Eating, Drinking and Oral Health

Article

Job characteristics and the subjective oral health

of Australian workers
Anne E. Sanders and A. John Spencer
Australian Research Centre for Population Oral Health, Dental School,
University of Adelaide, South Australia

Abstract
The way in which work is structured and
organised is associated with the health and
well-being of workers.

Objectives: To examine the associations

he restructuring of the labour market has altered several features of the

labour force in Australia. Changes
in working hours are one example. The Australian Bureau of Statistics monthly labour
force surveys1 show that not only has the
average number of hours worked by full-time
workers increased over two decades, but also
the proportion working long hours has increased. According to the Australian Council of Trade Unions, Australia ranks second
behind Korea for average working hours and
has the highest proportion of its labour force
working more than 50 hours per week among
OECD countries.2 Yet not all workers are
working longer hours, because the proportion of the labour force working part time
has also increased.3 Changes are also apparent in perceived job security. Time series data
show that the proportion of Australian workers who believed their job to be secure declined in the early to mid 1990s.4,5 In 1999,
a national poll of Australian workers found
that 74% believed their job to be safe, which
represented a decrease of seven percentage
points since the previous year.6 Organisational downsizing and job creation schemes
have spurred a need for retraining programs
and professional development to maintain a
skilled workforce.
Coinciding with these changes, labour
force participation rates for females increased from 46% in 1985 to 55% in 2001.7
Workers, especially those combining parenthood and paid work, require flexibility to
balance work and home demands. Currently,
Australia and the United States remain the
only two OECD countries not to offer a paid

parenting or maternity leave scheme, with

New Zealand introducing a scheme in 2002.
Because these changes were introduced
rapidly, they are likely to have an impact on
the health and well-being of workers. The
negative effect on employee health of organisational downsizing has been reported in
several longitudinal studies.8-10 A recent US
study found that physical and mental symptoms associated with downsizing were not
confined to those directly targeted by structural changes but were, to a milder extent,
also reported by workers less immediately
affected.11 To date, Australian research in this
area is limited and no studies have examined job characteristics and the subjective
oral health of workers. Unlike objectively
assessed measures of dental disease, subjective measures of oral health convey information about the impact of oral disease on
quality of life from the individuals perspective.
The first objective of the study was to examine the associations of hours worked, perceived job security, perceived risk of skill
obsolescence, and the strain of work and
home interference on the subjective oral
health of workers in Australia. The second
objective was to compare findings for different occupational groups.

between hours worked, job security, skill

maintenance and work and home
interference and subjective oral health; and
to compare findings for different
occupational groups.

Methods: Data were collected in 1999 from

a random stratified sample of households in
all Australian States and Territories using a
telephone interview and a questionnaire
survey. Subjective oral health was
evaluated with the short form Oral Health
Impact Profile (OHIP-14), which assesses
the adverse impact of oral conditions on
quality of life.

Results: Data were obtained for 2,347

dentate adults in the workforce. In the
12 months preceding the survey, 51.9%
had experienced oral pain and 31.0%
reported psychological discomfort from
dental problems. Males, young adults,
Australian-born workers, and those in
upper-white collar occupations reported
lower mean OHIP-14 scores (ANOVA

p<0.001). Having controlled for the effects

sex, age, country of birth and socioeconomic factors in a linear multiple
regression analysis, hours worked, skill
maintenance and work and home
interference were significantly associated
with OHIP-14 scores for all workers. While
part-time work was associated with higher
OHIP-14 among upper white-collar workers,
working >40 hours a week was associated

Methods
Data were from the 1999 National Dental
Telephone Interview Survey (NDTIS) and a
self-complete questionnaire sent to first person adult interviewees immediately following the interview. NDTIS is a periodic

with higher OHIP-14 scores for other

workers. Conclusions: Aspects of the work
environment are associated with the
subjective oral health of workers. Because
these contexts are subject to only limited
control by individual workers, their influence
is a public health issue.
(Aust N Z J Public Health 2004; 28: 259-66)

