A retrospective cohort study of shift work and risk of cancer-specific mortality in German male chemical workers

Objectives

Human evidence of carcinogenicity concerning shift work is inconsistent. In a previous study, we observed no elevated risk of total mortality in shift workers followed up until the end of 2006. The present study aimed to investigate cancer-specific mortality, relative to shift work.

Methods

The cohort consisted of male production workers (14,038 shift work and 17,105 day work), employed at BASF Ludwigshafen for at least 1 year between 1995 and 2005. Vital status was followed from 2000 to 2009. Cause-specific mortality was obtained from death certificates. Exposure to shift work was measured both as a dichotomous and continuous variable. While lifetime job history was not available, job duration in the company was derived from personal data, which was then categorized at the quartiles. Cox proportional hazard model was used to adjust for potential confounders, in which job duration was treated as a time-dependent covariate.

Results

Between 2000 and 2009, there were 513 and 549 deaths among rotating shift and day work employees, respectively. Risks of total and cancer-specific mortalities were marginally lower among shift workers when taking age at entry and job level into consideration and were statistically significantly lower when cigarette smoking, alcohol intake, job duration, and chronic disease prevalence at entry to follow-up were included as explanatory factors. With respect to mortality risks in relation to exposure duration, no increased risks were found in any of the exposure groups after full adjustment and there was no apparent trend suggesting an exposure–response relation with duration of shift work.

Conclusions

The present analysis extends and confirms our previous finding of no excess risk of mortality associated with work in the shift system employed at BASF Ludwigshafen. More specifically, there is also no indication of an increased risk of mortality due to cancer.     

Factors Associated With Sleep Quality Among Operating Engineers

Blue collar workers generally report high job stress and are exposed to loud noises at work and engage in many of risky health behavioral factors, all of which have been associated with poor sleep quality. However, sleep quality of blue collar workers has not been studied extensively, and no studies have focused Operating Engineers (heavy equipment operators) among whom daytime fatigue would place them at high risk for accidents. Therefore, the purpose of this study was to determine variables associated with sleep quality among Operating Engineers. This was a cross-sectional survey design with a dependent variable of sleep quality and independent variables of personal and related health behavioral factors. A convenience sample of 498 Operating Engineers was recruited from approximately 16,000 Operating Engineers from entire State of Michigan in 2008. Linear regression was used to determine personal and related health behavior factors associated with sleep quality. Multivariate analyses showed that personal factors related to poor sleep quality were younger age, female sex, higher pain, more medical comorbidities and depressive symptoms and behavioral factors related to poor sleep quality were nicotine dependence. While sleep scores were similar to population norms, approximately 34 % (n = 143) showed interest in health services for sleep problems. While many personal factors are not changeable, interventions to improve sleep hygiene as well as interventions to treat pain, depression and smoking may improve sleep quality resulting in less absenteeism, fatal work accidents, use of sick leave, work disability, medical comorbidities, as well as subsequent mortality.     

An investigation into the effects of vacations on the health status in male white-collar workers

There are many stress factors in occupational settings, and the lack of vacations could be one of factors in the context of work stress. The authors have been studying the relationship between workload and employee health. This time, an investigation into the effects of leisure vacations on worker health status using male white-collar employees aged 20–60 years engaged in a manufacturing company was conducted. The subjects were questioned on work stress factors including vacations and modifiers in their occupational settings, and on psychological and physiological stress reactions; that is, how often they were able to take leisure vacations every year, their average working hours a day and work stress factors from the Demand-Control-Support model. The questions also examined other factors concerning the employees such as type-A behavior and lifestyles as modifiers, diseases of the employees, physical complaints, feelings about sleep, perceived stress, job and life satisfaction, and stress reactions as measured by physiological examination. Correlation and logistic regression analysis were conducted with the 551 eligible subjects. The results were as follows: Leisure vacation was decreasingly related to some of psychological stress reactions after adjustment was made for working hours and for modifiers. Less vacation was increasingly related to the workers’ diseases especially among the employees aged 20–34, though the association was not statistically significant. Vacations did not show obvious association with physiological measures. These findings demonstrate the effectiveness and possibility of leisure vacation in controlling fatigue and maintaining the health of workers. Vacation should always be taken into consideration as a stress factor in a survey of the health problems of white-collar workers.     

