Intervening for Work Stress: Work-life Stress and Total Worker Health Approaches

Posted on by Daniel Ganster, PhD and Leslie Hammer, PhD with Jessica Streit, MS; Michelle Lee, BA; Naomi Swanson, PhD; Heidi Hudson, MPH; and Jeannie Nigam, MS


The NIOSH Office for Total Worker HealthTM recently launched a series of posts discussing total worker health (TWH) issues on the NIOSH Science Blog. As part of this series, we will summarize select TWH webinars and allow those who couldn’t participate in the original broadcast an opportunity to correspond with the presenters. Below you will find our first webinar summary.

On August 19, 2014, the NIOSH Office for Total Worker HealthTM and the NIOSH Work Organization and Stress-Related Disorders Research Program co-hosted Dr. Dan Ganster (Senior Associate Dean for Administration for the College of Business at Colorado State University) and Dr. Leslie Hammer (Professor of Industrial/Organizational Psychology and Director of the Occupational Health Psychology program at Portland State University and Associate Director of the NIOSH-funded Oregon Healthy Workforce Center) in a special presentation of the NIOSH Total Worker HealthTM Webinar Series that discussed workplace stress and work-stress interventions.

We provide a brief summary of the 90-minute webinar in this blog, but encourage you to access the archived recording for the full presentation, presentation slides, and free continuing education opportunities. Click here to access the archived recording Intervening for Work Stress: Work-life Stress and Total Worker Health Approaches.  A summary of the presentations by Dr. Dan Ganster and Dr. Leslie Hammer follows. At the end of the summary we have included Qs &As from the webinar and invite new questions via the comment section below.

Webinar Summary: Intervening for Work Stress- Work-life Stress and Total Worker Health Approaches

Data from the British Whitehall II study suggest an inverse social gradient for health — workers in lower-level jobs are at higher risks of morbidity and mortality, regardless of other health-related personal factors such as age.[i] However, when researchers limit their comparisons to groups of workers in jobs with similar exposures to physical hazards(such as noise levels, sedentary work, etc.), discrepancies in mortality risk by occupation still emerge. In one U.S. study, judges, lawyers, physicians, insurance agents, and real estate brokers were all twice as likely to die from atherosclerotic heart disease as individuals who were, for instance, college presidents or teachers.[ii]

What is it about certain jobs that might cause these mortality rate differences?

One word: stress.

Stress is a major occupational risk that must be addressed. A 2013 Towers Watson survey identifies stress as the number one workforce health issue, ranking above physical inactivity and obesity.[iii] Dr. Ganster identifies and discusses a number of key stressors, including low employee control over work tasks, role ambiguity, low job security, and worksite bullying. These stressors have been associated with unhealthy behaviors such as low physical activity, smoking, and alcohol use, which can impact chronic disease risk.

But how can we intervene on stress? Researchers and practitioners have generally taken one of two approaches to tackle this question: 1) an approach that attempts to provide coping tools to workers who are currently experiencing duress, or 2) an approach that changes workers’ exposures to stressors by changing the work experience. The first approach, while popular, is reactive to the issue and does not address the root cause of the stress. The second, preventive approach can have a bigger impact on health. You’ll want to listen to the webinar to hear Dr. Ganster’s discussion of these intervention approaches.

One important job stress topic for many workers in today’s dual-earner household society is work-life stress (often conceptualized as work-family balance). As discussed by Dr. Hammer, work-life stress is related to many unhealthy behaviors, including fast food consumption, inadequate sleep, smoking, alcohol use, low physical activity levels, and reduced use of health care services[iv]. Work-life stress is also implicated in numerous adverse job-related outcomes, including decreases in job satisfaction, commitment, performance, and safety and increases in absenteeism and turnover rates.[v]

In recent years, NIOSH has advocated for a Total Worker HealthTM research approach, which investigates worker health as a 24/7 construct. The key to achieving total worker health is the prevention of adverse job-related health conditions such as stress. Interventions are a key component to preventing work-life stress and facilitating a balance between work life and personal life responsibilities. Key levers include increasing job control[i] and enhancing workplace social support—especially from supervisors.[ii][iii][iv][v]. Dr. Hammer describes intervention tools she and her constituents have created and made available through the Work, Family, and Health Network (, the largest-ever national effort to intervene on work-life stress at the organizational level.