Correspondence to:
Professor A. John Spencer, Australian Research Centre for Population Oral Health,
Dental School, University of Adelaide, South Australia 5005. Fax: (08) 8303 4858;
e-mail: john.spencer@adelaide.edu.au

2004 VOL. 28 NO. 3

Submitted: December 2003

Revision requested: March 2004
Accepted: April 2004

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Sanders and Spencer

Article

cross-sectional population survey that monitors the self-reported

oral health of Australian residents aged five years and over and
their use of dental services. In 1999, a random stratified sample
was drawn for all States and Territories from the electronic telephone listings and one randomly selected household member was
interviewed. To maximise participation and response the methods recommended by Dillman were used.12 These included an
information letter sent to all households in advance of telephone
contact and up to four personalised approaches for the questionnaire.
Subjective oral health was evaluated with the 14-item Oral
Health Impact Profile (OHIP-14).13 This short form is useful when
space constraints and the risk of respondent burden do not permit
use of the full 49-item scale. This 49-item OHIP14 was based on
the international classification of impairments, disabilities and
handicaps developed in 1980 by the World Health Organization
and adapted for oral health by Locker.15 The OHIP explores seven
dimensions of impact arranged in ascending hierarchical order
from functional limitation, pain and discomfort, psychological
discomfort, through to physical, psychological and social disability
and finally handicap. In the short form OHIP-14 two questions
tap each of the seven dimensions. Participants are asked to report
the frequency with which they experienced impacts over the
12 months preceding the survey. Responses are coded on a fivepoint scale of 0=never, 1=hardly ever, 2=occasionally, 3=fairly
often and 4=very often. We used two summary statistics from
this scale: the percentage of persons reporting an impact occasionally or more often, and the mean scale score with higher scores
reflecting more adverse impact.
The questionnaire asked about occupation, working hours, perceptions of job security and skill obsolescence, and work-home
interference. Occupational title and main task descriptors were
coded according to the Australian Standard Classification of
Occupations16 and then collapsed into three groups: upper whitecollar (manager, administrator, professional), lower white-collar
(paraprofessional, tradesperson, clerk, salesperson, personal service work) and blue-collar (plant or machine operator, driver,
labourer or related). Response options for hours worked were up
to 30, 30-40 and >40, representing part time, standard working
week and overtime hours worked. Perceived job security was assessed with the question Do you expect that your job will be
secure for the next five years? Response options were yes, probably, unlikely, and no. The same response options were used
for the question Do you expect that your present job skills will
be obsolete within 10 years? Scoring on this item was reversed
so that an affirmative response reflected a high expectation of
skill maintenance. Finally, work-home interference was evaluated
using an eight-item scale tested by Gutek and colleagues.17 Four
items assessed the degree to which work interfered with home
life and the remaining items assessed the level of home-to-work
interference. Responses were recorded on a five-point scale coded
from 0 to 4 with higher scores indicating greater interference. In
an exploratory factor analysis of the items, a two-factor solution
emerged that conceptually supported the scales bi-directional
260

structure and which was empirically appropriate. Both factors had

eigenvalues greater than one that together accounted for 60.0%
of the total variance. The first factor was labelled work interferes
with home (=0.80) and the second home interferes with work
(=0.72). Continuous scores on the overall scale and two subscales
were categorised into five groups labelled low, low-moderate,
moderate, moderate-high, and high interference, with higher scores
reflecting a higher level of conflict. It was not possible to construct equal-sized quintiles because of the clustering of scores.
Consequently, the five groups approximated quintile ranges as
closely as data permitted.
Data were weighted to account for differing sampling probabilities due to the sampling design to be representative of the
Australian population in its age and sex composition for each
sampling stratum.
Bivariate associations between the explanatory variables and
OHIP-14 scores were examined using one-way ANOVA with the
level of statistical significance set to 5%. All explanatory variables were retained and were entered into a multiple regression
model to estimate the association between job characteristics and
the social impact of oral conditions. In multivariate analysis, the
ordinal variables of hours worked, job security and skill maintenance were transformed to dummy variables. Blocks of explanatory variables were entered in two steps so that the relative
contribution of the job characteristics entered at step two could
be distinguished from the effect of socio-demographic variables
entered in step one. A separate model was constructed for each of
the three occupational groups.
Both unstandardised and standardised beta coefficients are

