wages (toreduce the proportion of
workingpoor)
Improved accessto public transport
Work Organization and Occupational Health Disparities
Increasingthe availability ofaffordable housing
Food security programs
503
504 Landsbergis et al.
to this end, drawing upon political economy, health
inequalities, and other macro-structural perspectives
[Commission on Social Determinants of Health, 2008;
Marmot, 2010; Muntaner et al., 2010a; Siegrist et al.,
2011] and including primary, secondary, and tertiary pre-
vention at the micro-structural-level—drawing in particu-
lar from occupational and public health perspectives
[LaMontagne et al., 2007b; Landsbergis, 2009; Benach
et al., 2010c].
Most available evidence for addressing occupational
health disparities arising from work organization and
job insecurity pertains to improving psychosocial working
conditions and reducing associated illness and other
burdens in an absolute sense; thus, where explicit evidence
is lacking on how interventions affect disparities, the
available evidence requires extrapolation to how these
strategies can reduce disparities. Population-level interven-
tions that improve population health on average, however,
can at the same time potentially exacerbate health inequal-
ities in a phenomenon termed the ‘‘inequality paradox’’
[Frohlich and Potvin, 2008]. This can arise when disad-
vantaged groups have less capacity to transform public
health interventions into health improvements. This has
been observed, for example, in the context of smoking
cessation and tobacco control initiatives in the UK and
Australia, where population smoking prevalence steadily
declined over time but disparities in smoking prevalence
by SES widened [Baum, 2007; Frohlich and Potvin,
2008]. This is not to deny the value of population
approaches, but rather to highlight the need to monitor
disparities in intervention impacts as well as absolute
changes, to prioritize disadvantaged work groups and con-
texts in population approaches, and to implement tailored
intervention strategies for disadvantaged work groups and
contexts to complement population approaches (Table II).
Macro-Structural Interventions
The evidence base on the impacts of macro-level
interventions on work organization is underdeveloped, be-
cause it is a relatively new policy area and due to method-
ological challenges. Nevertheless, it is becoming an active
area of investigation [Quinlan et al., 2010; Benach et al.,
2010a; Muntaner et al., 2010c]. Macro-level policy and
other interventions can be conducted at various levels
ranging from international to national to industry/sector.
They can further be divided into regulatory versus volun-
tary approaches. The UK Health & Safety Executive
(HSE) 2004 Management Standards provide a regulatory
example. The Management Standards cover six key areas
of work organization: demand, control, managerial sup-
port, peer support, role relationships, and change. Formal
evaluations suggest the Management Standards have sub-
stantially increased the focus on the prevention of stress
among employers and other stakeholders in the UK and,
as a consequence, increased organizational policies and
procedures to deal with these issues [Broughton et al.,
2009].
While there are relatively few examples of regulatory
standards on psychosocial hazards to date, there are a
growing number of regulatory responses to temporary or
precarious employment. For example, in the Australian
state of New South Wales, under a 2001 law, home-
based clothing workers, a highly exploited primarily
immigrant workforce, were deemed employees, and thus
brought under labor regulations [Quinlan and Sokas,
2009]. Similarly, a 2011 California law prohibits the
‘‘willful misclassification’’ of employees as independent
contractors [Yamauchi and Allen, 2011].
An example of a voluntary macro-level intervention
is a recent standard on workplace psychosocial risk
management issued by the British Standards Institution,
the ‘‘PAS1010’’ [Leka et al., 2011]. The guidance and
recommendations in PAS1010 grew out of the European
Framework for Psychosocial Risk Management (PRIMA-
EF) initiative [Leka and Cox, 2008]. Labor-management
voluntary agreements are an example of macro-level
policy intervention at the industry or sector level. A 2004
joint labor/industry European framework agreement on
work stress aimed to increase the awareness and
understanding of work stress and ‘‘best practice’’ interven-
tions among employers, workers and their representatives
[European Trade Union Confederation et al., 2004].
Awareness-raising and policy advocacy can also be ad-
vanced by individual stakeholder groups. For example, in
September 2011, the Australian Council of Trades Unions
launched a national campaign titled ‘‘Secure Jobs—Better
Future’’ (http://securejobs.org.au), highlighting the elevat-
ed percentage of workers in insecure jobs (27% of work-
force in casual/temporary jobs, second only to Spain in
the OECD), the impacts and inequities of insecure work,
and the need for policy and practice reforms.
Some macro-level interventions may require further
research to determine appropriate intervention targets and
strategies. For example, social class and gender disparities
in job control exist across OECD countries (differential
exposure). However, there are wider social class inequal-
ities in low job control (and other work organization
hazards) in Spain compared to Denmark, which has a
more developed welfare state [Moncada et al., 2010]. Pre-
ventive strategies to reduce social inequalities in working
conditions need to consider economic and labor market
structures, education and training policy, labor relations
regulations, unionization, and other macro-level policies.
For example, in a cohort of the Australian working popu-
lation, working women reported significantly lower job
control than men, and this disparity persisted over eight
annual waves of observation (2001–2008) [LaMontagne
 Work Organization and Occupational Health Disparities
et al., 2011]. However, this job control disparity was large-
ly eliminated by adjustment for occupational skill level
and employment arrangement (permanent, precarious,
etc.). These findings suggest that differential exposure to
low job control by gender in this nationally representative
sample could be more systematically and effectively
addressed by macro-level interventions to redress the seg-
regation of women into lower quality jobs (e.g., job skills
training and equal opportunity employment initiatives)
over micro-level (e.g., organizational level) interventions
to improve women’s job control. This is supported by the
observation of smaller gender differences in job control
and other work organization hazards (as well as in physi-
cal and mental health) in Finland, where more gender
equality policies exist, than in the UK or Japan [Sekine
et al., 2011].
It is also necessary to address non-work-related ‘‘so-
cial determinants’’ of health in order to reduce differential
vulnerability to the effects of work organization hazards
and job insecurity (Table II). Many workers in lower
socioeconomic positions are also at higher risk of other
forms of disadvantage, such as low income, poor housing,
food insecurity, and lack of access to public transport.
While these are beyond the scope of this report and are
addressed in detail elsewhere [Commission on Social
Determinants of Health, 2008], it is important to acknowl-
edge them as potential limiting factors of the effectiveness
of both macro- and micro-level interventions to address
work organization and job insecurity. The UK is attempt-
ing to implement such a comprehensive approach. Follow-
ing on from the WHO’s global recommendations to
reduce health inequalities [Commission on Social
Determinants of Health, 2008], the 2010 UK Marmot
Review proposed a country-specific coordinated set of pol-
icies to reduce health inequalities overall, including a ma-
jor policy objective to ‘‘Create fair employment and good
work for all’’ alongside policy objectives for addressing
other social determinants [Marmot, 2010]. One of three
major arms of this policy proposal is to ‘‘Improve the
quality of jobs across the social gradient’’ through: (1) en-
hanced adherence to equality guidance and legislation,
(2) implementing guidance on stress management (draw-
ing largely on micro/organizational-level intervention re-
search), (3) developing greater employment security and
flexibility through greater retirement age flexibility, and
(4) encouraging and incentivizing employers to create or
adapt jobs that are suitable for disadvantaged workers and
people with disabilities or other work limitations.
Innovative approaches are being developed to investi-
gate differential vulnerability and ways of addressing it at
the macro-level. In a large-scale multi-country analysis,
the association of high work stress and depressive symp-
toms varied according to type of welfare regime, with the
strongest association in a ‘‘neo-liberal’’ country, the UK
505
(OR ¼ 2.64) and the smallest in Scandinavian countries
(OR ¼ 1.69), suggesting that weak social protections may
magnify the health impacts of poor work organization and
job insecurity [Dragano et al., 2011].
In summary, evidence to date suggests that general
social protection policies, as well as occupational health
and safety protection policies, can mitigate both differen-
tial exposure and differential vulnerability by gender,
socioeconomic position, and possibly other factors (e.g.,
employment arrangement).
Micro-Structural Interventions
The research literature on interventions to improve
work organization is dominated by micro-/organizational/
workplace-level studies, most likely due to the greater fea-
sibility of organizational-level intervention and research.
Here, we focus on those work organization interventions
aiming to reduce job stressors and job stress as most
germane to the topic at hand.
