write a response each for these articles Responses should be NO MORE OR LESS than 1 page in length and should be written as a reaction to something that you have learned in the assigned content. This SHOULD NOT be a repetition of assigned content, rather it should be based on your understanding of what you have read/learned. In other words, “How did this reading make you feel?” ; “Have you seen these topics in your own workplace environment? If so, how.” ; etc. Note: The response should not be a summary of the content. One rresponse or each article American Journal of Epidemiology
Copyright © 2003 by the Johns Hopkins Bloomberg School of Public Health
All rights reserved
Vol. 157, No. 11
Printed in U.S.A.
DOI: 10.1093/aje/kwg095
Life-Course Exposure to Job Strain and Ambulatory Blood Pressure in Men
Paul A. Landsbergis1,2, Peter L. Schnall3, Thomas G. Pickering2, Katherine Warren2, and
Joseph E. Schwartz4
1 Department of Community and Preventive Medicine, Mount Sinai School of Medicine, New York, NY.
2 Division of Cardiology, Department of Medicine, Mount Sinai School of Medicine, New York, NY.
3 Center for Occupational and Environmental Medicine, University of California, Irvine, CA.
4 Department of Psychiatry and Behavioral Science, State University of New York at Stony Brook, Stony Brook, NY.
Received for publication January 29, 2001; accepted for publication December 18, 2002.
This 1985–1995 study was designed to assess the association between blood pressure (measured by using
an ambulatory monitor) and history of exposure to job strain. Items from the Job Content Questionnaire were
completed by 213 employed men, aged 30–60 years at entry into the Work Site Blood Pressure Study in New
York City, New York, for each previous job they had held. The systolic blood pressure of men employed for ≥25
years who were exposed to job strain for 50% of their work life was 4.8 mmHg (95% confidence interval: –3.7,
13.4) higher at work and 7.9 mmHg (95% confidence interval: 0.8, 15.0) higher at home than that of men with no
past exposure, independent of current exposure. Evidence was inconsistent for the hypothesis of rapid induction
of/recovery from the effects of job strain on blood pressure, and there was little effect of past job strain on diastolic
blood pressure. These findings provide some support for the hypothesis of an effect of cumulative burden of
exposure to job strain on systolic blood pressure.
blood pressure; blood pressure monitoring, ambulatory; employment; hypertension; social class; stress; work
Abbreviations: AmBP, ambulatory blood pressure; JCQ, Job Content Questionnaire; WHQ, Work History Questionnaire.
Job strain, defined as the combination of high psychological job demands and low job decision latitude or low job
control, has been shown to be a risk factor for cardiovascular
disease and for blood pressure elevation when blood pressure is measured with an ambulatory monitor (1, 2). The
systolic and diastolic ambulatory blood pressure (AmBP) of
men who experience job strain is about 6–8 mmHg and 3–5
mmHg higher, respectively, than in men who do not (1, 2).
However, these values are likely underestimates of the
effect of job strain since, in most studies, job strain is
measured at only one point in time (1, 2). It is hypothesized
that chronic biologic arousal due to sustained job strain
contributes to the development of essential hypertension (1,
3). Use of current exposure as a surrogate for lifetime exposure is inaccurate, in part because people often gain skills
with time and age, may be promoted, may select out of
“high-strain” jobs, or may experience changing job characteristics even within the same job title. Many employees with
a lengthy history of job strain thus might be currently classified as having no job strain because of recent promotions or
other job changes—with a resulting bias toward the null
hypothesis.
We also have little knowledge of the temporal association
between job strain and blood pressure elevation. Are decades
of exposure required to raise blood pressure, or is the induction period short? After removal of exposure, does blood
pressure return to baseline (“recovery”), or is the process of
elevation irreversible? If reductions are possible, how
quickly do they occur?
To our knowledge, there have been no intervention studies
of job strain and blood pressure. However, recent findings
from the prospective Work Site Blood Pressure Study (4–7)
provide some indication of induction time and effect sizes.
