NIOSH publication says stress is greater health threat than ever’

Job conditions may be more significant than individual employee problems

In a new publication based on the latest research and in collaboration with industries, labor, and universities, the CDC’s National Institute for Occupational Safety and Health (NIOSH) in Cincinnati says, "Perhaps now more than ever before, job stress poses a threat to the health of workers."

The publication, Stress . . . At Work, makes these additional, thought-provoking assertions:

• While the role of individual factors should not be ignored, working conditions play a primary role in causing job stress, and job redesign should be a key strategy in combating stress.

• The beneficial effects of stress management are often short-lived, and stress management programs often ignore important root causes of stress because they focus on the worker and not on the environment.

"Research and experience tell us that certain factors such as heavy workload, conflicting or uncertain job responsibilities, and job insecurity are stressors across organizations. The risk for job stress can be reduced through smart, strategic action," notes NIOSH director Linda Rosenstock, MD, MPH.

Publication called a significant step’

Wellness experts find significance in the fact NIOSH has gone the lengths it has to produce such a publication.

"This will lend more credence to workers’ comp claims that have been and will be filed," notes Lewis Schiffman, president of Atlanta Health Systems, a wellness consulting firm. "In addition, health promotion professionals have been talking about stress and health for years, and when the government finally acknowledges a problem, it’s usually because it’s become blatantly obvious that it needs to be addressed. It’s beyond being a controversial or debatable topic — it’s acknowledging the reality of what is."

"The advantage of this publication is that it draws greater attention to stress at the workplace — which really ebbs and flows in terms of people’s concerns," adds Don R. Powell, PhD, president of the American Institute for Preventive Medicine, in Farmington Hills, MI. "Credible organizations like NIOSH give the issue more weight."

"It’s also of value as further evidence for what many of us are already doing, and to hopefully get top management to pay more attention to this as a strategic business issue," adds Schiffman.

How important are working conditions?

But what of the book’s primary assertions? Are working conditions more significant than the individual emotional state of the employee, and the way in which he or she reacts to stressful situations? In other words, as the book asserts, are certain working conditions universally stressful?

"I would say there is probably some truth to that, although NIOSH is doing something new in terms of expressing it just that way," says Schiffman. "For years, organizational development specialists have discussed how supervisory style, for example, affects productivity, performance, and shapes the corporate culture or work environment.

"If you put employees in an environment where they are unsure of their roles and expectations; where one person is often doing the job of two or three; where they’re not getting a lot of appreciation for their contribution; where they don’t feel empowered to make decisions or influence company policy; where there is often poor lighting, poor air quality, uncomfortable seating, and lack of availability of healthy nutritional options, most people will feel the subjective effects of stress," he continues. "Couple this with the fact that three-quarters of the population are not stress-hardy because they don’t exercise, that more than half of them are overweight, and that most are ingesting too much caffeine, sugar, and alcohol. It’s a wonder that more people aren’t on Prozac or engaging in violence or sabotage in the workplace."

Despite that, Schiffman wouldn’t definitively agree working conditions play a greater role in creating stress. "But they’re at least of equal weight," he acknowledges.

If individual employee problems were the primary cause of stress, then stress management programming might be a "cure-all" for what ails them. But, as the NIOSH publication points out, stress management programs have major disadvantages. Thus, NIOSH recommends a combination of organizational change and stress management to combat the effects of stress in the workplace.

"A two-pronged approach is definitely the best way," says Powell. "Many companies put a Band-Aid on the problem with stress management, relaxation techniques, time management, and cognitive coping skills. NIOSH is focusing also on organizational change; you have to look at corporate culture at the same time, or in a sense you’re dealing with only half the problem."

Powell counsels caution, however, when considering NIOSH’s recommendations. "Given their mandate, they certainly would be looking at organizational change," he notes. "OSHA, for example, studies workplace safety, looking not just at the person but the whole environment. I kind of think NIOSH is in the same realm."

Changes in corporate culture

Still, Schiffman says, the focus on corporate culture is not without merit. "If you have a hostile work environment, the best stress management program in the world won’t cure your problems. The results of that kind of approach are very short-lived because the root problems don’t go away," he notes. "Eventually, when people realize that things aren’t going to change, they lose the incentive to use the healthy coping skills and instead find it more attractive to drink, eat chocolate, complain, think about finding another job, and begin thinking, How can I do as little as possible so I can minimize the time I have to spend here?’"

But, says Powell, the "ABCDE" (antecedent, belief, consequence, dispute, effect) model of human behavior illustrates an individual’s response can make a difference. "In traditional thought, antecedent produces consequence," he explains. "But it’s not necessarily the overbearing boss (antecedent), but the belief — what the employee says to himself — that causes the stress. If he feels bad about himself, there will be stress. If his response is dispute,’ that he’s doing the best he can, and views it as the boss’ problem, the new effect is less of a stress response."

The problem with the two-pronged approach is that true cultural change, or job redesign, is extremely difficult to accomplish. While the NIOSH publication offers two or three examples of such changes, both Powell and Schiffman believe these are the exception rather than the rule.

"From a practical standpoint, most organizations do not want to change their culture, and therefore would tend to focus on stress management," says Powell. "My guess is that 75%-80% would opt for stress management, while 20%-25% would be willing to look at organizational change."

"That’s a great idea [to change the corporate culture], but I think most organizations would find that very threatening," adds Schiffman. "It would entail going to a more participatory style of leadership, hiring more people, and acknowledging that unreasonable demands have been made on employees."

Even if widespread changes in corporate culture or job redesign are not possible, there are still strategies wellness professionals can implement to augment stress management and other educational programs.

"Invite employees to become more actively involved in problem solving, which makes total sense since they are the ones closest to the problems," Schiffman suggests. "This also enables them to use their creativity, which will cause them to find work more stimulating and satisfying. You should also promote more social interaction and team development activities, so that people feel more of a sense of interconnectedness."

"You could set up a relaxation room’ and give employees an opportunity to relax during break periods," adds Powell. "Examine the colors on the office walls — the cool colors, like blues and greens, tend to be more soothing than oranges and yellows. Also, think about introducing soothing music and lighting."

The marketplace may actually force some reluctant employers to consider cultural changes, says Schiffman. "As the war for talent continues, it will become necessary for employers to create a more desirable work environment," he asserts.

But radical cultural change can be extremely time-consuming, he admits. "What may be even more time-efficient would be an annual employee satisfaction survey and a heath improvement team or quality of life/work team to be composed of informal employee leaders, the wellness and human resource professionals, and a front line supervisor," he suggests. "This team would monitor potentially stressful conditions and make recommendations to top management on how to address them." (For more of NIOSH’s findings on the cause, cure, and prevention of stress, see the checklists on p. 38.)

[Editor’s note: Copies of Stress . . . At Work and other NIOSH publications are available from: Publications Dissemination, EID, National Institute for Occupational Safety and Health, 4676 Columbia Parkway, Cincinnati, OH 45226-1998. Telephone: (800) 35-NIOSH. Web site:]


Lewis Schiffman, Atlanta Health Systems, 2516 Wowona Drive, Atlanta, GA 30319. Telephone: (404) 636-9437.

Don R. Powell, American Institute for Preventive Medicine, 30445 Northwestern Highway, Suite 350, Farmington Hills, MI 48344. Telephone: (248) 539-1800.