Fatigue and workability in twelve-hour fixed shifts]

OBJECTIVE: To analyze the variables associated with fatigue perception and workability on workers working 12-hour fixed night and day shifts. METHODS: A cross-sectional study was carried out. Forty-three workers, working 12-hour fixednight and day shifts in a textile factory, filled out questionnaires about fatigue, workability index, individual characteristics, life style and working conditions. A univariate linear regression analysis was performed. RESULTS: Fatigue-related factors are associated to the workers' life style (physical activities is a protection factor), and sleep difficulties, with may increase fatigue perception. Workability-related factors are associated to longevity on job and working night shifts - workability index decreases as job longevity increases. Working night shifts showed a higher workability index. The 12-hour shifts may cause a considerably higher workload, influencing worker's perception of fatigue and workability index and sleep disturbances. CONCLUSIONS: The results indicate that night shifts may not always be translated a health problem. However, this was a cross-sectional study with a small population sample and selection bias is not excluded. Since the workability index reduces while job longevity increases, there is a need for further longitudinal studies with larger population samples.     

Shift schedules,work factors,and mental health among onshore and offshore workers in the Norwegian petroleum industry

The purpose of the present study was to answer the following research questions: (1) Do workers in different shift schedules differ in mental distress? (2) Do workers in different shift schedules differ in neuroticism? (3) Do shift schedules differ in psychosocial work exposures? (4) Do psychosocial work exposures contribute to mental distress among onshore- and offshore workers? (5) Does neuroticism confound the association between work exposures and mental distress? Workers on six shift-schedules answered a questionnaire (1,471 of 2,628 employees). Psychological and social work factors were measured by QPS_Nordic, mental distress was measured by HADS and neuroticism was measured by EPQ. The results showed 1) No differences in mental distress between workers in different shift schedules, 2) Revolving-shift workers reported higher neuroticism compared to day workers, 3) Swing-shift workers and revolving-shift workers reported lower job control compared to permanent-night and -day workers, 4) Job demands and role conflict were associated with more mental distress. Job control, role clarity, support, and leadership were associated with lower mental distress, 5) Neuroticism influenced the relationship between psychosocial work factors and mental distress. The present study did not find differences in mental distress between shift schedules. Job characteristics may be contributing factors when determining health effects of shift work.     

Three-shift system increases job-related stress in Japanese workers

We assessed the relationship between shift work and job stress. The target subjects were 4,962 male workers (3,078 day workers and 1,884 shift workers) aged 18 to 60 yr who work in a Japanese steel company. We used the "Brief Job Stress Questionnaire", which was developed by a research group organized by the Japanese Ministry of Labour. We evaluated the effect of shift work on job stress using logistic regression analysis including age, lifestyle factors, work conditions, marital status, and living arrangements in the model. Job schedule type was significantly associated with job control, with an odds ratio of 2.22 for shift workers compared to day workers. The logistic regression analysis revealed that the odd ratios for having one or more stressor items in an unfavorable condition were significantly higher for shift workers compared to day workers. Increase in the amount of overtime and decrease in the number of holidays led to a significant deterioration in job stress. Our study reveals that the 3-shift system of employment increases work-related stress, and that job control is low among shift workers. To reduce job stress in this occupational population, a reduction in the amount of overtime and an increase in the number of holidays seem to be useful interventions.     

Health risks related to shift work

Summary In an oil refinery with a labour force of 1260 male blue-collar workers, 300 matched cases of permanent shift workers, day workers, and drop-outs were selected and split into four groups corresponding in age and years at work.In terms of an overall score (health score, computed from data concerning absence due to sickness, morbidity, distribution and severity of diseases, and subjective complaints) health was found to deteriorate with age, but to a different degree in the shift and day workers.In shift workers, a steep decrease in score during the first years at work was followed by a continued slight decrease in middle age; from the age of 41 years onwards there was a further pronounced decrease in score. In day workers a stabilization in score was observed up to middle age, with a distinct decrease thereafter.The difference in health parameters between the groups was only small in younger workers (up to 12 years at work), but became striking and significant with increasing age. In the permanent shift workers an increasing health risk was clearly indicated by increases in absence due to sickness, gastro-intestinal and cardiovascular diseases and unspecific health complaints (sleep disturbances, premature fatigue). A specific kind of behaviour during illness (e.g. less readiness to consult a doctor) was also observed in the shift workers. In the permanent day workers health risks were not strictly age-related. Whereas absence due to sickness was highest in young workers, morbidity for respiratory diseases and injuries was significantly elevated in the older workers; the frequency of subjective complaints increased up to middle age and decreased thereafter.In drop-outs with considerable prior exposure to shift work, strikingly high rates of absence due to sickness and excess rates of cardiovascular diseases were observed.     