International research on interventions to improve
work organization and to reduce job stress and stress-related
illness has been the subject of a number of systematic
reviews. The most comprehensive review (90 intervention
studies) focused on interventions wherein work organiza-
tion factors were proactively addressed [LaMontagne
et al., 2007a]. This review concluded that individual-
focused, low-systems approaches (e.g., coping and time
management skills) favorably affected individual level
outcomes such as health and health behaviors, but tended
not to have favorable impacts at the organizational level
(e.g., no reductions in stressor exposures, sickness absence
rates). However, organizationally focused high- and mod-
erate-systems approaches (addressing work organization
and working conditions), were beneficial at both individu-
al and organizational levels (e.g., improvements in work-
ing conditions as well as health).
More selective Cochrane systematic reviews (with
more stringent inclusion and exclusion criteria) reached
similar conclusions. A 2007 review of organizational
level interventions to increase job control found some
evidence of health benefits (e.g., reductions in anxiety
and depression) when employee control increased or (less
consistently) when demands decreased or support in-
creased [Egan et al., 2007a]. They also found evidence
of worsening employee health from downsizing and
restructuring [Egan et al., 2007a]. A second 2007
Cochrane review of task restructuring interventions
[Bambra et al., 2007] found that interventions that in-
creased control resulted in improved health. An ‘‘umbrel-
la’’ summary of systematic reviews of the effects on
health and health inequalities of organizational-level
changes to the psychosocial work environment was pub-
lished in 2009 [Bambra et al., 2009]. Shift work, work
506 Landsbergis et al.
scheduling, privatization and restructuring were also
considered. Findings suggested that organizational level
changes to improve psychosocial working conditions can
have important and beneficial effects on health. Though
the evidence base was limited, findings tentatively
suggested that organizational level interventions on the
psychosocial work environment also have the potential to
reduce health inequalities.
Participatory approaches were a consistent feature of
effective micro/organizational-level interventions to reduce
job stress, and warrant careful consideration with respect
to the potential to reduce occupational health disparities
[LaMontagne et al., 2007a; Landsbergis, 2009]. Participa-
tion is a concrete enactment of job control, demonstrates
organizational fairness and justice, and, if properly
implemented, builds mutual support among workers and
between workers and supervisors [LaMontagne et al.,
2012]. Despite the benefits that can be gained through
participatory approaches, active employee involvement
tends to be the exception rather the norm in practice.
The predominant approach to developing and implement-
ing organizational-level interventions is to assume
that employees are passive recipients of change, and to
adopt a top–down approach [Nielsen et al., 2010]. This is
of particular concern in relation to workers with lower lev-
els of power or influence. Concerns have been voiced re-
garding the extent to which attempts to gain employees’
insights are genuine and whether participatory processes
address employees’ real issues. NIOSH states, for exam-
ple, that ‘‘. . .worker participation or involvement strate-
gies may often be more ceremonial than substantive,
having little meaningful influence on worker empow-
erment. . .’’ [NIOSH, 2002].
Another factor influencing the effectiveness of partici-
patory processes is the extent to which they capture the
views and ideas of all relevant stakeholders. Studies exam-
ining the effectiveness of participatory-based interventions
indicate that the groups who are particularly vulnerable to
experiencing high levels of work-related ill-health are
also less likely to have the opportunity to take part in par-
ticipatory processes. This includes workers in lower socio-
economic positions; workers employed on a precarious/
contingent or short-term basis, particularly women; and
night-shift workers [Benach et al., 2002; Rotenberg et al.,
2009; Landsbergis, 2010; LaMontagne and Keegel, 2012;
LaMontagne et al., 2012]. Low paid temporary or precari-
ous/contingent employees, for example, are far less likely
to be represented in consultative forums (e.g., OHS com-
mittees) and are more likely to feel constrained by their
status with respect to complaining about work hazards
[Benach et al., 2002; Rotenberg et al., 2009]. They
are also likely to have less knowledge about their
working environments and experience more difficulty al-
tering working conditions [Benach et al., 2002; Rotenberg
et al., 2009]. Further research, as well as regulatory or
other intervention, is needed to develop, strengthen
and support participatory mechanisms for disadvantaged
workers.
Taken together, the available evidence base demon-
strates that effective and feasible micro-level strategies for
the prevention and control of workplace psychosocial
risks are available, but further research is needed, particu-
larly in relation to their application among disadvantaged
worker groups and their impacts on occupational health
disparities.
Intervention: Promise and Practice
Available research suggests that current intervention
practice lags far behind evidence-informed ‘‘best prac-
tice.’’ Despite evidence supporting systems or comprehen-
sive approaches as most effective, prevalent practice in
most OECD countries remains disproportionately focused
on individual-level interventions with inadequate attention
to organizational- and higher-level interventions [Hurrell
and Murphy, 1996; Giga et al., 2003; LaMontagne et al.,
2006; Leka et al., 2008]. Echoing this finding, a recent
survey covering over 28,000 enterprises in 31 European
countries revealed that even though work-related stress
was reported by managers as being among the key safety
and health concerns for European enterprises, only about
half the establishments surveyed reported that they inform
their employees about psychosocial risks and their effects
on health and safety [European Agency for Safety and
Health at Work, 2010; Siegrist et al., 2011]. This suggests
a need to better characterize worker and employer aware-
ness, knowledge, and attitudes towards work organization
and job insecurity in the US, and the need to consider
population-level awareness-raising and educational inter-
ventions to set the stage for more substantive interventions
to address psychosocial working conditions and their
health and social consequences at the regulatory, organiza-
tional, and other levels.
Summary of Findings
Considering the full evidence base linking job insecu-
rity and work organization hazards to health outcomes
(not just as pertains to disparities), various micro- and
macro-level policy and practice recommendations can be
made, as outlined in Table II. While there has been
limited research explicitly examining the impacts of inter-
vention on exposure or health disparities, available evi-
dence suggests that macro- and micro-level intervention
strategies have the potential to improve health and poten-
tially reduce disparities. Intervention can be implemented
at various levels, including macro-structural (e.g., occupa-
tional health and safety and employment rights legislation
 Work Organization and Occupational Health Disparities
and regulation), micro-structural (e.g., union- or employer-
based job stress prevention programs) and individual
(e.g., coping skills development training). Notably, many
of the relevant interventions lie outside public health
(e.g., education, employment, anti-discrimination), but are
important targets as upstream determinants of occupation-
al exposures and health disparities. The UK and some
European countries are currently implementing policy
interventions to reduce health disparities, including work-
directed as well as other intervention strategies. These
may offer valuable policy intervention insights in the
future.
RESEARCH AGENDA
Further research is needed in a number of methodo-
logical and substantive areas:
Surveillance
A high priority area is the development of surveil-
lance tools for monitoring key indicators of work organi-
zation [Dollard et al., 2007] at the organizational level as
well as the worker level. We recommend that NIOSH con-
vene a panel of experts to identify key aspects of work
organization necessary for national surveillance, create an
assessment battery for measuring these factors, and annual
or biennial assessment of these factors through standard
Bureau of Labor Statistics channels (e.g., Current Popula-
tion Survey). In addition, NIOSH should publicly provide
data on trends in work organization measures from nation-
al surveys conducted in 2002, 2006, and 2010, including
trends in these risk factors by SEP, gender, race, ethnicity,
and immigration status.
Existing channels for work organization surveillance
do not adequately capture work performed by individuals
in invisible segments of the labor force (e.g., immigrants).
Methodological research is needed to identify alternative
sampling strategies that capture workers in the full range
of occupations, or the creation of sampling strategies that
otherwise ‘‘enrich’’ probability samples with disadvan-
taged groups including immigrants, refugees, and mem-
bers of racial and ethnic minorities.
Measurement
Research is needed to ensure that individuals from
different segments of society interpret job security and
work organization questions similarly and use comparable
cognitive evaluations when articulating a response to those
questions. There is some evidence that instruments fre-
quently used in this literature, such as the Job Content
Questionnaire [Karasek and Theorell, 1990], have been
validated in several cultural contexts [Karasek et al.,
507
1998]. Other research suggests that concepts like job de-
mand and control have similar meaning in diverse cultural
contexts and that items used to measure these concepts are
appropriate [Grzywacz et al., 2009; Fujishiro et al., 2010].
Nevertheless, it is important to remain vigilant to the issue
of cross-cultural measurement equivalence.
Alternative Study Designs
Further research is needed to better characterize the
magnitude and mechanisms by which poor work organiza-
tion contributes to occupational health disparities. Al-
though the general work organization literature has many
strengths in terms of study design and measurement,
the literature on work organization and occupational
health disparities remains underdeveloped. For example,
<10% of studies of occupational health disparities
used objective indicators of either exposure (i.e., work or-
ganization) or outcome, and <5% can rule out competing
explanations (e.g., physical demands of discrete job
tasks) of associations between work organization factors
and health outcomes. Research using alternative designs
(e.g., case-control, case-crossover designs), alternative
sampling strategies to ensure adequate representation of
‘‘hard-to-reach’’ segments of the workforce (e.g., undocu-
mented immigrants), or alternative methods (e.g., propen-
sity score matching) are needed to more firmly establish
the specific role work organization plays in occupational
health disparities.
