J Community Health
DOI 10.1007/s10900-016-0249-8
ORIGINAL PApER
Association of Job Insecurity with Health Risk Factors
and Poorer Health in American Workers
Jagdish Khubchandani1 · James H. Price2
© Springer Science+Business Media New York 2016
Abstract  Perceived job insecurity and health risk factors
have not been well studied in the United States (US) work-
force. The purpose of this study was to assess the associa-
tion of specific health risk factors and morbidities with per-
ceived job insecurity in a large national random sample of
working adults in the US. The National Health Interview
Survey data were analyzed for this study. We computed
the prevalence of perceived job insecurity by demographic
characteristics and tested the relative association between
perceived job insecurity and selected health risk factors
using logistic regression analysis with adjusted odds ratios
(AORs). A total of 17,441 working adults were included
in the study: 75 % Whites, 51.5 % females, 73.3 % worked
for a private company, and 82.6 % were 25–64 years of
age. One in three (33 %) workers perceived their job to be
insecure. Those who reported job insecurity had signifi-
cantly higher odds of: being obese, sleeping less than 6 h/
day, smoking every day, having work loss days >2 weeks,
and worsening of general health in the past year. Job inse-
cure individuals had a likelihood of serious mental illness
within the past 30 days almost five times higher than those
who were not job insecure. In addition, job insecure indi-
viduals were significantly more likely to report pain condi-
tions (i.e. headaches, neck pain, and low back pain), and
lifetime histories of having ulcers, diabetes, hypertension,
angina pectoris, and coronary heart diseases. Job insecurity
is associated with poor health and health risk behaviors
in American adults. Potential interventions to address job
Jagdish Khubchandani
jkhubchandan@bsu.edu
1
Ball State University, Muncie, IN 47306, USA
2
University of Toledo, Toledo, OH 43606, USA
insecurity and improve the health and well-being of work-
ing adults have been discussed based on study findings.
Keywords  Job insecurity · Health behavior · Stress ·
Chronic disease · Health risk factors · Occupational
health · Occupational psychology
Introduction
The past three decades have seen dramatic changes in the
labor markets of Western countries [1]. There has been an
industrial shift away from manufacturing toward service
industries. Along with international competition, this has led
to downsizing (through layoffs and plant closings), outsourc-
ing, mergers, replacement of full-time permanent positions
with short-term contracts, and corporate reorganizations
affecting millions of workers each year. One of the job
safety nets of labor, namely unions, has seen a major decline
in numbers in recent decades [1, 2]. Among the various out-
comes of this job market upheaval has been a growing sense
of job insecurity among employees. Perceived job insecurity
is a subjective sense that one’s job is not secure and that in
the near future he/she may lose their job [3, 4]. According
to Ashford and colleagues’ pioneering work, the perception
of job insecurity may have several components (e.g. likeli-
hood of losing a job, importance of losing or having a job,
perceived powerlessness to resist threat, perceived role con-
flict in a job, role ambiguity in a job, perceptions of organi-
zational changes, and a cohort of subjective and objective
assessments of workplace situations by an individual) [5].
Perceived job insecurity was assessed in a study of 16
European countries and it was found that the prevalence
of job insecurity ranged from approximately 14 % (Spain)
to 42 % (Poland) [6]. Whereas, two complementary data
13
2 J Community Health
sources, the American’s Changing Lives (ACL) study of U.S.
adults in the late 1980s and the Midlife in the United States
(MIDUS) study of Americans from the mid-1990s to 2005,
were used to examine episodic and persistent perceived
job insecurity and found that job insecurity in these studies
ranged from about 13–18 % [7]. In addition, the Michigan
Recession and Recovery Study(MRRS) of 2009/2010 found
that 17.5 % of working age adults in southeastern Michigan
perceived their jobs to be insecure [8].
Numerous studies have explored social, psychological,
and physical health variables associated with job insecurity
[4–10]. A majority of these studies have been conducted in
European countries [6, 9, 10]. Job insecurity seems to have
its effects on the body through stress effects on allostatic
load, a process that disrupts the ability of the body to return
to homeostasis after encountering a stressful event, result-
ing in a chronic stress response [10–12]. In other words,
the interpretation of external stress stimuli (i.e. mass media
reports, rumors from peers, treatment by supervisors, etc.)
by a worker causes activation of the central nervous system
which in turn activates hormones in the body (psychoneuro-
endocrinology) [7–12]. Numerous acute insults and chronic
insults (e.g. stress) can result in disruption of homeostasis
(constancy of balance of internal systems), resulting in allo-
stasis (adaptation to variation in stress induced hormonal
changes) [11–13]. Allostatic load is the physiological cost
to the body to adapt to psychosocial stressors due to either
too much stress or inefficient operation of the neuroendo-
crine response system (hypothalamic-pituitary-adrenal axis;
sympathetic nervous system; and immune system). Typical
measures of allostatic load include high blood pressure and
body fat, increased cholesterol levels, sleep disruption, and
increased levels of a variety of hormones (e.g. glucocorti-
coids and catecholamines) [11–13].
The psychosocial detrimental effects of job insecurity
and its stress effects include emotional disturbances (anxi-
ety, tension, job dissatisfaction, lack of concentration, etc.),
sleep disturbance, major depression, and work related dis-
turbances (reduced organizational trust, increased inten-
tion to quit, lower job performance including tardiness and
absenteeism) [14, 15].
