Paul Landsbergis

• PhD, MPH
• Professor (Associate) at SUNY Downstate Health Sciences University

Hypertension is the foremost risk factor for cardiovascular disease (CVD), which is the leading cause of death globally. In some countries, such as the US, the prevalence of hypertension and working-age CVD mortality are increasing. CVD is also the most common work-related disease worldwide. Long working hours and other psychosocial stressors at wo...

The effects of long working hours, night and shift work on cardiovascular diseases, have been found in different populations around the world. The aim is to emphasize the importance of appropriate action in relation to the association of long working hours with cardiovascular disease. It is time to improve working conditions and health promotion an...

Background In recent years previous declines in cardiovascular disease (CVD) have stalled. There are occupational risk factors for CVD mortality. This study seeks to examine inequalities in CVD mortality for working‐age adults in the United States by occupation. Methods Death certificate data for CVD deaths were obtained from the National Center f...

Background: Although abundant evidence suggests that Urban Public Transport (UPT) workers are at high risk of poor mental health, there is no consensus on the exposures that explain these outcomes, nor on the effectiveness of mental health interventions in this occupational group. Objective: This study aims to systematically review the literature o...

Cardiovascular disease (CVD) is the leading cause of death globally, representing 32% of all deaths, and a major contributor to disability. Hypertension, the leading cause of CVD globally, affects an estimated 1.28 billion adults aged 30 to 79 years worldwide, two thirds living in low- and middle-income countries. Other CVD risk factors, including...

The research reviews recent studies on the mental health of public transport workers, and examines how mental health, particularly among young workers, was further harmed by the Covid-19 pandemic and associated lockdowns. The findings expose underlying gaps, weaknesses and failures which left workers exposed when the pandemic hit and highlights the...

Objectives: Work-related psychosocial stressors have been recognized as occupational hazards and assessed in workplaces in many countries for decades. Identifying tools to measure work-related psychosocial hazards to increase awareness in the United States about the impact on employees' health and safety, is critical.1. Methods: We describe the...

Objective: Opioids and the Workplace Prevention and Response (OWPR) Train-the-Trainer (TTT) and Leadership programs were piloted to improve trainees' abilities to conduct opioid awareness training and to introduce policies and programs in their workplaces. Methods: The TTT (N = 54) and Leadership (N = 19) pilot trainees were administered volunta...

Findings and conclusions from a recent review article by Moretti Anfossi et al. (2022) have drawn our attention. The authors stated that ‘there was sufficient evidence of a harmful relationship between job strain, shift work, and cardiovascular diseases (CVDs’) on which we agree. However, we disagree with the conclusions that ‘Evidence of no relati...

Background The National Institute of Environmental Health Sciences Worker Training Program developed instructor curriculum, a training tool, and materials to prepare trainees to conduct opioids workplace awareness training. Opioids and the Workplace Prevention and Response (OWPR) Train-the-Trainer (TTT) courses were held during three instructor-led...

Home care aides are a rapidly growing, non-standard workforce who face numerous health risks and stressors on the job. While research shows that aides receive limited support from their agency employers, few studies have explored the wider range of support that aides use when navigating work stress and considered the implications of these arrangeme...

Workers engaged in reproductive labor—the caring work that maintains society and supports its growth—contribute to societal health while also enduring the harms of precarious labor and substantial work stress. How can we conceptualize the effects of reproductive labor on workers and society simultaneously? In this commentary, we analyze four types...

Objectives This study was designed to evaluate the outcomes of a national summer 2020 ‘Opioids and the Workplace’ Prevention and Response (OWPR) Train-the-Trainer (TTT) and Leadership training tool and program at 6-month follow-up. The TTT program goal is to help instructors plan and conduct education and training on opioids and the workplace aware...

The workplace has been a neglected element in the national response to the opioid crisis. This ignores that workplace safety and health and drug policies have become important factors in opioid use disorder among workers. This results from physical or emotional pain related to workplace injuries, illnesses, and stress, and through punitive workplac...