Interventions
Given the dearth of tested interventions focused on
reducing occupational health disparities, we recommend
the creation of research funding opportunities focused on
systematic evaluations of micro- and macro-level interven-
tions targeting the improvement of work organization fac-
tors as a means of reducing disparities in psychosocial
working conditions and to alleviating the associated occu-
pational health disparities. Such funding opportunities
should prioritize participatory-based approaches involving
partnerships among worker groups, employers, community
advocacy groups, governmental agencies, and researchers.
The funding opportunity should emphasize process as well
as outcome evaluation, the inclusion of measures of dis-
parity, and the sustainability and scalability of the inter-
vention strategy being tested.
Relationships Between Levels of
Work Organization
More research is needed on the impact of employ-
ment conditions on organizational factors, as well as the
influence of organizational factors (e.g., downsizing,
508 Landsbergis et al.

subcontracting, production systems, staffing levels) on job
specific factors, health and safety, and health and safety
disparities. In addition, research is needed on the ways in
which these relationships might vary among different sec-
tors of the workforce (Fig. 1).
Key Research Questions
The research reviewed in this report leads to several
important research questions:
(1) Have changes in job insecurity and work organiza-
tion contributed to increasing socioeconomic health
disparities in cardiovascular disease [Gonzalez et al.,
1998; Tuchsen and Endahl, 1999], hypertension, dia-
betes, and smoking [Kanjilal et al., 2006]?
(2) Are higher exposures to job insecurity and some
work organization hazards among women, racial and
ethnic minorities, and immigrants primarily due to
their lower socioeconomic position?
(3) What factors explain differential vulnerability of in-
dividuals in lower SEPs to job insecurity and work
organization hazards? What role do non-work haz-
ards play in differential vulnerability to job insecuri-
ty and work organization hazards?
(4) What work organization factors may explain greater
health risks among blue-collar women versus blue-
collar men?
(5) To what extent do work organization hazards and
domestic responsibilities interact to increase illness
risks among women? [Brisson et al., 1999; Krantz
and Ostergren, 2001]
(6) What employment policies and work organization
policies can help workers better balance work life
and family life? [Messing and Östlin, 2006]
(7) What are the economic costs and benefits of organiz-
ing work in a health promotive way? In what
ways do these differ by sector and occupation?
[LaMontagne et al., 2010]
(8) Which intervention strategies are most effective in
reducing occupational health disparities? Table III
provides illustrations of promising intervention strat-
egies awaiting systematic evaluation.
ACKNOWLEDGMENTS
We are grateful to Sherry Baron and Andrea Steege of
the National Institute for Occupational Safety and Health
(NIOSH) for coordinating the production of the five re-
view articles on occupational health disparities and the
2011 NIOSH conference on Eliminating Health and Safety
Disparities at Work. We are also grateful to George
Koutsouras for his assistance in abstracting data from
reviewed articles. The only financial support received by
the authors from NIOSH for the preparation of this manu-
script were travel expenses to attend the 2011 conference
and to present an earlier version of this article at the con-
ference. The only other financial support was partial sup-
port for the third author (A.D.L.) provided by project

TABLE III. Intervention Research Recommendations

Type of intervention research Specific examples

Developmental research
Implementationresearch
Effectivenessresearch
Characterizeperceptions,knowledge, and attitudes amongworkers and employers on workorganization,jobinsecurity, and
occupational health disparities
Developevidence^basedmethodsforriskassessmentandtailoredinterventiondevelopmenttosupporttheadoptionofbestpractice
interventions
Develop participatory strategies that are both effective and safe for workers with lowerlevels orpowerorinfluence (e.g.,lowpaid
workers,racial and ethnic minorities,immigrant workers)
Disseminate evidence^based methods for risk assessment and tailored intervention development, and characterizebarriers and
facilitators ofimplementation
Participatory action and otherintervention implementationstudies to bettercharacterize successful andpotentially harmful
intervention processes and strategies
Characterizethe barriers to andrisks ofintervention participationfor workers with lowerlevels ofpowerorinfluence
Measure andreport notonly absolute changes in exposure or health measures outcomes as keyoutcomes,but also changes in
disparities exposure or health measures;
Long-termstudies evaluatingthe impacts ofmacro-level legislative andregulatory interventions
Organizational-level effectiveness studies focusing on the particularcircumstances of worker groups with lowerlevels ofpoweror
influence
 Work Organization and Occupational Health Disparities
grant #375196 from the Australian National Health &
Medical Research Council.
REFERENCES
Adarga MS, Becerril LC, Champion CD. 2010. Gender, Aging, and
Work: Aging Workers’ Strategies to Confront the Demands of
Production in Maquiladora Plants in Nogales, Mexico. New Solut
20:479–495.
Aiken LH, Sloan D, Klocinski JL. 1997. Hospital nurses’ occupa-
tional exposure to blood: Prospective, retrospective, and institutional
reports. Am J Public Health 87:103–107.
Akhavan S, Bildt C, Wamala S. 2007. Work-related health factors
for female immigrants in Sweden. Work 28(2):135–143.
Artazcoz L, Cortès I, Escribà-Agüir V, Cascant L, Villegas R. 2009.
Understanding the relationship of long working hours with health
status and health-related behaviours. J Epidemiol Community Health
63:521–527.
Bambra C, Egan M, Thomas S, Petticrew M, Whitehead M. 2007.
The psychosocial and health effects of workplace reorganisation. 2.
A systematic review of task restructuring interventions. J Epidemiol
Community Health 61:1028–1037.
Bambra CL, Whitehead MM, Sowden AJ, Akers J, Petticrew MP.
2008. Shifting schedules: The health effects of reorganizing shift
work. Am J Prev Med 34:427–434.
Bambra C, Gibson M, Sowden AJ, Wright K, Whitehead M, Petti-
crew M. 2009. Working for health? Evidence from systematic
reviews on the effects on health and health inequalities of organisa-
tional changes to the psychosocial work environment. Prev Med
48:454–461.
Baum F. 2007. Cracking the nut of health equity: Top down and
bottom up pressure for action on the social determinants of health.
Promot Educ 14:90–95.
Belkic K, Emdad R, Theorell T. 1998. Occupational profile and car-
diac risk: Possible mechanisms and implications for professional
drivers. Int J Occup Med Environ Health 11:37–57.
Belkic K, Landsbergis P, Schnall P, Baker D. 2004. Is job strain a
major source of cardiovascular disease risk? Scand J Work Environ
Health 30:85–128.
Benach J, Muntaner C. 2007. Precarious employment and health:
Developing a research agenda. J Epidemiol Community Health 61:
276–277.
Benach J, Muntaner C. 2010. Empleo, Trabajo y Desigualdades en
Salud: Una Vision Global (Employment, work, and health inequal-
ities: A global perspective). Barcelona: Icaria Editorial.
Benach J, Amable M, Muntaner C, Benavides FG. 2002. The conse-
quences of flexible work for health: Are we looking at the right
place? J Epidemiol Community Health 56:405–406.
Benach J, Gimeno D, Benavides FG, Martinez JM, Torne Mdel M.
2004. Types of employment and health in the European union:
Changes from 1995 to 2000. Eur J Public Health 14:314–321.
Benach J, Castedo A, Solar O, Martinez JM, Vergara M, Amable M,
Buxo M, Demiral Y, Muntaner C. 2010a. The role of employment
relations in reducing health inequalities. Methods for the study of
employment relations and health inequalities in a global context. Int
J Health Services 40:209–213.
Benach J, Muntaner C, Solar O, Santana V, Quinlan M. 2010b. Intro-
duction to the WHO Commission on Social Determinants of Health
Employment Conditions Network (EMCONET) study, with a glossa-
ry on employment relations. Int J Health Serv 40:195–207.
509
Benach J, Solar O, Santana V, Castedo A, Chung H, Muntaner C.
2010c. The role of employment relations in reducing health inequal-
ities. A micro-level model of employment relations and health
inequalities. Int J Health Services 40:223–227.
Benavides FG, Benach J, Muntaner C, Delclos GL, Catot N, Amable
M. 2006. Associations between temporary employment and occupa-
tional injury: What are the mechanisms? Occup Environ Med 63:
416–421.
