Publications by Author:

2023
Berkman LF, Kelly EL, Hammer LB, Mierzwa F, Bodner T, McNamara T, Koga HK, Lee S, Marino M, Klein LC, et al. Employee Cardiometabolic Risk Following a Cluster-Randomized Workplace Intervention From the Work, Family and Health Network, 2009–2013. American Journal of Public Health. 2023;113 (12) :1322-1331. Publisher's VersionAbstract
Objectives. To examine whether workplace interventions to increase workplace flexibility and supervisor support and decrease work–family conflict can reduce cardiometabolic risk. Methods. We randomly assigned employees from information technology (n = 555) and long-term care (n = 973) industries in the United States to the Work, Family and Health Network intervention or usual practice (we collected the data 2009–2013). We calculated a validated cardiometabolic risk score (CRS) based on resting blood pressure, HbA1c (glycated hemoglobin), HDL (high-density lipoprotein) and total cholesterol, height and weight (body mass index), and tobacco consumption. We compared changes in baseline CRS to 12-month follow-up. Results. There was no significant main effect on CRS associated with the intervention in either industry. However, significant interaction effects revealed that the intervention improved CRS at the 12-month follow-up among intervention participants in both industries with a higher baseline CRS. Age also moderated intervention effects: older employees had significantly larger reductions in CRS at 12 months than did younger employees. Conclusions. The intervention benefited employee health by reducing CRS equivalent to 5 to 10 years of age-related changes for those with a higher baseline CRS and for older employees. Trial Registration. ClinicalTrials.gov Identifier: NCT02050204. (Am J Public Health. 2023;113(12):1322–1331. https://doi.org/10.2105/AJPH.2023.307413)
2021
Fox KE, Johnson ST, Berkman LF, Sianoja M, Soh Y, Kubzansky LD, Kelly EL. Organisational- and group-level workplace interventions and their effect on multiple domains of worker well-being: A systematic review. Work & Stress. 2021 :1-30. Publisher's VersionAbstract
As a social determinant of health, work influences the health and well-being of workers. Interventions to change the conditions of work are an important complement to individually-focused wellness initiatives. This systematic literature review identified organisational- and group-level workplace intervention studies using experimental or quasi-experimental designs. It considered 83 studies with well-being outcomes that span the mental health continuum from ill-being to positive mental health, including context-free well-being (e.g. psychological distress), work-specific well-being (e.g. job satisfaction), and work-family well-being (e.g. work-family conflict). Interventions were categorised into four types: flexible work and scheduling changes; job and task modifications; relational and team dynamic initiatives; and participatory process interventions. There is significant heterogeneity in conceptualisation and measurement of well-being with job satisfaction being most commonly measured. Our review finds that strategies aiming to change work conditions have the potential to improve working well-being with demonstrable effects in all three well-being domains. Regardless of type, interventions involving increased control and opportunities for workers’ voice and participation more reliably improve worker well-being, suggesting these components are critical drivers of well-being. We recommend further research incorporate process evaluation to clarify how interventions create positive changes and examine the conditions in which specific interventions may be most effective.
2019
Kossek EE, Thompson RA, Lawson KM, Bodner T, Perrigino MB, Hammer LB, Buxton OM, Almeida DM, Moen P, Hurtado DA, et al. Caring for the Elderly at Work and Home: Can a Randomized Organizational Intervention Improve Psychological Health?. J Occup Health Psychol. 2019. Publisher's VersionAbstract
Although job stress models suggest that changing the work social environment to increase job resources improves psychological health, many intervention studies have weak designs and overlook influences of family caregiving demands. We tested the effects of an organizational intervention designed to increase supervisor social support for work and nonwork roles, and job control in a results-oriented work environment on the stress and psychological distress of health care employees who care for the elderly, while simultaneously considering their own family caregiving responsibilities. Using a group-randomized organizational field trial with an intent-to-treat design, 420 caregivers in 15 intervention extended-care nursing facilities were compared with 511 caregivers in 15 control facilities at 4 measurement times: preintervention and 6, 12, and 18 months. There were no main intervention effects showing improvements in stress and psychological distress when comparing intervention with control sites. Moderation analyses indicate that the intervention was more effective in reducing stress and psychological distress for caregivers who were also caring for other family members off the job (those with elders and those "sandwiched" with both child and elder caregiving responsibilities) compared with employees without caregiving demands. These findings extend previous studies by showing that the effect of organizational interventions designed to increase job resources to improve psychological health varies according to differences in nonwork caregiving demands. This research suggests that caregivers, especially those with "double-duty" elder caregiving at home and work and "triple-duty" responsibilities, including child care, may benefit from interventions designed to increase work-nonwork social support and job control. (PsycINFO Database Record
2018
Fan W, Moen P, Kelly EL, Hammer LB, Berkman LF. Job strain, time strain, and well-being: A longitudinal, person-centered approach in two industries. Journal of Vocational Behavior. 2018. Publisher's VersionAbstract
The notion of constellations is central to many occupational health theories; empirical research is nevertheless dominated by variable-centered methodologies. Guided by the job demands-resources framework, we use a person-centered longitudinal approach to identify constellations of job demands and resources (task-based and time-based) over time that predict changes in well-being. We situate our research in two dissimilar, but growing, industries in the United States—information technology (IT) and long-term care. Drawing on data collected over 18 months, we identify five patterned, stable constellations of job demands/resources using group-based multi-trajectory modeling: (1) high strain/low hours, (2) high strain/low hours/shift work, (3) high strain/long hours, (4) active (high demands, high control) and (5) lower strain (lower demands, high control). IT workers are overrepresented in the lower-strain and active constellations, whereas long-term care providers are more often in high-strain constellations. Workers in the lower-strain constellation experience increased job satisfaction and decreased emotional exhaustion, work-family conflict and psychological distress over 18 months. In comparison, workers in high-strain job constellations fare worse on these outcomes, as do those in the active constellation. Industrial contexts matter, however: Compared with long-term care workers, IT workers' well-being is more at risk when working in the “high strain/long hours” constellation. As the labor market continues to experience structural changes, scholars and policy makers need to attend to redesigning the ecological contexts of work conditions to promote workers' well-being while taking into account industrial differences.
Buxton OM, Soomi L, Miguel M, Beverly C, Almeida DM, Berkman LF. Sleep health and predicted cardiometabolic risk scores in employed adults from two industries. J Clin Sleep Med. 2018;14 (3) :371–383. Publisher's VersionAbstract