Table 1: Socio-demographic characteristics of the

weighted sample.
n

Occupational group
Upper white-collar
Lower white-collar
Blue-collar

791
1,009
256

38.5
49.1
12.5

Sex
Male
Female

1,301
1,045

55.5
44.5

392
571
700
477
206

16.7
24.3
29.8
20.3
8.8

Country of birth
Australia
Other

1,900
421

81.8
18.2

Education
Tertiary
No tertiary

961
1,373

41.2
58.8

Household income
<$50,000
>$50,000

1,230
1,000

55.2
44.8

Age group
18-24 years
25-34 years
35-44 years
45-54 years
55+ years

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Eating, Drinking and Oral Health

Job characteristics and subjective oral health

reported. The beta value (B) is a measure of how strongly each

independent variable is associated with mean OHIP-14 scores. It
indicates the change in mean OHIP-14 score that is due to a change
of one unit of each independent variable. To compare the relative
contribution of each independent variable across different models that is, between different occupational groups these
unstandardised beta coefficients (B) are reported. However, within
a single model (occupational group), comparisons of beta values
are difficult to interpret as the units in which these variables are
measured differ. To facilitate interpretation of the relative contribution of each independent variable, the standardised beta coefficients (beta) are also reported. These values standardise the
different units to standard deviations that vary from 1 to +1.

responded (64.6%). Analysis was limited to dentate adults who

were aged 18 to 65 years and in paid work (n=2,347). Males dominated blue-collar (82.0%) occupations and to a lesser extent upper white-collar occupations (57.9%), but contributed less than
half of the lower white-collar occupations (48.6%). Other sample
characteristics are presented in Table 1. Workers in upper whitecollar (UWC) occupations comprised 38.5%, lower white-collar
occupations (LWC) comprised nearly half (49.1%) and blue-collar (BC) workers comprised 12.5%. A sizeable minority (41.2%)
had tertiary education, and 44.8% had household income of more
than $50,000.
One-quarter (25.3%) worked <30 hours per week (see Table 2),
which approximates Australian Bureau of Statistics national estimates in 1999 of 26.0% of the labour force working fewer than
35 hours.18 The 43.0% working >40 hours is higher than the national estimate of 37%.19 Overtime was twice as common among
UWC workers (61.1%) than among LWC workers (30.5%).

Results
Participation in the NDTIS was 56.6% (n=7,829). Of the 6,152
adults who were sent the self-complete questionnaire, 3,973

Table 2: Distribution in hours worked, job security, skill maintenance and work-home interference for occupational
groups.
Upper
white collara
n
%