Relative to men not experiencing job strain at either time 1
(entry into the study) or time 2 (3 years later) (n = 138), those
exposed at both time 1 and time 2 (n = 15), that is, experi-
Correspondence to Dr. Paul Landsbergis, Department of Community and Preventive Medicine, Box 1043, Mount Sinai School of Medicine,
One Gustave L. Levy Place, New York, NY 10029-6574 (e-mail: paul.landsbergis@mssm.edu).
998
Am J Epidemiol 2003;157:998–1006
Cumulative Job Strain and Blood Pressure 999
TABLE 1. Numbers of eligible subjects entering the Work Site Blood Pressure
Study in New York City, New York, and participation in the work history substudy,
1985–1995
Time at entry
Year at entry
Men (no.)
Women (no.)
Work Site Blood Pressure Study
Time 1
1985–1988
283
25
Time 2
1988–1991
7
54
Time 3
1991–1995
6
97
296
176
222
161
Total
Work history substudy (1991–1995)
Eligible subjects participating at time 3
Work history substudy subjects for whom data were complete* (1991–1995)
Time 1
1985–1988
201
20
Time 2
1988–1991
6
44
Time 3
1991–1995
6
93
213
157
Eligible subjects with complete data
* All eligible subjects except four women completed the Work History Questionnaire.
The questionnaires of nine men were incomplete because of administration errors.
encing “chronic exposure,” had substantially higher systolic
(11–12 mmHg) and diastolic (6–9 mmHg) AmBP at both
time 1 and time 2 (7). These effects were greater than the
cross-sectional effects at either time (6–7 mmHg systolic, 2–
5 mmHg diastolic).
Prospectively, subjects reporting job strain at time 1 but no
job strain at time 2 (n = 25) exhibited significant decreases in
AmBP at work (5.3 mmHg systolic, 3.2 mmHg diastolic)
and at home (4.7 mmHg systolic, 3.3 mmHg diastolic) (7),
suggesting that recovery from the effects of job strain can
occur in a short period of time, that is, less than 3 years.
However, there was no significant AmBP change in the
group whose exposure changed from no job strain at time 1
to job strain at time 2, suggesting that the induction period
may be longer than 0–3 years. Contrary to the cumulative
burden hypothesis, no significant change was found in the
AmBP of the 15 men facing chronic job strain exposure over
3 years. This finding may have been due to their high AmBP
at entry into the study and a possible “saturation” effect (7).
Therefore, we planned to test the following two hypotheses by analyzing measures of historical exposure:
1. H1: An effect of cumulative burden of exposure to job
strain. Support would be provided by associations between
AmBP at entry into the study, independent of job strain at
entry, and measures of lifetime exposure to job strain prior to
entering the study.
2. H2: Rapid (30 hours per week, were able to read English, had a
body mass index (kg/m2) of 160 mmHg; or a
screening diastolic blood pressure of >105 mmHg.
After these criteria were applied, 1,674 men were found to
be eligible for the study—474 cases (screening diastolic
1000 Landsbergis et al.
blood pressure of >85 mmHg or taking medication for
hypertension) and 1,200 controls. To increase the statistical
power of the initial case-control study, cases were oversampled at an average ratio of two cases to three controls.
Eligible cases were further defined as subjects whose mean
casual diastolic blood pressure was >85 mmHg at both initial
screening and recruitment (4–6 weeks later) or who were
taking medication for hypertension. Those who had a diastolic blood pressure of ≤85 mmHg on both occasions and
were not taking antihypertensive medication were eligible to
serve as controls. A total of 84 cases and 186 controls were
enrolled in the initial case-control study. After the addition
of 13 subjects whose diastolic blood pressure “crossed over”
the 85-mmHg threshold between screening and recruitment,
283 male subjects were eligible for cross-sectional analyses
of blood pressure at time 1. An additional seven men were
recruited at time 2 and six men at time 3 (6–7 years after the
start of the cohort study) from the ninth and 10th work sites
as they entered the study (table 1).