Study Objectives: Sleep disorders and sleep deficiency can increase the risk for cardiovascular disease. Less is known about whether multiple positive attributes of sleep health known as the SATED (satisfaction, alertness, timing, efficiency, and duration) model, can decrease future cardiovascular disease risks. We examined whether and how a variety of indicators of sleep health predicted 10-year estimated cardiometabolic risk scores (CRS) among employed adults.

Methods: Workers in two industries—extended care (n = 1,275) and information technology (IT; n = 577)—reported on habitual sleep apnea symptoms and sleep sufficiency, and provided 1 week of actigraphy data including nighttime sleep duration, wake after sleep onset (WASO), sleep timing, and daytime napping. Workers also provided biomarkers to calculate future cardiometabolic risk.

Results: More sleep apnea symptoms predicted higher CRS in both industries. More sleep sufficiency, less WASO, and less daytime napping (having no naps, fewer naps, and shorter nap duration) were also linked to lower CRS, but only in the extended care workers. There was no effect of sleep duration in both industries. In the IT employee sample, shorter sleep duration (≤ 6 hours versus 6–8 hours) and more naps strengthened the link between sleep apnea and CRS.

Conclusions: Sleep health, measured by both subjective and objective methods, was associated with lower cardiometabolic disease risks among extended care workers (lower to middle wage workers). Sleep apnea was an important predictor of CRS; for the IT workers, the link between sleep apnea and CRS was exacerbated when they had poorer sleep health behaviors.

