psychosocial issues as predictors of occupational injury, illness, and assault

8/13/2019 Psychosocial Issues as Predictors of Occupational Injury, Illness, And Assault

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Psychosocial Issues as Predictors of Occupational Injury, Illness, and Assault

By

LEZAH PATRICIA BROWNB.S., Purdue University, West Lafayette, Indiana, 1987

M.S.P.H., University of Illinois at Chicago, Chicago, Illinois, 2004

THESIS

Subm itted as partial fulfillment of the requirem entsfor the degree of Doctor of Philosophy in Public Health Sciences

in the Graduate College of the University of Illinois at Chicago, 2008

Chicago, Illinois


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UMI Number: 3316542

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This thesis is dedicated to my three sons, Langston, Nolan, and Delan, for whom I live each

day, Daddy, Mim i, Grandma, and Donald.

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A C K N O W LED G EMEN TS

I would like to thank my thesis committee Kathleen Rospenda, Rosemary Sokas, Lorraine

Conroy, Sally Freels, and Naomi Swanson for their support and assistance. They provided help that

enabled me to accomplish this final step of my doctoral degree.

Over the last seven years, I have been fortunate enough to have a village of supporters who

have lifted me when I thought I could go no further. They are: Arika Owens, Italia Rolle, Semone

West, Margaret Ellington, Joseph Zanoni, Barbara Harper-Smith, Shirley Moore, Jessica Hosley,

Renita Moore, Iraida Rios, and Jennifer Rios. I thank the friends who provided their shoulders to cry

on in stressful times and planned shopping dates in less stressful tim es.

Lastly, I would like to acknowledge the funding sources which have made it possible for me

to accomplish this goal: Illinois Public Health Research Fellowship Program funded by the Centers

for Disease Control and Prevention Grant (#1T01 CD000189-01), NIOSH Training Program Grant

(# T42/CCT 522954-02), and The National Institute on Alcohol Abuse and Alcoholism Grant (#

AA013332).

LPB

IV


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TABLE OF CONTENTS

CHAPTER PAGE

I. INTRODUCTION 1

References 5

II. LITERATURE REVIEW 8

A. Stress in the Workplace 8

1. W orkplace Stressors 12

a. Harassment in the Workplace 12

i. Generalized W orkplace Harassment 13

ii. Sexual Harassment 15

b. Work Stressors - Job Pressure and Threat 17

B. Occupa tional Injuries, Illnesses and Assau lts (O ilA) - W hy Use

Psychosocial Factors as Predictors? 20

C. W ork Stress in Different Grou ps 25

1. Gender 26

2. Age 28

D. Coping Mechanisms and OIIAs 29

1. Social Support and OIIA s 29

2. Alcohol Use and Abuse and OIIAs 32

E. Conclusions 34

References 35

III. METHO DS 42A. Sample and Data Collection 42

B. Population 44

C. Measures 46

1. Occupational Injuries, Illness and Assau lts 46

v


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TABLE OF CONT ENTS continued) PAGE

RESEARCH QUESTIONS 83

METHODS 83

STUDY POPULATION 85

MEASURES 85

DATA ANALYSIS 89

RESULTS 92

DISCUSSION 96

REFERENCES 101

MA NUS CRIPT 3 - Are Occupational Injuries, Illnesses and Assaults at Wave-2

Predicted by Wave-1 Levels of Psychosocial Stressors and Coping Me chanisms?.. 108