Ambulatory monitoring
At each round of data collection, subjects wore a
Spacelabs (Redmond, Washington) AmBP monitor for 24
hours during a normal workday (4, 7) (model 5200 at time 1,
sites 1–7; model 90202 at time 1, site 8, and at time 2, all
sites; model 90207 at time 3, all sites). Men currently taking
antihypertensive medication were titrated off medication and
were then monitored for 3 weeks before wearing the AmBP
monitor. Medicated subjects were eligible only if they were
able to have their medication stopped for at least 3 weeks
before wearing the AmBP monitor and still maintain a diastolic blood pressure of 5 (“agree” with at least one of two job-demands items)
and decision latitude of 0.15.
§ mEq, milliequivalent; AmBP, ambulatory blood pressure.
¶ Measures of self-reported characteristics from the Job Content Questionnaire (10–12).
# Variable defined as job decision latitude 32 (their respective sample
medians for males) from the Job Content Questionnaire (10–12).
each year of job strain was associated with a 2.30 (95 percent
confidence interval: –0.33, 4.93) mmHg higher work and a
2.99 (95 percent confidence interval: 0.80, 5.17) mmHg
higher home systolic blood pressure. The substantial effects
in this time window remained after adjustment for possible
confounding by exposure in other time windows (restricted
to men employed for ≥25 years). However, these effects of
recent exposure were not observed when the complete
sample of 213 men was examined.
DISCUSSION
Our data provide some support for the hypothesis of an
effect of cumulative exposure to job strain. Proportion of
work life exposed to job strain was substantially associated
with systolic AmBP at entry into the cohort study, independent of job strain at entry, although only among men who
had at least 25 years of past employment. The correlation
between years of exposure in adjacent time periods was
greater in the sample restricted to men employed for ≥25
years. Thus, the long-term employed in this sample may
have experienced not only greater duration of exposure but
also greater stability of exposure, contributing to the cumulative effect.
Consistent support was not provided for the hypothesis of
rapid induction of/recovery from the effect of job strain on
AmBP. As hypothesized, stronger effects were observed for
recent compared with distant time windows. However,
substantial effects of recent exposure were observed in only
the long-term-employment group, suggesting an induction
period of more than 5 years for younger subjects. Little
effect of past exposure was found after adjustment for other
time windows and current job strain, supporting the hypothesis of relatively rapid recovery. However, this finding might
also have resulted in part from collinearity between
exposures (number of years of job strain) in adjacent time
windows for men employed for ≥25 years: 0–5 years with a
6- to 10-year window (r = 0.79), 6–10 years with a 11- to 15year window (r = 0.75), 11–15 years with a 16- to 20-year
window (r = 0.57), and 16–20 years with a 21- to 25-year
Am J Epidemiol 2003;157:998–1006
Cumulative Job Strain and Blood Pressure 1003
TABLE 3. Association between measures of life-course exposure to job strain and ambulatory blood pressure‡ among 213§ male
employees aged 30–60 years from nine work sites in New York City, New York, 1985–1995
Work ambulatory blood pressure (n = 212)
Home ambulatory blood pressure (n = 199)
Effect of job strain
No.
Diastolic
95% CI¶
Systolic
95% CI
No.