O'Donnell EM, Berkman LF, Kelly EL, Hammer LB, Marden J, Buxton OM. Cardiometabolic risks associated with work-to-family conflict: findings from the Work Family Health Network. Community, Work & Family. 2018 :1-26. Publisher's Version
2017
Williams JA, Buxton OM, Hinde JM, Bray JW, Berkman LF. Psychosocial Workplace Factors and Healthcare Utilization: A Study of Two Employers. International Journal of Health Policy and Management. 2017 :–. Publisher's VersionAbstract
Background While a large literature links psychosocial workplace factors with health and health behaviors, there is very little work connecting psychosocial workplace factors to healthcare utilization.   Methods Survey data were collected from two different employers using computer-assisted telephone interviewing as a part of the Work-Family Health Network (2008-2013): one in the information technology (IT) service industry and one that is responsible for a network of long-term care (LTC) facilities. Participants were surveyed four times at six month intervals. Responses in each wave were used to predict utilization in the following wave. Four utilization measures were outcomes: having at least one emergency room (ER)/Urgent care, having at least one other healthcare visit, number of ER/urgent care visits, and number of other healthcare visits. Population-averaged models using all four waves controlled for health and other factors associated with utilization.   Results Having above median job demands was positively related to the odds of at least one healthcare visit, odds ratio [OR] 1.37 (P < .01), and the number of healthcare visits, incidence rate ratio (IRR) 1.36 (P < .05), in the LTC sample. Work-to-family conflict was positively associated with the odds of at least one ER/urgent care visit in the LTC sample, OR 1.15 (P < .05), at least one healthcare visit in the IT sample, OR 1.35 (P < .01), and with more visits in the IT sample, IRR 1.35 (P < .01). Greater schedule control was associated with reductions in the number of ER/urgent care visits, IRR 0.71 (P < .05), in the IT sample.   Conclusion Controlling for other factors, some psychosocial workplace factors were associated with future healthcare utilization. Additional research is needed.
Shafer EF, Kelly EL, Buxton OM, Berkman LF. Partners’ overwork and individuals’ wellbeing and experienced relationship quality. Community, Work & Family. 2017 :1-19. Publisher's VersionAbstract
ABSTRACTIn this paper, using high quality data from the Work, Family, and Health Network in a sample of IT workers in the US (N = 590), we examine whether partners’ long work hours are associated with individuals’ perceived stress, time adequacy with partner, and relationship quality, and whether these relationships vary by gender. In addition, following the marital stress model, we investigate whether any negative correlation between partners’ long work hours and relationship quality is mediated by time adequacy or perceived stress. We find that women partnered to men who work long hours (50 or more hours per week) have significantly higher perceived stress and significantly lower time adequacy and relationship quality compared to women partnered to men who work a standard full-time work week (35–49 hours). Further, the increased stress associated with being partnered to a man who overworks, not lower time adequacy, mediates the negative relationship between overwork and relationship quality. Conversely, we find that men partnered to women who work long hours report no differences in stress, time adequacy, or relationship quality than men who are partnered to women who work a standard full-time work week.
DePasquale N, Polenick CA, Davis KD, Berkman LF. A Bright Side to the Work–Family Interface: Husbands’ Support as a Resource in Double-and-Triple-Duty Caregiving Wives’ Work Lives. The Gerontologist. 2017. Publisher's VersionAbstract
Purpose of the Study:
This study examined how women who combine long-term care employment with unpaid, informal caregiving roles for children (double-duty-child caregivers), older adults (double-duty-elder caregivers), and both children and older adults (triple-duty caregivers) differed from their workplace-only caregiving counterparts on workplace factors related to job retention (i.e., job satisfaction and turnover intentions) and performance (i.e., perceived obligation to work while sick and emotional exhaustion). The moderating effects of perceived spouse support were also examined.
Design and Methods:
Regression analyses were conducted on survey data from 546 married, heterosexual women employed in U.S.-based nursing homes.
Results:
Compared to workplace-only caregivers, double-duty-elder and triple-duty caregivers reported more emotional exhaustion. Double-duty-child caregivers reported lower turnover intentions and both double-and-triple-duty caregivers felt less obligated to work while sick when perceiving greater support from husbands.
Implications:
Results indicate that double-and-triple-duty caregiving women’s job retention and obligation to work while sick may depend on perceived spouse support, highlighting the important role husbands play in their wives’ professional lives. Findings also lend support to the emerging literature on marriage-to-work positive spillover, and suggest that long-term care organizations should target marital relationships in family-friendly initiatives to retain and engage double-and-triple-duty caregiving employees.
Sin NL, Almeida DM, Crain TL, Kossek EE, Berkman LF, Buxton OM. Bidirectional, Temporal Associations of Sleep with Positive Events, Affect, and Stressors in Daily Life Across a Week. Annals of Behavioral Medicine. 2017 :1–14. Publisher's VersionAbstract
Sleep is intricately tied to emotional well-being, yet little is known about the reciprocal links between sleep and psychosocial experiences in the context of daily life.
2016
Lee S, Almeida DM, Berkman LF, Olson R, Moen P, Buxton OM. Age differences in workplace intervention effects on employees' nighttime and daytime sleep. Sleep Health. 2016;2 (4) :289 - 296. Publisher's VersionAbstract
To examine the effects of a workplace flexibility/support intervention on employees' sleep quantity and quality during nights and days and whether the effects differ by employee age. Cluster-randomized controlled trial. Information technology industry workplaces. US employees (Mage=46.9years) at an information technology firm who provided actigraphy at baseline and a 12-month follow-up (N=396; n=195 interventio