Shift work and risk of non-cancer mortality in a cohort of German male chemical workers

Objectives

Shift work is widely considered to be a health risk. In a previous study, we observed no elevated risk of total mortality in BASF shift workers followed up until the end of 2006. The present study aims to investigate non-cancer mortality, especially mortality caused by ischaemic heart disease (IHD), relative to shift work.

Methods

The cohort consisted of 14,038 male shift and 17,105 male day workers from manufacturing plants, who were employed for at least 1 year between 1995 and 2005. Vital status was followed from 2000 to 2009. Cause-specific mortality was obtained from death certificates. Non-cancer mortality as well as mortality specific to diagnoses from I20.0 to I25.9 according to International Classification of Disease version 10 was compared between the two working-time systems. To estimate the impact of shift work on the outcome of interest, Cox proportional hazard model was used to adjust for potential confounders such as age, smoking, alcohol consumption, job level, and disease status at baseline. The effect estimates were then given as hazard ratio (HR) with 95 % confidence interval (CI).

Results

Between 2000 and 2009, a total of 1,062 deaths occurred in the cohort: 513 (3.6 %) in shift and 549 (3.2 %) in day workers. Among them were 122 deaths resulting from IHD, 55 (0.39 %) and 67 (0.39 %), respectively. After adjustment for age at entry and job level, no increased risk of non-cancer mortality (HR 0.94; 95 % CI 0.77–1.15) as well as of IHD-caused mortality was found among shift workers (HR 0.77; 95 % CI 0.52–1.14). The risk estimates were robust after further adjustment for more factors in all models and consistently tended to be in favour of shift workers. Considering the duration of exposure to shift, no dose–response relationship was found.

Conclusion

The present analysis does not find strong evidence for an increased mortality risk due to non-cancer disease and, more specifically, IHD-caused mortality associated with this shift system. Initial selection based on health criteria as well as ongoing health surveillance and health promotion is likely to have contributed to this result. Shift work over 34 years may lead to a loss of this initial selection advantage over time, but the respective risk estimates lacked statistical precision.     

Types of employment and health: analysis of the Second European Survey on Working Conditions

OBJECTIVES: To investigate the relationships among types of employment and several health self-perceived outcomes in a sample of active workers from the 15 state members of the European Union. METHODS: Cross-sectional study with data drawn from the Second European Survey on Working Conditions (n = 15,146 individuals). The predictive variable was the types of employment aggregated in: permanent workers, sole traders, small employers (less than 10 employees) and temporary workers (full-and part-time). Unconditional logistic regression models were adjusted by age, gender and several indications of working conditions. Permanent workers was used as the baseline category. RESULTS: Employees with permanent (69,3%) and temporary (12,5%) contracts notified the highest level of a job absenteeism while temporary employees reported the highest level of job dissatisfaction. On the other hand, sole traders (12,2%) and small employees (6.1%) notified the most frequent level of overall fatigue, backache and muscular pains. Having permanent workers as baseline category, temporary employees was associated with high dissatisfaction (OR = 1.68), and and overall fatigue (OR = 1.16), but with lower frequency of stress (OR = 0.74) and job absenteeism (OR = 0.87). Small employers showed a low frequency of absenteeism (OR = 0.68), but a high stress (OR = 1.77) and overall fatigue (OR = 1.27). Finally, sole traders reported more frequently overall fatigue (OR = 1.40), and stress (OR = 1.33), but less job absenteeism (OR = 0.58). CONCLUSIONS: These findings suggest that types of employment may have an independent effect on several health self-perceive outcomes. Further research is necessary to overcome various shortcoming of this study, and to assess the role either job security or level of income and social protection.     

Health and performance factors in health care shift workers

OBJECTIVES: To assess the impact of shift work on health care workers. SUBJECTS AND METHODS: A cross-sectional study assessed health and performance markers of 188 day and night shift nonphysician health care workers. RESULTS: Night-shift workers were more likely to report difficulty with routine orders, lower energy levels, unpredictable work schedules, and sleep disturbance but no difference with injuries or motor vehicle crashes. A classification of day shift, night shift without unpredictable schedule or sleep problems, and night shift with unpredictable schedule or sleep problems revealed a trend of increased difficulty with routine orders, suggesting a "dose response effect." CONCLUSIONS: Findings suggest an association with night shift health care workers and adverse health and performance markers. A "higher-risk" subgroup may benefit from targeted interventions to reduce potential adverse effects from shift work and improve health care delivery.     