Diastolic
95% CI
Systolic
95% CI
212
3.8**
1.3, 6.3
4.8*
0.5, 9.1
199
3.9**
1.3, 6.5
5.7**
1.5, 9.9
Per year exposed: total work life¶¶
212
–0.11
–0.30, 0.08
–0.02
–0.35, 0.31
199
–0.05
–0.25, 0.15
0.12
–0.19, 0.44
For 50% vs. 0% of work life exposed##
212
–1.4
–3.5, 0.7
–0.9
–4.6, 2.7
199
–0.9
–3.0, 1.3
–0.4
–3.9, 3.1
Restricted to ≥10 years of employment
200
–1.2
–3.3, 0.9
–1.0
–4.7, 2.8
190
–0.7
–2.9, 1.5
–0.3
–3.9, 3.4
Restricted to ≥15 years of employment
157
–2.6†
–5.3, 0.1
–1.2
–6.2, 3.8
150
–1.1
–3.8, 1.5
0.4
–4.0, 4.9
Restricted to ≥20 years of employment
125
0.0
–3.7, 3.8
1.6
–5.1, 8.4
121
1.4
–2.2, 5.0
3.5
–2.4, 9.5
Restricted to ≥25 years of employment
87
–0.1
–4.8, 4.6
4.8
–3.7, 13.4
83
0.8
–3.7, 5.2
7.9*
0.8, 15.0
In the past 3 years
212
–0.12
–1.34, 1.10
0.82
–1.31, 2.95
199
–0.22
–1.48, 1.03
0.76
–1.28, 2.80
In the past 5 years
212
–0.12
–0.86, 0.63
0.34
–0.97, 1.65
199
–0.10
–0.88, 0.68
0.43
–0.83, 1.69
In the past 6–10 years
200
–0.38
–1.05, 0.30
–0.31
–1.53, 0.91
190
–0.38
–1.09, 0.33
–0.13
–1.31, 1.04
In the past 11–15 years
157
–0.94*
–1.71, –0.16
–0.40
–1.82, 1.03
150
–0.65
–1.42, 0.12
–0.63
–1.88, 0.63
In the past 16–20 years
125
–0.60
–1.88, 0.68
0.41
–1.04, 1.87
121
0.31
–0.48, 1.09
0.70
–0.59, 2.00
In the past 21–25 years
87
–0.28
–1.30, 0.74
0.12
–1.75, 1.99
83
0.04
–0.93, 1.01
0.70
–0.90, 2.31
In the past ≥26 years
85
0.01
–0.61, 0.72
0.12
–1.14, 1.38
81
0.30
–0.33, 0.93
0.60
–0.46, 1.66
At entry into the study (JCQ¶)#,‡‡
Past job strain (WHQ¶)§§
Exposure windows unadjusted for each
other (per year exposed)¶¶
* p < 0.05, ** p < 0.01: significance of ambulatory blood pressure difference between exposed and nonexposed groups.
† p < 0.10: significance of ambulatory blood pressure difference between exposed and nonexposed groups.
‡ Adjusted for age, race/ethnicity, education, body mass index, alcohol consumption, smoking, winter season, standing position, work site, and job strain at entry
into the study.
§ One man with fewer than five ambulatory blood pressure readings at work and 14 men with fewer than five ambulatory blood pressure readings at home were
excluded from the analysis.
¶ CI, confidence interval; JCQ, Job Content Questionnaire; WHQ, Work History Questionnaire.
# The blood pressure values reflect the difference between men with and without exposure to job strain when they entered the study.
‡‡ Job strain is defined as job decision latitude 32 (their respective sample medians for males) from the JCQ (10–12).
§§ Job strain is defined as two-item job decision latitude 5 (“agree” with at
least one of two job demands items) from the WHQ (17).
¶¶ The blood pressure values reflect the effect of 1 year of exposure within the specified time period, e.g., the difference between men with 1 year vs. 0 years of
exposure or 4 years vs. 5 years of exposure.
## The blood pressure values reflect the difference between men for whom 50% vs. 0% of their work life was exposed to job strain.
window (r = 0.80). Therefore, it may be difficult to observe
the independent effects of different time windows in this
sample, and adjustment for confounding may represent overadjustment.