Background Our objective was to examine occupational risk factors for musculoskeletal disorders of the shoulders, elbows, wrists, and hands among railroad maintenance-of-way (MOW) workers. Little systematic research on musculoskeletal disorders has been conducted in this occupational group. Methods In total, 3995 active members of the Brotherhood...

Objectives This study sought to assess the association between long working hours, psychosocial safety climate (PSC), work engagement (WE) and new major depression symptoms emerging over the next 12 months. PSC is the work climate supporting workplace psychological health. Setting Australian prospective cohort population data from the states of Ne...

The National Institute of Environmental Health Sciences Worker Training Program piloted an Opioids and the Workplace: Prevention and Response training tool and program in 2019. The pilot trainees (N = 97) were surveyed (n = 27) and interviewed (n = 6) six months posttraining, and those who downloaded the training tool from the Worker Training Progr...

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Objectives: To examine work characteristics in relation to body mass index (BMI) and risk of obesity. Methods: We analyzed data from 1150 participants working 20+ h week-1 from the 2014 National NIOSH Quality of Work Life Survey, based on a representative sample of US workers. We used multiple linear regression for BMI and multiple logistic regr...

Elementary and secondary school educators face many work stressors, which appear to be increasing due to economic, political, and social trends. Therefore, we analyzed data from a 2017 national American Federation of Teachers survey of U.S. education staff, including data from two New York School districts that have adopted collaborative labor-mana...

Background: The World Health Organization (WHO) and the International Labour Organization (ILO) are developing Joint Estimates of the work-related burden of disease and injury (WHO/ILO Joint Estimates), with contributions from a large network of experts. Evidence from mechanistic data suggests that exposure to long working hours may cause ischaemi...

Maintenance-of-way workers in North America who construct railroad tracks utilize specialized powered-hand tools, which lead to hand-transmitted vibration exposure. In this study, the maintenance-of-way workers were surveyed about neuro-musculoskeletal disorders, powered-hand tools and work practices. Information about vibration emission data of tr...

Background: Our objective was to examine occupational risk factors for musculoskeletal disorders of the neck, back, and knee among railroad maintenance-of-way (MOW) workers. Methods: Four thousand eight-hundred sixteen active, retired, and disabled members of the Brotherhood of Maintenance of Way Employes Division (BMWED) completed a survey. We...

Background: Long work hours may be associated with adverse outcomes, including cardiovascular disease. We investigated cross-sectional associations of current work hours with coronary artery calcification (CAC). Methods: Participants (n = 3046; 54.6% men) were from the Multi-Ethnic Study of Atherosclerosis. The number of hours worked in all jobs...

There are no national guidelines or regulations for prevention of work stress in the US. Also, there is no national standard occupational health surveillance instrument for work organization hazards. As part of the on-going Healthy Work Campaign (https://healthywork.org/), the Healthy Work Survey (HWS) project aims to develop a short, standard ques...

Objectives To assess changes in work characteristics, socioeconomic status inequalities in changes in work characteristics, and whether US workplaces are becoming more stressful. Methods We analyzed data from 5361 employed participants from the 2002, 2006, 2010, and 2014 NIOSH Quality of Work Life Surveys, based on representative samples of US wor...

Objective: The aim of this study was to measure musculoskeletal disorders and occupational risk factors among railroad maintenance-of-way (MOW) workers. Methods: Four thousand eight hundred sixteen active, retired, and disabled members of the Brotherhood of Maintenance of Way Employes Division (BMWED) completed a survey. Results: Compared with...

Telomere length (TL) is considered as a marker of cell senescence, but factors influencing the rate of TL attrition are not well understood. While one previous study reported the association of occupation and TL, many subsequent studies have failed to find the association. This may be due to heterogeneity within the samples and cross-sectional desi...