Besosa M. 2007. New Public Management. Academe 93.
Blau F, Ferber M, Winkler A. 2002. The economics of women, men
and work. Upper Saddle River, NY: Prentice Hall.
Bonacich E, Appelbaum R. 2005. The return of the sweatshop.
In: Kleniewski N, editor. Cities and society. New York: Blackwell
Publishing, pp 127–143.
Borrell C, Muntaner C, Benach J, Artazcoz L. 2004. Social class and
self-reported health status among men and women: What is the role
of work organisation, household material standards and household
labour? Soc Sci Med 58:1869–1887.
Bosma H, Marmot MG, Hemingway H, Nicholson AC, Brunner EJ,
Stansfeld SA. 1997. Low job control and risk of coronary heart
disease in Whitehall II (prospective cohort) study. Br Med J 314:
558–565.
Bosma H, Peter R, Siegrist J, Marmot M. 1998. Two alternative job
stress models and the risk of coronary heart disease. Am J Public
Health 88:68–74.
Brisson C, Vinet A, Vezina M, Gingras S. 1989. Effect of duration
of employment in piecework on severe disability among female gar-
ment workers. Scand J Work Environ Health 15:329–334.
Brisson C, Laflamme N, Moisan J, Milot A, Masse B, Vezina M.
1999. Effect of family responsibilities and job strain on ambulatory
blood pressure among white-collar women. Psychosom Med 61:
205–213.
Broughton A, Tyers C, Denvir A, Wilson S, O’Regan S. 2009. Man-
aging stress and sickness absence. Progress of the Sector Implemen-
tation Plan—Phase 2. Research Report RR694 Sudbury: HSE books.
Brunette M. 2004. Construction safety research in the United States:
Targeting the Hispanic workforce. Inj Prev 10:244–248.
Bureau of Labor Statistics. 2005. Contingent and alternative employ-
ment arrangements. Washington, DC: Bureau of Labor Statistics.
Bureau of Labor Statistics. 2010. Table 18. Employed persons by
detailed industry, sex, race, and Hispanic or Latino ethnicity.
Burgard SA, Brand JE, House JS. 2009. Perceived job insecurity and
worker health in the United States. Soc Sci Med 69:777–785.
Carroll D, Samardick R, Bernard S, Gabbard S, Hernandez T. 2005.
Findings from the National Agricultural Workers Survey (NAWS)
2001–2002 : A demographic and employment profile of United
States farm workers. Washington, DC: US Department of Labor.
Chibnall JT, Tait RC. 2005. Disparities in occupational low back
injuries: Predicting pain-related disability from satisfaction with case
management in African Americans and Caucasians. Pain Med 6(1):
39–48.
Choi B. 2006. Methodological and theoretical issues in cross-
national comparative studies of psychosocial job hazards: From
questionnaire items to social class [dissertation]: University of
Massachusetts.
Choi B, Clays E, De Bacquer D, Karasek R. 2008. Socioeconomic
status, job strain and common mental disorders—An ecological
(occupational) approach. Scand J Work Environ Health (Suppl. 6):
22–32.
510 Landsbergis et al.
Clarke M, Lewchuk W, de Wolff A, King A. 2007. This just isn’t
sustainable’: Precarious employment, stress and workers’ health. Int
J Law Psychiatry 30:311–326.
Clougherty J, Souza K, Cullen M. 2010. Work and its role in shaping
the social gradient in health. Ann N Y Acad Sci 1186:102–124.
Commission on Social Determinants of Health. 2008. Closing
the gap in a generation: Health equity through action on the social
determinants of health. Final Report of the Commission on Social
Determinants of Health. Geneva: World Health Organisation.
Cortina L, Magley V, Williams J, Langhout R. 2001. Incivility in
the workplace: Incidence and impact. J Occup Health Psychol 6:
64–80.
Cummings KJ, Kreiss K. 2008. Contingent workers and contingent
health: Risks of a modern economy. JAMA 299:448–450.
De Witte H. 1999. Job insecurity and psychological well-being:
Review of the literature and exploration of some unresolved issues.
Eur J Work Organ Psychol 8:155–177.
Dekker S, Schaufeli W. 1995. The effects of job insecurity on psy-
chological health and withdrawal: A longitudinal study. Aust Psychol
30:57–63.
Delp L, Wallace SP, Geiger-Brown J, Muntaner C. 2010. Job stress
and job satisfaction: Home care workers in a consumer-directed
model of care. Health Serv Res 45:922–940.
Dollard M, Skinner N, Tuckey M, Bailey T. 2007. National surveil-
lance of psychosocial risk factors in the workplace: An international
overview. Work Stress 21:1–29.
Dragano N, Verde PE, Siegrist J. 2005. Organisational downsizing
and work stress: Testing synergistic health effects in employed men
and women. J Epidemiol Community Health 59:694–699.
Dragano N, Siegrist J, Wahrendorf M. 2011. Welfare regimes, labour
policies and unhealthy psychosocial working conditions: A compara-
tive study with 9917 older employees from 12 European countries.
J Epidemiol Community Health 65:793–799.
D’Souza RM, Strazdins L, Lim LL, Broom DH, Rodgers B. 2003.
Work and health in a contemporary society: Demands, control, and
insecurity. J Epidemiol Community Health 57:849–854.
Eaker ED, Sullivan LM, Kelly-Hayes M, D’Agostino RB, Sr., Benja-
min EJ. 2004. Does job strain increase the risk for coronary heart
disease or death in men and women? The Framingham Offspring
Study. Am J Epidemiol 159:950–958.
Egan M, Bambra C, Thomas S, Petticrew M, Whitehead M,
Thomson H. 2007a. The psychosocial and health effects of work-
place reorganisation. 1. A systematic review of organisational-level
interventions that aim to increase employee control. J Epidemiol
Community Health 61:945–954.
Egan M, Petticrew M, Ogilvie D, Hamilton V, Drever F. 2007b.
‘‘Profits before people’’? A systematic review of the health and safe-
ty impacts of privatising public utilities and industries in developed
countries. J Epidemiol Community Health 61:862–870.
Elovainio M, Kivimaki M, Vahtera J. 2002. Organizational justice:
Evidence of a new psychosocial predictor of health. Am J Public
Health 92:105–108.
Elovainio M, Leino-Arjas P, Vahtera J, Kivimaki M. 2006. Justice
at work and cardiovascular mortality: A prospective cohort study.
J Psychosom Res 61:271–274.
European Agency for Safety and Health at Work. 2010. ESENER—
European Survey of Enterprises on New and Emerging Risks.
Luxembourg: Publications Office of the European Union.
European Trade Union Confederation, Union of Industrial And
Employers’ Confederations of Europe, European Association of
Craft Small and Medium-Sized Enterprises, Interest ECoEw-
PPaoEoGE. 2004. Framework agreement on work-related stress.
4 pp.
Ferrie JE, Shipley MJ, Marmot MG, Stansfeld SA, Smith GD. 1998.
An uncertain future: The health effects of threats to employment
security in white-collar men and women. Am J Public Health 88:
1030–1036.
Ferrie J, Shipley M, Stansfeld S, Marmot M. 2002. Effects of chronic
job insecurity and change in job security on self-reported health mi-
nor psychiatric morbidity physiological measures, and health related
behaviours in British civil servants: The Whitehall II Study. J Epide-
miol Community Health 56:450–454.
Ferrie JE, Shipley MJ, Newman K, Stansfeld SA, Marmot M.
2005. Self-reported job insecurity and health in the Whitehall II
study: Potential explanations of the relationship. Soc Sci Med 60:
1593–1602.
Ferrie JE, Westerlund H, Oxenstierna G, Theorell T. 2007. The
impact of moderate and major workplace expansion and downsizing
on the psychosocial and physical work environment and income in
Sweden. Scand J Public Health 35:62–69.
Ferrie J, Westerlund H, Virtanen M, Vahtera J, Kivimäki M. 2008.
Flexible labor markets and employee health. Scandinavian Journal of
Work, Environ Health (Suppl. 6):98–110.
Fischbacher CM, White M, Bhopal RS, Unwin NC. 2005. Self-
reported work strain is lower in South Asian than European people:
Cross-sectional survey. Ethn Health 10:279–292.
Flannery RJ, Hanson M, Penk W, Pastva G, Navon M, Flannery G.
1997. Hospital downsizing and patients’ assaults on staff. Psychiatr
Q 68:67–76.