Lower
white collarb
n
%

Blue collarc
n

Total
n

Hours worked
Up to 30 hours
31-40 hours
More than 40 hours
Total

119
187
481
787

15.1
23.8
61.1
100.0

344
352
305
1,001

34.4
35.2
30.5
100.0

54
110
92
256

21.1
43.0
35.9
100.0

517
649
878
2,044

25.3
31.8
43.0
100.0

Job security
Yes
Probably
Unlikely
No
Total

401
281
67
41
790

50.8
35.6
8.5
5.2
100.0

410
424
114
57
1,005

40.8
42.2
11.3
5.7
100.0

92
102
30
29
253

36.4
40.3
11.9
11.5
100.0

903
807
211
127
2,048

44.1
39.4
10.3
6.2
100.0

Skill maintenance
Yes
Probably
Unlikely
No
Total

369
309
75
38
791

46.6
39.1
9.5
4.8
100.0

391
403
155
52
1,001

39.1
40.3
15.5
5.2
100.0

97
103
44
11
255

38.0
40.4
17.3
4.3
100.0

857
815
274
101
2,047

41.9
39.8
13.4
4.9
100.0

Work interferes with home

Low interference
Low-moderate
Moderate
Moderate-high
High interference
Total

154
172
154
138
163
782

19.7
22.0
19.7
17.7
20.9
100.0

353
235
170
127
89
976

36.2
24.1
17.4
13.1
9.1
100.0

73
58
38
30
54
252

28.8
22.9
15.0
11.8
21.4
100.0

592
490
379
308
340
2,109

28.1
23.2
18.0
14.6
16.1
100.0

Home interferes with work

Low interference
Low-moderate
Moderate
Moderate-high
High interference
Total

223
110
246
64
139
782

28.5
14.1
31.5
8.2
17.7
100.0

286
119
318
72
181
976

29.3
12.2
32.6
7.4
18.5
100.0

53
42
71
49
39
252

20.8
16.5
27.9
19.2
15.5
100.0

578
283
669
190
389
2,109

27.4
13.4
31.7
9.0
18.5
100.0

Notes:
(a) Manager/administrator; professional.
(b) Paraprofessional; tradesperson; clerk; sales or personal service worker.
(c) Plant or machine operator or driver; labourer or related worker.

2004 VOL. 28 NO. 3

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Article

Compared with other workers, a greater proportion of UWC workers perceived their job to be secure. Almost twice the proportion
of BC workers than white-collar workers perceived their job as
definitely not secure. UWC workers were more likely than were
other workers to report that their job skills would be maintained
over the next 10 years. The distribution of high work interferes
with home scores was not even across occupational groups. Approximately 21% of UWC and BC workers had scores in this
range, compared with only 9.1% of LWC workers. Compared with
both UWC and LWC workers, more than twice the proportion of
BC workers had moderate to high scores for home to work interference. Socio-economic advantage was associated with lower
OHIP-14 scores (see Table 3), as was male sex, Australian born,
and age 18-24 years relative to older age.
Overall, 61.5% of workers experienced at least one of the OHIP14 impacts occasionally, fairly often or very often in the 12 months
preceding the survey. Impacts were not distributed evenly among
occupational groups. Just over half (53.3%) of the UWC workers
reported impacts this frequently, compared with two-thirds
(66.3%) of LWC workers and 70.2% of BC workers. Table 4 shows
the percentage of workers in each occupational group who experienced impacts in the seven dimensions occasionally or more
often. Key words from the two OHIP-14 items comprising each
dimension are included as footnotes to the table. More than half
(51.9%) of all workers had experienced physical pain and nearly
one-third (31.0%) had experienced psychological discomfort
caused by an oral condition. Compared with UWC workers, approximately twice the proportion of BC workers experienced
physical disability, psychological disability and social disability.
Compared with other workers, upper white-collar workers reported
significantly lower levels of impact on each dimension except for
functional limitation.
Mean (se) OHIP-14 scores for occupational groups are presented in Table 5. Workers in UWC occupations reported lower
mean OHIP-14 scores than those in LWC and BC work. Other
groups reporting lower mean OHIP-14 scores were males, adults
aged <25 years, Australian-born workers and those with tertiary

Table 3: Mean (se) OHIP-14 scores for sociodemographic characteristics.