The effect on systolic AmBP of cumulative past exposure
combined with current exposure is substantial. A man who,
for 50 percent of his 25 years of employment, was exposed
to job strain as well as experienced current job strain would
have a 10.2-mmHg higher work and a 14.6-mmHg higher
home systolic AmBP relative to a man with no current or
past exposure (summary of independent effects from the
same regression model). This effect is roughly twice the
difference between Blacks and Whites in this sample, and it
is larger than the estimated effect of aging 30 years or
gaining 40 pounds (18 kg) of weight (7). These effects are
also clinically significant. An elevation of 8–10 mmHg in
systolic blood pressure is associated with a 20–25 percent
increased risk of coronary heart disease mortality and a 34–
43 percent increased risk of stroke mortality (21).
Evidence for the construct validity of the WHQ (16, 17)
makes it unlikely that greater measurement error explains the
Am J Epidemiol 2003;157:998–1006
weaker effects of distant past exposure. However, such a
hypothesis cannot be ruled out. Support for the cumulativeburden hypothesis was weakened by the lack of an association between most measures of past job strain and diastolic
AmBP. The WHQ scales had predictive validity for systolic
but not diastolic AmBP. The limited predictive validity of
the WHQ, coupled with the borderline reliability of the twoitem WHQ decision-latitude scale and the lack of agreement
between dichotomous job-strain variables constructed from
WHQ and JCQ scales, suggests that even larger estimates of
effect might be observed if the full set of JCQ items were
used to assess previous jobs.
The Work Site Blood Pressure Study was designed to
minimize potential selection bias that might artificially
inflate associations. To reduce the likelihood that hypertensives might select into high-strain jobs, cases were required
to be at their work site at least 3 years before diagnosis. In
addition, no association was found between case-control
status (or mean AmBP) and personality/psychological
measures such as anxiety, hostility, anger, or Type A
behavior that might influence job selection (4, 22). In fact, in
1004 Landsbergis et al.
TABLE 4. Association between measures of life-course exposure to job strain and ambulatory blood pressure‡ for only those men
aged 30–60 years employed for ≥25 years§ at nine work sites in New York City, New York, 1985–1995
Work ambulatory blood pressure (n = 87)
Home ambulatory blood pressure (n = 83)
Effect of job strain
No.
Diastolic
95% CI¶
Systolic
95% CI
No.
Diastolic
95% CI
Systolic
95% CI
87
5.0*
0.4, 9.5
6.4
–1.9, 14.7
83
4.2
–0.1, 8.5
8.4*
1.3, 15.4
Per year exposed: total work
life¶¶
87
–0.01
–0.30, 0.27
0.29
–0.23, 0.80
83
0.04
–0.23, 0.31
0.49*
0.06, 0.92
In the past 3 years
87
1.84
–0.64, 4.31
3.79†
–0.70, 8.28
83
0.56
–1.83, 2.94
4.63*
0.89, 8.37
In the past 5 years
87
0.99
–0.47, 2.44
2.30†
–0.33, 4.93
83
0.43
–0.98, 1.84
2.99*
0.80, 5.17
In the past 6–10 years
87
–0.17
–1.78, 1.43
1.96
–0.97, 4.90
83
–0.52
–2.03, 1.00
2.41†
–0.03, 4.85
In the past 11–15 years
87
–0.93
–2.45, 0.59
1.21
–1.59, 4.01
83
–0.71
–2.16, 0.74
1.58
–0.79, 3.95
In the past 16–20 years
87
0.01
–1.07, 1.08
0.85
–1.06, 2.76
83
0.10
–0.93, 1.12
1.33
–0.31, 2.96
In the past 21–25 years
87
–0.27
–1.29, 0.76
0.16
–1.68, 2.01
83
0.07
–0.91, 1.04
0.79
–0.85, 2.33
At entry into the study
(JCQ¶)#,‡‡
Past job strain (WHQ¶)§§
Exposure windows adjusted for
each other (per year
exposed)¶¶
In the past 5 years
85
3.20†
–0.00, 6.41
3.37
–2.66, 9.39
81
3.12†
–0.07, 6.31
4.72†
–0.31, 9.74
In the past 6–10 years
85
–2.96
–7.90, 1.99
–1.85
–11.15, 7.45
81
–3.97
–8.86, 0.93
–2.99
–10.70, 4.72
In the past 11–15 years
85
–0.37
–3.63, 2.88
0.80
–5.33, 6.93
81
0.85
–2.34, 4.03
1.28
–3.74, 6.29
In the past 16–20 years
85
1.01
–0.91, 2.92
1.45
–2.19, 5.10
81
0.22
–1.64, 2.07
1.34
–1.62, 4.30
In the past 21–25 years
85
–0.86
–2.46, 0.73
–0.96
–4.01, 2.09
81
–0.20
–1.76, 1.36
–0.44
–2.96, 2.08
* p < 0.05: significance of ambulatory blood pressure difference between exposed and nonexposed groups.
