55. Methods to Assess Workplace Stress and Psychosocial Factors

7/30/2019 55. Methods to Assess Workplace Stress and Psychosocial Factors

1/24

METHODS TO ASSESSWORKPLACE STRESS AND

PSYCHOSOCIAL FACTORS

Barbara Curbow, Ph.D.*,

David J. Laflamme,* M.P.H., C.H.E.S.Jacqueline Agnew, Ph.D.

School of Hygiene and Public Health, Johns Hopkins University

Baltimore, Maryland

There is increasing evidence that a high percentage of workers are exposed to occupationalstressors on the job and that these stressors can contribute to a wide range of negative healthoutcomes including cardiovascular disease, musculoskeletal disorders, psychological disor-ders, injury, suicide, cancer, ulcers, and impaired immune function.1 In the environmentalliterature, stress has been associated with the perception and the reporting of symptomsrelated to indoor air quality (IAQ). Most frequently, this association is discussed within thecontext of sick building syndrome (SBS). In general, sick building syndrome can be thoughtof as one of a spectrum of workplace disorders that are characterized by a variety of non-specific somatic and psychological symptoms (p. 220).2 Other commonly cited aspects ofSBS are the worsening of symptoms during hours spent in the building and improvement onleaving the building and, often, an inability to find specific physical environmental causes.The problem of workplace stress often arises in building investigations, and in fact, theoccurrence of SBS may heighten awareness of stressors and stress.

This chapter is designed to provide information for two audiences: IAQ researchers andIAQ problem solvers. Researchers may focus more on the application and development ofthe theories and methodological issues that we discuss. Problem solvers may be more inter-ested in the relevance of these theoretical and research issues for implementation of solu-tions. In the first section of this chapter, we will define the concept of stress and present the

major occupational stress conceptual approaches. This will be followed by a discussion ofsome possible models of the IAQstress link. In the next section, we will present anoverview of the literature on the IAQstress link, and we will discuss the variables that havebeen most frequently investigated. In the third section, we will discuss measures of occupa-tional stress as they represent the major conceptual approaches. In the final section, we offersuggestions concerning implementation of these theories in the workplace.

CHAPTER 55

55.1

*Department of Health Policy and Management, Faculty of Social and Behavioral Sciences.

Department of Environmental Health Sciences, Division of Occupational Health.

Copyright 2001 by The McGraw-Hill Companies Retrieved from: www.knovel.com


2/24

55.1 STRESS AT WORK

What Is Stress?

Although the termsjob stress and occupational stress are frequently used common parlance,

in the research literature they must be distinguished from two related concepts: stressors andstrain. Job stressors are the work-related environmental conditions or exposures that canpotentially affect the psychological, social, and physiological health of an individual.3

Stressors can be measured subjectively (i.e., a workers perceptions of the environment) orobjectively (i.e., actual characteristics of the environment). Strain refers to the negative out-comes (psychological, social, physical, and behavioral) associated with exposure to stres-sors.3 Stress is an intervening variable between stressors and strain. Using a definition byLazarus,4 stress is the sense that environmental events tax or exceed the persons resources.The relationships among stressors, stress, and strain are depicted in Figure 55.1. Also

included in the figure is another class of variablesmodifiers. As will be discussed below,several of the dominant occupational stress models assume that the stressor stress and thestress strain relationships can be altered by the presence or absence of modifying variables,which are generally classified as external to the person (e.g., social support) or internal to theperson (e.g., coping strategies, self-esteem). For example, a common hypothesis in the liter-ature is that people who are exposed to stressors but who have high social support will notexperience effects as negative as will people who have low social support.

Conceptual Approaches in Occupational Stress

We begin a discussion of measurement issues with an overview of the dominant conceptualapproaches in the occupational stress literature because the selection of an approach shouldguide the variables that are examined in a study of the stressindoor air quality link. Vaggand Spielberger5 recently described the four major conceptual approaches that haveinformed the general occupational stress literature: personenvironment fit (PE fit),6 thedemandcontrol model,7 the effortreward imbalance model,8 and the transactional modelof stress.4 Although these models represent different views on the roles of the environmentand the individual in the etiology of strain, shared aspects can be found among them.

PersonEnvironment Fit. According to Hurrell et al.,3 the modern era of research on jobstress began in the early 1960s at the University of Michigan. French and Kahn 9 (cited in3)began a program of research on particular aspects of the work environment that might bedetrimental to the individual. These aspects included role ambiguity, workload, role conflict,having responsibility for other persons, and relationships among members of the group. Thisearly research led to the formulation of the PE fit model of job stress, which emphasizesthe goodness of fit between the characteristics of the person and the properties of the envi-ronment.10 Although Vagg and Spielberger5 characterized PE fit as the most influentialand most widely accepted of the job stress models, they also noted that it has been heav-

ily criticized on both theoretical and methodological grounds. However, there is empiricalsupport for it in the literature. For example, Conway et al.10 demonstrated that a misfitbetween perceived and desired levels of control was associated with poorer psychologicaladjustment.

Demand-Control Model. The demand-control model of stress is concerned with the inter-active effects of levels of job pressures (demands) and decision latitude (control).11 Differentoutcomes are associated with varying levels of demands and control.11 High demands and

55.2 ASSESSING IAQ



3/24

low control are associated with high levels of psychological strain; high demands and high con-trol are associated with good stress, which can lead to high job motivation; and low demands

and low control are associated with low job motivation. The demand-control model does notrule out a role for individual difference variables.7,11 Karasek et al.11 write: A dynamic versionof the model integrates the job strain and active behavior hypothesis with personality charac-teristics measuring accumulated strain and self-esteem development7 with the goal of predict-ing strain development and learning over time (p. 323). Although support has been found forthe model by many researchers, others have found that there is incomplete support for it. Forexample, Fletcher and Jones12 found small but independent effects (i.e., no interaction) fordemands and control in predicting psychological strain and job and life satisfaction, but rela-tionships with blood pressure were in the opposite direction. Bosma, Peter, Siegrist, and

Marmot

13

found support for the predictive ability of control but not demands for explainingnew cases of coronary heart disease.

EffortReward Imbalance Model. This newer model states that stress occurs when thereis a lack of reciprocity between the effort that a worker puts into a job and the potentialrewards she or he receives for completing it (p. 295).5 Under conditions of high effort inresponse to external work pressures but low potential for reward (e.g., promotion), there ishigh work stress, which leads to health-related problems. Bosma et al.13 recently tested theeffortreward imbalance model against the demandcontrol model in predicting the risk ofcoronary heart disease and found that the full effortreward imbalance model was associated

with increased risk, but only the control component of the demandcontrol model was asso-ciated with increased risk. The concept of work rewards (or resources) has been investigatedby other researchers in job stressnotably by Barnett and colleagues.14

Transactional Model. Lazarus4 conceptualization of the stress process differs from theprevious three. In his model, potential stressors from the environment are subjected to a two-stage appraisal process: The person first appraises whether the event is a challenge or a threatand if it is the latter, he or she then appraises the level of coping resources available to dealwith the event. Key to this model is the notion of resources or what a person draws on in

order to cope (p. 158).

