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
In Press, 2014
Lawson KM, Davis KD, McHale SM, Hammer LB, Buxton OM.
Prior research shows that employees’ work experiences can “spill over” into their family lives and “cross over” to affect family members. Expanding on studies that emphasize negative implications of work for family life, this study examined positive work-to-family spillover and positive and negative crossover between mothers and their children. Participants were 174 mothers in the extended care (nursing home) industry and their children (ages 9–17), both of whom completed daily diaries on the same 8 consecutive evenings. On each workday, mothers reported whether they had a positive experience at work, youth reported on their mothers’ positive and negative mood after work, and youth rated their own mental (positive and negative affect) and physical health (physical health symptoms, sleep quality, sleep duration). Results of 2-level models showed that mothers’ positive mood after work, on average, was directly related to youth reports of more positive affect, better sleep quality, and longer sleep duration. In addition, mothers with more positive work experiences, on average, displayed less negative mood after work, and in turn, adolescents reported less negative affect and fewer physical health symptoms. Results are discussed in terms of daily family system dynamics.
DePasquale N, Davis KD, Zarit SH, Moen P, Hammer LB, Almeida DM.
Objectives. Women who combine formal and informal caregiving roles represent a unique, understudied population. In the literature, healthcare employees who simultaneously provide unpaid elder care at home have been referred to as double-duty caregivers. The present study broadens this perspective by examining the psychosocial implications of double-duty child care (child care only), double-duty elder care (elder care only), and triple-duty care (both child care and elder care or “sandwiched” care).Method. Drawing from the Work, Family, and Health Study, we focus on a large sample of women working in nursing homes in the United States (n = 1,399). We use multiple regression analysis and analysis of covariance tests to examine a range of psychosocial implications associated with double- and triple-duty care.Results. Compared with nonfamily caregivers, double-duty child caregivers indicated greater family-to-work conflict and poorer partner relationship quality. Double-duty elder caregivers reported more family-to-work conflict, perceived stress, and psychological distress, whereas triple-duty caregivers indicated poorer psychosocial functioning overall.Discussion. Relative to their counterparts without family caregiving roles, women with combined caregiving roles reported poorer psychosocial well-being. Additional research on women with combined caregiving roles, especially triple-duty caregivers, should be a priority amidst an aging population, older workforce, and growing number of working caregivers.
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.
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.
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.
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)
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.
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.
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.
OBJECTIVES: We examined the relationship between smoking and work-family conflict among a sample of New England long-term-care facility workers.
METHODS: To collect data, we conducted in-person, structured interviews with workers in 4 extended-care facilities.
RESULTS: There was a strong association between smoking likelihood and work-family conflict. Workers who experienced both stress at home from work issues (i.e., work-to-home conflict) and stress at work from personal issues (i.e., home-to-work conflict) had 3.1 times higher odds of smoking than those who did not experience these types of conflict. Workers who experienced home-to-work conflict had an odds of 2.3 compared with those who did not experience this type of conflict, and workers who experienced work-to-home conflict had an odds of 1.6 compared with workers who did not experience this type of conflict.
CONCLUSIONS: The results of this study indicate that there is a robust relationship between work-family conflict and smoking, but that this relationship is dependent upon the total amount of conflict experienced and the direction of the conflict.