† p < 0.10: significance of ambulatory blood pressure difference between exposed and nonexposed groups.
‡ Adjusted for age, race/ethnicity, education, body mass index, alcohol consumption, smoking, winter season, standing position, work site, and job strain at entry
into the study.
§ Because of missing data, complete data for all time periods within the past 25 years were available for 85 men.
¶ CI, confidence interval; JCQ, Job Content Questionnaire; WHQ, Work History Questionnaire.
# The blood pressure values reflect the difference between men with and without exposure to job strain when they entered the study.
‡‡ Job strain is defined as job decision latitude 32 (their respective sample medians for males) from the JCQ (10–12).
§§ Job strain is defined as two-item job decision latitude 5 (“agree” with at
least one of two job demands items) from the WHQ (17).
¶¶ The blood pressure values reflect the effect of 1 year of exposure within the specified time period, e.g., the difference between men with 1 year vs. 0 years of
exposure or 4 years vs. 5 years of exposure.
national studies (23), as in the current study (16), the opposite pattern is observed—people tend to select out of highstrain jobs over time.
On the other hand, restrictions to the range of variation in
exposure and outcome due to study design might have
reduced the statistical power available to detect main effects
of job strain. Blue-collar and high-strain jobs were probably
underrepresented in this sample, and non-English speakers
(e.g., those working in “sweatshops”) were excluded. Participants whose screening blood pressure was >160/105 mmHg
were also excluded because of ethical reasons (the risks of
stopping antihypertensive medication while wearing the
ambulatory monitor) and the hypothesis that stress mechanisms (e.g., sympathetic hyperactivity) have little additional
effect at these levels since structural changes in the arterial
wall result in permanent elevations in blood pressure (24).
Finally, potential subjects who had cardiovascular disease
were excluded because blood pressure is typically lower
following a heart attack or stroke (25), and those with docu-
mented target organ damage might select out of high-strain
jobs.
The validity of our findings was enhanced by use of the
state-of-the-art technique of AmBP monitoring, which is more
reliable and valid than recording blood pressure in a clinic
setting (26). Reliability was improved through absence of
observer bias and an increased number of readings. Validity
was improved by measuring blood pressure during a person’s
normal daily activities. AmBP is also more highly correlated
with target organ damage and cardiovascular disease than are
casual (clinic) blood pressure measurements (26).
Work history questions were based on the JCQ (10–12), a
widely used instrument to assess job strain (1, 2). The JCQ
does not ask about perceptions of stress, rather about objective job characteristics. Expert ratings have been highly
correlated (r > 0.6) with self-reported measures of jobdecision latitude (27–29). National US surveys show high
proportions of between-occupation variance in self-reported
job-decision latitude and valid patterns of response (30).
Am J Epidemiol 2003;157:998–1006
Cumulative Job Strain and Blood Pressure 1005
However, the potential remains for self-reported exposure
to overestimate associations, particularly for psychological
job demands, an inherently more subjective measure than
decision latitude. Subjects entering the study at time 1 or time
2 and completing the WHQ at time 3 were aware of earlier
AmBP levels, but little evidence exists that cases exaggerated
their job demands. Job demands were not associated with
case-control status (4) nor with mean diastolic blood pressure
at time 1, only with work systolic blood pressure (6).