15

Stress can occur when the person does not have the necessaryresourceswhether they are internal to the person (e.g., an optimistic disposition) or exter-nal to the person (e.g., social support)16to adequately respond to the external threat.

Shared Features. All four of these models point to the importance of environmental stressorsin the chain of events leading to a strain response. Two of the models (PE fit and transactional)focus on the role of individual characteristics in modifying the stress response (e.g., copingresources) and two (demandcontrol and effortreward imbalance) focus on additional aspectsof work (e.g., job control or job rewards) as modifiers of the stress response. The concept of job

METHODS TO ASSESS WORKPLACE STRESS AND PSYCHOSOCIAL FACTORS 55.3

Stimulus(stressor)

Intervening

Variable(perceived

stress)

Response(strain)

Modifying Variables

FIGURE 55.1 Perceived stress as an intervening variable.



4/24

control is compatible with all of the models. As noted earlier, Conway et al.,10 using the PE fitmodel, found that a misfit between perceived and desired control was associated with poorerpsychological adjustment. Control is a central aspect of the demandcontrol model and, in fact,some researchers have found the main effect for control to be the most highly predictive com-ponent of the model.13 Having control at work can be conceptualized as a rewarding aspect of

work (effortreward imbalance), and perceived control has often been conceptualized as a per-sonal resource that assists in adapting to stressors, for example, reference 17. Finally, two of themodels explicitly acknowledge the importance of positive aspects of work (effortrewardimbalance and transactional) and the notion is compatible with the PE fit model (e.g., misfitbetween perceived and desired rewards).

The NIOSH Model. The NIOSH Job Stress Model18 (Figure 55.2) integrates features ofseveral of the dominant job stress models: It incorporates the measurement of stressors and

job control and investigates their relationships with strain indicators and, ultimately, healthoutcomes. Additionally, it holds that the relationship between stressors strain can be mod-ified by internal resources and external factors. The only component not found in the NIOSHmodel is the concept of perceived stressas used as an intervening variable. In fact, all ofthe approaches mentioned, except for the transactional model, do not explicitly measure theindividuals overall sense of being taxed or overburdened by stressors. However, the NIOSHmodel represents an integrated model that can be used to conceptualize the aspects of thework environment and the person that may be critical to measure.

Models of the Indoor Air QualityStress Relationship

After selecting a conceptual approach to guide measurement of stressors, stress, and strain,it is necessary to focus on how the concept of indoor air quality fits within it. Three illustra-tive models of the stressindoor air quality link are presented in Fig. 55.3; all of these mod-

55.4 ASSESSING IAQ

Job Stressors

Individual Factors

Acute ReactionsIllness

Nonwork Buffers

Job/task demands

Work load ControlOrganizational

Role demands Management Career security

InterpersonalPhysical

Conditions

PersonalityStage ofcareer

Financialstatus

Family

Socialsupport

Coping

Psychological,affect, job

dissatisfaction

Physiologicalheart rate

blood pressure

Behavioral

sleepsubstance use

Hyperten-sion

CHD

AlcoholismMentalillness

FIGURE 55.2 NIOSH model of job stress and health. (From Hurrell.18

)



5/24

els could be elaborated to include other factors. These models are all conceptually plausible,but they have very different implications for measurement, study design, problem solving,and workeremployer relationships.

Model A. In model A, exposure to workplace stressors leads to an increased perception

of IAQ symptoms, irrespective of the actual exposure to contaminants. This model is com-patible with explanations for the stressIAQ link such as mass psychogenic illness,19

mass hysteria,20 and epidemic psychogenic illness.21 Typical of the explanation of thestressIAQ link is the following reasoning: High levels of occupational stress, especiallywhen they are coupled with poor workermanagement relationships, lead to an increase instress-related symptoms (e.g., fatigue). When the stress-related symptoms are linked withsome physical environmental cue (e.g., odor) or some social environmental cue fromcoworkers (e.g., fainting), the stress-related symptoms may be misattributed to IAQ byworkers. This, in turn, leads to an increase in the perception and reporting of symptoms.

This explanation is often used post hoc by researchers when no detectable physical environ-

mental cause can be found for the symptom reporting. It assumes that the problem originates inthe psychosocial climate of the workplace, for example, in a poor organizational climate. If thismodel were to be tested, it would need, at a minimum, measures of the environmental stressorsand perceptions/reporting of symptoms. It could, for example, be investigated within thedemandcontrol or effortreward imbalance conceptual frameworks such that these two aspectsof the environment could be assessed for their associations with symptoms.

Model B. In model B, exposure to IAQ problems is considered a stressor within the work-place. Much as exposures to cold or noise at work are thought of as physical stressors thatmay increase perceived stress and lead to both physiological and psychosocial effects, IAQproblems could follow this same pattern. It is important to note that such a model wouldassume that the problem lies in the physical environment of the workplace and that IAQproblems would be perceived as stressors by most, if not all, of the exposed workforce.Investigators taking this stance would need, at a minimum, careful measures of the physicalenvironment and a measure of perceived stress.

Model C. In model C, the perception of IAQ symptoms is caused by some combination ofactual exposure to IAQ problems, other workplace stressors, and individual factors. This modelmight lead to hypotheses such as the following: People who are exposed to poor IAQ and who


FIGURE 55.3 Possible models of the IAQ-stressor link.

Exposure

to work

stressors

Perception

of IAQ

symptoms

Exposure

to IAQproblems

Increased

perceivedstress

Exposure +Stressors +

Individual

factors

Perception

of IAQsymptoms

A

B

C



6/24

have high levels of workplace stressors and/or who have either a biological (e.g., allergies) orpsychological (e.g., high trait anxiety) vulnerability would perceive and report a higher level ofsymptoms. This model would assume that the problem might lie in a combination of the phys-ical environment, the psychosocial environment, and the individual. Using this model,researchers would need measures of the physical work environment, the psychosocial work

environment, relevant internal (e.g., anxiety, depression, allergies) and external (e.g., relation-ships with coworkers) modifiers, and symptom perceptions and reporting. This model would becompatible with the PE fit, NIOSH, and transactional conceptual frameworks.

55.2 THE IAQ-STRESS LINK: REVIEW OF THE

LITERATURE

Overview

The literature reviewed here was compiled principally through online searches of theNational Library of Medicines PubMed database and the American PsychologicalAssociations PsycINFO database. Some of the key words used in the search were stress,

psychological stress, workplace, sick building syndrome, psychosocial, mass psychogenicillness, indoor air pollution, and indoor air quality. These were used in various combina-tions. Several more articles came from the Indoor Air 99 Conference Proceedings CD-ROM.22 The bibliographies for several of the major articles were cross-examined forcommonly cited articles, and these were obtained. Although the search was not exhaustive,

it was comprehensive and representative in scope. A total of 29 articles containing originalempirical data on psychosocial variables relating to sick building syndrome or indoor airquality were retrieved and examined. Nearly 100 additional review and discussion articleswere also retrieved and examined. Table 55.1 contains the 17 empirical articles containingpsychosocial variables that are cited in this section. Several review/discussion articles andempirical articles containing no psychosocial variables are also cited; however they are notincluded in Table 55.1.