Spearman’s rho (p-value) between education and each of the two occupational characteristics. (DOCX)

Estimated change in 10-year telomere attrition by hazardous working conditions and sociodemographic characteristics from the linear mixed effects (hybrid) model with a random intercept and robust standard errors (n = 914). (DOCX)

Least square mean and standard error of the hazardous working conditions score (standardized) by gender and race/ethnicity. (DOCX)

Estimated change in 10-year telomere attrition by occupational complexity and education among white men from the linear mixed effects (hybrid) model with a random intercept and robust standard errors. (DOCX)

Estimated change in 10-year telomere attrition associated with a 1-unit increase in education by gender and race/ethnicity. (DOCX)

Job titles with high and low scores on substantive complexity and hazardous working conditions for men by race/ethnicity. (DOCX)

Job titles with high and low scores on occupational complexity and hazardous working conditions for women by race/ethnicity. (DOCX)

Estimated change in 10-year telomere attrition by occupational complexity and sociodemographic characteristics from the linear mixed effects (hybrid) model with a random intercept and robust standard errors (n = 914). (DOCX)

Least square mean and standard error of the substantive complexity of work score (standardized) by gender and race/ethnicity. (DOCX)

Individual trajectories of telomere length between baseline and follow-up by gender and race (spaghetti plots). (DOCX)

Model specification. (DOCX)

Background: The World Health Organization (WHO) and the International Labour Organization (ILO) are developing a joint methodology for estimating the national and global work-related burden of disease and injury (WHO/ILO joint methodology), with contributions from a large network of experts. In this paper, we present the protocol for two systematic...

Dear Editor: Our previous letter (1) regarding the paper by Dragano et al (2) on effort-reward imbalance (ERI) and coronary heart disease (CHD) asked for more information on the ERI-CHD association by several alternative operationalizations of ERI beyond the most popular ERI operationalization, a ratio of ERI ˃ 1, given various operationalizations...

Objectives: The prognostic utility of lifestyle risk factors and job-related conditions (LS&JRC) for cardiovascular disease (CVD) risk stratification remains to be clarified. Methods: We investigated discrimination and clinical utility of LS&JRC among 2532 workers, 35-64 years old, CVD-free at the time of recruitment (1989-1996) in four prospect...

We examine strategies, programs, and policies that educators have developed to reduce work stressors and thus health risks. First, we review twenty-seven empirical studies and review papers on organizational programs and policies in K-12 education published from 1990 to 2015 and find some evidence that mentoring, induction, and Peer Assistance and...

Organizational interventions that may reduce sources of occupational stress faced by K-12 teachers take many forms, including support/skills building interventions, such as mentoring programs, Peer Assistance and Review (PAR), teacher assistance teams, and teacher training on classroom management, as well as forms of job redesign. Most intervention...

This chapter describes sources of stress in the work environment, their adverse effects on the health of workers, and how they are influenced by economic globalization, political systems, laws, government policies, and the changing labor market. Models of occupational stress, in particular job strain and effort-reward imbalance, are presented. Addi...

Dear Editor: We recognize the important contribution of Dragano et al.’s study: “Effort–Reward Imbalance at Work and Incident Coronary Heart Disease: A Multicohort Study of 90,164 Individuals”1. At the same time, we think that the authors’ statement in the study: “The availability of alternative ways of defining effort–reward imbalance can encour...

Purpose: Participation in health studies may be inversely associated with employment and stress. We investigated whether employment, perceived stress, work-related stress, and family caregiving were related to participation in a longitudinal US community-based health study of black and white men and women aged ≥45 years. Methods: Prevalence rati...

Research on racial/ethnic health disparities and socioeconomic position has not fully considered occupation; however, because occupations are racially patterned, certain occupational characteristics may explain racial/ethnic difference in health. This study examines the role of occupational characteristics in racial/ethnic disparities in all-cause...

Work stress and its contribution to cardiovascular disease and its risk factors are well documented in a large body of research spanning more than 30 years, including prospective cohort studies and meta-analyses. This chapter gives a brief overview of the major work stress models and discusses the mechanisms, both psychological and biological, by w...

Cardiovascular disease (CVD), a global epidemic, is responsible for about 30% of all deaths worldwide. While mortality rates from CVD have been mostly declining in the advanced industrialized nations, CVD risk factors, including hypertension, obesity, and diabetes, have been on the increase everywhere. Researchers investigating the social causes of...

