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Am J Public Health. 2013 Nov;103(11):2090-7. doi: 10.2105/AJPH.2012.301090. Epub 2013 May 16.

Job strain and health-related lifestyle: findings from an individual-participant meta-analysis of 118,000 working adults.

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Katriina Heikkilä, Solja T. Nyberg, Marianna Virtanen, and Mika Kivimäki are with the Finnish Institute of Occupational Health, Helsinki. Eleonor I. Fransson is with the School of Health Sciences, Jönköping University, Jönköping. Lars Alfredsson is with the Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden. Marie Zins, Marcel Goldberg, and Archana Singh-Manoux are with the Centre for Research in Epidemiology and Population Health, Villejuif, France. Hugo Westerlund is with the Stress Research Institute, Stockholm University, Stockholm, Sweden. Peter Westerholm is with the Department of Occupational and Environmental Medicine, Uppsala University, Uppsala, Sweden. Jussi Vahtera, Paula Salo, Jaana Pentti, and Tuula Oksanen are with the Finnish Institute of Occupational Health, Turku. Sakari Suominen is with the Department of Public Health, University of Turku, Turku, Finland. Andrew Steptoe, Michael G. Marmot, and Jane E. Ferrie are with the Department of Epidemiology and Public Health, University College London, London, UK. Maria Nordin is with the Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden. Thorsten Lunau and Nico Dragano are with the Department of Medical Sociology, University of Düsseldorf, Düsseldorf, Germany. Karl-Heinz Ladwig is with the German Research Center for Environmental Health, Munich. Markku Koskenvuo is with the Department of Public Health, University of Helsinki, Helsinki, Finland. Anders Knutsson is with the Department of Health Sciences, Mid Sweden University, Sundsvall. France Kittel and Annalisa Casini are with the School of Public Health, Université Libre de Bruxelles, Brussels, Belgium. Karl-Heinz Jöckel is with the Institute for Medical Informatics, Biometry, and Epidemiology, University Duisburg-Essen, Essen, Germany. Raimund Erbel is with the Department of Cardiology, West-German Heart Center Essen, University Duisburg-Essen. Dirk DeBacquer and Els Clays are with th



We examined the associations of job strain, an indicator of work-related stress, with overall unhealthy and healthy lifestyles.


We conducted a meta-analysis of individual-level data from 11 European studies (cross-sectional data: n = 118,701; longitudinal data: n = 43,971). We analyzed job strain as a set of binary (job strain vs no job strain) and categorical (high job strain, active job, passive job, and low job strain) variables. Factors used to define healthy and unhealthy lifestyles were body mass index, smoking, alcohol intake, and leisure-time physical activity.


Individuals with job strain were more likely than those with no job strain to have 4 unhealthy lifestyle factors (odds ratio [OR] = 1.25; 95% confidence interval [CI] = 1.12, 1.39) and less likely to have 4 healthy lifestyle factors (OR = 0.89; 95% CI = 0.80, 0.99). The odds of adopting a healthy lifestyle during study follow-up were lower among individuals with high job strain than among those with low job strain (OR = 0.88; 95% CI = 0.81, 0.96).


Work-related stress is associated with unhealthy lifestyles and the absence of stress is associated with healthy lifestyles, but longitudinal analyses suggest no straightforward cause-effect relationship between work-related stress and lifestyle.

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