As noted earlier, the term SBSis used to describe a variety of symptoms reported byworkers in a common building, usually an office building. The World Health Organizationdefines it as specific symptoms with unspecified aetiology which are experienced by a pro-

portion of people working or living in a particular building and disappear after leaving it.23

Sick building syndrome symptoms are most evident during the work shift and diminish ordisappear upon leaving the building. No specific cause or illness can be identified, althoughIAQ is often suspected. Although the name implies that building factors are the cause of thesymptoms, research into this area has shown that nonbuilding-related factors contribute toSBS.

SBS symptoms reported by workers include eye, nose, or throat irritations, headache,nausea, dry cough, dry or itchy skin, dizziness, difficulty in concentrating, fatigue, and sen-sitivity to odors.24 These symptoms are often vague and difficult to measure, and affected

workers commonly show no clinical signs of illness.25

Many studies have focused on IAQ as a cause for SBS and frequently have shown thatcomplaints are not fully explained by contaminant levels.26 For this reason, in this chap-ter we will present a review of SBS studies that have included measures of occupationalstressors and psychosocial factors. For an in-depth discussion of SBS refer to Chapter 66in this handbook.

More than one study examining SBS complaints found that they were not associated withIAQ.27,28 The prevalence of workers with at least one SBS symptom has been reported to beas high as 70 percent.29 Although a few studies have used case-control designs, the majority

55.6 ASSESSING IAQ



7/24

N/number of

Study buildings* Country Instrument Design Measurements

Influences on sick building 624/3 South Africa Profile of Mood Cross-sectional Questionnaire: psychological

syndrome symptoms States state, job stress, interperson

in three buildings34 relationships at work, SBS

musculoskeletal pains,

environmental exposures.

The role of psychosocial 111/3 United States MMPI, Symptom Cross-sectional Questionnaire: MMPI, Sympt

factors in the report of Checklist-90- Checklist-90-Revised, Neur

building-related Revised, in-house Symptom Checklist, Perceiv

symptoms in sick neurobehavioral Stress Scale.

building syndrome33 symptom checklist,

and Perceived

Stress Scale

Effects of personal and 3155/18 United States Job satisfaction Cross-sectional Questionnaire developed

occupational factors on scale adapted from from first authors previous

sick building syndrome Job Satisfaction Job stress, job satisfaction,

reports in air-conditioned Scale

4

environmental variables, smoffices26 history, attitude toward toba

exposure, job category, VD

reports of SBS. Smoking po

used to separate into

experimental groups.

Investigation of factors 269/1 Canada A component of Case-control Perception of sociocultural str

affecting mass Karasek Job (work and outside work),

psychogenic illness in Content Questionnaire skills discretion, skills creat

employees in a and a component of decision authority, decision

fish-packing plant57 the NIOSH physical exertion, psycholo

General Job job demands, job insecurity

Stress questionnaire coworker support, supervisosupport, family support, job

satisfaction and social supp

from the family.

TABLE 55.1 IAQ-Stress Studies

Copyright 2001 by The McGraw-Hill Companies Retrieved from: www


8/24


9/24


10/24

N/number of

Study buildings* Country Instrument Design Measurements

Why do women report sick 4943/ Sweden Physchosocial workload Cross-sectional Gender, SBS symptoms, worki

building symptoms more index described personal factors, exposure fa

often than men?40 in previoous article at home and work, perceptio

by same author and physical conditions, and perc

referenced in this one psychosocial work condition(psychosocial work index

same as above).

No relation between indoor 80/4 Netherlands Cross-sectional Electronic questionnaire: satisf

climate and other aspects welfare (tasks, relationships

of quality of working life61 conditions at work) and safe

health (indoor climate, light

furniture, equipment, physic

problems, noise, cleaning, fi

toilets, etc.)

*N number of subjects/workers.

55.10

TABLE 55.1 IAQ-Stress Studies (Continued)

Copyright 2001 by The McGraw-Hill Companies Retrieved from: ww


11/24

have used cross-sectional questionnaires and causal relationships are consequently difficultto assess (see Table 55.1). It is important to keep in mind that many of the variables dis-cussed in this section are surrogates for actual measures of the causes of SBS, many of whichare poorly understood or simply unknown. Sick building syndrome is perhaps best explainedusing a multifactorial approach such as that depicted by the model in Figure 55.1. The vari-

ables described below are categorized by the headings in this model.

Stimulus (Stressors)

Numerous stressors have been investigated in relation to sick building syndrome. These fallinto two basic categories based on measurement characteristics: physical and psychosocialstressors. Often the physical stressors are measured objectively, and the psychosocial stressorsare measured subjectively, although this is not always the case.

Physical Stressors

Physical stressors that have been measured in SBS studies include environmental tobaccosmoke, vibration, lighting, noise, temperature, and a variety of other measures. Results froma study of 2856 office workers in 56 buildings30 included noise, temperature, and poor light-ing among the stressors that predicted SBS symptoms. Higher temperatures have been foundby others to be connected with higher levels of symptoms.31 Noise complaints have originatedfrom ceiling-mounted unit ventilators.32 When noise stems from ventilation units, there is the

danger that levels of contaminants will increase because of occupants shutting down the noisyunit and interrupting the flow of proper ventilation. Tobacco smoke is an environmental fac-tor that has been found to be associated with SBS symptoms,33 in addition to being responsi-ble for increased rates of lung cancer. Odors, humidity, and temperature in three buildingsstudied by Bachmann and Myers34 were related to an increase in SBS symptoms. The OfficeIllness Project in northern Sweden35 linked work responsibilities, such as video display ter-minal (VDT) use, with facial skin symptoms. Perceived physical workspace condition hasalso been shown to have a strong association with symptom reporting.28

Psychosocial Stressors

Organizational factors such as work climate have not been as well examined in relation toSBS but nonetheless may have an effect on symptoms. Two Swedish studies36,37 found thata negative climate of cooperation at work was positively associated with SBS symptoms.Ooi and Goh27 found similar results.

In a matched case-control study of SBS in office workers,38 the psychosocial workloadindex was related to an increased prevalence of symptoms. The authors of this study createdan index for psychosocial work from three questions asking about interesting and stimulat-

ing work, too much work to do, and opportunity to influence the working conditions.These concepts coincide nicely with the demandcontrol model described earlier.

Bachmann and Myers34 based their measurement of job stress on questions asking theextent subjects had enough time for their work, had spare time, chose their work, chose howand when to work, used their skills at work, and found their work interesting, rewarding orsatisfying. The authors cite Karaseks work6 as the basis for these questions. Job stress wasnot statistically significantly associated with SBS symptom reporting. Interestingly, inter-personal work relationships were also investigated in this study. However, details were notprovided on how this factor was measured. Interpersonal work relationships were not foundto be associated with SBS symptoms.




12/24

In a study of four nonproblem U.S. office buildings,28 a scale for job stress was based onthe demandcontrol model, incorporating scores for perception of influence over work andhaving to work hard. Job satisfaction and conflicting supervisory instructions were alsoinvestigated. All of these factors were found to be statistically significantly associated withSBS symptoms, although the relationships were not very strong. The questionnaire was

adapted from a variety of instruments used by other researchers, includingthe NIOSH JobStress Instrument.

