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.
Kelly EL, Moen P, Oakes MJ, Fan W, Okechukwu C, Davis KD, Hammer LB, Kossek EE, King RB, Hanson GC, et al.
Schedule control and supervisor support for family and personal life may help employees manage the work-family interface. Existing data and research designs, however, have made it difficult to conclusively identify the effects of these work resources. This analysis utilizes a group-randomized trial in which some units in an information technology workplace were randomly assigned to participate in an initiative, called STAR, that targeted work practices, interactions, and expectations by (1) training supervisors on the value of demonstrating support for employees’ personal lives and (2) prompting employees to reconsider when and where they work. We find statistically significant, although modest, improvements in employees’ work-family conflict and family time adequacy, and larger changes in schedule control and supervisor support for family and personal life. We find no evidence that this intervention increased work hours or perceived job demands, as might have happened with increased permeability of work across time and space. Subgroup analyses suggest the intervention brought greater benefits to employees more vulnerable to work-family conflict. This study uses a rigorous design to investigate deliberate organizational changes and their effects on work resources and the work-family interface, advancing our understanding of the impact of social structures on individual lives.
In this paper, we describe the development of the most comprehensive work–family organizational change initiative to date in the United States. Our goal is to share an in-depth case study with examples and critical lessons that emerged. We draw on our years of experience working with major employers from two industries representative of today's workforce (health care and IT professionals). Employers and applied researchers can draw on this study and lessons to create, customize, and deliver evidence-based interventions to improve work, family and health.
Flexible work accommodations provided by employers purport to help individuals struggling to manage work and family demands. The underlying model for change is accommodation—helping individuals accommodate their work demands with no changes in the structure of work or cultural expectations of ideal workers. The purpose of this article is to derive a Work Redesign Model and compare it with the Accommodation Model. This article centers around two change initiatives—Predictability, Teaming and Open Communication and Results Only Work Environment—that alter the structure and culture of work in ways that enable better work and better lives.
Although critical to health and well-being, relatively little research has been conducted in the organizational literature on linkages between the work–family interface and sleep. Drawing on conservation of resources theory, we use a sample of 623 information technology workers to examine the relationships between work–family conflict, family-supportive supervisor behaviors (FSSB), and sleep quality and quantity. Validated wrist actigraphy methods were used to collect objective sleep quality and quantity data over a 1 week period of time, and survey methods were used to collect information on self-reported work–family conflict, FSSB, and sleep quality and quantity. Results demonstrated that the combination of predictors (i.e., work-to-family conflict, family-to-work conflict, FSSB) was significantly related to both objective and self-report measures of sleep quantity and quality. Future research should further examine the work–family interface to sleep link and make use of interventions targeting the work–family interface as a means for improving sleep health.
Biomarkers are directly-measured biological indicators of disease or health. In population and social sciences, biomarkers need to be easy to obtain, transport, and analyze. Dried Blood Spot (DBS) collection meets this need, can be collected in the field with high response rates and analyzed for a variety of biomarkers.
Marino M, Li Y, Rueschman M, Winkelman JW, Ellenbogen JM, Solet JM, Dulin H, Berkman LF, Buxton OM.
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).
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.
Employed parents perceive a time squeeze even as trends from the 1960s show they are spending more time with their children. Work conditions (e.g., hours and schedule control) would seem to affect both parents' time with children and perceived time squeeze, but most studies rely on cross-sectional data that do not establish causality. The authors examined the effects of the introduction of a workplace flexibility initiative (Results Only Work Environment [ROWE]) on changes in mothers' and fathers' perceptions of the adequacy of their time with children and actual time spent with children (N = 225). Baseline data show the importance of work conditions for parents' sense of perceived time adequacy. Panel data show that mothers (but not fathers) in ROWE report increased schedule control and improved time adequacy, but no change in actual time spent with children, except that ROWE increases evening meals with children for mothers sharing few meals at baseline.
Cortisol is a biomarker of stress reactivity, and its diurnal pattern is an indicator of general neuroendocrine health. Despite theories conceptualizing marital dyads as dynamic systems wherein spouses are interdependent in their physiology and stress coping, little is known about the daily processes in which spouses possibly influence each other in biological stress. Nineteen heterosexual couples provided saliva samples containing cortisol 4 times a day for 4 consecutive days. We used multilevel modeling to examine whether one’s cortisol awaking response (CAR) and diurnal cortisol slope (DCS) predict those of the spouse’s on the same day and/or on the next day. We found that spouses synchronize their DCS, such that on days when one experiences faster or slower decline in diurnal cortisol than usual, the spouse also experiences faster or slower decline than usual. For CAR, positive synchrony was only observed in couples reporting high levels of marital strain and disagreement. Cross-lagged regression analysis reveals stability in diurnal cortisol pattern. A steeper cortisol slope on a particular day predicts a steeper slope on the next day within an individual, but no significant cross-lagged relation was found between spouses. Couples reporting more spousal support tend to have stronger stability in CAR. These findings provide evidence that spouses are interdependent in their diurnal cortisol patterns on a day-to-day basis, and that these daily dynamics are associated with marital relationship quality. The study contributes to our understanding of marital processes and biobehavioral health. It also contributes methodologically to the advancement of longitudinal dyadic analysis. (PsycINFO Database Record (c) 2013 APA, all rights reserved)
How are professionals responding to the time strains brought on by the stress of their higher status jobs? Qualitative data from professionals reveal (a) general acceptance of the emerging temporal organization of professional work, including rising time demands and blurred boundaries around work/ nonwork times and places, and (b) time work as strategic responses to work intensification, overloads, and boundarylessness. We detected four time-work strategies: prioritizing time, scaling back obligations, blocking out time, and time shifting of obligations. These strategies are often more work-friendly than family-friendly, but "blocking out time" and "time shifting" suggest promising avenues for work-time policy and practice.