Risk Factors for Work-related Fatigue in Students With School-Year Employment

PurposeTo explore potential risk factors for acute and chronic work-related fatigue in students working at a paid job while pursuing school studies. Although work-related fatigue was identified as a potential hazard for youth health, academic achievement, and occupational safety, very few studies have specifically addressed its correlates and possible predictors.MethodsCross-sectional data from an ongoing prospective cohort study of health risk behaviors in adolescents was used to identify factors associated with increased levels of acute and chronic fatigue in 209 students aged 17–18 years working during the school year. Multiple stepwise regression analyses were performed with acute and chronic fatigue levels as dependent variables, and demographic, work, and health factors as potential explanatory variables.ResultsAverage hours worked per week by students was 14.7 hours. It was observed that higher psychological distress, poorer health perception, greater sleep debt, and higher exposure to physical work factors were associated with higher levels of acute fatigue. Also, it was observed that higher psychological distress, poorer health perception, higher exposure to physical work factors, and holding multiple jobs were associated with higher levels of chronic fatigue. The number of hours worked weekly was associated with neither acute nor chronic work-related fatigue.ConclusionsFindings suggest that prevention strategies devised to minimize work-related fatigue in students should consider exposure to physical work factors. Results also re-emphasize the importance of obtaining sufficient sleep so as to prevent high levels of acute work-related fatigue.     

Melatonin, sleep, and shift work adaptation

BACKGROUND: Night work is associated with disrupted circadian rhythms, fatigue, accidents, and chronic disease. Melatonin secretion helps regulate sleep and circadian rhythms. OBJECTIVE: Melatonin, sleep disturbances, and symptoms (sleep, fatigue, mental) were compared among workers on permanent day, swing, and night shifts. METHODS: Urinary 6-hydroxymelatonin sulfate (6-OHMS) was measured in postwork and postsleep samples. Disrupted circadian melatonin production was evaluated using the sleep:work 6-OHMS ratio. Wrist actigraphy characterized light exposures and sleep characteristics. RESULTS: Night workers had altered melatonin, disrupted sleep, and elevated symptom prevalence. Subjects grouped by their sleep:work 6-OHMS ratio rather than shift had even greater symptom prevalence. Risks for two or more symptoms were 3.5 to 8 times greater among workers with sleep:work ratios < or =1 compared to those with ratios >1. CONCLUSIONS: This ratio may help identify workers at increased risk for accidents or injuries.     

Modifying effects of perceived adaptation to shift work on health, wellbeing, and alertness on the job among nuclear power plant operators

This study examined the relationship between perceived adaptation to shift work and shift-related problems. A total of 608 male operators at nuclear power plants completed a set of validated questionnaires including a modified version of the Standard Shiftwork Index, which covered adaptation to shift work, fit to job content, chronotypes, chronic fatigue, sleep, naps, shift work locus of control (SHLOC), psychological health, social/family life, daytime sleepiness, workload, alertness on the job, and lifestyle factors. Participants were divided into two groups according to their perceived level of adaptation to shift work. The good adaptation group showed better outcomes than the poor adaptation group in terms of fit to job content, chronic fatigue, daytime sleep before night shifts, social and family disruption, SHLOC, psychological health, and alertness during night shifts (ps<0.001). Operators who reported good adaptation also took a more frequent, longer nap and more cigarettes during night shifts (ps<0.05). The cross-sectional study design cannot determine a causal relationship between perceived adaptation and shift work problems, yet the present results suggest that the effects of working shifts may be modified by perceptions of shift work adaptation.     