Frohlich KL, Potvin L. 2008. Transcending the known in public
health practice: The inequality paradox: The population approach
and vulnerable populations. Am J Public Health 98:216–221.
Fujishiro K, Landsbergis PA, Diez Roux AV, Stukovsky KH, Shrager
S, Baron S. 2011. Factorial invariance, scale reliability, and construct
validity of the job control and job demands scales for immigrant
workers: The multi-ethnic study of atherosclerosis. J Immigr Minor
Health 13:533–540.
Gadinger MC, Fischer JE, Schneider S, Terris DD, Kruckeberg K,
Yamamoto S, Frank G, Kromm W. 2010. Gender moderates the
health-effects of job strain in managers. Int Arch Occup Environ
Health 83:531–541.
GAO. 2006. Employment arrangements: Improved outreach could
help ensure proper worker classification. Washington, DC: U.S. Gov-
ernment Accountability Office.
Giga SI, Noblet AJ, Faragher B, Cooper CL. 2003. The UK perspec-
tive: A review of research on organisational stress management inter-
ventions. Aust Psychol 38:158–164.
Gisselmann MD, Hemstrom O. 2008. The contribution of maternal
working conditions to socio-economic inequalities in birth outcome.
Soc Sci Med 66:1297–1309.
Golden L. 2008. Limited access: Disparities in flexible work sched-
ules and work-at-home. J Fam Econ Issues 29:86–109.
Gong F, Baron S, Ayala L. 2009. Formative research in occupational
health and safety intervention for diverse, underserved worker popu-
lations: A homecare worker intervention project. Public health
reports (Washington, DC: 1974). 124 (Suppl. 1):84–89.
Gonzalez MA, Artalejo FR, Calero JR. 1998. Relationship between
socioeconomic status and ischaemic heart disease in cohort and
case-control studies: 1960–1993. Int J Epidemiol 27:350–358.
Government Accountability Office. 2005. Workplace safety and
health: Safety in the meat and poultry industry, while improving,
 Work Organization and Occupational Health Disparities
could be further strengthened. Washington, DC: US Government
Accountability Office.
Greenlund KJ, Kiefe CI, Giles WH, Liu K. 2010. Associations of
job strain and occupation with subclinical atherosclerosis: The CAR-
DIA Study. Ann Epidemiol 20:323–331.
Grosch JW, Caruso CC, Rosa RR, Sauter SL. 2006. Long hours of
work in the U.S.: Associations with demographic and organizational
characteristics, psychosocial working conditions, and health. Am J
Ind Med 49:943–952.
Grzywacz JG, Arcury TA, Marı́n A, Carrillo L, Coates ML, Burke
B, Quandt SA. 2007. The organization of work: Implications for in-
jury and illness among immigrant Latino poultry-processing workers.
Arch Environ Occup Health 62:19–26.
Grzywacz J, Alterman T, Muntaner C, Gabbard S, Nakamoto J,
Carroll D. 2009. Measuring job characteristics and mental health
among Latino farmworkers: Results from cognitive testing. J Immigr
Minor Health 11:131–138.
Hallqvist J, Diderichsen F, Theorell T, Reuterwall C, Ahlbom A.
1998. Is the effect of job strain on myocardial infarction risk due to
interaction between high psychological demands and low decision
latitude? Results from Stockholm Heart Epidemiology Program
(SHEEP). Soc Sci Med 46:1405–1415.
Heaney C, Israel B, House J. 1994. Chronic job insecurity among
automobile workers: Effects on job satisfaction and health. Soc Sci
Med 38:1431–1437.
Hemstrom O. 1999. Does the work environment contribute to excess
male mortality? Soc Sci Med 49:879–894.
Hill JJ III, Slade MD, Cantley L, Vegso S, Fiellin M, Cullen MR.
2008. The relationships between lost work time and duration of
absence spells: Proposal for a payroll driven measure of absenteeism.
J Occup Environ Med 50:840–851.
Hintsa T, Kivimaki M, Elovainio M, Keskivaara P, Hintsanen M,
Pulkki-Raback L, Keltikangas-Jarvinen L. 2006. Parental socioeco-
nomic position and parental life satisfaction as predictors of job
strain in adulthood: 18-year follow-up of the Cardiovascular Risk in
Young Finns Study. J Psychosom Res 61:243–249.
Hipple S. 2001. Contingent work in the late 1990s. Mon Labor Rev
124:3–27.
Huisman M, Van Lenthe F, Avendano M, Mackenbach J. 2008. The
contribution of job characteristics to socioeconomic inequalities in
incidence of myocardial infarction. Soc Sci Med 66:2240–2252.
Hurrell JJJ, Murphy LR. 1996. Occupational stress intervention. Am
J Ind Med 29:338–341.
Inoue A, Kawakami N, Ishizaki M, Shimazu A, Tsuchiya M, Tabata
M, Akiyama M, Kitazume A, Kuroda M. 2010. Organizational
justice, psychological distress, and work engagement in Japanese
workers. Int Arch Occup Environ Health 83:29–38.
Johnson JV. 1989. Collective control: Strategies for survival in the
workplace. Int J Health Serv 19:469–480.
Johnson JV, Hall EM. 1988. Job strain, workplace social support,
and cardiovascular disease: A cross-sectional study of a random
sample of the Swedish working population. Am J Public Health
78:1336–1342.
Johnson JV, Lipscomb J. 2006. Long working hours, occupational
health and the changing nature of work organization. Am J Ind Med
49:921–929.
Johnson JV, Hall EM, Theorell T. 1989. Combined effects of job
strain and social isolation on cardiovascular disease morbidity and
mortality in a random sample of the Swedish male working popula-
tion. Scand J Work Environ Health 15:271–279.
511
Kanjilal S, Gregg EW, Cheng YJ, Zhang P, Nelson DE, Mensah G,
Beckles GL. 2006. Socioeconomic status and trends in disparities in
4 major risk factors for cardiovascular disease among US adults,
1971–2002. Arch Intern Med 166:2348–2355.
Karasek R, Theorell T. 1990. Healthy work: Stress, productivity, and
the reconstruction of working life. New York, NY: Basic Books.
Karasek R, Brisson C, Kawakami N, Houtman I, Bongers P, Amick
B. 1998. The job content questionnaire (JCQ): An instrument for
internationally comparative assessments of psychosocial job charac-
teristics. J Occup Health Psychol 3:322–355.
Karlsson BH, Knutsson AK, Lindahl BO, Alfredsson LS. 2003.
Metabolic disturbances in male workers with rotating three-shift
work. Results of the WOLF study. Int Arch Occup Environ Health
76:424–430.
Kelsh MA, Lu ET, Ramachandran K, Jesser C, Fordyce T, Yager JW.
2004. Occupational injury surveillance among electric utility
employees. J Occup Environ Med 46:974–984.
Kern JH, Grandey AA. 2009. Customer incivility as a social stressor:
The role of race and racial identity for service employees. J Occup
Health Psychol 14:46–57.
Kim IH, Khang YH, Muntaner C, Chun H, Cho SI. 2008. Gender,
precarious work, and chronic diseases in South Korea. Am J Ind
Med 51:748–757.
Kivimaki M, Vahtera J, Pentti J, Ferrie JE. 2000. Factors underlying
the effect of organisational downsizing on health of employees:
Longitudinal cohort study. BMJ 320:971–975.
Kivimaki M, Vahtera J, Virtanen M, Elovainio M, Pentti J, Ferrie J.
2003. Temporary employment and risk of overall and cause-specific
mortality. Am J Epidemiol 158:663–668.
Kivimaki M, Ferrie J, Brunner E, Head J, Shipley M, Vahtera J,
Marmot M. 2005. Justice at work and reduced risk of coronary heart
disease among employees: The Whitehall II Study. Arch Intern Med
165:2245–2251.
Kivimaki M, Honkonen T, Wahlbeck K, Elovainio M, Pentti J,
Klaukka T, Virtanen M, Vahtera J. 2007. Organisational downsizing
and increased use of psychotropic drugs among employees who
remain in employment. J Epidemiol Community Health 61:154–
158.
Kouvonen A, Kivimaki M, Elovainio M, Virtanen M, Linna A,
Vahtera J. 2005. Job strain and leisure-time physical activity in
female and male public sector employees. Prev Med 41:532–539.
Kouvonen A, Kivimaki M, Elovainio M, Pentti J, Linna A, Virtanen
M, Vahtera J. 2006. Effort/reward imbalance and sedentary lifestyle:
An observational study in a large occupational cohort. Occup
Environ Med 63:422–427.