Mean (se) OHIP-14
Occupational groupc
Upper white collar
Lower white collar
Blue collar

0.46 (0.02)
0.58 (0.02)
0.56 (0.04)

Sexa
Male
Female

0.50 (0.01)
0.56 (0.02)

Age groupb
18-24 years
25-34 years
35-44 years
45-54 years
55+ years

0.45
0.52
0.57
0.53
0.57

Country of birthc
Australia
Other

0.50 (0.01)
0.61 (0.03)

Educationa
Tertiary
No tertiary

0.50 (0.02)
0.55 (0.01)

Household incomeb
<$50,000
>$50,000

0.50 (0.01)
0.58 (0.02)

(0.02)
(0.02)
(0.02)
(0.02)
(0.04)

Notes:
(a) p<0.05; (b) p<0.01; (c) p<0.001 ANOVA.

education and higher household income. Mean OHIP-14 scores

are associated with working hours, job security, skill maintenance,
work interference and home interference for the three occupational groups. Part-time work was associated with highest OHIP14 scores for UWC workers. For BC workers, however, working
>40 hours was associated with highest OHIP-14 scores. Having
job security was associated with lowest OHIP-14 scores for UWC
workers, and uncertainty about job security was associated with
highest OHIP-14 scores. While this also appeared to be the case

Table 4: Per cent of workers experiencing dimensions of social impact occasionally, fairly often or very often in the last
year.
Functional
limitationa

Physical Psychological Physical Psychological

painb
discomfortc disabilityd
disabilitye

Social
disabilityf

Handicapg

6.7
9.6
11.6
8.4i

4.6
8.4
6.1
6.8i

Mean OHIP-14 scores

Occupational group
Upper white collar
Lower white collar
Blue collar
All workers

10.5
14.0
16.1
13.1h

44.4
55.7
57.1
51.9j

26.4
36.2
31.0
31.0j

11.7
18.7
26.8
16.4j

13.4
23.0
24.4
18.5j

Notes:
(a) Difficulty with pronunciation, affected taste.
(b) Pain in mouth, discomfort when eating.
(c) Feeling self-conscious, feeling tense.
(d) Diet unsatisfactory, interruption to meals.
(e) Difficulty to relax, feeling embarrassed.
(f) Irritability, difficulty relaxing.
(g) Life less satisfying, inability to function.
(h) p>0.05; (i) p<0.05; (j) p<0.001 Pearson chi-square.

262

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Eating, Drinking and Oral Health

Job characteristics and subjective oral health

for BC workers, differences failed to reach statistical significance.

For LWC workers, the increasing risk to security was associated
with a stepwise increase in mean OHIP-14 scores. Differences in
skill maintenance expectations were significantly associated with
OHIP-14 scores for each occupational group. For all workers,
those who were certain that their job skills would be maintained
reported lowest mean OHIP-14 scores. For white-collar workers
a monotonic gradient was observed characterised by decreasing
mean OHIP-14 scores with increasing certainty of skill maintenance.
For both upper and lower white-collar workers, highest levels
of work interference and home interference were associated with
highest mean OHIP scores. Although those BC workers who experienced least interference also reported least social impact, there
was not a clear relationship between level of interference and the
impact of dental problems.
The correlations between the independent variables were examined for collinearity as high correlation would reduce the precision of estimates in the multivariate regression analysis.

Although significant, associations were weak, with Spearmans

rank correlation coefficients ranging from 0.05 for the association between hours worked and job security, to 0.31 for the association between work-to-home interference and job security.
In multivariate regression analysis, the potential confounding
effect of socio-demographic factors was taken into account by
entering sex, age in years, country of birth (Australia or other),
education (tertiary or not tertiary) and household income
(>$A50,000 or $A50,000) in the models before the explanatory variables. The results are presented in Table 6. For UWC
workers, female sex and age were positively associated with mean
OHIP-14 scores but country of birth and socio-economic indicators were not. Compared with those working standard hours, parttime workers had greater impact scores. Workers with uncertain
job security (but not those whose job was definitely not secure)
reported greater social impact than workers in secure jobs.
Workers in jobs where skill maintenance was unlikely reported
significantly greater social impact than workers whose skill maintenance was assured. Both work interference with home and home

Table 5: Mean (se) social impact scores according to work-related characteristics for occupational groups.