Webinar Qs and As

The session generated a robust question-and-answer session that we hope to continue on this blog. Attendees voiced a number of great questions, including those listed below. Please add your questions by using the comment section at the end of the blog.

Q: Given the TWH focus – does either presenter have any thoughts on how stress impact safety and productivity

A (Dr. Ganster): The evidence is strong that work stress has an impact on safety. This can happen through fatigue effects and also through increased pressure to perform (a kind of stressor). I’ll let Leslie elaborate further on this question.

A (Dr. Hammer): Stress can impact safety through several mechanisms. The first is by using up resources that could be allocated towards focusing on safety, but instead are allocated towards dealing with the stressor. I have conducted research (Cullen & Hammer, 2007, Journal of Occupational Health Psychology) that shows a strong relationship between the experience of family-to-work conflict (a stressor) and safety compliance, for example. Additionally, stress can impact safety through negative coping. For example, stress may lead to drinking that may then impact safety.

What I argue for is a primary prevention approach, as opposed to a tertiary approach (fixing the person). We are investigating many ways that workplaces can change the environment through things like supervisory training to be more supportive of workers, or changing the job to provide more control to the worker, that in turn will decrease stress and in turn improve safety.

Q: Could job control be correlative yet not causative, i.e., stronger people tend to command greater control of their environments

A (Dr. Ganster): It is very likely that some traits (e.g., locus of control) have some influence over how much individuals take control over their work environment. Because much of the research on job control is non-experimental, we cannot rule out such effects. However, there are experimental interventions that are shown to increase employee perceptions of control, and these have some positive outcomes for both employees and the organizations.

Q: How do you get organizational commitment and support for allowing supervisory support? Can you comment on cognitive biases against introspection of managerial and supervisory contributions to stress?

A (Dr. Ganster): I don’t think it is a hard sell to organizations that their supervisors should be supportive. But one needs to specify what is meant by support. Being a supportive supervisor should not be equated with putting no emphasis on employee performance; that is, being lenient and unconcerned about employee performance. In the research literature supervisory support is generally categorized as emotional and instrumental. In the former type, supportive supervisors are good listeners and show concern for the well-being of their employees. In the latter, supportive supervisors help employees problem-solve difficult challenges on their job and help ensure that employees have the necessary knowledge and resources in order to perform effectively. Both types of support should be encouraged in supervisors.

As for introspection biases, I don’t think there is a strong case for attributing the observed relationships between social support and well-being on some self-report biases on the part of the employees. There is simply an abundance of evidence, suing various methodologies, that argues for the beneficial impact of supportive supervisors.

Q: 1/3 of Americans are obese: Obesity-related conditions include heart disease, stroke, type 2 diabetes and certain types of cancer, some of the leading causes of preventable death.   When you think about the average office worker and the amount of time they sit at desks you wonder how that is tied in with all of this. Would it be a beneficial thing to recommend desks that are adjustable and can allow the employee to stand throughout the day etc.

A (Dr. Ganster): A case is being made for the thinking of sitting as the new smoking. I’d love to have the opportunity to conduct a controlled study on both standing desks and treadmills. In the meantime, I currently use an adjustable standing desk with a treadmill in front of it.

A (Dr. Hammer): Absolutely! There is much work currently being done on the severe negative health effects of sitting and a number of recommendations are emerging. Standing desks are one of them. Ensuring that one stands up and walks around at least every 45 minutes is also very important. This may ultimately change the way that office work is done and we may eventually see more and more standing or walking meetings, for example.