ABSTRACT 108

INTRODUCTION 109

RESEARCH QUESTIONS I l l

METHODS 112

STUDY POPULATION 114

MEASURES 115

DATA ANALY SIS 118

RESULTS 121

DISCUSSION 124

REFERENCES 127

Conclusions 133

REFERENCES 139

Vita 143

vn


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TABLE

LIST OF TABLES

PAGE

MANUSCRIPT 1

I. WEIGHTED SAMPLE DEMOGRAPHICS BY OIIA STATUS (N=l 899) 66

II. BIVARIATE RELATIONSHIPS BETWEEN STUDY VARIABLES AND

OIIA 69

III. MULTIVARIATE ASSOCIATIONS BETWEEN OCCUPATIONAL

PSYCHOSOCIAL STRESSORS AND OIIA CONTROLLING A GE, SEX,

RACIAL GROUP AND OCCUPATIONAL GROUP 70

MANUSCRIPT 2

IV. WEIGH TED SAMPLE DEMO GRAPHICS BY OIIA STATUS (N=1315) 91

V. MULTIVARIATE ASSOCIATIONS BETWEEN COPING MECHANISMS

AND OIIA TAKING INTO ACCOUNT THE THREE PSYCHOSOCIAL

VARIABLES CONTROLLING AGE, SEX, RACIAL G ROUP, AND

OCCUPATIONAL GROUP 92

VI. EFFECTS OF COPING MECHANISMS ON OIIA BEYOND WOR KPLACE

PSYCHOSOCIAL STRESSORS (N=l 315 94

MANUSCRIPT 3

VII. WEIGH TED SAMPLE DEMO GRAPHICS BY OIIA STATUS (N=871) 120

VIII. BASE LOGISTIC REGRESSION MODEL SHOWING ASSOCIATIONS

BETWEEN WAVE-1 WORKPLACE PSYCHOSOCIAL STRESSOR

VARIABLES PREDICTING WAVE-2 OIIA CON TROLLING FOR W AVE-1CONTROL VARIABLES (AGE, SEX, RACIAL GR OUP, OCC UPATIONALGROUP,ANDWAVE-10IIA)(N=871) 122

vi n


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TABLE

LIST OF TABL ES continued)

PAGE

IX. EFFECTS OF COPING MECHANISMS ON WAVE-2 OIIA BEYOND

WAVE-1 LEVEL WORKPLACE PSYCHOSOCIAL STRESSORS

PREDICTING WAV E-20IIA CONTROLLING FOR WAVE-1 CONTROL

VARIABLES (AGE, SEX, RACIAL GROUP, OCCUPATIONAL GR OUP,

AND WAV E-1 OIIA) 123

IX


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LIST OF FIGURES

FIGURES PAGE

3.1 Mu ltiple logistic regression model 52

x


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LIST OF ABBREVIATIONS

BLS

BC

BELTRESS

CATI

CFR

CPS

EAP

EEOC

GWH

GWHQ

IRB

JPT

LifeSS

MCS

NIOSH

OIIA

OSHA

PTSD

SEQ

SH

SIG

SRL

TWEAK

USUSDOL

W-l o rWl

W-2 or W2

WorkSS

Bureau of Labor Statistics

Bureau of Census

Belgium Job Stress Project

Computer Assisted T elephone Interview

Code of Federal Regulation

Current Population Survey

Employee Assistance Program(s)

Equal Employment Opportunity Comm ission

Generalized W orkplace Harassment

Generalized W orkplace Harassment Q uestionnaire

Institutional Review Board

Job Pressure and Threat

Social Support away from work

Maastricht Cohort Study of Fatigue at Work

National Institute for Occupational Safety and Health

Occupational Injury, Illness, and Assault

Occupational Safety and Health Administration

Post Traumatic Stress Disorder

Sexual Experience Q uestionnaire

Sexual H arassment

Stress in General

Survey Research Laboratory

Problem Drinking assessment tool

United StatesUnited States Department of Labor

Wave 1 data

Wave 2 data

Social Support at Work

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SUMMARY

A study which examines associations between psychosocial workplace stressors, coping

mechanism utilization and occupational injury, illness, and assault was carried out in cross-sectional

and longitudinal study designs. Data were collected from 2,151 workers living the continental US.

Information on demographics, perceptions of generalized workplace harassment, sexual harassment,

job pressure and threat, social support at work and away from work, and occupational injuries,

illnesses, and assaults were collected during 2 sampling waves (periods) during 2003 and 2004.

The cross-sectional findings showed psychosocial stressors were significantly associated

with occupational injury, illness, and assault when experienced during wave-1. Due to limitations of

cross-sectional analyses, causal effects could not be determined. As far as coping mechanism

utilization, lower social support at work was significantly associated with occupational injury,

illness, and assault in production/transportation work ers. The longitudinal findings showed no

significant association between wave-1 psychosocial stressors, or coping mechanisms predicting

wave 2 occupational injury, illness, and assault.