Hours worked
Up to 30 hours
31-40 hours
More than 40 hours
Total

Upper
white collar
Mean (se)

Lower
white collar
Mean (se)

Blue collar

0.56 (0.04)
0.41 (0.03)
0.45 (0.02)
0.46 (0.02)

Job security
Yes
Probably
Unlikely
No
Total
Skill maintenance
Yes
Probably
Unlikely
No
Total

0.60
0.58
0.56
0.58

(0.03)
(0.03)
(0.03)
(0.02)

0.35 (0.02)
0.59 (0.04)
0.58 (0.06)
0.45 (0.10)
0.46 (0.02)

0.50 (0.02)
0.61 (0.03)
0.63 (0.04)
0.77 (0.09)
0.58 (0.02)

0.41 (0.02)
0.48 (0.03)
0.56 (0.07)
0.65 (0.10)
0.46 (0.02)

0.51 (0.02)
0.58 (0.03)
0.69 (0.05)
0.82 (0.11)
0.58 (0.02)

Work interferes with home

Low interference
Low-moderate
Moderate
Moderate-high
High interference
Total

0.32 (0.03)
0.45 (0.04)
0.35 (0.03)
0.55 (0.04)
0.62 (0.04)
0.46 (0.02)

Home interferes with work

Low
Low-moderate
Moderate
Moderate-high
High
Total

0.30 (0.02)
0.44 (0.04)
0.53 (0.03)
0.38 (0.05)
0.63 (0.05)
0.46 (0.02)

0.44 (0.03)
0.64 (0.04)
0.55 (0.03)
0.51 (0.05)
0.87 (0.05)
0.59 (0.02)

0.58
0.49
0.51
0.67
0.92
0.59

(0.03)
(0.03)
(0.03)
(0.05)
(0.08)
(0.02)

Mean (se)
0.59
0.40
0.74
0.56

(0.10)
(0.05)
(0.06)
(0.04)
a

0.47
0.65
0.43
0.53
0.54

(0.05)
(0.06)
(0.11)
(0.10)
(0.04)
b

0.44
0.71
0.50
0.58
0.56

(0.05)
(0.07)
(0.07)
(0.15)
(0.04)
c

0.41
0.52
0.80
0.48
0.72
0.57

(0.07)
(0.07)
(0.10)
(0.08)
(0.09)
(0.04)
d

0.32
0.98
0.40
0.61
0.72
0.57

(0.06)
(0.12)
(0.06)
(0.06)
(0.11)
(0.04)

Notes:
(a) p>0.05; (b) p<0.05; (c) p<0.01; (d) p<0.001 ANOVA.

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interference with work were positively associated with the adverse impact of oral conditions. As indicated by the standardised
coefficients, home-to-work interference had greatest effect, followed by work-to-home interference and probable job security.
Similar associations were observed for LWC workers. Again
the uncertainty of skill maintenance relative to certain skill maintenance was positively associated with social impact. So, too, were
work-to-home and home-to-work interference. In contrast to the
experience of UWC workers, working overtime relative to standard working hours was positively associated with social impact
for LWC workers. Again, work and home interference had greatest effects.
Results for BC workers were conspicuously different to
those of white-collar workers. Being born overseas and low household income were positively associated with mean OHIP-14
scores. As noted for LWC workers, working overtime relative to

standard hours was associated with greater social impact. The

probable likelihood that skills would be maintained relative to
certainty was positively associated with mean OHIP-14 scores as
was work-to-home but not home-to-work interference. Greatest
effects were for overtime, lower income and probable skill maintenance. For BC workers, job security was not significantly associated with social impact in the presence of other variables.
An examination of the unstandardised beta coefficients enabled an evaluation of the relative magnitude of the regression
coefficients between the three occupational groups. Although
fewer variables were significant in the model for BC workers, the
relative magnitude of their effect was substantially greater. For
instance, the magnitude of the effect of working overtime was
almost double that for BC workers compared with LWC workers.
This was reflected in the adjusted R2 statistic that showed that a
greater proportion of the variance in mean OHIP-14 scores was