Object: This study analyzed the association between job strain and self-reported hypertension. Methods: A cross sectional study concerning nursing professionals involved with patient care was performed at three hospitals in Rio de Janeiro, Brazil, in 2005-2006. The sample comprised 1,307 female workers (participation rate: 81.9%). Job strain was as...

Objective: To assess associations of occupational categories and job characteristics with prevalent hypertension. Methods: We analyzed 2517 Multi-Ethnic Study of Atherosclerosis participants, working 20+ hours per week, in 2002 to 2004. Results: Higher job decision latitude was associated with a lower prevalence of hypertension, prevalence rat...

The IPD-Work (individual-participant data meta-analysis of working populations) Consortium has published several papers on job strain (the combination of low job control and high job demands) based on Karasek’s demand–control model (1) and health-related outcomes including cardiovascular disease (CVD), cancer, obesity, diabetes as well as health-re...

Objective: To investigate associations of work hours, job control, job demands, job strain, and occupational category with brachial artery flow-mediated dilation (FMD) in 1499 Multi-Ethnic Study of Atherosclerosis participants. Methods: Flow-mediated dilation was obtained using high-resolution ultrasound. Mean values of FMD were examined across...

We read with interest the paper by Siegrist et al. (2013) about the validation of short partial or proxy versions of the effort-reward imbalance (ERI) scales in 10 cohorts of the IPD-Work consortium. The validation was conducted using 5 IPD-Work consortium cohorts with original ERI scales. Due to serious methodological problems in the validation pr...

Objectives The role of occupation in the development of cardiovascular disease (CVD) remains a topic of research because few studies have examined longitudinal associations, and because occupation can be an indicator of socioeconomic position (SEP) and a proxy for hazard exposure. This study examines associations of occupational category as an SEP...

Objectives To investigate associations of work hours, job control, job demands, job strain, and occupational category with endothelial function, a predictor of cardiovascular disease (CVD). Method Currently employed participants free of CVD (n = 1499; 55.5% men; 62% non-white) of the Multi-Ethnic Study of Atherosclerosis provided information on wo...

OBJECTIVE: To evaluate associations between work-related stress, stressful life events, and perceived stress and semen quality. DESIGN: Cross-sectional analysis. SETTING: Northern California. PATIENT(S): 193 men from the Child Health and Development Studies evaluated between 2005-2008. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Measures of str...

Background: Changes in employment conditions in the global economy over the past 30 years have led to increased job insecurity and other work organization hazards. These hazards may play a role in creating and sustaining occupational health disparities by socioeconomic position, gender, race, ethnicity, and immigration status. Methods: A concept...

Because of several significant methodological and interpretational errors in Heikkilä et al.(1) pertaining to job strain and health-related lifestyle, we disagree with the authors that reducing work-related psychosocial stress … is unlikely to be an important target for any policy or intervention aiming to influence health-related lifestyle factors...

In the study by Nascimento and colleagues , 1 the patients who received increased plasma and platelet transfusions had greater mortality due to bleeding (22%) than the control group (9%), albeit not statistically significantly so. Nonetheless, it raises the question of whether the plasma and platelet transfusion worsened hemorrhage rather than miti...

We read this paper with great interest on the association between job strain (a combination of low job control and high job demands) and cancer. This paper is one of the few prospective occupational studies that have examined the risk of job strain for cancer. The authors concluded, based on the null associations between job strain and overall canc...

We read with great interest the paper by Nyberg et al [1] on job strain (a work stressor combining low job control and high psychological job demands) in relation to body mass index (BMI) using 13 European cohort studies. First of all, we think that the authors' brief characterization of the existing literature as being null or mixed does not give...

Evidence suggests that the workplace plays an important etiologic role in blood pressure (BP) alterations. Associations in female samples are controversial, and the domestic environment is hypothesized to be an important factor in this relationship. This study assessed the association between job strain and BP within a sample of female nursing work...

We have identified structural causes of workplace injuries and illnesses in Spain. At issue is to what extent these are also influential factors in the U.S. Two different econometric estimates were carried out in Spain using panel data techniques and logit econometric models. Similar models will be used to: a) analyze data for the entire U.S. fro...