Did cases exaggerate their responsibility and authority
levels (decision latitude) because of the prevailing popular
belief in “executive stress”? If so, then cases would have
underreported job strain, and associations between job strain
and AmBP would have been underestimated. Finally, we
found no association between case-control status (or mean
AmBP) and personality/psychological measures that might
have influenced reporting (4, 22).
To our knowledge, the Work Site Blood Pressure Study is
the only prospective study of job strain and AmBP of greater
than 1 year in duration. Ten years of follow-up have just
been completed on a sample of men and women, which will
provide further data to assess the hypotheses of cumulative
burden and of induction and recovery time.
ACKNOWLEDGMENTS
This research was supported in part by grants HL 30605,
HL 57450, and HL 55165 from the National Heart, Lung,
and Blood Institute, Bethesda, Maryland.
Dr. Landsbergis conducted the analysis as part of his
doctoral dissertation at the Columbia University Mailman
School of Public Health, New York, New York. He is
grateful to his committee—Drs. Ana Diez-Roux, Bruce
Link, Sharon Schwartz, Joseph Schwartz, and Jeanne
Stellman—for their support and their helpful comments on
the manuscript.
REFERENCES
1. Schnall PL, Landsbergis PA, Baker D. Job strain and cardiovascular disease. Annu Rev Public Health 1994;15:381–411.
2. Belkic KB, Landsbergis PA, Schnall P, et al. Psychosocial factors: review of the empirical data among men. In: Schnall P,
Belkic K, Landsbergis PA, et al, eds. The workplace and cardiovascular disease. Occupational medicine: state of the art
reviews. Philadelphia, PA: Hanley & Belfus, 2000:24–46.
3. Schwartz JE, Belkic KB, Schnall PL, et al. Mechanisms leading
to hypertension and CV morbidity. In: Schnall P, Belkic K,
Landsbergis PA, et al, eds. The workplace and cardiovascular
disease. Occupational medicine: state of the art reviews. Philadelphia, PA: Hanley & Belfus, 2000:121–32.
4. Schnall PL, Pieper C, Schwartz JE, et al. The relationship
between “job strain,” workplace diastolic blood pressure, and
left ventricular mass index. Results of a case-control study.
JAMA 1990;263:1929–35. (Erratum published in JAMA 1992;
267:1209).
5. Schnall PL, Schwartz JE, Landsbergis PA, et al. Relation
between job strain, alcohol, and ambulatory blood pressure.
Hypertension 1992;19:488–94.
Am J Epidemiol 2003;157:998–1006
6. Landsbergis PA, Schnall PL, Warren K, et al. Association
between ambulatory blood pressure and alternative formulations of job strain. Scand J Work Environ Health 1994;20:349–
63.
7. Schnall PL, Landsbergis PA, Schwartz J, et al. A longitudinal
study of job strain and ambulatory blood pressure: results from
a three-year follow-up. Psychosom Med 1998;60:697–706.
8. Frohlich ED, Grim C, Labarthe D, et al. Recommendations for
human blood pressure determination by sphygmomanometers.
Hypertension 1988;11:209A–22A.
9. Llabre MM, Ironson GH, Spitzer SB, et al. How many blood
pressure measurements are enough? An application of generalizability theory to the study of blood pressure reliability.
Psychophysiology 1988;25:97–106.
10. Karasek RA, Gordon G, Pietroskovsky C, et al. Job Content
Instrument: questionnaire and user’s guide. Los Angeles, CA:
University of Southern California, 1985.
11. Karasek R, Brisson C, Kawakami N, et al. The Job Content
Questionnaire (JCQ): an instrument for internationally comparative assessments of psychosocial job characteristics. J Occup
Health Psychol 1998;3:322–55.