Marino M, Killerby M, Lee S, Klein LC, Moen P, Olson R, Kossek EE, King RB, Erickson L, Berkman LF, et al. The effects of a cluster randomized controlled workplace intervention on sleep and work-family conflict outcomes in an extended care setting. Sleep Health. 2016 :-. Publisher's VersionAbstract
AbstractObjectives To evaluate the effects of a workplace-based intervention on actigraphic and self-reported sleep outcomes in an extended-care setting. Design Cluster randomized trial. Setting Extended-care (nursing) facilities. Participants \US\ employees and managers at nursing homes. Nursing homes were randomly selected to intervention or control settings. Intervention The Work, Family, and Health Study developed an intervention aimed at reducing work-family conflict within a 4-month work-family organizational change process. Employees participated in interactive sessions with facilitated discussions, role-playing, and games designed to increase control over work processes and work time. Managers completed training in family-supportive supervision. Measurements Primary actigraphic outcomes included total sleep duration, wake after sleep onset, nighttime sleep, variation in nighttime sleep, nap duration, and number of naps. Secondary survey outcomes included work-to-family conflict, sleep insufficiency, insomnia symptoms, and sleep quality. Measures were obtained at baseline, 6 months, and 12 months postintervention. Results A total of 1522 employees and 184 managers provided survey data at baseline. Managers and employees in the intervention arm showed no significant difference in sleep outcomes over time compared with control participants. Sleep outcomes were not moderated by work-to-family conflict or presence of children in the household for managers or employees. Age significantly moderated an intervention effect on nighttime sleep among employees (P = .040), where younger employees benefited more from the intervention. Conclusion In the context of an extended-care nursing home workplace, the intervention did not significantly alter sleep outcomes in either managers or employees. Moderating effects of age were identified where younger employees' sleep outcomes benefited more from the intervention.
Buxton OM, Lee S, Beverly C, Berkman LF, Moen P, Kelly EL, Hammer LB, Almeida DM. Work-Family Conflict and Employee Sleep: Evidence from IT Workers in the Work, Family and Health Study. Sleep. 2016.Abstract
STUDY OBJECTIVES: Work-family conflict is a threat to healthy sleep behaviors among employees. This study aimed to examine how Work-to-Family Conflict (demands from work that interfere with one's family/ personal life; WTFC) and Family-to-Work Conflict (demands from family/ personal life that interfere with work; FTWC) are associated with several dimensions of sleep among information technology workers. METHODS: Employees at a U.S. IT firm (N=799) provided self-reports of sleep sufficiency (feeling rested upon waking), sleep quality, and sleep maintenance insomnia symptoms (waking up in the middle of the night or early morning) in the last month. They also provided a week of actigraphy for nighttime sleep duration, napping, sleep timing, and a novel sleep inconsistency measure. Analyses adjusted for work conditions (job demands, decision authority, schedule control, and family-supportive supervisor behavior), and household and sociodemographic characteristics. RESULTS: Employees who experienced higher WTFC reported less sleep sufficiency, poorer sleep quality, and more insomnia symptoms. Higher WTFC also predicted shorter nighttime sleep duration, greater likelihood of napping, and longer nap duration. Furthermore, higher WTFC was linked to greater inconsistency of nighttime sleep duration and sleep clock times, whereas higher FTWC was associated with more rigidity of sleep timing mostly driven by wake time. CONCLUSION: Results highlight the unique associations of WTFC/ FTWC with employee sleep independent of other work conditions and household and sociodemographic characteristics. Our novel methodological approach demonstrates differential associations of WTFC and FTWC with inconsistency of sleep timing. Given the strong associations between WTFC and poor sleep, future research should focus on reducing WTFC.
Hurtado DA, Okechukwu CA, Buxton OM, Hammer LB, Hanson GC, Moen P, Klein LC, Berkman LF. Effects on cigarette consumption of a work–family supportive organisational intervention: 6-month results from the work, family and health network study. Journal of Epidemiology and Community Health. 2016. Publisher's VersionAbstract
Background Observational studies have linked work–family issues with cigarette consumption. This study examined the 6-month effects on cigarette consumption of a work–family supportive organisational intervention among nursing home workers.Methods Group randomised controlled trial where 30 nursing homes across New England states were randomly assigned to either usual practice or to a 4-month intervention aimed at reducing work–family conflict via increased schedule control and family supportive supervisory behaviours (FSSB). Cigarette consumption was based on self-reported number of cigarettes per week, measured at the individual level.Results A total of 1524 direct-care workers were enrolled in the trial. Cigarette consumption was prevalent in 30% of the sample, consuming an average of 77 cigarettes/week. Smokers at intervention sites reduced cigarette consumption by 7.12 cigarettes, while no reduction was observed among smokers at usual practice sites (b=−7.12, 95% CI −13.83 to −0.40, p<0.05) (d=−0.15). The majority of smokers were US-born White nursing assistants, and among this subgroup, the reduction in cigarette consumption was stronger (b=−12.77, 95% CI −22.31 to −3.22, p<0.05) (d=−0.27). Although the intervention prevented a decline in FSSB (d=0.08), effects on cigarette consumption were not mediated by FSSB.Conclusions Cigarette consumption was reduced among smokers at organisations where a work–family supportive intervention was implemented. This effect, however, was not explained by specific targets of the intervention, but other psychosocial pathways related to the work–family interface.Trial registration number NCT02050204; results.
2015
Hammer LB, Johnson RC, Crain TL, Bodner T, Kossek EE, Davis KD, Kelly EL, Buxton OM, Karuntzos GT, Chosewood CL, et al. Intervention Effects on Safety Compliance and Citizenship Behaviors: Evidence From the Work, Family, and Health Study. Journal of Applied Psychology. 2015. Publisher's VersionAbstract