Q: In a 2012 study published in Lancet, many of those who have led the research on Job Strain (Kivimaki, Theorell, Marmot) over the last 30 years seemed to back pedal from their previous findings, claiming that the level of risk related to job strain –.based on major meta-analysis of previous studies — was , based on this fuller analysis, low (3-4%), and that employers would be better off focusing on “standard risk factors,” such as smoking. Thoughts?

A (Dr. Ganster): This is a tricky issue. For one, the data are pretty strong relating high job strain (high demands and low control) with physical health outcomes, including cardiovascular health. Some studies show a weaker (but generally still significant effect) of job strain after controlling for such risk factors as waist-hip ratio, blood cholesterol, resting blood pressure, etc. But the problem with controlling for such “risk factors” is that job strain can be a causal factor in affecting those same risk factors. To the extent that high job strain leads to increased smoking, higher blood pressure, more depression, more cortisol release, and higher waist-hip ratios, and these “risk factors, in turn, are predictive of cardiovascular health, then statistically controlling for the risk factors underestimates the total causal effect of job strain. We would expect job stressors to have their impact on cardiovascular health through their effects on such intervening risk factors, including health-related behaviors. We delve into this question in depth in a recent review article: Ganster, D.C. & Rosen (2013). Work Stress and Employee Health: A Multidisciplinary Review, Journal of Management, 39, 1085-1122.

More Questions?

What do you still want to know about Intervening for Work Stress?  Comment below by December 11 for an opportunity to have your question answered by Dr. Hammer, Dr. Ganster, and NIOSH’s own workplace stress experts.


Daniel Ganster, PhD and Leslie Hammer, PhD

NIOSH Contributors:  Jessica Streit, MS; Michelle Lee, BA; Naomi Swanson, PhD; Heidi Hudson, MPH; and Jeannie Nigam, MS


[i] Marmot, M.G. & Shipley M.J.. (1996). Do socioeconomic differences in mortality persist after retirement? 25 year follow up of civil servants from the first Whitehall study. British Medical Journal, 313(7066): 1177-1180.

[ii] Kasl, S.V. (1984). Stress and health. In L. Breslow, J.E. Fielding, & L.B. Lane (Eds.) Annual Review of Public Health, 5:319-342.

[iii] 2013/2014 Staying@Work Report. Towers Watson.

[iv] Hammer, L.B., & Sauter, S. (2013). Total worker health and work-life stress. Journal of Occupational and Environmental Medicine, 55, S25-S29.

[v] Amstad, F. T., Meier, L. L., Fasel, U., Elfering, A., & Semmer, N. K. (2011). A meta-analysis of work–family conflict and various outcomes with a special emphasis on cross-domain versus matching-domain relations. Journal of Occupational Health Psychology16, 151-169. doi:10.1037/a0022170

[vi] Kelly, E.L. & Moen, P. (2007). Rethinking the ClockWork of Work: Why Schedule Control May Pay Off at Work and at Home. Advances in Developing Human Resources. 9: 487-309.

[vii] Hammer, L.B., Kossek, E.E., Zimmerman, K., & Daniels, R. (2007). Clarifying the construct of family supportive supervisory behaviors: A multilevel perspective. Research in Occupational Stress and Well-Being. 6:171–211.

[vii Hammer, L. B., Kossek, E. E., Yragui, N., Bodner, T.,, & Hanson, G.C. (2009). “Development and Validation of a Multidimensional Measure of Family Supportive Supervisor Behaviors (FSSB).” Journal of Management 35:837–56.

[ix] Hammer, L. B., Kossek E., Anger, W. K., Bodner, T., & Zimmerman, K. L. (2011).Clarifying Work-Family Intervention Processes: The Roles of Work-Family Conflict and Family Supportive Supervisors. The Journal of applied psychology. 96(1); 134-150

[x]Kossek, E., Pichler, S., Bodner, T. & Hammer, L.  2011. Workplace social support and work-family conflict: A meta-analysis clarifying the influence of general and work-family specific supervisor and organizational support,   Personnel Psychology, 64: 289-313.

