Kouvonen Anne, Kivimäki Mika, Virtanen Marianna, Heponiemi Tarja, Elovainio Marko, Pentti Jaana, Linna Anne, Vahtera Jussi
Department of Psychology, University of Helsinki, POB 9, FIN-00014, Finland.
BMC Public Health. 2006 Feb 7;6:24. doi: 10.1186/1471-2458-6-24.
In occupational life, a mismatch between high expenditure of effort and receiving few rewards may promote the co-occurrence of lifestyle risk factors, however, there is insufficient evidence to support or refute this hypothesis. The aim of this study is to examine the extent to which the dimensions of the Effort-Reward Imbalance (ERI) model--effort, rewards and ERI--are associated with the co-occurrence of lifestyle risk factors.
Based on data from the Finnish Public Sector Study, cross-sectional analyses were performed for 28,894 women and 7233 men. ERI was conceptualized as a ratio of effort and rewards. To control for individual differences in response styles, such as a personal disposition to answer negatively to questionnaires, occupational and organizational-level ecological ERI scores were constructed in addition to individual-level ERI scores. Risk factors included current smoking, heavy drinking, body mass index > or =25 kg/m2, and physical inactivity. Multinomial logistic regression models were used to estimate the likelihood of having one risk factor, two risk factors, and three or four risk factors. The associations between ERI and single risk factors were explored using binary logistic regression models.
After adjustment for age, socioeconomic position, marital status, and type of job contract, women and men with high ecological ERI were 40% more likely to have simultaneously > or =3 lifestyle risk factors (vs. 0 risk factors) compared with their counterparts with low ERI. When examined separately, both low ecological effort and low ecological rewards were also associated with an elevated prevalence of risk factor co-occurrence. The results obtained with the individual-level scores were in the same direction. The associations of ecological ERI with single risk factors were generally less marked than the associations with the co-occurrence of risk factors.
This study suggests that a high ratio of occupational efforts relative to rewards may be associated with an elevated risk of having multiple lifestyle risk factors. However, an unexpected association between low effort and a higher likelihood of risk factor co-occurrence as well as the absence of data on overcommitment (and thereby a lack of full test of the ERI model) warrant caution in regard to the extent to which the entire ERI model is supported by our evidence.
在职业生活中，高付出与低回报之间的不匹配可能会促使生活方式风险因素同时出现，然而，目前尚无足够证据支持或反驳这一假设。本研究旨在探讨努力-回报失衡（ERI）模型的各个维度——努力、回报和ERI——与生活方式风险因素同时出现的关联程度。
基于芬兰公共部门研究的数据，对28894名女性和7233名男性进行了横断面分析。ERI被概念化为努力与回报的比率。为了控制应答方式的个体差异，例如个人倾向于对问卷给出否定回答，除了个体水平的ERI得分外，还构建了职业和组织层面的生态ERI得分。风险因素包括当前吸烟、大量饮酒、体重指数≥25kg/m²以及缺乏体育活动。使用多项逻辑回归模型来估计存在一种风险因素、两种风险因素以及三种或四种风险因素的可能性。使用二元逻辑回归模型探讨ERI与单一风险因素之间的关联。
在对年龄、社会经济地位、婚姻状况和工作合同类型进行调整后，与低ERI的女性和男性相比，高生态ERI的女性和男性同时存在≥3种生活方式风险因素（与0种风险因素相比）的可能性高出40%。单独检查时，低生态努力和低生态回报也与风险因素同时出现的患病率升高有关。个体水平得分的结果方向相同。生态ERI与单一风险因素的关联通常不如与风险因素同时出现的关联明显。
本研究表明，职业努力与回报的高比率可能与多种生活方式风险因素的风险升高有关。然而，低努力与风险因素同时出现的较高可能性之间的意外关联以及缺乏过度投入的数据（从而缺乏对ERI模型的全面检验），使得我们在证据支持整个ERI模型的程度方面需要谨慎对待。