Modifying Variables

Modifying variables act to moderate or mediate the effects of stressors on the person. Theymay be protective or they may increase susceptibility and are generally classified as internalor external to the person.

Internal. Regarding the effects of age, Ooi and colleagues30 found that younger employ-ees reported more SBS symptoms than did older employees. The researchers hypothesizethat this effect could be a result of environmental adaptation and a self-selection processamong older employees who had worked in the building longer. A history of allergy, not sur-prisingly, has been shown to be predictive of SBS symptoms.30 This is an example of why itis so difficult to determine the causes of SBSsymptoms of SBS often match symptoms ofother conditions such as allergic reactions.

Because it is known that females generally report health symptoms more than men do,39 itis not unexpected to learn that this finding carries over into SBS symptom reporting.34 It is not

clear why females report symptoms at higher rates. Some researchers posit that women aresimply more attuned than men to physical symptoms.27 Stenberg and Wall40 reported femalesand males work under unequal physical and psychosocial conditions. Their findings suggestthat the gender differences in SBS symptoms are not the result of reporting behaviors. Moodstates have also been shown to account for differences in symptom reporting between men andwomen.41 One study of SBS in three buildings34 used questions derived from the Profile ofMoods States Questionnaire to measure psychological symptoms such as anxiety, irritability,anger, depression, claustrophobia, tiredness, forgetfulness, and difficulty sleeping or concen-trating, finding that these predicted several SBS symptoms. The authors noted, however, it isarguable whether psychological symptoms are a cause or an effect of SBS.

Personality has been postulated as potentially playing a role in SBS.42 Personality mayact as a modifier between stressful workplace characteristics and SBS outcomes, mediatingthe effects on each individual. Crawford and Bolas,43 in their review of SBS studies investi-gating personality, concluded, the handful of studies in the area are inconclusive. It hasbeen measured using instruments such as the Minnesota Multiphasic Personality Inventory,the Eysenck Personality Inventory, or Ravens Standard Progressive Matrices,44 but theseare general multifactorial inventories of personality, and they may not be specific enough tobe of much use. Measures that are more specific should be included in future research to bet-ter define the possible relationship between personality and SBS symptoms.

Intervening Variable (Perceived Stress)

Job stress has consistently been shown by several studies27,30,34,45 to be predictive of SBSsymptoms. Ooi and Goh27 had subjects rate the climate of cooperation at work on a 10-pointscale ranging from 0 (not stressful) to 10 (extremely stressful). Work-related physical andmental stress were similarly evaluated. A definition of stress was not provided to the respon-dents. Odds ratios calculated for these three measures showed consistent incrementalchanges that the authors concluded were suggestive of a positive doseresponse relationship

55.12 ASSESSING IAQ



13/24

between stress and SBS symptoms. The possibility of interaction between the perception ofstress and several covariates (thermal discomfort, medical condition, noise, lighting, age)was investigated; however, no significant effect modification was found.

In another study investigating the effects of personal and occupational factors on SBSreports,26job stress and job satisfaction were measured using several questions answered on a

5-point rating scale (strongly agree, mostly agree, uncertain, mostly disagree, strongly dis-agree). Six questions making up the job satisfaction scale were adapted from a previously con-structed job satisfaction scale.4 The five items making up the job stress scale were adapted fromseveral sources. Factor analyses were performed on both scales, yielding Cronbachs values of.90 for job satisfaction and .70 for job stress. Both job stress and job satisfaction were signifi-cantly related to the total number of SBS symptoms, in the absence of significant levels of IAQpollutants. Still, the occupational and personal factors investigated in this study only accountedfor 10 percent of the variation in the number of SBS symptoms reported.

Summary of Literature Review

Overall, the literature supports the theory that SBS symptoms are not always related to IAQproblems. Job stress, job satisfaction, job demands, and job control play significant roles inSBS. Gender has clearly been identified as a confounding variable in SBS studies, andresearchers and other SBS investigators must remember to stratify by gender when per-forming analyses.

The instruments used in the studies to date have been quite varied. Many investigatorsrefine their instruments from study to study or adapt the instruments used by others, making it

difficult to compare between studies. An attempt to develop summary statistics for the vari-ables in the studies listed in Table 55.1 proved nearly impossible due to the inconsistencies inthe measurement methodologies used in each study. There is an explicit need to increase theuse of validated measurement instruments such as the ones described in the next section. Doingso will not only improve the validity and reliability of the measures in SBS studies but also willallow for cross-comparisons and pave the road for future meta-analyses.

55.3 INSTRUMENTS AND MEASUREMENT

ISSUES

Problems Found in Existing Studies

Although, as seen in the previous section, several studies of indoor air effects have includedpsychosocial measures, few have explicitly related the selection of variables to a conceptualtheory. Most studies designed with a psychosocial component have not addressed a com-prehensive set of relevant domains. Additionally, Table 55.1 shows that the targeteddomains, as well as their respective measures, have varied greatly.

Use of Theory. A theory-based approach to the investigation of indoor air quality ques-tions provides a framework that guides both the selection of appropriate variables and theexamination of their statistical relationships. A model such as that presented in Figure 55.2allows for the comprehensive inclusion of relevant domains that may have main, modify-ing, or confounding effects on the health outcomes of interest. This enables characteriza-tion of the modifying effects of psychosocial variables in relation to environmentalmeasures of chemical, physical, or biological exposures. It also allows for inclusion ofvariables previously reported to be associated with health outcomes. Additionally, studies




14/24

designed according to a theoretical model avoid redundancy among variables unless it is anaim of the study to develop or validate new measurement instruments.

Some investigations have collected data on several psychosocial variables but have sub-sequently included only one composite index, combining responses for separate measures,in the analyses.36,38 This approach neglects the richness of the data set and masks the influ-

ence of specific components of the index on any observed associations. Thus, the relativeimportance of single domains within the index will not be apparent. For example, social sup-port has been shown to be an important modifier of workplace stressors,46 but this relation-ship is obscured when the values for level of social support are embedded within a summedcomposite index. Thus, the use of composite indexes does not inform decisions regardingpreventive interventions.

Psychometric Properties. To support sound inferences, psychosocial domains should berepresented by measures that meet acceptable levels of validity and reliability. In addition tocontent validity, which indicates the ability of a measure to address its respective domain ofthe conceptual theory, measures should have established face validity, or conceptual clarity,and construct validity, indicating comparability of responses with other measures of thesame constructs. Predictive validity, another desirable property, represents the degree towhich the measure is known to correlate with expected criteria such as anticipated healthoutcomes. Finally, it is desirable to limit random measurement error by ensuring that theinstrument is characterized by two forms of reliability, internal consistency and stabilityover time. Item intercorrelations and test-retest analyses provide the means for assessingthese characteristics.

Several standardized instruments are available for which validity and reliability have

been established. However, a number of investigators have employed measurement tech-niques for psychosocial concepts without reporting their respective psychometric properties.Better ascertainment and documentation of measurement characteristics would strengthenstudies of the indoor environmentstress link. This process, which can take considerableeffort, would constitute a contribution not only to the study at hand but also to future inves-tigations.