Krantz G, Ostergren PO. 2001. Double exposure. The combined
impact of domestic responsibilities and job strain on common
symptoms in employed Swedish women. Eur J Public Health 11:
413–419.
Krieger N, Waterman PD, Hartman C, Bates LM, Stoddard AM,
Quinn MM, Sorensen G, Barbeau EM. 2006. Social hazards on the
job: Workplace abuse, sexual harassment, and racial discrimina-
tion—A study of Black, Latino, and White low-income women and
men workers in the United States. Int J Health Serv 36:51–85.
Kuper H, Marmot M. 2003. Job strain, job demands, decision lati-
tude, and risk of coronary heart disease within the Whitehall II study.
J Epidemiol Community Health 57:147–153.
Kuper H, Singh-Manoux A, Siegrist J, Marmot M. 2002. When reci-
procity fails: Effort-reward imbalance in relation to coronary heart
disease and health functioning within the Whitehall II study. Occup
Environ Med 59:777–784.
512 Landsbergis et al.
Kwon H, Pontusson J. 2006. Globalization, union decline and the
politics of social spending growth in OECD countries, 1962–2000:
Yale University.
Laflamme N, Brisson C, Moisan J, Milot A, Masse B, Vezina M.
1998. Job strain and ambulatory blood pressure among female white-
collar workers. Scand J Work Environ Health 24:334–343.
Lahelma E, Laaksonen M, Aittomaki A. 2009. Occupational class
inequalities in health across employment sectors: The contribution of
working conditions. Int Arch Occup Environ Health 82:185–190.
LaMontagne AD, Keegel TG. 2012. Reducing Stress in the Work-
place (An Evidence Review: Full Report). Melbourne: Victorian
Heath Promotion Foundation (VicHealth). 58 pp. Open access
at http://www.vichealth.vic.gov.au/workplace, ISBN: 978-1-921822-
08-7.
LaMontagne AD, Louie A, Keegel T, Ostry A, Shaw A. 2006. Work-
place Stress in Victoria: Developing a Systems Approach Melbourne:
Victorian Health Promotion Foundation. 143 pp. Open access at
www.vichealth.vic.gov.au/workplacestress, ISBN 0-9757335-3-2.
LaMontagne AD, Keegel T, Louie AM, Ostry A, Landsbergis PA.
2007a. A systematic review of the job stress intervention evaluation
literature: 1990—2005. Intl J Occup Environ Health 13:268–280.
LaMontagne AD, Keegel T, Vallance DA. 2007b. Protecting &
promoting mental health in the workplace: Developing a systems
approach to job stress. Health Promot J Austr 18:221–228.
LaMontagne AD, Keegel T, Vallance D, Ostry A, Wolfe R. 2008.
Job strain—Attributable depression in a sample of working Austral-
ians: Assessing the contribution to health inequalities. BMC Public
Health 8:181.
LaMontagne AD, Sanderson K, Cocker F. 2010. Estimating the
Economic Benefits of Eliminating Job Strain as a Risk Factor for
Depression Melbourne: Victorian Heath Promotion Foundation
(VicHealth). 37 pp. Open accessed at http://www.vichealth.vic.gov.
au/jobstrain, ISBN: 978-1-921822-02-5.
LaMontagne A, Krnjacki L, Kavanagh A, Bentley R. 2011. Psycho-
social working conditions: Time trends in psychosocial working
conditions in a representative sample of working Australians 2000–
2008: Evidence of narrowing disparities? (abstract). Occup Environ
Med 68(Suppl. 1):A22.
LaMontagne AD, Noblet AJ, Landsbergis PA. 2012. Intervention
development and implementation: Understanding and addressing
barriers to organisational-level interventions. In: Biron C, Karanika-
Murray M, Cooper CL, editors. Improving organizational interven-
tions for stress and well-being: Addressing process and context.
London: Routledge/Psychology Press, pp 21–38.
Landsbergis PA. 2009. Interventions to reduce job stress and improve
work organization and worker health. In: Schnall P, Dobson M,
Rosskam E, Gordon D, Landsbergis PA, Baker D, editors. Unhealthy
work: Causes, consequences, cures amityville. NY: Baywood Pub-
lishing, pp 193–209.
Landsbergis PA. 2010. Assessing the contribution of working condi-
tions to socioeconomic disparities in health: A commentary. Am J
Ind Med 53:95–103.
Landsbergis P, Cahill J, Schnall P. 1999. The impact of lean produc-
tion and related new systems of work organization on worker health.
J Occup Health Psychol 4(2):108–130.
Landsbergis P, Schnall P, Pickering T, Warren K, Schwartz J. 2003.
Lower socioeconomic status among men in relation to the associa-
tion between job strain and blood pressure. Scandinavian Journal of
Work, Environ Health 29:206–215.
Landsbergis P, Grzywacz J, LaMontagne A, with contributions by,
Muntaner C, Benach J, Lipscomb J, Johnson J, Schnall P, Riley K,
Rosskam E, Zelnick J, 2011a. Work Organization, Job Insecurity,
and Occupational Health Disparities: An Issue Paper for Discussion
at the NIOSH Eliminating Health and Safety Disparities at Work
Conference, Chicago, Illinois.
Landsbergis P, Sinclair R, Dobson M, Hammer L, Jauregui M,
LaMontagne A, Olson R, Schnall P, Stellman J, Warren N. 2011b.
Occupational health psychology. In: Anna D, editor. The occupation-
al environment: Its evaluation, control, and management. Fairfax,
VA: American Industrial Hygiene Association, pp 1086–1130.
Laszlo KD, Pikhart H, Kopp MS, Bobak M, Pajak A, Malyutina S,
Salavecz G, Marmot M. 2010. Job insecurity and health: A study of
16 European countries. Soc Sci Med 70:867–874.
Leka S, Cox T, editors. 2008. The European Framework for Psycho-
social Risk Management: PRIMA-EF. Nottingham (UK): Institue of
Work, Health & Organisations.
Leka S, Vartia M, Hassard J, Pahkin K, Sutela S, Cox T, Lindstrom
K. 2008. Best practice in interventions for the prevention and man-
agement of work-related stress and workplace violence and bullying.
In: Leka S, Cox T, editors. The European Framework for Psychoso-
cial Risk Management: PRIMA-EF. Nottingham, UK: Institute of
Work, Health and Organisations, pp 136–173.
Leka S, Jain A, Widerszal-Bazyl M, Żołnierczyk-Zreda D, Zwetsloot
G. 2011. Developing a standard for psychosocial risk management:
PAS 1010. Saf Sci 49:1047–1057.
Lim S, Lee A. 2011. Work and nonwork outcomes of workplace
incivility: Does family support help? J Occup Health Psychol 16:
95–111.
Lim S, Cortina L, Magley V. 2008. Personal and workgroup incivili-
ty: Impact on work and health outcomes. J Appl Psychol 93:95–107.
Lipscomb HJ, Loomis D, McDonald MA, Argue RA, Wing S. 2006.
A conceptual model of work and health disparities in the U.S. Int J
Health Services 36(1):25–50.
Lipscomb HJ, Dement JM, Epling CA, Gaynes BN, McDonald MA,
Schoenfisch AL. 2007. Depressive symptoms among working
women in rural North Carolina: A comparison of women in poultry
processing and other low-wage jobs. Int J Law Psychiatry 30(4–5):
284–298.
Lopes CS, Araya R, Werneck GL, Chor D, Faerstein E. 2010. Job
strain and other work conditions: Relationships with psychological
distress among civil servants in Rio de Janeiro, Brazil. Soc Psychia-
try Psychiatr Epidemiol 45:345–354.
Louie A, Ostry A, Quinlan M, Keegel T, Shoveller J, LaMontagne
A. 2006. Empirical study of employment arrangements and pre-
cariousness in Australia. Relations Industrielles/Ind Relat 61:
465–489.
Lynch J, Krause N, Kaplan G, Tuomilehto J, Salonen J. 1997. Work-
place conditions, socioeconomic status, and the risk of mortality and
acute myocardial infraction: The Kuopio Ischemic Heart Disease
Risk Factor Study. Am J Public Health 87:617.
Malinauskiene V, Theorell T, Grazuleviciene R, Malinauskas R,
Azaraviciene A. 2004. Low job control and myocardial infarction
risk in the occupational categories of Kaunas men, Lithuania. J Epi-
demiol Community Health 58:131–135.
Marmot M. 2010. Fair Society, Healthy Lives: A Strategic Review of
Health Inequalities in England Post-2010. London: Marmot Review.
