2 ALTERNATIVE JOB STRESS MODELS AND THE RISK OF CORONARY HEART-DISEASE

Objectives. This study examined the association between two alternativ e job stress models-the effort-reward imbalance model and the job stra in model-and the risk of coronary heart disease among male and female British civil servants. Methods. The logistic regression analyses were based on a prospective cohort study (Whitehall Il study) comprising 6 895 men and 3413 women aged 35 to 55 years. Baseline measures of both job stress models were related to new reports of coronary heart diseas e over a mean 5.3 years of follow-up. Results. The imbalance between p ersonal efforts (competitiveness, work-related overcommitment, and hos tility) and rewards (poor promotion prospects and a blocked career) wa s associated with a 2.15-fold higher risk of new coronary heart diseas e. Job strain and high job demands were not related to coronary heart disease; however, low job control was strongly associated with new dis ease. The odds ratios for low job control were 2.38 and 1.56 for self- reported and externally assessed job control, respectively. Work chara cteristics were simultaneously adjusted and controlled for employment grade level negative affectivity, and coronary risk factors. Conclusio ns. This is apparently the first report showing independent effects of components of two alternative job stress models-the effort-reward imb alance model and the job strain model (job control only)-on coronary h eart disease.