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The HEALTH INEQUALITIES between populations of higher versus lower socioeconomic position (SEP) are substantial. Poor working conditions and unhealthy lifestyles contribute to the disease burden, and are more prevalent in low SEP groups than in higher SEP groups.



Poor working conditions and unhealthy lifestyles are independent determinants of the poorer health status in low SEP workers, but they likely also interact. Particular working conditions, which are prevalent in low SEP workers, may prompt unhealthy lifestyles. For example, a high physical workload or a high work pressure is associated with smoking and excessive alcohol consumption. Knowledge on their interplay and how they explain the adverse health effects in low SEP workers is however lacking.


The OBJECTIVE of this project is to get insight into the interplay between specific and combined working conditions and lifestyle factors, and the role of lifestyle in the adverse health effects of poor working conditions in low SEP workers and low SEP workers with a chronic disease.


More specifically, the following RESEARCH QUESTIONS have been formulated:

1. What is the effect of poor working conditions (i.e. physical and psychosocial working conditions) on lifestyle behaviors among low SEP workers and low SEP workers with a chronic disease?

2. Which subgroups (moderators) can be identified based on unhealthy lifestyle behaviors that have an increased effect of poor working conditions on health (i.e. perceived general, physical and mental health)?

3. What is the mediating role of unhealthy lifestyle behaviors in the adverse health effect of poor working conditions among low SEP workers and low SEP workers with a chronic disease?


The STUDY POPULATION consists of workers with a LOW SEP, here defined by low educational level. In addition, the study population consists of low SEP workers with one or more of the following CHRONIC DISEASES: diabetes type 2, cardiovascular diseases, lung diseases, depression, and back disorders. These diseases are particularly prevalent among low SEP workers, have a high disease burden, and are related to poor working conditions.


The project consists of LONGITUDINAL DATA ANALYSES in 5 large cohort studies. We apply a longitudinal design, and perform analyses on existing datasets: GLOBE, DCS, Lifelines, PME Construction Industry, and SHARE. The cohort studies are clearly complementary and each has its own strength:

- GLOBE: focus on socioeconomic health inequalities, long follow-up

- DCS: extensive and objective measurements of lifestyle behaviors, long follow-up and extensive information on shift work

- Lifelines: large numbers, heterogeneous low SEP worker population

- PME construction: workers in the construction industry

- SHARE: older workers aged 50+ years from 27 European countries


The project distinguishes 4 STUDIES:

Study 1 consists of statistical analyses (Mixed Models) to answer research question 1. Pooling of the results (meta-analysis) will identify the working conditions and lifestyle factors of significance to be studied in study 2 and 3.

Study 2 consists of longitudinal data analyses using additive interaction effects (RERI terms) to answer research question 2.

Study 3 consists of mediation analyses by means of the counterfactual framework to answer research question 3.

Study 4 is aimed at the dissemination of the findings from study 1-3.



Study 1 will give insight into which physical and psychosocial working conditions are related to which unhealthy lifestyles in low SEP workers, and whether this is different for low SEP workers with a chronic disease.

Study 2 will identify subgroups of low SEP workers based on unhealthy lifestyle behaviors, who have an increased adverse health effect of poor working conditions.

Study 3 will yield input to determine to what extent and which unhealthy lifestyles mediate the health effect of poor working conditions.

Study 4 will enhance successful dissemination of the results to all relevant stakeholders.



The results will be summarized and presented in various ways to reach all relevant stakeholders, including workers with a low SEP, employers, trade organizations, occupational health professionals, policy makers, and scientists. A variety of dissemination activities and products will be delivered, such as an accessible summary of the findings (e.g. infographic and factsheet), scientific papers, an article in a national professional journal, presentation on websites, conferences, and newsletter of Volandis.


Moreover, the results will form input for policy measures to promote health among lower SEP workers, and low SEP workers with a chronic disease. We will formulate to what extent policy should be focused on a single factor (i.e. either a specific working condition or lifestyle), or on both thus implying integral policy.


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