Purpose . To estimate the cost to the workplace of implementing initiatives to reduce work-family conflict. Design . Prospective cost analysis conducted alongside a group-randomized multisite controlled experimental study, using a microcosting approach. Setting . An information technology firm. Subjects . Employees (n = 1004) and managers (n = 141) randomized to the intervention arm. Intervention . STAR (Start. Transform. Achieve. Results.) to enhance employees' control over their work time, increase supervisor support for employees to manage work and family responsibilities, and reorient the culture toward results. Measures . A taxonomy of activities related to customization, start-up, and implementation was developed. Resource use and unit costs were estimated for each activity, excluding research-related activities. Analysis . Economic costing approach (accounting and opportunity costs). Sensitivity analyses on intervention costs. Results . The total cost of STAR was $709,654, of which $389,717 was labor costs and $319,937 nonlabor costs (including $313,877 for intervention contract). The cost per employee participation in the intervention was $340 (95% confidence interval: $330-$351); $597 ($561-$634) for managers and $300 ($292-$308) for other employees (2011 prices). Conclusion . A detailed activity costing approach allows for more accurate cost estimates and identifies key drivers of cost. The key cost driver was employees' time spent on receiving the intervention. Ignoring this cost, which is usual in studies that cost workplace interventions, would seriously underestimate the cost of a workplace initiative.
Recently, scholars have demonstrated the importance of Family Supportive Supervisor Behaviors (FSSB), defined as behaviors exhibited by supervisors that are supportive of employees' family roles, in relation to health, well-being, and organizational outcomes. FSSB was originally conceptualized as a multidimensional, superordinate construct with four subordinate dimensions assessed with 14 items: emotional support, instrumental support, role modeling behaviors, and creative work–family management. Retaining one item from each dimension, two studies were conducted to support the development and use of a new FSSB-Short Form (FSSB-SF). Study 1 draws on the original data from the FSSB validation study of retail employees to determine whether the results using the 14-item measure replicate with the shorter 4-item measure. Using data from a sample of 823 information technology professionals and their 219 supervisors, Study 2 extends the validation of the FSSB-SF to a new sample of professional workers and new outcome variables. Results from multilevel confirmatory factor analyses and multilevel regression analyses provide evidence of construct and criterion-related validity of the FSSB-SF, as it was significantly related to work–family conflict, job satisfaction, turnover intentions, control over work hours, obligation to work when sick, perceived stress, and reports of family time adequacy. We argue that it is important to develop parsimonious measures of work–family specific support to ensure supervisor support for work and family is mainstreamed into organizational research and practice.
Drawing on two waves of survey data conducted six months apart in 2006, this study examined the impacts of a team-level flexibility initiative (ROWE--results only work environment) on changes in the work-home spillover and health behavior of employees at the Midwest headquarters of a large U.S. corporation. Using cluster analysis, we identified three distinct baseline spillover constellations: employees with high negative spillover, high positive spillover, and low overall spillover. Within-team spillover measures were highly intercorrelated, suggesting that work teams as well as individuals have identifiable patterns of spillover. Multilevel analyses showed ROWE reduced individual- and team-level negative work-home spillover but not positive work-home spillover or spillover from home-to-work. ROWE also promoted employees' health behaviors: increasing the odds of quitting smoking, decreasing smoking frequency, and promoting perceptions of adequate time for healthy meals. Trends suggest that ROWE also decreased the odds of excessive drinking and improved sleep adequacy and exercise frequency. Some health behavior effects were mediated via reduced individual-level negative work-home spillover (exercise frequency, adequate time for sleep) and reduced team-level negative work-home spillover (smoking frequency, exercise frequency, and adequate time for sleep). While we found no moderating effects of gender, ROWE especially improved the exercise frequency of singles and reduced the smoking frequency of employees with low overall spillover at baseline.