Generic Instruments. Most studies that have considered the relationship between job-related stressors and health outcomes have depended on the use of generic measures todescribe levels of job stressors. Examples are the scales typically used to measure work-related control, demands, and social support (i.e., Job Content Questionnaire11). Althoughthese tools can be used to demonstrate general effects of work factors on stress, a limitationis their inability to identify specific work-related stressors. This has been addressed byBaker,47 who pointed to the need to identify specific stressors in developing realistic pre-vention strategies for reducing stress. For example, occupation-specific stress measures,based on job stress models, have been developed by our team and used with worker popu-lations such as childcare, telecommunications, and military workers. The development ofoccupation-specific measures is a complex and iterative process, but it can better helpexplain the variance observed in stress-related health outcomes and thus better guide the

design of effective preventive interventions.

Major Comprehensive Instruments

There has been a proliferation of broad-based comprehensive job stress measures over thepast two decades. A recent issue of the Journal of Occupational Health Psychology wasdevoted to overviews of these instruments3,5 and to in-depth reviews of specific instruments.

55.14 ASSESSING IAQ



15/24

Skill variety, task significance, task identity,

autonomy, feedback

Skill variety, autonomy, feedback, coworker

interaction, task identity, friendships

Interpersonal relationships, orientation toward

personal growth, organizational structure

Occupational role stress; vocational,

psychosocial, and physical strain

Sources of pressure in work environment

Role demands, workload, time pressure,

task demands

Decision latitude, psychological and physical

demands, exposure to physical hazards

Examples: role conflict and ambiguity,

workload, control, cognitive demands

Organizational stress, job risk

Job pressure, organizational support

1 Job Diagnostic

Survey22

2 Job Characteristics

Index62

3 Work Environment

Scale63

4 Occupational

Stress Inventory64

5 Occupational Stress

Indicator65

6 Stress Diagnostic

Survey66

7 Job Content

Questionnaire67

8 Generic Job Stress

Questionnaire68

9 Work Stress Inventory69

10 Job Stress Survey70

PE fit

DC

ER

PE fit

PE fit

PE fit

DC

Transactional

DC

PE fit

Internal motivation

Coping and social sup

Type A behavior, locu

control, coping strateg

Self-esteem

Dom

Instrument/reference Approach5 Work-related stressors Internal modifiers

TABLE 55.2 Measures of Occupational Stress and Examples of the Domains They Represent

Copyright 2001 by The McGraw-Hill Companies Retrieved


16/24

Dom

Instrument/reference Approach5 Work-related stressors Internal modifiers

Workload; relationships at work;

recognition; organization climate; personal

responsibility; managerial role; daily

hassles; homework balance

Conflict with others at work

Constraints on work

Amount of work and work pace

11 Pressure Management

Indicator71

12 Interpersonal Conflict at

Work72

Organizational

Constraints

Quantitative Workload

Inventory

Physical Symptoms

Inventory

Transactional Drive; patience-

impatience; proble

focus; lifework

balance; use of soc

support; control;

personal influence

55.16

TABLE 55.2 Measures of Occupational Stress and Examples of the Domains They Represent (Contin

Copyright 2001 by The McGraw-Hill Companies Retrieved


17/24

Depicted in Table 55.2 are descriptions of 12 multicomponent instruments that are usedmost frequently in the literature. Further descriptions are found in the special issue ofJOHP,in the literature, and on the instrument Websites. As can be seen in Table 55.2, all of theinstruments cover multiple types of work-related stressors. Coverage of other domains isless consistent. Many researchers fill in the gaps in the coverage of domains by using addi-

tional, targeted instruments (e.g., for depression, anxiety).

Selection of an Instrument. When selecting an instrument, there are conceptual, method-ological, and practical issues to consider. As noted in Table 55.2, most of the instruments haveidentifiable conceptual approaches that they represent. The primary conceptual issues are toselect an instrument that represents the framework to be employed and that covers the con-structs that are of interest. Methodological issues include consideration of the psychometricproperties of the instruments (validity, reliability), whether normative data are available thatpertain to worker characteristics of interest (e.g., by gender, race, type of job), the method ofadministration (survey, interview, observation), the reading level of the instrument (is it toohigh or low for the audience?), and the ease of scoring, analyzing, and interpreting the find-ings. Practical issues include cost of the instrument, amount of time to administer it, andwhether additional expertise is needed in the team to be able to use the results.

Perceived Stress. Notably missing in Table 55.2 is a dimension representing perceivedstress. This lack is because most instrument packages measure perceived stressors but notperceived stress (i.e., the feeling of being overwhelmed or unable to garner sufficientresources). A detailed discussion of the measurement of perceived stress has been providedby Monroe and Kelley.48 They conclude that only one instrument is an empirically estab-

lished indexthat falls into the category of general appraisal instruments (p. 138)thePerceived Stress Scale.49 The original version of this instrument included 14 items such as,In the last month, how often have you felt that you were unable to control important thingsin your life? and In the last month, how often have you felt that you were on top of things?Shorter versions of the instrument have also been developed.50

55.4 IMPLEMENTATION ISSUES

Ideally, the IAQstress link would be prevented through management of the physical envi-ronment and/or the psychosocial environment. Realistically, most IAQ specialists, unlessthey are conducting longitudinal research, will be brought into an ongoing situation. It islikely, if the problems have gone on for some time or if there is a poor organizational cli-mate, that emotions and opinions of workers and management may be polarized. Withinsuch a setting, it becomes more difficult to find a resolution that will satisfy all groups, andinterpersonal communication becomes as important as scientific findings. Below, we outlinesome implementation issues that we believe are critical to consider; several of these issueshave been presented in more detail elsewhere.51

Address Concerns in a Timely Manner

Although it may be tempting to take a wait and see attitude when responding to IAQ prob-lems, this is problematic for at least three reasons. First, and foremost, workers health maybe at risk and time may exacerbate health problems. Second, the most important character-istic of an IAQ team is credibility. In the persuasive communications field, source credibil-ity is viewed as essential to most communications settings.52 Credibility is intertwined with




18/24

two related characteristics: knowledgeability and trustworthiness. Even the best of scientists(i.e., those high in knowledgeability) can be compromised by poor trustworthiness. Aprompt response is essential to maintaining the trust of workers, as are other actions that willbe described below. Third, it is difficult, if not impossible, to dismiss accounts of mass psy-chogenic illness (MPI) in the literature on IAQ. A prompt response is more likely to inter-

rupt any potential sequencing of MPI events such as using cues from coworkers to attributevague symptoms to IAQ problems.

Involve Workers from the Beginning

Worker representatives should be involved in the process to the greatest extent possible.There are several reasons for this. First, and most importantly, the imposition of a solutionon a worker group is likely to be viewed negatively and as another violation of trust in theemployeeemployer relationship. When workers are barred from the process, it can lead tothe circulation of rumors and half-truths, which can further undermine confidence in the IAQteam. Second, exclusion of workers sets up an insider versus outsider dynamic that pro-hibits positive interpersonal communications. Third, by not including workers, IAQ spe-cialists are losing a vital source of information. Workers are specialists in providinginformation about how they see the IAQ problem (e.g., is it a matter of high or low con-cern?), the perceived causes for the problem (e.g., ventilation system versus carpeting), theinfluence of the problem on the social environment (e.g., is it causing rifts among groups ofworkers?), and communications needs of workers (what do they want to know, and who dothey want to tell them?).