Posted on by Daniel Ganster, PhD and Leslie Hammer, PhD with Jessica Streit, MS; Michelle Lee, BA; Naomi Swanson, PhD; Heidi Hudson, MPH; and Jeannie Nigam, MS

9 comments on “Intervening for Work Stress: Work-life Stress and Total Worker Health Approaches”

Comments listed below are posted by individuals not associated with CDC, unless otherwise stated. These comments do not represent the official views of CDC, and CDC does not guarantee that any information posted by individuals on this site is correct, and disclaims any liability for any loss or damage resulting from reliance on any such information. Read more about our comment policy ».

    Apparently the speakers weren’t aware that there is a Cochrane systematic review currently very near to publication that is titled: “Workplace interventions for reducing sitting at work”. We hope to publish it before Christmas. Here is a link to the protocol:

    Regarding stress, I heartily recommend everybody to check out our recently published Cochrane review update titled: “Preventing occupational stress in healthcare workers”. Access the full review via this link:

    Dr. Ruotsalainen,

    Thank you very much for sharing these exciting new developments by the Cochrane Collaboration.

    We look forward to the release of the review of interventions to reduce sitting time at work —it will certainly make a valuable contribution to the scientific discussion of this popular topic.

    We concur with the conclusions of the currently-available Cochrane review of stress interventions for healthcare workers. It is important that organization-level stress prevention efforts are designed to target specific job stressors. Additional investigations of such focused stress prevention programs will contribute greatly to the stress research field.

    We recognize, however, that stress prevention efforts are difficult to undertake. We hope our readers will share their personal experiences (both positive and negative) in applying this organizational approach in research or in practice.

    Reducing stress originating at work is the responsibility of the employer. However, educating the family about how work may potentially affect the employee and their families outside of work may help employees implement strategies to reduce family-to-work stress (e.g., through more support from home).
    Further, employers can implement policies and programs (e.g., reasonable limits and advance notice of schedule changes, equitable rewards and advancement opportunities, flexibility, caregiving resources, and concierge benefits) that can help facilitate work-life management.

    Very interesting piece!! Stress is a normal response to difficult situations. We often confuse it as some form of mental pressure caused due to our own inability to deal with things. But that’s not what it is. Stress is not an action, it’s a reaction. Stress is our reaction to various external factors.

    Before we get to the whole coping part, first we need to understand a few things about stress that are essential.
    According to me Stress is not always bad.

    Stress is the body’s way of reacting to a challenge. When faced with a tough situation, there are a whole lot of reactions that the body goes through. Increased pulse rate, adrenaline boost, faster response to stimuli and among those, stress is one.

    But the same stress that ‘stresses us out’, also makes us quicker and more prone to handle situations better. Stress makes us do our best. So it isn’t always a bad thing.


    Thank you for your comment. You make a good point and the terminology is the important thing here. The NIOSH position has always been that stress and challenge are not necessarily the same things. Challenge isn’t just a little stress or “positive” stress. Occupational stress is the negative reaction to stressors in the workplace. It isn’t the “revved up” feeling (challenge) that you get when you are problem-solving or engaging with an issue that you are excited about tackling. We appreciate you calling attention to this distinction.

    Is there any legislation in the US for work related stress? What are the legal requirements for Employers?

    The United States does not have any legislation specific to work-related stress. However, many labor laws are relevant to preventing stress in the workplace. Examples include the Occupational Safety and Health Act of 1970 [General Duty Clause], Fair Labor Standards Act, many civil rights laws (e.g., Civil Rights Act [Title VII]; Age Discrimination in Employment Act, Americans with Disabilities Act), and workers’ compensation laws.

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