Direction of shift rotation among three-shift workers in relation to psychological health and work-family conflict

OBJECTIVES: The aim of the present study was to investigate whether the direction of shift rotation was related to the need for recovery, fatigue, sleep quality, work-family conflict, and leisure time among three-shift workers. METHODS: Data of 95 workers in forward-rotating three-shift work and 681 workers in backward-rotating three-shift work, with 32 months of follow-up, in the Maastricht cohort study (N=12,095) were used. Both cross-sectional and longitudinal analyses were carried out. RESULTS: A backward rotation schedule was prospectively related to an increased need for recovery [relative risk (RR) 2.88, 95% confidence interval (95% CI) 1.06-7.81] and poor general health (RR 3.21, 95% CI 1.32-7.83), as compared with a forward rotation schedule. Adjustment for demographic and health variables and the characteristics of the work environment did not alter these relations considerably. Furthermore, a forward rotation schedule was prospectively related to less work-family conflict and better sleep quality over the 32 months of follow-up. Finally, high levels of fatigue, need for recovery, poor sleep quality, poor general health, insufficient leisure time, and work-family conflict at first measurement were associated with an increased risk of leaving shiftwork during the follow-up. CONCLUSIONS: Optimization of shiftwork schedules, in terms of shift rotation, seems a promising method for decreasing the negative impact accompanying shiftwork. Future studies should investigate whether these findings for three-shift workers are applicable to other shiftwork schedules as well. Furthermore, this study clearly illustrates the existence of secondary selection processes among shiftworkers and thereby emphasizes the complexity of valid shiftwork research.     

How do employment types and job stressors relate to occupational injury? A cross-sectional investigation of employees in Japan

Objective

This study investigated whether 1) the risk of occupational injury differs among permanent employees and specific types of temporary workers, 2) the risk of occupational injury differs across different employment types depending on the degree of job stressors.

Study design

A cross-sectional study design based on self-report survey data.

Methods

A total of 36,688 full-time workers (28,868 men and 7820 women; average age = 35.4) were surveyed by means of a self-administered questionnaire. Employment types consisted of permanent employment and two forms of temporary employment: direct-hire and temporary work agent (TWA). Job characteristics including job demands, job control, and social support at work were measured. Occupational injury was measured by asking whether the participant had an injury on the job in the past 12 months that required a medical treatment. To investigate the relationships between employment types, job stressors, and occupational injury, hierarchical moderated logistic regression tests were conducted.

Results

High job demands (OR = 1.44) and low job control (OR = 1.21) were significantly associated with an increased risk of occupational injury, while controlling for demographic, life style, health, and occupational factors. In addition, direct-hires (OR = 1.85) and temporary agent workers (OR = 3.26) had a higher risk of occupational injury compared with permanent employees. However, the relationship between employment types and the risk of occupational injury depended on the levels of job demands and job control. Specifically, the magnitude of the relationship between job demands and the risk of occupational injury was substantially greater for temporary work agents than for permanent employees when they reported low levels of job control. Such an interaction effect between job demands and job control on the risk of occupational injury was not observed between permanent employees and direct-hire temporary workers.

Conclusion

The current study indicated that temporary workers might be more vulnerable to occupational injury than permanent employees. High levels of job demands and low levels of job control might also add to temporary workers' risk of occupational injury, particularly for TWAs.     

Epidemiological diagnosis of occupational fatigue in a fly-in fly-out operation of the mineral industry

OBJECTIVE: A prospective epidemiological study was conducted at a fly-in-fly-out mining operation in Australia to assess the dynamics of occupational fatigue and its potential risk factors. METHODS: Performance and perceived fatigue were measured at the start/finish of each 12-h shift throughout the 28-day roster (10 days day shift work on-site, 5 days rest off-site, 8 days night shift work on-site and 5 days rest off-site) using the Mackworth Clock Vigilance test and the Swedish Occupational Fatigue Inventory, respectively. Additionally, major predisposing/reinforcing factors of fatigue were measured including a detailed sleep diary (length/quality of sleep, wake patterns), a diary on alcohol consumption and a general health/fitness questionnaire. RESULTS: Of 55 production staff at the site 52 (95%) participated in the study. Significantly increased occupational fatigue was observed at concerning levels at the finish of night shifts 1-3 and from day shift 8 onwards. At the measured level, total hours of sleep (average 6.8 h per night) and number of standard drinks (average 1.5) were not significantly correlated with fatigue measurements. CONCLUSIONS: A disturbed diurnal rhythm at the beginning of night shift and a roster of more than eight consecutive days were identified as the primary contributing factors to occupational fatigue in this setting. The observed magnitude of effects suggests adverse implications for safety as the effects on performance were beyond what would be expected at blood alcohol concentrations of 0.05%. The results of this study have been used to generate highly specific strategies to reduce fatigue in the workplace.     