Overall, the data analyses in this study showed younger and Hispanic workers were at

greatest risk of experiencing occupational injuries, illnesses, and assaults. When considering

occupational groups, service and production/transportation subgroups were at greatest risk of

experiencing an occupational injury, illness, or assault taking into account psychosocial stressor

exposures. This research provides important information relevant to health and safety professionals

practicing in private industry and public safety sectors who deal with w orkers.

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I. INTRODUCTION

Occupational health and safety professionals have the responsibility of ensuring safe

workplaces free from recognizable hazards. Traditionally, health and safety professionals are trained

in biological, chemical and physical sciences resulting in job titles such as industrial hygienist, safety

engineers, environmental engineers or occupational medicine professionals. They are responsible for

ensuring workers' health by controlling workplace exposures to chemicals, physical agents and

machinery. When workplace exposures are not controlled, workers are at risk of experiencing

occupational injuries and/or illnesses.

Occupational injuries and illnesses continue to occur at the rate of over 4 million a year in the

private sector in spite of instituting engineering controls, standard operating procedures and other

hazard elimination processes . Occupational injuries, illnesses and assaults (OIIAs) include: minor

incidents such as scrapes, contusions and foreign objects in the eye; serious injuries such as

lacerations, broken bones and amputations; and death. When OIIAs occur, the health and safety

professional investigates and examines the physical environment such as the machinery, chemical

and biological exposures, physical workstation setup and any potential work shift issues which may

include the number of hours worked that day, week or rest-time between shifts. Ultimately, health

and safety investigations seek to identify deficiencies in standard operating procedures, lack of

engineering controls, or disregard for safety procedures.

The missing piece of the puzzle in health and safety investigations is the psychosocial aspects

of the work environment, or psychosocial stressors. Psychosocial stressors experienced at work have

been characterized as: heavy workloads, skill under-utilization, poor communication within the

organization, poor social environment, lack of social support, and job insecurity. Job stressors have

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been defined as work-related environmental exposures (some of which are listed above) which

impact workers' health and wellbeing (Hurrell, Nelson, et al., 1998); a variant of job stressors, job

strain is the psychological and physiological reactions caused by work demands and range of

decision-making freedom a worker has available to deal with those work demands (Karasek, Baker,

et al., 1981; Hu rrell, Nelson, et al., 1998). In this dissertation, GW H, SH , and JPT are considered to

be psychosocial stressors unless otherwise specified. Additionally, job stress is used in this

dissertation to describe the general concept of incorporating both job stressors resulting in job strain.

Occupational stress is a generalized term that is influenced by many factors and is considered

to be multi-leveled by Bliese and Jex (1999). The levels of influence that interact to form an

individual's perception of workplace stress are largely driven by corporate policies and procedures

along with interactions with co-workers and superiors (Jick and Mitz, 1985; Fitzgerald et al., 1997;

Gillen et al., 200 2; Gershon et al., 2002)

Generalized workplace harassment and sexual harassment are examples of psychosocial

stress experienced on the job . Generalized workp lace harassmen t (GW H) involves in terpersonal

hostile interactions such as being yelled at, sworn at, or subjected to humiliating or demeaning

behavior without explicit reference to gender or other legally protected social status characteristics

(Rospenda et al., 2000). The presence of GW H might interfere with an individual's ability to safely

carryout their job tasks.

Sexual harassment (SH) experiences have been identified as problems in the workplace since

the late 1980s. Fitzgerald and colleagues (1988) have shown SH to be a widespread phenomenon in

both women workers and university students. Sexual harassment may be linked to the recipient


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feeling a sense of threat and insecurity in their jobs which potentially influences their ability to

function productively and safely carry out work-tasks. Because of this, SH has been included in the

set of variables used to examine associations of risk-related psychosocial stressors and OIIA's

(Fitzgerald et al., 1988).

