Shannon Griffin-Blake, PhD Northrop Grumman Mariela Alarcon-Yohe, MPH

1. Blue collar women and job stress: Recommendations for improving their health-related quality of life Shannon Griffin-Blake, PhD Northrop Grumman Mariela Alarcon-Yohe, MPH Directors of Health Promotion & Education Leandris Liburd, PhD, MPH Centers for Disease Control & Prevention

2. Background Blue Collar Workers • Hourly, non-office employees (e.g., factory workers, construction, janitorial/cleaning staff, restaurant workers) • 42% of U.S. workforce when adding all hourly blue collar/service occupations • Hallmarks of blue collar work: restricted job autonomy, limited decisional latitude, lack of co-worker support

3. Background Women in the Workforce • 46% of 137 million workers in U.S. • In 2005, 35% of traditional blue collar jobs held by female workers • Twice as likely to suffer from stress-related illness than male counterparts • Health issues caused by job stress: coronary heart disease, smoking, alcohol consumption, depression, musculoskeletal disorders

4. Purpose The objectives for this investigation were two-fold: • To gather information for use by employers and health agencies about the sources and effects of job stress among female, blue collar workers; • To offer recommendations for future occupational and health promotion efforts for this working subpopulation.

5. Methods To explore the sources and effects of job stress among female, blue collar workers, the U.S. Centers for Disease Control and Prevention (CDC) contracted with the Directors of Health Promotion and Education (DHPE) to conduct focus groups with blue collar women throughout 5 geographical areas within the United States. 1. Bloomfield, CT 2. Decatur, GA 3. Fresno, CA 4. Jackson, MS 5. Madison, WI

6. Methods • Community-based organizations (CBOs) in five different states conducted 2 focus groups • Participants recruited using sampling criteria • 7-9 participants in each focus group (n = 79) • Informed consent forms and participant profile questionnaires read aloud and competed prior to commencement of all focus groups • Trained moderator & notetaker followed facilitator’s guide • $50 enabler provided

7. Select Participant Characteristics • 53% were between the ages of 31 – 50 years • 37% were married • 67% had high school degree or some college • 47% were African American • 41% were clerical workers • 44% had an income below $25,000

8. Select ParticipantHealth-related Quality of LifeCharacteristics • 82% reported their health to be ‘good’ to ‘very good’ • 44% felt physically healthy daily in the last month • 29% felt mentally healthy daily in the last month • 9% felt that they got rest/enough sleep each night in the last month • 51% felt sad, blue, or depressed 3 or more days in the last month • 69% felt worried, tense, or anxious 3 or more days in the last month

9. Participants’ Health Status • 64% are overweight or obese (BMI) • 38% are current smokers • 50% smoke daily • 56% consume alcohol on monthly basis • 46% consume 3 or more drinks per occasion • 23% drink 6 or more per occasion

10. Findings Health Impact: • Participants linked work stress to insomnia, psychosomatic complaints, and disease conditions (e.g., high blood pressure, diabetes) they believed were caused by or worsened by stressful work conditions. “for me, in the workplace, I have gotten migraines. I have really bad migraines, from all the stress.” “…cause basically for my health I just found out that I have diabetes and I felt like on the job stress helped contribute to it.”

11. Findings Health Impact: • Stressful work conditions created anxiety, mental fatigue, and anger. “You have a stress level that is very high and you can take a lot of things. But some of us in general, it doesn’t take anything but the straw that broke the camels back. I felt it out in my van…I had an anxiety attack. My arms were hurting. Before I knew anything I had the ambulance coming to take me to the hospital…those types of stressors we are not aware of.” “…you are grumpy, you are short tempered, you tend to close yourself off.”

12. Findings Work Culture: • Women felt devalued when their contributions were not acknowledged and incompetent when they could not meet work expectations. These feelings exacerbated their sense of powerlessness. “You are not in charge, they [managers] don’t care…it makes you feel bad. Like I said, they don’t respect your opinion, you’re there getting paid and that’s it. Your opinions do not count.” • Participants reported that they had to maintain a professional demeanor despite verbal abuse from customers. “We deal with a lot of people with all these different attitudes. You try to tell them something and they get smart. You have to bite your mouth to keep from saying anything so it’s really stressful to me.”

13. Findings Work Culture: • Workers did not feel free to communicate openly with supervisors or make independent decisions. “No control because you’re not a manager, you’re not a boss, you’re just another employee-- you have no control. Regardless--if you want the job, you have to do what you are told basically. That makes it very stressful.” • Supervisors imposed heavy workloads or accelerated schedules that exceeded the ability of individuals to control the demand. “Trying to get everything done within our schedule especially in the mornings [makes me most stressed at work]… It’s just kind of from one thing to the next and I don’t have time to breathe. “

14. Findings Family & Work Balance: • Stress from work was often displaced or misdirected towards family members, which in turn not only made participants feel guilty, but created stressful situations at home. “You are going to find that a lot of what happens to you at work will spill over into your relationships at home, church, and with your friends. I just suppose you cannot help it. You try not to bring it home, but at times it’s hard not to…“ “It’s just a lot of unnecessary arguing…it’ll really have nothing to do with him [my husband]. It’s me. But it makes me, at that point, feel better because I am able to get something out.”

15. Findings Family & Work Balance: • The cyclical interplay of work-home stress created even more stress in the workplace. “Because you have a [job] responsibility, and you also have responsibility at home, and you feel the pressures that you have to do a good job to keep a job because you need a job. You have to provide, you’re contributing to have a home, to pay for a car, to feed the children, so you want to do a very good job so you can maintain a job.”

16. Recommendations Employers should… • Allow greater employee involvement in job negotiations (e.g., workload, schedule) • Increase access to learning opportunities and general support services for employees (e.g., skills training, computer class, financial counseling) • Develop and support work policies that: • Recognize family obligations (e.g., flexible work arrangements) • Promote healthy behaviors (no smoking policy, healthy food menu at workplace cafeteria, on-site screenings and vaccinations)

17. Recommendations Employers should sponsor and implement worksite health promotion programs that… • Include Employee Assistance Program (EAP) (e.g., substance abuse treatment) • Encompass on-site health education classes for employees and their families • Stress management and relaxation • Healthy coping strategies (e.g., healthy eating, physical activity, anger management) • Negative health behaviors (e.g., smoking, alcohol abuse, overeating) • Administer regular health assessments and screenings • Encourage support groups among female employees

18. Recommendations Employees should… • Seek opportunities for advancing their education and personal skill development • Be open to and supportive of informal & formal modes of communication within the workplace • Organize employee action team to review workers’ health needs and work environment • Request access to worksite health promotion programs • Regularly participate in health promotion classes and health screenings • Encourage family members’ participation in worksite health promotion programs • Recognize the negative affects of job stress on personal behaviors (e.g., smoking, drinking, withdrawal from others) • Seek positive coping strategies for job stress

19. Limitations Sample • Possible selection bias due to voluntary participation • Small sample size Findings • Relied on self-report data • Cannot generalize to other blue collar or working populations

20. Contact Information Shannon Griffin-Blake, PhD dyu9@cdc.gov Mariela Alarcon-Yohe, MPH malarcon@dhpe.org Leandris Liburd, PhD, MPH lcliburd@cdc.gov