The influence of the work environment on cardiovascular health: a historical, conceptual, and methodological perspective.

The framework of psychosocial epidemiology is used to examine research developments that characterize the accumulation of knowledge regarding the role of the work environment in cardiovascular health and disease. The discussion of current programs of research focuses on the work of T. Theorell and R. Karasek (1996) and J. Siegrist (1996) as exemplars of European and American studies that have contributed the most to the understanding of occupational cardiovascular health. It is argued that researchers need to maintain and nurture relatively broad conceptual models of etiology because cardiovascular disease involves multiple biomedical risk factors and because specific aspects of the work environment are embedded in a large, complex matrix of other psychosocial influences. At the same time, investigators need to push ahead with focused research strategies to clarify the precise nature of the work environmental risk factors that emerge in the broad, somewhat imprecise epidemiologic study designs.