Marmot MG, Bosma H, Hemingway H, Brunner E, Stansfeld S.
1997. Contribution of job control and other risk factors to social
variations in coronary heart disease incidence. Lancet 350:235–239.
Marmot M, Newman K, Ferrie J, Stansfeld S. 2001. The contribution
of job insecurity to socio-economic inequalities Lancaster Lancaster
University, Health Variations Programme.
 Work Organization and Occupational Health Disparities
Martikainen P, Maki N, Jantti M. 2008. The effects of workplace
downsizing on cause-specific mortality: A register-based follow-
up study of Finnish men and women remaining in employment.
J Epidemiol Community Health 62:1008–1013.
Matthews S, Hertzman C, Ostry A, Power C. 1998. Gender, work
roles and psychosocial work characteristics as determinants of
health. Soc Sci Med 46:1417–1424.
Mayhew C, Quinlan M. 1999. The effects of outsourcing on occupa-
tional health and safety: A comparative study of factory-based work-
ers and outworkers in the Australian clothing industry. Int J Health
Serv 29:83–107.
McCurdy SA, Samuels SJ, Carroll DJ, Beaumont JJ, Morrin LA.
2003. Agricultural injury in California migrant Hispanic farm work-
ers. Am J Ind Med 44:225–235.
Messing K, Östlin P. 2006. Gender equality, work and health: A re-
view of the evidence. Geneva: World Health Organization.
Meyer JD, Muntaner C. 1999. Injuries in home health care workers:
An analysis of occupational morbidity from a state compensation
database. Am J Ind Med 35:295–301.
Moncada S, Pejtersen JH, Navarro A, Llorens C, Burr H, Hasle P,
Bjorner JB. 2010. Psychosocial work environment and its association
with socioeconomic status. A comparison of Spain and Denmark.
Scand J Public Health 38:137–148.
Muntaner C, Eaton WW, Diala C, Kessler RC, Sorlie PD. 1998a.
Social class, assets, organizational control and the prevalence of
common groups of psychiatric disorders. Soc Sci Med 47:2043–
2053.
Muntaner C, Nieto FJ, Cooper L, Meyer J, Szklo M, Tyroler HA.
1998b. Work organization and atherosclerosis: Findings from the
ARIC study. Am J Prev Med 14:9–18.
Muntaner C, Borrell C, Benach J, Pasarı́n M, Fernandez E. 2003.
The associations of social class and social stratification with patterns
of general and mental health in a Spanish population. Int J Epide-
miol 32:950–958.
Muntaner C, Eaton W, Miech R, O’Campo P. 2004. Socioeconomic
position and major mental disorders. Epidemiol Rev 26:53–62.
Muntaner C, Chung H, Kim I, Benach J. 2008. Populations at special
health risk: Workers. In: Heggenhougen K, Quah S, editors. Interna-
tional Encyclopedia of Public Health. San Diego: Academic Press,
pp 285–301.
Muntaner C, Chung H, Solar O, Santana V, Castedo A, Benach J.
2010a. The role of employment relations in reducing health inequal-
ities. A macro-level model of employment relations and health
inequalities. Int J Health Serv 40:215–221.
Muntaner C, Solar O, Vanroelen C, Martinez JM, Vergara M, San-
tana V, Castedo A, Kim IH, Benach J. 2010b. Unemployment, infor-
mal work, precarious employment, child labor, slavery, and health
inequalities: Pathways and mechanisms. Int J Health Serv 40:281–
295.
Muntaner C, Sridharan S, Chung H, Solar O, Quinlan M, Vergara M,
Benach J. 2010c. The role of employment relations in reducing
health inequalities. The solution space: Developing research and pol-
icy agendas to eliminate employment-related health inequalities. Int
J Health Serv 40:309–314.
Nicholson VJ, Bunn TL, Costich JF. 2008. Disparities in work-relat-
ed injuries associated with worker compensation coverage status.
Am J Indust Med 51(6):393–398.
Niedhammer I, Bourgkard E, Chau N. 2011. Occupational and
behavioural factors in the explanation of social inequalities in prema-
ture and total mortality: A 12.5-year follow-up in the Lorhandicap
study. Eur J Epidemiol 26(1):1–12.
513
Nielsen K, Taris TW, Cox T. 2010. The future of organizational
interventions: Addressing the challenges of today’s organizations.
Work Stress 24:219–233.
NIOSH. 2002. The changing organization of work and the safety and
health of working people. Cincinnati, Ohio: National Institute for
Occupational Safety and Health.
Ostry A, Maggi S, Tansey J, Dunn J, Hershler R, Chen L, Louie
AM, Hertzman C. 2007. The impact of psychosocial work conditions
on attempted and completed suicide among western Canadian saw-
mill workers. Scand J Public Health 35:265–271.
Paoli P, Merllié D. 2001. Third European Survey on Working Con-
ditions Dublin: European Foundation for the Improvement of Living
and Working Conditions.
Park H, Sandefur GD. 2003. Racial/ethnic differences in voluntary
and involuntary job mobility among young men. Soc Sci Res 32:
347–375.
Parslow RA, Jorm AF, Christensen H, Broom DH, Strazdins L, RM
DS. 2004. The impact of employee level and work stress on mental
health and GP service use: An analysis of a sample of Australian
government employees. BMC Public Health 4:41.
Pikhart H, Bobak M, Pajak A, Malyutina S, Kubinova R, Topor R,
Sebakova H, Nikitin Y, Marmot M. 2004. Psychosocial factors at
work and depression in three countries of Central and Eastern
Europe. Soc Sci Med 58:1475–1482.
Pollack KM, Sorock GS, Slade MD, Cantley L, Sircar K, Taiwo O,
Cullen MR. 2007. Association between body mass index and acute
traumatic workplace injury in hourly manufacturing employees. Am
J Epidemiol 166:204–211.
Probst TM. 2002. Layoffs and tradeoffs: Production, quality, and
safety demands under the threat of job loss. J Occup Health Psychol
7:211–220.
Probst T. 2004. Job Insecurity: Exploring a New threat to employee
safety. In: Barling J, Frone M, editors. The psychology of workplace
safety. Washington, DC: American Psychological Association.
Probst T. 2005. Economic stressors. In: Barling J, Kelloway E, Frone
M, editors. Handbook of work stress. Thousand Oaks, CA: Sage
Publications.
Probst TM, Brubaker TL. 2001. The effects of job insecurity on em-
ployee safety outcomes: Cross-sectional and longitudinal explora-
tions. J Occup Health Psychol 6:139–159.
Quandt SA, Grzywacz JG, Marin A, Carrillo L, Coates ML, Burke
B, Arcury TA. 2006. Illnesses and injuries reported by Latino poultry
workers in western North Carolina. Am J Ind Med 49:343–351.
Quinlan M, Bohle P. 2009. Overstretched and unreciprocated com-
mitment: Reviewing research on the occupational health and safety
effects of downsizing and job insecurity. Int J Health Serv 39:1–44.
Quinlan M, Sokas RK. 2009. Community campaigns, supply chains,
and protecting the health and well-being of workers. Am J Public
Health 99(Suppl. 3):S538–S546.
Quinlan M, Mayhew C, Bohle P. 2001. The global expansion of pre-
carious employment, work disorganization, and consequences for oc-
cupational health: A review of recent research. Int J Health Serv
31:335–414.
Quinlan M, Muntaner C, Solar O, Vergara M, Eijkemans G, Santana
V, Chung H, Castedo A, Benach J. 2010. Policies and interventions
on employment relations and health inequalities. Int J Health Serv
40:297–307.
Radi S, Ostry A, LaMontagne A. 2007. Job stress and other working
conditions: Relationships with smoking behaviors in a representative
sample of working Australians. Am J Ind Med 50:584–596.
514 Landsbergis et al.
Richardson C. 2008. Working alone: The erosion of solidarity in
today’s workplace. New Labor Forum 17:69–78.
Robertson R, Fallavollita B, Siegel L, Peterson J, Campbell J. 2006.
Employment Arrangements: Improved Outreach Could Help Ensure
Proper Worker Classification [GAO-06-656]. Washington, DC: US
Government Accountability Office.
Rostila M. 2008. The Swedish labour market in the 1990s: The very
last of the healthy jobs? Scand J Public Health 36:126–134.
Rotenberg L, Griep RH, Fischer FM, Fonseca M, Landsbergis PA.
2009. Working at night and work ability among nursing personnel:
When precarious employment makes the difference. Int Arch Occup
Environ Health 82:877–885.
