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A longitudinal study comparing the effort - reward imbalance and demand - control models using objective measures of physician utilization

Department of Health Care and Epidemiology, University of British Columbia, Canada, ostry{at}interchange.ubc.ca

Ruth Hershler

Department of Health Care and Epidemiology, University of British Columbia, Canada

Lisa Chen

Department of Health Care and Epidemiology, University of British Columbia, Canada

Clyde Hertzman

Department of Health Care and Epidemiology, University of British Columbia, Canada

Background: The objectives of this study were to compare the predictive validity of the demand - control and effort - reward imbalance models using objective measures of physician utilization. Methods: Self-reports for psychosocial work conditions were obtained in interviews with 1,028 workers using the demand - control and effort - reward imbalance models. Physician utilization outcomes were obtained through linkage to the British Columbia Linked Health Database. Outcomes were any visit to a physician for mental health reasons and 30 or more physician visits for any reason. The predictive validity of both models was compared in a longitudinal study using logistic regression. Results: Neither job strain nor effort - reward imbalance predicted either outcome. However, low esteem reward and low status control increased the risk for 30 or more physician visits by, respectively, approximately 60% and 30%. Conclusions: In a sample of middle-aged blue-collar current and ex-sawmill workers in Western Canada, followed prospectively, after controlling for sociodemographic and workplace confounders, and reducing the potential for adverse health selection into high-stress jobs, low esteem reward and low status control were associated with a significantly greater risk for 30 or more physician visits for any reason.

Key Words: demand - control model • effort - reward imbalance model • physician utilization.

Scandinavian Journal of Public Health, Vol. 32, No. 6, 456-463 (2004)
DOI: 10.1080/14034940410028190


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