12. Karasek R, Theorell T. Healthy work: stress, productivity, and
the reconstruction of working life. New York, NY: Basic
Books, 1990.
13. Jenkins CD, Rosenman RH, Zyzanski SJ. Prediction of clinical
coronary heart disease by a test for the coronary-prone behavior
pattern. N Engl J Med 1974;290:1271–5.
14. Cahalan D, Cisin IH, Crossley HM. American drinking practices: a national study of drinking behavior and attitudes. New
Brunswick, NJ: Rutgers Center for Alcohol Studies, 1969.
(Monograph no. 6).
15. Schnall PL, Devereux RB, Pickering TG, et al. The relationship
between “job strain,” workplace diastolic blood pressure, and
left ventricular mass index: a correction. (Letter, comment).
JAMA 1992;267:1209.
16. Landsbergis PA. The workplace and cardiovascular disease: an
application of social epidemiology. New York, NY: Division of
Epidemiology, Columbia University, 2000.
17. Landsbergis PA, Schnall PL, Pickering TG, et al. Validity and
reliability of a work history questionnaire derived from the job
content questionnaire. J Occup Environ Med 2002;44:1037–47.
18. Rothman KJ, Greenland S, eds. Modern epidemiology. 2nd ed.
Philadelphia, PA: Lippincott-Raven, 1998.
19. Checkoway H, Pearce NE, Crawford-Brown DJ. Research
methods in occupational epidemiology. New York, NY: Oxford
University Press, 1989.
20. Johnson JV, Hall EM, Stewart W, et al. Work stress over the
life course: project report. Baltimore, MD: Johns Hopkins University School of Hygiene and Public Health, 1993.
21. Rutan GH, Kuller LH, Neaton JD, et al. Mortality associated
with diastolic hypertension and isolated systolic hypertension
among men screened for the Multiple Risk Factor Intervention
Trial. Circulation 1988;77:504–14.
22. Friedman R, Schwartz JE, Schnall PL, et al. Psychological variables in hypertension: relationship to casual or ambulatory
blood pressure. Psychosom Med 2001;63:19–31.
23. Karasek RA, Theorell T, Schwartz JE, et al. Job characteristics
in relation to the prevalence of myocardial infarction in the US
Health Examination Survey (HES) and the Health and Nutrition
Examination Survey (HANES). Am J Public Health 1988;78:
910–18.
24. Julius S. Sympathetic hyperactivity and coronary risk in hypertension. Hypertension 1993;21:886–93.
25. McCall M, Elmfeldt D, Vedin A, et al. Influence of a myocardial infarction on blood pressure and serum cholesterol. Acta
Med Scand 1979;206:477–81.
1006 Landsbergis et al.
26. Pickering TG. Ambulatory monitoring and blood pressure variability. London, United Kingdom: Science Press, 1991.
27. Karasek R, Baker D, Marxer F, et al. Job decision latitude, job
demands, and cardiovascular disease: a prospective study of
Swedish men. Am J Public Health 1981;71:694–705.
28. Johnson JV, Stewart W. Measuring work organization exposure
over the life course with a job-exposure matrix. Scand J Work
Environ Health 1993;19:21–8.
29. Hasselhorn H, Hammar N, Alfredsson L, et al. Differences in
the impact of self-rated and externally rated job strain on risk
factors for coronary heart disease. Work stress and health: organization of work in a global economy. Baltimore, MD: American Psychological Association/National Institute of Occupational Safety and Health, 1998.
30. Schwartz JE, Pieper C, Karasek RA. A procedure for linking
psychosocial job characteristic data to health surveys. Am J
Public Health 1988;78:904–9.
Am J Epidemiol 2003;157:998–1006
Order an Essay Now & Get These Features For Free:
Turnitin Report
Formatting
Title Page
Citation
Outline