Job stressors may include concepts such as job decision latitude, job demands (Karasek et al,

1981), job control and victimization (Aquino, et al., 1999, 2000; Bosma et al., 1998; Stanton et al.,

2002), and job pressure (Vagg and Spielberger, 1998). Health outcomes associated with perceiving

high work stress include depression, anxiety (Spector and Jex, 1998), diminished mental functioning

(inattentiveness, fatigue), headaches (Repetti, 1993), absenteeism (Greiner et al., 1998), and

occupational injuries (Li et al., 2001). Job pressure and threat have been included in this study

because minimum information is available that describes potential relationships with risk of OIIA.

When occupational stress is an issue, individuals seek out ways to cope with the situations as

they arise. Therefore, social support systems in and out of work have been incorporated into this

study because the presence of social support at work or in one's personal life may enable an

individual to deal with the perceived adversities described by the presence of SH, GWH, job

pressure and job threat.

Another coping mechanism included is excessive use of alcohol or problem drink ing .

Research has shown that individuals drink for different reasons and at different levels (Webb et al.,

1994; Richman et al. 1999, 2002; Rospenda et al., 2000, 2002, 2005; Veazie and Smith, 2000). The

coping mechanisms recognized in this body of research have been included to better understand the


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various pathways that maybe associated with OIIA's in addition to complex psychosocial issues that

may show protective or deleterious associations with OIIA's.

To date, there have been no research studies published in the English language that explicitly

examine associations between GWH, JPT and SH on OIIA's. I am approaching this research project

from a health and safety perspective by considering multiple psychosocial issues as predictors of

OIIA. In order to understand the reasons for choosing the psychosocial measures, GWH, SH and

JPT, I will explain and define the psychosocial concepts established by the occupational psychology

and sociology researchers that are relevant to this research project. The worker is the center of the

research focus because the measurements used to create the variables evolve from his or her

perceptions, experiences and health and safety outcomes.

This study attempts to bridge the gap between health and safety and social science paradigms

by exploring associations between workplace psychosocial variables and occupational injuries and

illnesses. This research will contribute to the knowledge of the health and safety community such

that the psychosocial workplace environment is considered in program development and

implementation, as well as incorporating the status of psychosocial issues into injury and illness

investigations.

The research presented in this dissertation intends to examine OIIA with respect to

occupational psychosocial stressors (GWH, SH and JPT) and coping mechanism utilization. This

dissertation is organized as three different data analyses addressing a series of related questions.


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RE F E RE N CE S

Aqu ino, K., and M. Bradfield. Perceived V ictimization in the W orkplace: The Role of Situational

Factors and Victim Characteristics. Organization Science 11, no. 5 (200 0): 525 - 37.

Aqu ino, Karl, Steven L. Grover, Murray Bradfield, and David G. Allen. The Effects of Ne gative

Affectivity, Hierarchical Status, and Self-Determination on Workplace Victimization.The

Academy of M anagement Journal 42, no. 3 (1999): 260 -72.

Bliese, Paul D, and Steve M. Jex. Incorporating Multiple Levels of Analysis into Occupational

Stress Research. Work Stress 13, no. 1 (1999): 1 - 6.

Bosma, Hans, Stephen A. Stansfeld, and Michael G. Marm ot. Job Control, Personal Chara cteristics,

and Heart Disease. Journal of Occupational ealth Psychology 3, no. 4 (1998): 402-09.

DO L/BL S. Workplace Injuries and Illnesses in 2004. edited by Department of Labor, 2005.

Fitzgerald, Louise F., Fritz Drasgow, Charles L. Hulin, Michele J. Gelfand, and Vicki J. Magley.

Antecedents and Consequences of Sexual Harassment in Organizations: A Test of an

Integrated Model. Journal of Applied Psychology 82, no. 4 (1997): 578-89.

Fitzgerald, Louise F., Sandra L. Shullman, Nancy Bailey, Margaret Richards, Janice Swecker, Yael

Gold, Mimi Ormerod, and Lauren W eitzman. The Incidence and Dim ensions of Sexual

Harassment in Academia and the Workplace.Journal of Vocational Behavior 32 (1988):

152-72.

