Publications by Author:

In Press
Lee S, Almeida DM, Berkman L, Olson R, Moen P, Buxton OM. Age differences in workplace intervention effects on employees' nighttime and daytime sleep. Sleep Health: Journal of the National Sleep Foundation. In Press.Abstract

Objectives: 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.

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 [Internet]. 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.
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.
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 [Internet]. 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.
Marino M, Killerby M, Lee S, Klein LC, Moen P, Olson R, Kossek EE, King R, 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 [Internet]. 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 L, 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 [Internet]. 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.
Hammer LB, Johnson RC, Crain TL, Bodner T, Kossek EE, Davis KD, Kelly EL, Buxton OM, Karuntzos GT, Chosewood LC, et al. Intervention Effects on Safety Compliance and Citizenship Behaviors: Evidence From the Work, Family, and Health Study. Journal of Applied Psychology [Internet]. 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 [Internet]. 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, Erikson L, Moen P, Berkman LF, Buxton OM. A workplace intervention improves sleep: results from the randomized controlled Work, Family & Health Study. Sleep Health [Internet]. 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

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 [Internet]. 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 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.

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 [Internet]. 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.

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.
Nelson CC, Li Y, Sorensen G, Berkman LF. Assessing the relationship between work-family conflict and smoking. Am J Public Health. 2012;102 (9) :1767-72.Abstract
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.
Okechukwu CA, El Ayadi AM, Tamers SL, Sabbath EL, Berkman LF. Household food insufficiency, financial strain, work-family spillover, and depressive symptoms in the working class: the Work, Family, and Health Network study. Am J Public Health. 2012;102 (1) :126-33.Abstract

OBJECTIVES: We evaluated the association of household-level stressors with depressive symptoms among low-wage nursing home employees. METHODS: Data were collected in 2006 and 2007 from 452 multiethnic primary and nonprimary wage earners in 4 facilities in Massachusetts. We used logistic regression to estimate the association of depressive symptoms with household financial strain, food insufficiency, and work-family spillover (preoccupation with work-related concerns while at home and vice versa). RESULTS: Depressive symptoms were significantly associated with household financial strain (odds ratio [OR] = 1.82; 95% confidence interval [CI] = 1.03, 3.21) and food insufficiency (OR = 2.10; 95% CI = 1.10, 4.18). Among primary earners, stratified analyses showed that food insufficiency was associated with depressive symptoms (OR = 3.60; 95% CI = 1.42, 9.11) but financial strain was not. Among nonprimary wage earners, depressive symptoms correlated with financial strain (OR = 3.65; 95% CI = 1.48, 9.01) and work-family spillover (OR = 3.22; 95% CI = 1.11, 9.35). CONCLUSIONS: Household financial strain, food insufficiency, and work-family spillover are pervasive problems for working populations, but associations vary by primary wage earner status. The prevalence of food insufficiency among full-time employees was striking and might have a detrimental influence on depressive symptoms and the health of working-class families.

Hurtado DA, Sabbath EL, Ertel KA, Buxton OM, Berkman LF. Racial disparities in job strain among American and immigrant long-term care workers. Int Nurs Rev. 2012;59 (2) :237-44.Abstract

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.

King RB, Karuntzos GT, Casper LM, Moen P, Davis KD, Berkman L, Durham M, Kossek EE. Work-Family Balance Issues and Work-Leave Policies. In: Handbook of Occupational Health and Wellness. New York, NY: Springer ; 2012. pp. 323-339.
Ertel KA, Berkman LF, Buxton OM. Socioeconomic status, occupational characteristics, and sleep duration in African/Caribbean immigrants and US White health care workers. Sleep. 2011;34 (4) :509-18.Abstract
STUDY OBJECTIVES: o advance our understanding of the interplay of socioeconomic factors, occupational exposures, and race/ethnicity as they relate to sleep duration. We hypothesize that non Hispanic African/Caribbean immigrant employees in long term health care have shorter sleep duration than non Hispanic white employees, and that low education, low income, and occupational exposures including night work and job strain account for some of the African/Caribbean immigrant-white difference in sleep duration. DESIGN: Cross sectional SETTING: Four extended care facilities in Massachusetts, United States PARTICIPANTS: 340 employees in extended care facilities MEASUREMENTS AND RESULTS: Sleep duration was assessed with wrist actigraphy for a mean of 6.3 days. In multivariable regression modeling controlling for gender and age, African/Caribbean immigrants slept 64.4 fewer minutes (95% CI: -81.0, -47.9) per night than white participants; additional control for education and income reduced the racial gap to 50.9 minutes (-69.2, -32.5); additional control for the occupational factors of hours worked per week and working the night shift reduced the racial gap to 37.7 minutes (-57.8, -17.6). CONCLUSIONS: his study provides support for the hypothesis that socioeconomic and occupational characteristics explain some of the African/ Caribbean immigrant-white difference in sleep duration in the United States, especially among health care workers.
O'Donnell EM, Ertel KA, Berkman LF. Depressive symptoms in extended-care employees: children, social support, and work-family conditions. Issues Ment Health Nurs. 2011;32 (12) :752-65.Abstract
To examine the relation between having a child aged 18 years and under in the home and employee depressive symptoms, we analyzed cross-sectional data from four extended care facilities in Boston, MA (n = 376 employees). Results show that having a child is associated with slightly higher depressive symptoms. The strength of this relationship in our models is attenuated with the inclusion of social support at home (β = 1.08 and β = 0.85, with and without support, respectively) and may differ by gender. We recommend that future research examine the role of parenting and social support in predicting employee mental health.
Berkman LF, Buxton OM, Ertel K, Okechukwu C. Manager’s practices related to work-family balance predict employee cardiovascular risk and sleep duration in extended care settings. Journal of Occup Health Psychology. 2010;15 (3) :316–329.
Ertel KA, Koenen KC, Berkman LF. Incorporating home demands into models of job strain: findings from the work, family, and health network. J Occup Environ Med. 2008;50 (11) :1244-52.Abstract
OBJECTIVE: The purpose of this article was to integrate home demands with the demand-control-support model to test if home demands interact with job strain to increase depressive symptoms. METHODS: Data were from 431 employees in four extended care facilities. Presence of a child younger than 18 years in the household signified home demands. The outcome was depressive symptoms based on a shortened version of the Center for Epidemiologic Studies Depression Scale. RESULTS: The association between job strain and depressive symptoms was moderated by social support (SS) and presence of a child in the household (child). There was no association among participants with high SS and no child, but a positive one among participants with low SS and a child. CONCLUSIONS: Job strain may be a particularly important determinant of depressive symptoms among employees with family demands. Models of job strain should expand to incorporate family demands.