Some IAQ specialists may believe that if they conduct a session with workers to tell themwhat is happening and why, they have fulfilled their inclusion obligations. We disagree withthis approach, which has been faulted in the risk communication literature.53 There are mul-tiple roles for workers in the inspection of the IAQstress link. First, a small but representa-tive set of workers who have the trust and respect of their colleagues should be part of the coredecision-making team. They can provide valuable insights into the dynamics of the work-place and how different approaches may be perceived by their coworkers. Second, largergroups of workers may be used in key informant interviews, focus groups, or surveysallvaluable tools to gather information on the issues listed above.

Use an Interdisciplinary Team

Although not all IAQ cases will warrant an in-depth response, there are times when the useof an interdisciplinary team may be critical. Cases that involve large groups of workers,highly publicized or politically sensitive issues, or vulnerable populations are candidates foran extensive examination of the IAQstress link. At a minimum, an interdisciplinary teamshould involve specialists in the areas of IAQ, occupational health, occupational stress mea-surement, and risk communication. Each of these disciplines can contribute to multifaceted

examination and reporting of the issues.

Carefully Think Through the Conceptual Approach That Is Used

We have outlined four distinct and one hybrid conceptualizations of occupational stress inthis chapter. The conceptual approach that is used will determine the variables to be mea-sured, the study design, the assumed IAQstress model, and the conclusions that can bedrawn. The IAQ team members should think about the entire scope of the workfrom how

55.18 ASSESSING IAQ



19/24

the problem is framed to the possible solutionsbefore selecting a model. For example,if the demandcontrol model is selected, it would imply the following: (1) Workers per-ceptions of the physical and psychological demands put on them and the amount of controlthat they have over their work would be in the primary areas of inspection (although, newerversions of this approach also include social support; (compare with reference 46). (2) The

model implies that workers with high demands and low control would exhibit the strongestreactions to IAQ problems. (3) Appropriate interventions would include altering the levelsof demands or control or the balance between the two. Each conceptual approach has dis-tinct implications.

Use a Comprehensive Conceptual Approach from the Beginning. We advise IAQ teamsto use a comprehensive approach from the beginning rather than to collect information in afragmented and piecemeal fashion. For example, the NIOSH approach would allow for thecollection of variables that could test an overall model.

Use Psychometrically Sound and Relevant Instruments

Psychometrically sound instruments are those that have high levels of validity and reliabil-ity and that have been developed using standard, accepted methods (compare with reference54). Relevant instruments are those that (1) measure components of the conceptual approachused and (2) are appropriate for the population. Much has been written concerning the selec-tion of psychometrically sound instruments in the occupational stress field, but the issue ofrelevance may be subtler. For example, when exploring the effects of personality as a mod-

erator of stressors on SBS symptoms, some researchers have used extensive personality bat-teries such as the MMPI.33 The problem with this approach is threefold. First, researchershave not justified the use of such a broad-scale instrument with sound, theory-based assess-ments of how and why certain components are important. Second, the length of such instru-ments makes it difficult to adequately cover other important aspects of the conceptualapproach due to respondent fatigue. Third, the items in such batteries may seem overly intru-sive and lacking in face validity to respondents. This, in turn, could threaten the overallacceptance of the entire data collection instrument. A second example of relevance is basedon gender. There is speculation in the field that some instruments or approaches may not besuitable to adequately describe the work that women do.55

Use a Strong Study Design

Most of the studies that we have reviewed involve cross-sectional data. A common limita-tion has been the inability to determine the temporal relationships between exposure to stressorsand symptom outcomes. This is especially important in the study of stress-related conditionsbecause of the possibility that health problems may change the way workers perceive theirenvironment, therefore introducing a bias toward positive findings. Even some case-control

studies have faced the difficulty of ascertaining the timing of symptoms relative to the stres-sor experiences. Although longitudinal studies may be challenging, they may be useful incircumstances where organizational changes are introduced and symptom development, orresolution, can be tracked. Longitudinal designs will be particularly helpful in the evaluationof intervention strategies.

Another feature of previous studies has been the use of internal control groups, often instudies of single buildings that have already been declared problem buildings. Althoughthis design makes it possible to control for many factors that are unique to an organization,it can limit the external validity of the investigation. The ability to generalize findings will




20/24

be enhanced by studying populations most representative of those who experience the stres-sors of interest. These and other issues that lend strength to investigations, such as adequatepower, blinding to exposure or outcome status, control for major confounding variables, andavoidance of measurement error have been discussed by Mendell.56

Use Appropriate Data Collection Techniques

Three primary categories of data collection may be used in stress studiesself-administeredsurveys, interviews, and observations. By far, the most widely used method is the self-administered survey because it is less labor intensive and generally cheaper to conduct. Nomatter which method is used, several aspects of data collection need to be considered. Firstand foremost, worker confidentiality must be maintained. This is true for ethical reasons andto establish and maintain trust within the organization. Second, it is important to get as rep-resentative of a sample as is possible. If all of the worker group cannot be surveyed orobserved, a random sample should be used. Once workers are selected to be in the targetedgroup, reasonable efforts to increase the response rate should be employed (multiple and var-ied contacts) to reduce the effects of selection bias.

Use Sensitivity in Communicating Results

As noted above, workers should be consulted on the communications issue. If they are keptapprised of the results as the study progresses, a crisis at the end of the study can be avoided.

Workers should be assessed for their levels of knowledge on topics that are essential to fullyunderstanding the results (e.g., probability). Efforts should be made to give workers theinformation tools that they need to understand and interpret the findingsthis is essential toallay concerns. In addition, input from workers on what topics they want information aboutand who they want to tell them should be gathered. It may be that members of the IAQ teamhave sufficient credibility that workers will accept hearing the findings from themor, theymay prefer to have a neutral, outside person present the findings.

Special Issues around Null Findings. Logically, we might expect that the dominant emo-tion following negative results would be relief. However, this is not always the case. If neg-ative findings are presented in a situation where there is mistrust and suspicion, they mayraise feelings of hostility and anger in workers. Even within a situation of positive relation-ships, negative findings may lead to feelings of frustration because workers have to searchfor another cause for their symptoms. The IAQ team needs to recognize that negative emo-tions can surface even when things seem positive and that these negative emotions shouldnot be belittled or minimized. Persons who have high levels of symptoms or concerns mayneed individualized attention.

55.5 CONCLUSION

The use of a conceptual framework and psychometrically sound instruments will aid theresearcher and problem solver alike, providing a basis for understanding and measuringworkplace stress and psychosocial factors that may be contributing to IAQ problems. Thereis no doubt that workplace stress and psychosocial factors often play a role in IAQ problems.By addressing these issues in an investigation, IAQ specialists will benefit from a greaterunderstanding of the contributing factors in each unique situation. This will allow for tai-

55.20 ASSESSING IAQ



21/24

lored solutions to be effectively designed and implemented, often leading to quicker andmore complete resolution of the problems. Building residents may be more likely to wel-come sensitive communication of findings based on scientifically sound investigations fol-lowing the guidelines outlined in this chapter.