Table 6: Multiple regression unstandardised coefficients (se) and standardised coefficients for the social impact of oral
problems for occupational groups.
Upper white collar
SE
Betab Sig

Ba
1 (Constant)
Sex
Male
Female
Age in years
Country of birth
Australia
Overseas
Education
Tertiary
No tertiary
Household income
>$50,000
<$50,000
2 Hours worked
<30 hours
30-40 hours
>40 hours
Job secure
Yes
Probably
Unlikely
No
Skill maintenance
Yes
Probably
Unlikely
No
Work-home interference
Work interferes with home
Home interferes with work

Blue collar
SE
Betab

Sig

Ba
-0.11

(0.17)

0.07
0.00

(0.10)
(0.00)

0.05
0.02

Sig

0.29

(0.08)

-0.09
0.00

(0.04)
(0.00)

-0.08
-0.01

0.05

(0.05)

0.04

0.26

(0.10)

0.18

0.06

0.00

(0.04)

0.00

-0.04

(0.11)

-0.02

(0.04)

-0.02

-0.02

(0.04)

-0.02

0.29

(0.07)

0.25

(0.06)

0.10

0.01

(0.04)

0.01

0.05

(0.10)

0.03

(0.04)

0.05

-0.16

(0.04)

-0.14

0.31

(0.09)

0.27

(ref)
0.13
0.14
0.08

(0.04)
(0.06)
(0.08)

0.13
0.08
0.04

0.01
-0.01
0.07

(0.04)
(0.06)
(0.08)

0.01
0.00
0.03

0.01
-0.17
0.16

(0.09
(0.12)
(0.13)

0.01
-0.09
0.09

(ref)
0.04
0.12
0.09

(0.04)
(0.06)
(0.09)

0.05
0.08
0.04

0.07
0.16
0.08

(0.04)
(0.05)
(0.08)

0.07
0.11
0.03

0.31
0.09
0.31

(0.08)
(0.11)
(0.19)

0.27
0.06
0.10

0.09
0.15

(0.02)
(0.03)

0.16
0.17

0.12
0.16

(0.02)
(0.03)

0.19
0.18

0.11
-0.01

(0.05)
(0.08)

0.19
-0.01

Adjusted
0.037
0.143

R2

R2

change
0.061
0.205

-0.31

(0.09)

(ref)
0.09
0.01

(0.04)
(0.00)

0.09
0.14

(ref)
0.08

(0.04)

0.06

(ref)
0.06

(0.04)

(ref)
-0.03
0.13
(ref)
0.04

R2
Block 1 (socio-demographic)
Block 2 (job characteristics)

Lower white collar

SE
Betab

Ba

change
0.044
0.117

d
c

c
d
c

R2

change
0.009
0.115

Adjusted
0.003
0.109

c
c

e
c

R2

c
c

f
c
c

d
c

Adjusted R2
0.040
0.215

Notes:
(a) Unstandardised beta coefficients.
(b) Standardised beta coefficients.
(c) p>0.05; (d) p<0.05; (e) p<0.01; (f) p<0.001 ANOVA.

264

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2004 VOL. 28 NO. 3

Eating, Drinking and Oral Health

explained in the model for BC workers (21.5%) than for UWC

(14.3%) or LWC workers (10.9%). An examination of the change
statistics revealed that in each model, the job characteristics entered in the second step accounted for a substantially greater proportion of the explained variance than did the socio-demographic
factors entered at step one. For UWC and BC workers, the job
characteristics explained about three times more variance than
did the socio-demographic factors.