Rugulies R, Bultmann U, Aust B, Burr H. 2006. Psychosocial work
environment and incidence of severe depressive symptoms: Prospec-
tive findings from a 5-year follow-up of the Danish Work Environ-
ment Cohort Study. Am J Epidemiol 163:877–887.
Runyan J. 2000. Summary of federal laws and regulations affecting
agricultural employers, 2000. Agricultural Handbook No. 719 ed.:
Food and Rural Economics Division, Economic Research Service,
US Department of Agriculture.
Salminen S, Kivimaki M, Elovainio M, Vahtera J. 2003. Stress fac-
tors predicting injuries of hospital personnel. Am J Ind Med 44:32–
36.
Schnall P, Belkic K, Landsbergis PA, Baker De. 2000. The work-
place and cardiovascular disease. Occupational Medicine: State-of-
the-Art Reviews. Philadelphia, PA: Hanley and Belfus.
Schnall P, Rosskam E, Dobson M, Gordon D, Landsbergis P, Baker
D, editors. 2009. Unhealthy work: Causes, consequences and cures
amityville. NY: Baywood Publishing.
Seixas NS, Blecker H, Camp J, Neitzel R. 2008. Occupational health
and safety experience of day laborers in Seattle, WA. Am J Indust
Med 51:399–406.
Sekine M, Chandola T, Martikainen P, Marmot M, Kagamimori S.
2009. Socioeconomic inequalities in physical and mental functioning
of British, Finnish, and Japanese civil servants: Role of job demand,
control, and work hours. Soc Sci Med 69:1417–1425.
Sekine M, Tatsuse T, Kagamimori S, Chandola T, Cable N, Marmot
M, Martikainen P, Lallukka T, Rahkonen O, Lahelma E. 2011. Sex
inequalities in physical and mental functioning of British, Finnish,
and Japanese civil servants: Role of job demand, control and work
hours. Soc Sci Med 73(4):595–603.
Siegrist J, Rodel A. 2006. Work stress and health risk behavior.
Scand J Work Environ Health 32:473–481.
Siegrist J, Starke D, Chandola T, Godin I, Marmot M, Niedhammer
I, Peter R. 2004. The measurement of effort-reward imbalance at
work: European comparisons. Soc Sci Med 58:1483–1499.
Siegrist J, Rosskam E, Leka S. 2011. Review of social determinants
of health and the health divide in the WHO-European Region: Em-
ployment and working conditions including occupation, unemploy-
ment and migrant workers (unpublished report). Copenhagen: World
Health Organization.
Silverstein B, Welp E, Nelson N, Kalat J. 1998. Claims incidence of
work-related disorders of the upper extremities: Washington state,
1987 through 1995. Am J Public Health 88:1827–1833.
Silverstein B, Viikari-Juntura E, Kalat J. 2002. Use of a prevention
index to identify industries at high risk for work-related musculo-
skeletal disorders of the neck, back, and upper extremity in Washing-
ton state, 1990–1998. Am J Ind Med 41:149–169.
Smith MJ, Carayon P, Sanders KJ, Lim S-Y, LeGrande D. 1992.
Employee stress and health complaints in jobs with and without elec-
tronic performance monitoring. Appl Ergon 23:17–27.
Smith PM, Frank JW, Mustard CA, Bondy SJ. 2008. Examining the
relationships between job control and health status: A path analysis
approach. J Epidemiol Community Health 62:54–61.
Sousa E, Agudelo-Suarez A, Benavides FG, Schenker M, Garcia
AM, Benach J, Delclos C, Lopez-Jacob MJ, Ruiz-Frutos C, Ronda-
Perez E, Porthe V, Project I. 2010. Immigration, work and health in
Spain: The influence of legal status and employment contract on
reported health indicators. Int J Public Health 55:443–451.
Steenland K. 2000. Shift work, long hours, and CVD: A review.
Occup Med State Art Rev 15:7–17.
Sundquist J, Ostergren PO, Sundquist K, Johansson SE. 2003. Psy-
chosocial working conditions and self-reported long-term illness: A
population-based study of Swedish-born and foreign-born employed
persons. Ethn Health 8:307–317.
Suominen S, Vahtera J, Korkeila K, Helenius H, Kivimaki M,
Koskenvuo M. 2007. Job strain, life events, and sickness absence: A
longitudinal cohort study in a random population sample. J Occup
Environ Med 49:990–996.
Sverke M, Hellgren J, Naswall K. 2002. No security: A meta-analy-
sis and review of job insecurity and its consequences. J Occup
Health Psychol 7:242–264.
Thomas C, Power C. 2010. Do early life exposures explain associa-
tions in mid-adulthood between workplace factors and risk factors
for cardiovascular disease? Int J Epidemiol 39:812–824.
Toh S, Quinlan M. 2009. Safeguarding the global contingent work-
force? Guestworkers in Australia. Int J Manpower 30:453–471.
Tuchsen F, Endahl LA. 1999. Increasing inequality in ischaemic
heart disease morbidity among employed men in Denmark 1981–
1993: The need for a new preventive policy. Int J Epidemiol 28:
640–644.
Vaananen A, Koskinen A, Joensuu M, Kivimaki M, Vahtera J,
Kouvonen A, Jappinen P. 2008. Lack of predictability at work and
risk of acute myocardial infarction: An 18-year prospective study of
industrial employees. Am J Public Health 98:2264–2271.
Vahtera J, Kivimaki M, Pentti J, Linna A, Virtanen M, Virtanen P,
Ferrie J. 2004. Organisational downsizing, sickness absence, and
mortality: 10-town prospective cohort study. BMJ 328:555.
Vanroelen C, Levecque K, Moors G, Gadeyne S, Louckx F. 2009.
The structuring of occupational stressors in a Post-Fordist work envi-
ronment. Moving beyond traditional accounts of demand, control
and support. Soc Sci Med 68:1082–1090.
Virtanen P, Liukkonen V, Vahtera J, Kivimaki M, Koskenvuo M.
2003. Health inequalities in the workforce: The labour market core-
periphery structure. Int J Epidemiol 32:1015–1021.
Virtanen M, Kivimaki M, Joensuu M, Virtanen P, Elovainio M, Vah-
tera J. 2005. Temporary employment and health: A review. Int J Epi-
demiol 34:610–622.
Virtanen M, Vahtera J, Pentti J, Honkonen T, Elovainio M,
Kivimaki M. 2007. Job strain and psychologic distress influence on
sickness absence among Finnish employees. Am J Prev Med 33:
182–187.
Virtanen M, Kivimaki M, Singh-Manoux A, Gimeno D, Shipley MJ,
Vahtera J, Akbaraly TN, Marmot MG, Ferrie JE. 2010. Work disabil-
ity following major organisational change: The Whitehall II study. J
Epidemiol Community Health 64:461–464.
Virtanen P, Janlert U, Hammarstrom A. 2011. Exposure to temporary
employment and job insecurity: A longitudinal study of health
effects. Occup Environ Med 68:570–574.
Vives A, Amable M, Ferrer M, Moncada S, Llorens C, Muntaner C,
Benavides FG, Benach J. 2010. The Employment Precariousness
 Work Organization and Occupational Health Disparities
Scale (EPRES): Psychometric properties of a new tool for epidemio-
logical studies among waged and salaried workers. Occup Environ
Med 67:548–555.
Wang JL, Lesage A, Schmitz N, Drapeau A. 2008. The relationship
between work stress and mental disorders in men and women: Find-
ings from a population-based study. J Epidemiol Community Health
62:42–47.
Wang JL, Schmitz N, Dewa C, Stansfeld S. 2009. Changes in per-
ceived job strain and the risk of major depression: Results from a
population-based longitudinal study. Am J Epidemiol 169:1085–1091.
Wege N, Dragano N, Erbel R, Jockel KH, Moebus S, Stang A, Sieg-
rist J. 2008. When does work stress hurt? Testing the interaction
515
with socioeconomic position in the Heinz Nixdorf Recall Study. J
Epidemiol Community Health 62:338–341.
Westerberg L, Theorell T. 1997. Working conditions and family situ-
ation in relation to functional gastrointestinal disorders. The Swedish
Dyspepsia Project. Scand J Prim Health Care 15:76–81.
Wilson G, Eitle TM, Bishin B. 2006. The determinants of racial dis-
parities in perceived job insecurity: A test of three perspectives.
Sociol Inq 76:210–230.
Yamauchi B, Allen K. 2011. New Law Ups the Ante Significantly
for California Employers Who Are Caught Misclassifying Employ-
ees As Independent Contractors.