Application of Karasek's demand/control model a Canadian occupational setting including shift workers during a period of reorganization and downsizing

PURPOSE: To apply Karasek's Job Content Model to an analysis of the relationships between job type and perceived stress and stress behaviors in a large company during a period of reorganization and downsizing. DESIGN: Cross-sectional mail-out, mail-back survey. SETTING: A large Canadian telephone/telecommunications company. SUBJECTS: Stratified random sample (stratified by job category) of 2200 out of 13,000 employees with a response rate of 48.8%. MEASURES: Responses to 25 of Karasek's core questions were utilized to define four job types: low-demand and high control = "relaxed"; high demand and high control = "active"; low demand and low control = "passive", and high demand and low control = "high strain." These job types were compared against self-reported stress levels, perceived general level of health, absenteeism, alcohol use, exercise level, and use of medications and drugs. Similar analyses were performed to assess the influence of shift work. RESULTS: Employees with "passive" or "high strain" job types reported higher levels of stress (trend test p < .0001); poorer health (trend test P = .006); and higher levels of absenteeism (trend test p < .0001). More shift workers reported themselves in poor or fair health (chi-square p = .018) and reported high levels of stress at home (chi-square p = .002) than nonshift workers. The relationships between job type and levels of stress, health and absenteeism, however, held for nonshift workers as well. CONCLUSIONS: Job types with high demand and low control were associated with increased stress, increased absenteeism, and poorer self-concept of health. The demand/control model of Karasek and Theorell was validated in this setting with respect to stress and some stress-associated attitudes and behaviors.     

Effect of lifestyle modification program implemented in the community on workers' job satisfaction

It is important for occupational health to justify the impact of health promotion programs on job satisfaction, which is associated with work-related outcomes. The aim of this study is to estimate the effects of lifestyle modification activity implemented by the community on job satisfaction, and to analyze the factors which contributed to the improvement of workers' job satisfaction. A lifestyle modification program consisting of aerobic exercise and diet counseling was conducted for 12 wk in the community. Data on 264 workers were obtained before and after the intervention. The subjects were asked to fill out questionnaires about work-related items, lifestyle, and mental health status. In addition to the ameliorations of GHQ, lifestyle, subjective complaints, and the risk factors of lifestyle-related diseases, an improvement in workers' job satisfaction was shown by the participation in the community-based lifestyle modification program. For analyzing factors which contributed to the improvement in job satisfaction, logistic regression analysis was employed. Refreshment from fatigue by sleep independently contributed to the improvement of job satisfaction even after adjusting for the other variables. The health promotion program implemented in the community may be useful for workers' job satisfaction especially through the dissipation of fatigue by refreshment sleep.     

How do types of employment relate to health indicators? Findings from the Second European Survey on Working Conditions

STUDY OBJECTIVE: To investigate the associations of various types of employment with six self reported health indicators, taking into account the part played by demographic variables, individual working conditions and four ecological indicators at the country level. DESIGN: Cross sectional survey (structured interview) of a sample of the active population of 15 European countries aged 15 years or over. Main independent variables were nine types of employment categorised as follows: small employers, full and part time permanent employees, full and part time fixed term employees, full and part time sole traders and full and part time temporary contracts. Main outcome measures were three self reported health related outcomes (job satisfaction, health related absenteeism, and stress) and three self reported health problems (overall fatigue, backache, and muscular pains). Logistic regression and multilevel models were used in the analyses. SETTING: 15 countries of the European Union. PARTICIPANTS: 15 146 employed persons aged 15 or over. MAIN RESULTS: Precarious employment was consistently and positively associated with job dissatisfaction but negatively associated with absenteeism and stress (as compared with full time permanent workers). Fatigue, backache and muscular pains also tended to be positively associated with precarious employment, particularly with full time precarious employment. Small employers reported high percentages of stress and fatigue, but absenteeism was relatively low. Sole traders generally reported high percentages of all outcomes, except for absenteeism, which was low. For each type of employment (except temporary contracts), full time workers tended to report worse health outcomes than part time workers. Patterns were generally consistent across countries. Associations persisted after adjustment for individual level working conditions and were not modified by country level variables. CONCLUSIONS: This study is the first to examine the relations between various types of employment and six health related indicators for all 15 member states of the European Union. Suggestive patterns worthy of further exploration have been found. Standardised definitions of types of underemployment and health related outcomes, more potent epidemiological designs and the inclusion of socioeconomic information (for example, social security systems, incapacity benefit schemes) at the regional level are proposed for inclusion in further research.