We tested the effects of a work–family intervention on employee reports of safety compliance and organizational citizenship behaviors in 30 health care facilities using a group-randomized trial. Based on conservation of resources theory and the work–home resources model, we hypothesized that implementing a work–family intervention aimed at increasing contextual resources via supervisor support for work and family, and employee control over work time, would lead to improved personal resources and increased employee performance on the job in the form of self-reported safety compliance and organizational citizenship behaviors. Multilevel analyses used survey data from 1,524 employees at baseline and at 6-month and 12-month postintervention follow-ups. Significant intervention effects were observed for safety compliance at the 6-month, and organizational citizenship behaviors at the 12-month, follow-ups. More specifically, results demonstrate that the intervention protected against declines in employee self-reported safety compliance and organizational citizenship behaviors compared with employees in the control facilities. The hypothesized mediators of perceptions of family-supportive supervisor behaviors, control over work time, and work–family conflict (work-to-family conflict, family-to-work conflict) were not significantly improved by the intervention. However, baseline perceptions of family-supportive supervisor behaviors, control over work time, and work–family climate were significant moderators of the intervention effect on the self-reported safety compliance and organizational citizenship behavior outcomes. (PsycINFO Database Record (c) 2015 APA, all rights reserved)

Berkman LF, Liu SY, Hammer LB, Moen P, Klein LC, Kelly EL, Fay M, Davis KD, Durham M, Karuntzos GT, et al. Work–Family Conflict, Cardiometabolic Risk, and Sleep Duration in Nursing Employees. Journal of Occupational Health Psychology. 2015. Publisher's VersionAbstract