Building on Karasek and Theorell (R. Karasek & T. Theorell, 1990, Healthy work: Stress, productivity, and the reconstruction of working life, New York, NY: Basic Books), we theorized and tested the relationship between time strain (work-time demands and control) and seven self-reported health outcomes. We drew on survey data from 550 employees fielded before and 6 months after the implementation of an organizational intervention, the results only work environment (ROWE) in a white-collar organization. Cross-sectional (wave 1) models showed psychological time demands and time control measures were related to health outcomes in expected directions. The ROWE intervention did not predict changes in psychological time demands by wave 2, but did predict increased time control (a sense of time adequacy and schedule control). Statistical models revealed increases in psychological time demands and time adequacy predicted changes in positive (energy, mastery, psychological well-being, self-assessed health) and negative (emotional exhaustion, somatic symptoms, psychological distress) outcomes in expected directions, net of job and home demands and covariates. This study demonstrates the value of including time strain in investigations of the health effects of job conditions. Results encourage longitudinal models of change in psychological time demands as well as time control, along with the development and testing of interventions aimed at reducing time strain in different populations of workers.
BACKGROUND: Nursing homes are occupational settings, with an increasing minority and immigrant workforce where several psychosocial stressors intersect.
AIM: This study aimed to examine racial/ethnic differences in job strain between Black (n = 127) and White (n = 110) immigrant and American direct-care workers at nursing homes (total n = 237).
METHODS: Cross-sectional study with data collected at four nursing homes in Massachusetts during 2006-2007. We contrasted Black and White workers within higher-skilled occupations such as registered nurses or licensed practical nurses (n = 82) and lower-skilled staff such as certified nursing assistants (CNAs, n = 155).
RESULTS: Almost all Black workers (96%) were immigrants. After adjusting for demographic and occupational characteristics, Black employees were more likely to report job strain, compared with Whites [relative risk (RR): 2.9, 95% confidence interval (CI) 1.3 to 6.6]. Analyses stratified by occupation showed that Black CNAs were more likely to report job strain, compared with White CNAs (RR: 3.1, 95% CI: 1.0 to 9.4). Black workers were also more likely to report low control (RR: 2.1, 95% CI: 1.1 to 4.0). Additionally, Black workers earned $2.58 less per hour and worked 7.1 more hours per week on average, controlling for potential confounders.
CONCLUSION: Black immigrant workers were 2.9 times more likely to report job strain than White workers, with greater differences among CNAs. These findings may reflect differential organizational or individual characteristics but also interpersonal or institutional racial/ethnic discrimination. Further research should consider the role of race/ethnicity in shaping patterns of occupational stress.
Using data from a daily diary study of hourly hotel employees in the U.S. and their children, this study examined links between youth supervision arrangements and maternal worry while at work, examining both differences between individuals and day-to-day variation within individuals. Multilevel model analyses revealed both between- and within-person effects linking youth supervision to maternal worry. Mothers' partner status functioned as moderator, and maternal knowledge also emerged as a protective factor when youth were in self-care, highlighting a potential target for future work-family interventions, particularly those for hourly employees with limited access to family-friendly workplace policies.En utilisant les données d'une étude de journal quotidien des employés horaires de l'hôtel aux États-Unis et leurs enfants, cette étude a examiné les liens entre les modalités de supervision des jeunes et l'inquiétude maternelle pendant le travail, en examinant à la fois les différences inter individus et la variation intra individus au jour le jour. Analyses multi-niveaux ont révélé à la fois des effets inter et intra reliant la supervision des jeunes à l'inquiétude maternelle. Statut de partenaire des mères a fonctionné en tant que modérateur, et la connaissance maternelle est également apparue comme un facteur de protection lorsque les jeunes ont pris soins d'eux-mêmes, soulignant une cible potentielle pour des interventions de conciliation travail-famille, en particulier ceux conçus pour des employés horaires avec un accès limité à des politiques favorables à la famille.
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.
PURPOSE: This study examined links between diurnal patterns of the stress hormone cortisol and time spent by adolescents in nine common daily activities.
METHODS: During eight consecutive nightly telephone interviews, 28 youths (n = 12 girls), 10-18 years of age, reported their daily activities. On 4 days, four saliva samples were also collected and assayed for cortisol. Multilevel models assessed within- and between-person associations between time in each activity and cortisol area under the curve (AUC), cortisol awakening response (CAR), morning peak (30 minutes after wake up), and daily decline (morning peak to bedtime).
RESULTS: Links with AUC were found for most activities; significant associations with cortisol rhythms suggested that most effects were due to anticipation of the day's activities. Specifically, on days when youths spent more time than usual on video games and television, they had lower AUCs, with lower morning peaks. Youths who spent more time reading (within-person) and in computer-related activities (between-person) had higher AUCs, with stronger CARs (within-person). Youths who slept more had lower AUCs, with lower morning peaks on both the between- and within-person levels. Amounts of time spent in clubs, and for older adolescents in sports, were also linked to lower AUCs. Finally, youths who spent more time in school/schoolwork had lower average AUCs, but on days when youths spent more time than usual in school, they had higher AUCs, stronger CARs, and steeper daily declines.
CONCLUSION: Beyond their known implications for psychological adjustment, youths' everyday activities are linked to stress physiology.