The NIOSH Total Worker Health model emphasizes the need for attending to population, job, and worksite characteristics, however industry-specific worksite health protection and promotion (WHPP) approaches have been lacking. In the face of a high prevalence of metabolic disorders and other health problems in bus operators, the Transportation Coopera...

We read with interest the paper by Kivimaki et al [1] on the association of job strain and lifestyle risk factors with risk of coronary artery disease (CAD) using data from seven European cohort studies. We believe that the paper includes several significant methodological and interpretational errors. First, the authors should have excluded obesity...

Background We examined the association between long work hours, assembly line work and stress‐related diseases utilizing objective health and employment data from an employer's administrative databases. MethodsA North American automobile manufacturing company provided data for claims for sickness, accident and disability insurance (work absence of...

Introduction Masked hypertension, i.e., normal clinic blood pressure but elevated blood pressure during normal daily activities as measured by ambulatory monitoring, is a common problem and a serious cardiovascular risk factor. Given previously reported associations between work stressors and ambulatory blood pressure, an inquiry into the relations...

Objective: Telomere length has been proposed as a biomarker of cell senescence, which is associated with a wide array of adverse health outcomes. While work is a major determinant of health, few studies have investigated the association of telomere length with various dimensions of occupation. Accelerated cellular aging could be a common pathway l...

Compared with other restaurant hazards, organizational stressors are an understudied topic. Among organizational stressors, discrimination from management (DFM) appears widespread.OBJECTIVE: Objectives were to assess the prevalence and links between musculoskeletal symptoms (MSSs) in three anatomical regions and five sources of DFM. A cross-section...

Background: We examined the association between long work hours, assembly line work and stress-related diseases utilizing objective health and employment data from an employer's administrative databases. Methods: A North American automobile manufacturing company provided data for claims for sickness, accident and disability insurance (work absen...

We reviewed evidence of the relationship between job strain and ambulatory blood pressure (ABP) in 29 studies (1985–2012). We conducted a quantitative meta-analysis on 22 cross-sectional studies of a single exposure to job strain. We systematically reviewed 1 case–control study, 3 studies of cumulative exposure to job strain, and 3 longitudinal stu...

Chapter in Swedish. The characteristics of lean production such as standardization, waste elimination, resource reduction, improvement of quality and productivity, and just in time production have implications for the organization of daily work at the workplaces. In many cases work intensification is reported. Also, impacts on job control, social...

Objective: To evaluate the association of heart rate variability with job strain in first year resident physicians. Methods: We performed the study at the "Manuel Gea González" General Hospital in Mexico City. 54 resident doctors were studied over a period of 24 hr in their first year of specialization. Two questionnaires were administered: the...

Long working hours may be associated with cardiovascular disease (CVD). The objective was to investigate cross-sectional associations of work hours with carotid intima-media thickness (CIMT) and ankle-brachial index (ABI). Participants were 1694 women and 1868 men from the Multi-Ethnic Study of Atherosclerosis. CIMT and ABI were measured using stan...

This study examines associations of occupation with smoking status, amount smoked among current and former smokers (number of cigarettes per day and lifetime cigarette consumption (pack-years)), and workplace exposure to environmental tobacco smoke (ETS) independent from income and education. This is a cross-sectional analysis of data from a commun...

Firefighters and police officers have the third highest prevalence of obesity among 41 male occupational groups in the United States (US). However, few studies have examined the relationship of firefighter working conditions and health behaviors with obesity. This paper presents a theoretical framework describing the relationship between working co...

This paper is designed to synthesize what is known about the role work organization plays in creating, sustaining, or exacerbating occupational health disparities. Work organization is an umbrella concept referring to the way "work gets done"; it includes multiple focal points at different levels, including: the way individual jobs are designed and...

Background and Objective: Firefighters (FF) are frequently obese and are at high risk for CVD. Few validated instruments are available that assess the unique working conditions and health behaviors of firefighters who work on a 24 hr-shift system. Our goal was to develop an occupational health questionnaire informed by focus groups of FF's for use...