REFERENCES

1. NIOSH. Stressat work. Publication No. 99-101. Cincinnati, Ohio, National Institute ofOccupational Safety and Health, 1999.

2. Ryan, C. M., and L. A. Morrow, Dysfunctional buildings or dysfunctional people: An examinationof the sick building syndrome and allied disorders.Journal of Consulting and Clinical Psychology1992; 60(2):220224.

3. Hurrell, Jr., J. J., D. L. Nelson, and B. L. Simmons. Measuring job stressors and strains: Where we

have been, where we are, and where we need to go. Journal of Occupational Health Psychology1998; 3(4):368389.

4. Lazarus, R. S. Psychological stress in the workplace.Journal of Social Behavior and Personality1991; 6:113.

5. Vagg, P. R., and C. D. Spielberger. Occupational stress: Measuring job pressure and organizationalsupport in the workplace.Journal of Occupational Health Psychology 1998; 3(4):294305.

6. Caplan, R. D., S. Cobb, J. R. P. French, R. V. Harrison, and S. Pinneau, Jr.Job demands and workerhealth. 1975. Washington, D.C. HEW Publication No. (NIOSH) 75-160.

7. Karasek, R., and T. Theorell, T.Healthy work: Stress, productivity and the reconstruction of work-

ing life. New York: Basic Books, 1990.8. Siegrist, J. Adverse health effects of high-effort/low-reward conditions.Journal of Occupational

Health Psychology 1996; 1:2741.

9. French, J. R. P., and R. L. Kahn. A programmatic approach to studying the industrial environmentand mental health.Journal of Social Issues 1962; 18:147.

10. Conway, T. L., R. R. Vickers, Jr., and J. R. P. French, Jr. An application of the Person-EnvironmentFit Theory: Perceived versus desired control.Journal of Social Issues 1992; 48:95107.

11. Karasek, R., N. Kawakami, C. Brisson, I. Houtman, P. Bongers, and B. Amick. The Job ContentQuestionnaire (JCQ): An instrument for internationally comparative assessments of psychosocial

job characteristics.Journal of Occupational Health Psychology 1998; 3(4):322355.

12. Fletcher, B. C., and F. Jones. A refutation of Karaseks demand-discretion model of occupationalstress with a range of dependent measures.Journal of Organizational Behavior1993; 14:319330.

13. Bosma, H., R. Peter, J. Siegrist, and M. Marmot. Two alternative job stress models and the risk ofcoronary heart disease.American Journal of Public Health 1998; 88:6874.

14. Barnett, R. C., and R. T. Brennan. Change in job conditions and change in psychological distresswithin couples: A study of crossover effects. Womens Health: Research on Gender, Behavior, andPolicy 1998; 4:313339.

15. Lazarus, R. S., and S. Folkman, Stress, appraisal, and coping. New York: Springer Publishing,1984.

16. Curbow, B., and M. Somerfield. Introduction. In: B. Curbow and M. Somerfield, eds. Psychosocialresource variables in cancer studies: Conceptual and measurement issues. New York: HaworthPress, 1995: 19.

17. Thompson, S. C., and M. A. Collins. Applications of perceived control to cancer: An overview oftheory and measurement. In: B. Curbow and M. Somerfield. eds. Psychosocial resource variablesin cancer studies: Conceptual and measurement issues. New York: Haworth Press, 1995: 1126.

18. Hurrell, Jr., J. J. An overview of organizational stress and health. In: Murphy, I. R., Schoenborn, T.F., eds. Stress management in work settings. U.S. Department of Health and Human Services.DHHS (NIOSH) Publication No. 87-111, 1987: 3145.




22/24

19. Boxer, P. A. Indoor air quality: A psychosocial perspective.Journal of Occupational Medicine1990; 32(5):425428.

20. Faust, H., and L. B. Brilliant. Is the diagnosis of mass hysteria an excuse for incomplete investi-gation of low-level environmental contamination? Journal of Occupational Medicine 1981;23(1):2226.

21. Tiwary, R. S., K. S. Baghiana, and P. Sarkar. An epidemic of psychogenic illness in a telephoneexchange building.Indian Journal of Psychiatry 1989; 31(4):341343.

22. IAIAS. Proceedings of the 8th International Conference on Infoor Air Quality and Climate, August8-13, 1999, Edinburgh, Scotland. International Academy of Indoor Air Sciences. London:Construction Research Communications, Ltd., 1999.

23. Guidelines for air quality. 1999. Geneva, World Health Organization. 2-11-2000.

24. Sick building syndrome (SBS). Environmental Protection Agency. 4-7-1998. EPA.

25. Hedge, A. Addressing the psychological aspects of indoor air quality.http://ergo.human.cornell.edu/airquality/iaqslides96/ahpaper.html. 9-23-1996. 2-9-2000.

26. Hedge, A., W. A. Erickson, and G. Rubin. Effects of personal and occupational factors on sickbuilding syndrome reports in air-conditioned offices. In: Quick, J. C., L. R. Murphy, and J. J.Hurrell, eds. Stress and well-being at work: Assessments and interventions for occupational men-tal health. Ann Arbor, Mich.: Braun-Brumfield, Inc., 1992: 286298.

27. Ooi, P. L., and K. T. Goh. Sick building syndrome: An emerging stress-related disorder?International Journal of Epidemiology 1997; 26(6):12431249.

28. Nelson, N. A., J. D. Kaufman, J. Burt, and C. Karr. Health symptoms and the work environment infour nonproblem United States office buildings. Scandinavian Journal of Work, Environment, and

Health 1995; 21:5159.

29. Bardana, E. J., and A. Montanaro. Tight building syndrome.Immunology and Allergy Practice1986; 3(8):7488.

30. Ooi, P. L., K. T. Goh, M. H. Phoon, S. C. Foo, and H. M. Yap. Epidemiology of sick building syn-drome and its associated risk factors in Singapore. Occupational Environmental Medicine 1998;55:188193.

31. Enhanced particle filtration in a non-problem office environment: Summary findings from a dou-ble-blind crossover intervention study. London: Construction Research Communication Ltd., 1999.

32. Construction problems cause numerous air quality complaints in high school addition. London:Construction Research Communication Ltd., 1999.

33. Bauer, R. M., K. W. Greve, E. L. Besch, C. J. Schramke, J. Crouch, A. Hicks, et al. The role of psy-

chosocial factors in the report of building-related symptoms in sick building syndrome.Journal ofConsulting and Clinical Psychology 1992; 60(2):213219.

34. Bachmann, M. O., and J. E. Myers. Influences on sick building syndrome symptoms in three build-ings. Sociology, Science, and Medicine 1995; 40(2):245251.

35. Stenberg, B., N. Eriksson, K. H. Mild, J. Hoog, M. Sandstrom, J. Sundell, et al. Facial skin symp-toms in visual display terminal (VDT) workers. A case-referent study of personal, psychosocial,building- and VDT-related risk indicators. International Journal of Epidemiology 1995;24(4):796803.