Gershon, Robyn R.M., Susan Lin, and Xianbin L i. Work Stress in Aging Police Officers.Journal

of Occupational and Environmental Medicine 44 (2002): 160-67.

Gillen, Marion, Davis Baltz, Margy Gassel, Luz Kirsch, and Diane Vacca ro. Perceived Safety

Climate, Job Demands, and Coworker Support among Union and Nonunion Injured

Construction Workers. Journal of Safety Research 31 (2002): 33-51.


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Greiner, Birgit A., Nik las Krause, David R. Ragland, and June M. Fisher. Objective Stress Factors,

Accidents, and Absenteeism in Transit Operators: A Theoretical Framework and Empirical

Evidnece. Journal of O ccupational Health Psychology 3 , no. 2 (1998): 130-46.

Hurrell Jr., Joseph J., Debra L. Nelson , and Bret L. Simm ons. Measuring Job S tressors and Strains:

Where We Have Been, Where We Are, and Where We Need to Go.Journal of

Occupational Health Psychology 3 , no. 4 (1998): 368 - 89.

Jick, Todd D., and Linda F. Mitz. Sex Difference in Work S tress.The Academy of M anagement

Journal 10, no. 3 (1985): 408-20.

Karasek, Robert, Dean Baker, Frank Marxer, Anders Ahlbom , and Tores Theore ll. Job Decision

Latitude, Job Demands, and Cardiovascular Disease: A Prospective Study of Swedish Men.

American Journal of Public Health 71 , no . 7 (1981): 694-705.

Karasek, Robert, Chantal Brisson, Norito Kawakami, Irene Houtman, Paulien Bongers, and

Benjamin A mick. The Job Content Questionnaire (Jcq): An Instrument for Internationally

Comparative Assessments of Physchosocial Job Characteristics.Journal of Occupational

Health Psychology 3 , no. 4 (1998): 322-55.

Li, C.-Y. K.-R. Chen, C.-H. Wu, and F.-C. Sung. Job Stress and Dissatisfaction in Association

with Non-Fatal Injuries on the Job in a Cross-Sectional Sample of Petrochemical Workers.

Occupational Medicine 51 (2001): 50-55.

Richman, Judith A., Kathleen M. Rospenda, Stephanie J. Nawyn, Joseph A. Flaherty, Michael

Fendrich, Melinda L. Drum, and Timo thy P. Johnson. Sexual Harassment and Generalized

Workplace Abuse among University Employees: Prevalence and Mental Health Correlates.

American Journal of Public Health 89, no. 3 (1999): 358-63.

Rospen da, Kathleen M. Workplace Harassment, Services Utilization, and Drinking Outcomes.

Journal of Occupational Health Psychology 7, no. 2 (2002): 141 - 55.


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Rospenda, Kathleen M., Judith A. Richman, Jennifer E hmke, L.Z., and Kenneth W. Zlatoper. Is

Workplace Harassment Hazardous to You Health?Journal of Business and Psychology 20,

no . 1 (2005): 95-110.

Rospenda, Kathleen ML, Judith A. Richman, Joseph S. Wislar, and Joseph A. Flaherty. Chron icity

of Sexual Harassment and Generalized Work-Place Abuse: Effects on Drinking Outcomes.

Addiction 95, no. 12 (2000): 1805-20.

Spector, Paul E., and Steve M. Jex. Developm ent of Four Self-Report M easures of Job S tressors

and Strain: Interpersonal Conflict at Work Scale, Organizational Constraints Scaled

Quantitative Workload Inventory, and Physical Symptoms Inventory. Journal of

Occupational Health Psychology 3, no. 4 (1998): 336-67.

Stanton, Jeffrey M ., Peter D. Bachiochi, Chet Robie, Lisa M. Perez, and Patricia C. Smith. Revising

the JDI Work Satisfaction Subscale: Insights into Stress and Control.Educational and

Psychological Measurement 62, no. 5 (2002): 877-95 .

Vag g, Peter R., and Charles D. Spielberger. Occupational S tress: Mea suring Job Pressure and

Organization Support in the Workplace.Journal of Occupational Health Psychology 3, no.

4 (1998): 294 -3 05 .