We investigated associations of work–family conflict and work and family conditions with objectively measured cardiometabolic risk and sleep. Multilevel analyses assessed cross-sectional associations between employee and job characteristics and health in analyses of 1,524 employees in 30 extended-care facilities in a single company. We examined work and family conditions in relation to: (a) validated, cardiometabolic risk score based on measured blood pressure, cholesterol, glycosylated hemoglobin, body mass index, and self-reported tobacco consumption and (b) wrist actigraphy–based sleep duration. In fully adjusted multilevel models, work-to-family conflict but not family-to-work conflict was positively associated with cardiometabolic risk. Having a lower level occupation (nursing assistant vs. nurse) was associated with increased cardiometabolic risk, whereas being married and having younger children at home was protective. A significant Age × Work-to-Family Conflict interaction revealed that higher work-to-family conflict was more strongly associated with increased cardiometabolic risk in younger employees. High family-to-work conflict was significantly associated with shorter sleep duration. Working long hours and having children at home were both independently associated with shorter sleep duration. High work-to-family conflict was associated with longer sleep duration. These results indicate that different dimensions of work–family conflict may pose threats to cardiometabolic health and sleep duration for employees. This study contributes to the research on work–family conflict, suggesting that work-to-family and family-to-work conflict are associated with specific health outcomes. Translating theory and findings to preventive interventions entails recognition of the dimensionality of work and family dynamics and the need to target specific work and family conditions.

Olson R, Crain TL, Bodner T, King RB, Hammer LB, Klein LC, Erickson L, Moen P, Berkman LF, Buxton OM. A workplace intervention improves sleep: results from the randomized controlled Work, Family & Health Study. Sleep Health. 2015;1 (1) :55-65. Publisher's VersionAbstract

Study objectives: The Work, Family, and Health Network Study tested the hypothesis that a workplace intervention designed to increase family-supportive supervision and employee control over work time improves actigraphic measures of sleep quantity and quality.

Design: Cluster-randomized trial.

Setting: A global information technology firm.

Participants: US employees at an information technology firm.

Interventions: Randomly selected clusters of managers and employees participated in a 3-month, social, and organizational change process intended to reduce work-family conflict. The intervention included interactive sessions with facilitated discussions, role playing, and games. Managers completed training in family-supportive supervision.

Measurements and results: Primary outcomes of total sleep time (sleep duration) and wake after sleep onset (sleep quality) were collected from week-long actigraphy recordings at baseline and 12 months. Secondary outcomes included self-reported sleep insufficiency and insomnia symptoms. Twelve-month interviews were completed by 701 (93% retention), of whom 595 (85%) completed actigraphy. Restricting analyses to participants with ≥3 valid days of actigraphy yielded a sample of 473-474 for intervention effectiveness analyses. Actigraphy-measured sleep duration was 8 min/d greater among intervention employees relative to controls (P < .05). Sleep insufficiency was reduced among intervention employees (P = .002). Wake after sleep onset and insomnia symptoms were not different between groups. Path models indicated that increased control over work hours and subsequent reductions in work-family conflict mediated the improvement in sleep sufficiency.

Conclusions: The workplace intervention did not overtly address sleep, yet intervention employees slept 8 min/d more and reported greater sleep sufficiency. Interventions should address environmental and psychosocial causes of sleep deficiency, including workplace factors

2014
Hurtado DA, Berkman LF, Buxton OM, Okechukwu CA. Schedule Control and Nursing Home Quality; Exploratory Evidence of a Psychosocial Predictor of Resident Care. Journal of Applied Gerontology. 2014. Publisher's VersionAbstract

Aim: To examine whether nursing homes’ quality of care was predicted by schedule control (workers’ ability to decide work hours), independently of other staffing characteristics. Method: Prospective ecological study of 30 nursing homes in New England. Schedule control was self-reported via survey in 2011-2012 (N = 1,045). Quality measures included the prevalence of decline in activities of daily living, residents’ weight loss, and pressure ulcers, indicators systematically linked with staffing characteristics. Outcomes data for 2012 were retrieved from Medicare.gov. Results: Robust Linear Regressions showed that higher schedule control predicted lower prevalence of pressure ulcers (β = −0.51, p < .05). This association was independent of staff mix, staffing ratios, job satisfaction, and turnover intentions. Conclusion: Higher schedule control might enhance the planning and delivery of strategies to prevent or cure pressure ulcers. Further research is needed to identify potential causal mechanisms by which schedule control could improve quality of care.