Discussion
The main finding of this study was a strong association between
job characteristics and the subjective oral health of workers. Comparative studies of workers in the oral health literature are very
limited. Marcenes and Sheiham found that work-related mental
demand was related to periodontal disease in male workers aged
35 to 44 years,20 and in other research the flexibility of working
hours was associated with dental self-care behaviour in workers
aged 24-44 years.21 The general health literature has reported
widely the relationship between work-related psychosocial factors such as decision latitude, job demands and social support
and workers health. Yet fewer studies have examined the associations between health and ways that work is structured in terms of
hours worked, job security, continuing education and flexibility
to manage competing work and home commitments. Moreover,
many studies have been limited to white-collar workers, omitting
those in manual occupations.
The OHIP-14 questionnaire and the original 49-item OHIP have
been widely used to evaluate subjective oral health in more than
25 studies, including randomised clinical trials and nationally
representative population surveys.22 The importance of this studys
findings from a population perspective is the extent to which oral
health problems are experienced. In all, 61.5% of workers reported
impacts occasionally or more often. More than half (51.9%) recalled that dental problems had caused oral pain and almost onethird (31.0%) reported feeling self-conscious or tense as a
consequence of dental problems.
Our findings are limited by the cross-sectional design of the
study. It is not possible, for instance, to infer that changing characteristics of the labour force have affected the health of workers.
However, findings from the Whitehall II prospective cohort study
of British civil servants support this argument. Like Australia,
Britain underwent economic reform to improve productivity and
international competitiveness. Whitehall II showed that the threat
of privatisation of the civil service had a greater adverse effect on
the subjective health of employees than the actual change in employment status that followed.23 This finding also supports our
observation among UWC workers that a perceived threat to job
security was associated with greater impact than the knowledge
that the job was not secure.
Because both the OHIP-14 and job characteristics were selfreported, a second limitation is self-reporting bias. In reviewing
the literature on organisational stress, Zapf and colleagues24 described this as bias whereby underlying factors such as negative
2004 VOL. 28 NO. 3

Job characteristics and subjective oral health

affect can lead to a tendency to report in one direction potentially

altering the association between perceived stress and subjective
health status. We argue that this is a threat when measuring subjective oral health with the global self-rated health item. Responses
to this global item reflect multiple dimensions of oral health that
are not specified by the researcher, and which are consequently
prone to personality traits of the respondent. Because OHIP items
address specific impacts such as the sense of taste, pain, interruption to meals, and social irritability, their clearly defined
boundaries minimise the potential impact of subjective interpretation resulting in bias.
In Australia, there is a strong occupational dimension to working overtime. Overall, managers are most likely to work the longest hours, while professionals have the greatest proportion of
workers who routinely work overtime.25 We found that although
a greater proportion of UWC workers worked overtime, this factor was not associated with elevated mean OHIP-14 scores among
these workers. Yet for BC workers, and to a lesser extent for LWC
workers, working overtime was a key risk factor. It is likely that
the long hours worked by managers and professionals are chosen
rather than obligated by financial need or employer demand.
Clearly, substantial variation exists in levels and types of stressors
experienced by different occupational groups in the Australian
labour force. Implicit in this finding is the implication that different interventions are required for different groups to optimise the
health of workers.
Two job characteristics were associated with the social impact
of oral conditions for all three occupational groups. One was the
perception that the maintenance of job skills was unlikely and the
other was the interference of work demands on home obligations.
For white-collar workers the interference of home obligations on
work demands was also associated with greater impact of oral
conditions on daily living.

Conclusion
Job characteristics in the Australian labour force are associated
with subjective oral health. This is one of an increasing number
of health outcomes that have been linked to conditions in the
workplace. Our study underscores the importance of recognising
that people are kept healthy or become ill in the environments in
which they live and work. Because job characteristics that shape
the work environment are subject to only limited control by the
individual, their influence is a public health issue.

Acknowledgement
The research on which this paper is based was supported by the
Australian Dental Research Foundation.

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