Vea zie, Mark A., and Gordon S. Smith. Heavy Drinking, Alcohol Depe ndence , and Injuries at

Work among Young Workers in the United States Labor Force.Alcoholism: Clinical and

Experimental Research 24, no. 12 (2000): 1811-19.

Webb, Gloria R., Selina Redman, Deborah J. Hennrikus, G. Richard Kelman, Robert W. Gibberd,

and Robert W. Sanson-Fisher. The Relationship s between High-Risk and Problem Drinking

and the Occurrence of Work Injuries and Related Absences.J. Stud Alcohol 55 (1994):

434-46.


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II . LITERATURE REVIEW

The information presented in this literature review contains information relevant to the

variables used in this research project. The literature was acquired from PubMed, JSTOR,

Psychlnfo, PsycArticles, ArticleFirst, Academic Search Premier, OVID, ScienceDirect and Health

Sciences: A SAGE Full-Text Collection on the University of Illinois Library system. Examples of

keywords used to query literature included but were not limited to, occupational injury, occupational

illness, incivility, generalized workplace harassment, sexual harassment, job threat, job pressure,

coping, social support, etc. The literature search results were printed, categorized and stored in

hardcopy versions. Research was considered from all parts of the world (e.g., the Netherlands,

China, Japan, Great Britain and France).

This literature review includes peer-reviewed journal articles addressing information relevant

to research on GWH, SH, JPT, social support at work and away from work, problem drinking and

OIIA. The chapter is organized such that: 1. stress in the workplace and specific workplace stressors

such as GWH, SH and JPT are described; 2. background information on occupational stressors and

OIIA is provided; 3. work stress in different populations is discussed; and 4. an overview of coping

mechanism utilization is provided.

A. Stress in the W orkplace

Merriam-Webster (2007) defines stress as physical, chemical, or emotional factors that cause

bodily or mental tension and may be a factor in disease causation. In reference to workplace stress, J.

Roberts (1993) defined stressors as anything in one 's social or physical environment that is

perceived as a threat and which induces a feeling of anxiety (p.75). This dissertation will exp lore

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workplace stressors, limited to generalized workplace harassment, sexual harassment and job

pressure and threat, along with coping mechanisms (social support at work and away from work) and

their associations w ith occupational injuries, illnesses and assaults.

Pearlin (1989) published an article entitled The Sociological Study of Stress where he argued

that stress was present in an indiv idua l's life based on their perception of social interactions. Thu s,

researchers should consider prior experiences shaped by ethnic and cultural habits which may

influence sociological outcomes of the research population. He further argued that social structures

and locations where individuals function can be sources of strains due to individuals' role

responsibility. Work is one location that can be associated with multiple types of strains such as role

overload (exists when demands on energy and stamina exceed the individual's capacities), inter-role

conflict (entails problems and difficulties that arise among those w ho interact with each o ther in sets

of complementary roles), and role restructuring (where the actors and the roles sets remain the same,

and either the aging process or extraneous exigencies force alterations in long-established patterns

of expectation and interaction).

Organizational psychologists have researched and reported on the various characteristics of

the workplace that influence an individual's psychological and social well-being. Such

characteristics determine how one perceives workplace stressors.

Workp lace strain is a difficult phenom enon to explain or recognize by the general workfo rce.

The concept of workplace strain is usually accepted as part of the job and something that has to be

tolerated in order for a person to survive in the workplace and make a wage. Organizational stress

researchers categorize outcomes related to job strain as affective reactions, somatic symptoms or


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disease manifestation (Spector, 1988). Work stressors which may lead to the above conditions

include, but are not limited to, work overload, work underload, interpersonal conflicts at work and

role ambiguity that may impede the individual from achieving work goals (Spector, 1988).

Spector et al. (1988) performed a study that investigated the relationship between several job

stressors and stress outcomes with data collected from university secretaries and their supervisors.