36. Norback, D., I. Michel, and J. Widstrom. Indoor air quality and personal factors related to the sick

building syndrome. Scandinavian Journal of Work, Environment, and Health 1990; 16:121128.37. Norback, D., M. Torgen, and C. Edling. Volatile organic compounds, respirable dust, and personal

factors related to prevalence and incidence of sick building syndrome in primary schools. BritishJournal of Industrial Medicine 1990; 47:733741.

38. Stenberg, B., N. Eriksson, J. Hoog, J. Sundell, and S. Wall. The sick building syndrome (SBS) inoffice workers. A case-referent study of personal, psychosocial and building-related risk indicators.

International Journal of Epidemiology 1994; 23(6):11901197.

39. van Wijk, C. M., and A. M. Kolk. Sex differences in physical symptoms: The contribution of symp-tom perception theory. Soc. Sci. Med. 1997; 45(2):231246.

55.22 ASSESSING IAQ



23/24

40. Stenberg, B., and S. Wall. Why do women report sick building symptoms more often than men?Soc. Sci. Med. 1995; 40(4):491502.

41. Gijsbers van Wijk, C. M., H. Huisman, and A. M. Kolk. Gender differences in physical symptomsand illness behavior. A health diary study. Soc. Sci. Med. 1999; 49(8):10611074.

42. Hodgson, M. The sick-building syndrome. Occup. Med. 1995; 10(1):167175.

43. Crawford, J. O., and S. M. Bolas. Sick building syndrome, work factors and occupational stress.Scandinavian Journal of Work, Environment, and Health 1996; 22:243250.

44. Olkinuora, M. Psychogenic epidemics and work. Scandinavian Journal of Work, Environment, andHealth 1984; 10:501504.

45. Convariations among attitude to the indoor air quality, perception of the physical environment,study situation and sensitivity. London: Construction Research Communication Ltd., 1999.

46. Johnson, J. V., and E. M. Hall. Job strain, work place social support, and cardiovascular disease: Across-sectional study of a random sample of the Swedish working population.American Journal ofPublic Health 1988; 78:13361342.

47. Baker, D. B. The study of stress at work.Annu. Rev. Public Health 1985; 6:367381.

48. Monroe, S. M., and J. M. Kelley. Measurement of stress appraisal. In: S. Cohen, R. C. Kessler, andL. U. Gordon, eds.Measuring stress: A guide for health and social scientists. New York: OxfordUniversity Press, 1995: 122147.

49. Cohen, S., T. Kamarck, and R. Mermelstein. A global measure of perceived stress. Journal ofHealth and Social Behavior1983; 24:385396.

50. Cohen, S., and G. M. Williamson. Perceived stress in a probability sample of the United States. In:Spacapan, S., and Oskamp, S., eds. The social psychology of health. Newbury Park, Calif.: Sage,1988: 3167.

51. Curbow, B., M. A. McDiarmid, P. Breysse, and P. S. J. Lees. Investigation of a spontaneous abor-tion cluster: Development of a risk communication plan.American Journal of Industrial Medicine1994; 26:265275.

52. Perloff, R. M. The dynamics of persuasion. Hillsdale, N. J.: Lawrence Erlbaum, 1993.

53. Fischhoff, B. Risk perception and communication unplugges: Twenty years of process. In: T.Tinker, M. T. Pavlova, A. R. Gotsch, and E. B. Arkin, eds. Communicating risk in a changingworld. Solomons Island, MD: The Ramazzini Institute/OEM Press, 1998: 1126.

54. Robinson, J. P., P. R. Shaver, and L. S. Wrightsman. Criteria for scale selection and evaluation. In:J. P. Robinson, P. R. Shaver, and L. S. Wrightsman, eds.Measures of personality and social psy-chological attitudes: volume 1. New York: Academic Press, 1991: 116.

55. Griffin, J. M. M. The effect of job and home strain on symptoms associated with musculoskeletaldisorders and depression. Johns Hopkins University, 1998.

56. Mendell, M. J. Non-specific symptoms in office workers: A review and summary of the epidemio-logic literature.Indoor Air1993; 3:227236.

57. House, R. A., and D. L. Holness. Investigation of factors affecting mass psychogenic illness inemployees in a fish-packing plant.American Journal of Industrial Medicine 1997; 32:9096.

58. Knasko, S. Performance, mood, and health during exposure to intermittent odors. Achieves ofEnvironmental Health 1993; 48(5):305308.

59. Nordstrom, K., D. Norback, and R. Akselsson. Influence of indoor air quality and personal factors

on the sick building syndrome (SBS) in Swedish geriatric hospitals. Occupational andEnvironmental Medicine 1995; 52:170176.

60. Skov, P., O. Valbjorn, and B. V. Pedersen. Influence of personal characteristics, job-related factorsand psychosocial factors on the sick building syndrome. Scandinavian Journal of Work,

Environment, and Health 1989; 15:286295.

61. No relation between indoor climate and other aspects of quality of working life. London:Construction Research Communication, 1999.

62. Sims, Jr., H. P., A. D. Szilagyi, and R. T. Keller. The measurements of job characteristics.Acad.Manage. J. 1976; 19(2):195212.




24/24

63. Insel, P. M., and R. H. Moos. Work environment scale, form R. Palo Alto, Calif., ConsultingPsychologists Press, 1974.

64. Osipow, S. J., and A. R. Spokan. Occupational stress inventory manual: Research version. Odessa,Fla.: Psychological Assessment Resources, 1981.

65. Cooper, C. L., S. G. Sloan, and S. Williams. The occupational stress indicator: Management guide.

Windsor, England: NFER-Nelson, 1988.66. Ivancevich, J. M., and M. T. Matteson.Diagnostic Survey (SDS): Comments and psychometric

properties of a multidimensional self-report inventory. Houston, Tex.: FD Associates, 1976.

67. Karasek, R. Job demands, job decision latitude and mental strain: Implications for job redesign.Administrative Science Quarterly 1979; 24:285308.

68. Hurrell, Jr., J. J., and M. A. McLaney. Exposure to job stressa new psychometric instrument.Scand. J. Work. Environ. Health 1988; 14 Suppl 1:2728.

69. Barone, D. F., G. R. Caddy, A. D. Datell, R. B. Roselione, and R. A. Hamilton. The work stressinventory.Educational and Psychological Measurement1988; 48:141154.

70. Spielberger, C. D. Preliminary professional manual for the job stress survey (JSS). Odessa, Fla.:Psychological Assessment Resources, 1986.

71. Williams, S., and C. L. Cooper. Measuring occupational stress: Development of the pressure man-agement indicator.Journal of Occupational Health Psychology 1998; 3(4):306321.

72. Spector, P. E., and S. M. Jex. Development of four self-report measures of job stressors and strain:Interpersonal conflict at work scale, organizational constraints scale, quantitative workload inven-tory, and physical symptoms inventory. Journal of Occupational Health Psychology 1998;3(4):356367.

55.24 ASSESSING IAQ

Documents

55. Methods to Assess Workplace Stress and Psychosocial Factors