2013
Marino M, Li Y, Rueschman M, Winkelman JW, Ellenbogen JM, Solet JM, Dulin H, Berkman LF, Buxton OM. Measuring Sleep: Accuracy, Sensitivity, and Specificity of Wrist Actigraphy Compared to Polysomnography. SLEEP. 2013;36 (11) :1747-1755. Publisher's VersionAbstract

Objectives: We validated actigraphy for detecting sleep and wakefulness versus polysomnography (PSG).

Design: Actigraphy and polysomnography were simultaneously collected during sleep laboratory admissions. All studies involved 8.5 h time in bed, except for sleep restriction studies. Epochs (30-sec; n = 232,849) were characterized for sensitivity (actigraphy = sleep when PSG = sleep), specificity (actigraphy = wake when PSG = wake), and accuracy (total proportion correct); the amount of wakefulness after sleep onset (WASO) was also assessed. A generalized estimating equation (GEE) model included age, gender, insomnia diagnosis, and daytime/nighttime sleep timing factors.

Setting: Controlled sleep laboratory conditions.

Participants: Young and older adults, healthy or chronic primary insomniac (PI) patients, and daytime sleep of 23 night-workers (n = 77, age 35.0 ± 12.5, 30F, mean nights = 3.2).

Interventions: N/A.

Measurements and Results: Overall, sensitivity (0.965) and accuracy (0.863) were high, whereas specificity (0.329) was low; each was only slightly modified by gender, insomnia, day/night sleep timing (magnitude of change < 0.04). Increasing age slightly reduced specificity. Mean WASO/night was 49.1 min by PSG compared to 36.8 min/night by actigraphy (β = 0.81; CI = 0.42, 1.21), unbiased when WASO < 30 min/night, and overestimated when WASO > 30 min/night.

Conclusions: This validation quantifies strengths and weaknesses of actigraphy as a tool measuring sleep in clinical and population studies. Overall, the participant-specific accuracy is relatively high, and for most participants, above 80%. We validate this finding across multiple nights and a variety of adults across much of the young to midlife years, in both men and women, in those with and without insomnia, and in 77 participants. We conclude that actigraphy is overall a useful and valid means for estimating total sleep time and wakefulness after sleep onset in field and workplace studies, with some limitations in specificity.

Citation: Marino M; Li Y; Rueschman MN; Winkelman JW; Ellenbogen JM; Solet JM; Dulin H; Berkman LF; Buxton OM. Measuring sleep: accuracy, sensitivity, and specificity of wrist actigraphy compared to polysomnography. SLEEP 2013;36(11):1747-1755.

2012
O'Donnell EM, Berkman LF, Subramanian SV. Manager support for work-family issues and its impact on employee-reported pain in the extended care setting. J Occup Environ Med. 2012;54 (9) :1142-9.Abstract
OBJECTIVE: Supervisor-level policies and the presence of a manager engaged in an employee's need to achieve work-family balance, or "supervisory support," may benefit employee health, including self-reported pain. METHODS: We conducted a census of employees at four selected extended care facilities in the Boston metropolitan region (n = 368). Supervisory support was assessed through interviews with managers and pain was reported by employees. RESULTS: Our multilevel logistic models indicate that employees with managers who report the lowest levels of support for work-family balance experience twice as much overall pain as employees with managers who report high levels of support. CONCLUSIONS: Low supervisory support for work-family balance is associated with an increased prevalence of employee-reported pain in extended care facilities. We recommend that manager-level policies and practices receive additional attention as a potential risk factor for poor health in this setting.

Pages