Results of this study showed anx iety, frustration, and job satisfaction were intercorrelated as was job

satisfaction and the intention to quit. Additionally the authors reported that affective outcomes and

stressors were highly correlated versus somatic symptoms and illness variables showing weak

correlations with stressors. When job stressor data was analyzed for convergence between secretary

and supervisor, the results showed supervisors were not always aware that their interaction could be

perceived as defensively biased by their secretaries. The authors concluded that there was

convergent validity for stressors in organizations (Spector et al., 1988). These results are important

to the present study because they show that worker and supervisor perception s of job stressors are

not congruent which may explain why stressful workplaces and hostile interpersonal relationships

develop. The limitation of this study is that the population is limited to a university setting which

may no t generalize to other occupational settings.

In regards to psychological strains and occupational accidents, Siu et al., (2004) performed a

study on Chinese construction workers to evaluate various aspects of occupational accidents, the

safety climate at work, and psychological strains. The results showed a positive association between

high levels of reported psychological strain at work and increased incidence of occupational

accidents/near misses. Further, the research demonstrated that psychological distress appeared to be

a mediator when evaluating relationships between safety attitudes and accident rates (Siu, 2004).


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This research is important because it justifies examining associations between GWH, SH, and JPT

related to OIIA outcomes. A limitation of this research centers around the fact that the results are

based on Chinese construction workers which causes uncertainty in comparing them to US

construction workers. However, it will be difficult to determine comparability between Chinese and

US construction workers due to possible variations in environmental exposures, and labor practices.

As far as US research is concerned, NIOSH has demonstrated that working conditions play

an important part in job stress which could determine whether an individual is at greater risk for

having an O IIA. NIOS H's model of job stress (e.g., workload and work pace, work schedule, careersecurity factors, and interpersonal relations) puts the individual and their situational factors in the

middle of the presence of stressful job conditions and the risk of injury and illness. Further, NIOSH

argues that an individual's situational factors may be influenced by three main factors; whether there

is balance between work and family life, whether there is a support network of friends and

coworkers, and whether the individual has a relaxed and positive outlook. Job-related stress has

evolved as a priority in the health and safety occupations due to the adverse health outcomes that

have been documented for years in the literature. Health outcomes associated with job-related stress

range from mild to severe. Mild health outcom es may include headaches, difficulty conce ntrating,

upset stomach or insomnia, whereas more severe health outcomes include cardiovascular disease,

musculoskeletal disorders and psychological disorders. Although the adverse health outcomes listed

above did not specifically include OIIAs, it is reasonable to believe that any combination of the

above conditions could affect an individual such that their concentration and mental capacity would

be diminished to a point that would increase risk for experiencing and OIIA (Sauter, 1990).


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1. W orkplace Stressors

a. Harassment in the Workplace

The selection of literature presented in this section describes research in occupational settings

related to harassment measures used in this study. Generalized workplace harassment and sexual

harassment are relatively recently studied concepts in the US . The workplace is a complex

environment due to random mixtures of personalities which have to interact with each other. Levels

of risk for workplace harassment may be related to size of the company, geographical location,

highest educational attainment level, and hierarchical status in the company and various personality

traits (Fitzgerald et al., 1988, 1997; Gelfand et al., 1995).

Workplace harassment has been defined as negative acts which occur in interpersonal

relationships at work which cause an individual to feel helpless and vulnerable (Richman et al.,

1999, 2002; Rospenda et al., 2000, 2002). In many cases, harassment is associated with mental

health outcomes such as depression, anxiety or increased alcohol consumption (Richman et al.,

1999, 2002; Rospenda et al., 2000, 2002; Shannon et al., 2006). The different forms of harassment

discussed in this dissertation include both generalized workplace harassment and sexual harassment.

The source and type of harassment depends on the workplace setting. For example, the

nursing profession is an occupational group potentially exposed to multiple sources and types of

workplace harassment. Nurses who work in hospitals and clinical settings are exposed to many

potential sources of harassment such as: patients, family, co-workers (nursing), physicians and

administration. At the same time, nurses are exposed to multiple types of abuse including emotional,

physical and sexual. Hesketh et al. (2003) reported results from a study carried out amongst the

Canadian registered nurses licensed in Alberta and British Columbia. The study objectives explored

psychosocial issues as predictors of occupational injury, illness, and assault

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