The most toxic effects of job insecurity include a variety
of physical health consequences including hormonal dys-
regulation, autoimmune disorders, some cancers, metabolic
syndrome (including abdominal obesity, dyslipidemia, high
blood pressure, insulin resistance, and prothrombic state),
and increased cardiovascular morbidity and mortality [14–
18]. For example, the most recent meta-analysis of self-
reported job insecurity and incident coronary heart disease
adjusted for sociodemographic and health risk factors found
that 19 % had statistically significant increases in incident
coronary heart disease for individuals who reported job
insecurity [19]. The morbidity associated with job insecurity
13
is often in part attributable to poorer socioeconomic circum-
stances, less favorable health risk factors, and psychosocial
profiles among people with job insecurity [14–19].
One of the few national studies to examine job insecurity
in the US utilized the 2010 National Health Interview Survey
(NHIS) data and found the prevalence of job insecurity to be
almost 32 % [20]. However, this NHIS analysis by Alterman
and colleagues did not explore the variety of health risk behav-
iors and comorbidities that may be increased in those who
reported job insecurity [20]. Thus, the purpose of this study
was to assess the association of specific health risk factors and
perceived job insecurity in a large national random sample of
working adults in the US. In addition, this study explored the
psychological and physical health consequences of job inse-
curity and health outcomes associated with job insecurity. We
also explored the demographic and employment characteris-
tics of individuals who reported having job insecurity.
A meta-analytic review of the job insecurity literature by
gender found that there were no significant differences in
psychological health or physical health [21]. However, this
study was on general psychological and physical health and
did not mention specific factors that impact health status. In
addition, the literature also indicates that with regard to spe-
cific risks to health there are significant differences between
males and females in relation to smoking rates, alcohol
dependency, and prevalence of overweight/obesity [22–24].
Thus, we also report our health risk factors analyses by gen-
der to control for the aforementioned gender differences in
health risk factors.
Methods
Study Design and Participants
This study is a secondary data analysis of the National
Health Interview Survey (NHIS) data. The NHIS is con-
ducted by the National Center for Health Statistics (NCHS)
of the US Centers for Disease Control and Prevention
(CDC). The NHIS has been conducted since 1957 to moni-
tor the health of individuals living in the US by collecting
data on a variety of health topics. This survey of the civilian
non-institutionalized American population involves multi-
stage clustered sampling of households with oversampling
of African-American, Asian, and Hispanic individuals.
Details about the survey methods, sampling, and response
rates have been published by the US CDC [25]. The 2010
NHIS data were collected on a total of 27,157 adults. Study
procedures were approved by the NCHS Research Ethics
Review Board. This study used de-identified publicly avail-
able data and there was no recruitment or direct contact with
the participants for this study [25, 26]. Therefore, no addi-
tional IRB approval was necessary.
J Community Health
Measures
Job Insecurity and Demographic Characteristics
For our analysis, we included all the adults who partici-
pated in the 2010 NHIS, had continuous employment in
the past year, and responded to the question on job inse-
curity (n = 17,441). In 2010, the NHIS had a variable for
adult respondents where they were asked to rate their level
of agreement with the following statement “I am/was wor-
ried about being unemployed” (applicable for the past 12
months). The response options were: strongly agree, agree,
disagree, and strongly disagree. We categorized strongly
agree/agree as ‘yes’ and disagree/strongly disagree as ‘no’
to create a dichotomous variable on job insecurity which
served as the main independent predictor variable. Infor-
mation on participants’ age, gender, race, ethnicity, and
marital status were used to assess if the probability of job
insecurity differed based on demographic characteristics. In
addition, employment characteristics of participants’ such
as employer type, work schedule, number of jobs held, and
number of employees at work were also considered in the
analysis to assess the prevalence of job insecurity [25, 26].
Lifestyle Behaviors
The NHIS asked respondents about their sleep duration on
an average day, tobacco use frequency (e.g. current, ever,
former, and never), alcohol use patterns (e.g. heavy, moder-
ate, light), and level of light to moderate physical activity,
vigorous exercise, and strength training on a weekly basis.
Self-reported height and weight were used to compute the
body mass index (BMI) of the respondents. We categorized
individuals based on their BMI as normal weight (18.5–
24.9), underweight (below 18.5), overweight (25.0–29.9),
or obese (30.0 and above) [25, 26]. These lifestyle behaviors
were used as dependent outcome variables to assess if they
were associated with perceived job insecurity.
Health and Work-Life
To assess the influence of job insecurity on work-life and
general health we used a series of variables from the NHIS
data such as work loss days (range of 1–365), bed days
(range of 1–365), work-family life imbalance in the past
year (response options: strongly agree, agree, disagree, and
strongly disagree, categorized as ‘yes’ vs. ‘no’), and per-
ceived general health status compared to 12 months back
(response options: better, same, worse). We also used two
health service utilization variables (i.e. number of visits
to a general practitioner or emergency room in the past 12
months: range of 1–365, which we categorized as ‘yes’ vs.
‘no’) [25, 26].
3
Chronic Diseases
To test the association between perceived job insecurity and
chronic diseases and risk factors we analyzed variables such
as prevalence of pain disorders in the past 3 months (e.g.
headache, low back pain, and neck pain), and lifetime his-
tory of asthma, ulcers, diabetes and cardiovascular illnesses
such as stroke, heart attacks, angina pectoris, and hyperten-
sion. The NHIS asked respondents to confirm if they had
been diagnosed with the aforementioned chronic diseases
and health conditions (with response options as ‘yes’ versus
‘no’) [25, 26].
Psychological Distress
The NHIS uses the Kessler 6 scale (K6 scale) to estimate the
prevalence of nonspecific psychological distress [25, 26].
The K6 scale asks respondents about psychological distress
using the following questions: ‘‘During the past 30 days,
how often did you feel: so sad that nothing could cheer you
up? Nervous? Restless or fidgety? Hopeless? that every-
thing was an effort? and Worthless?’’ The response options
were: ‘All of the time,’ ‘Most of the time,’ ‘Some of the
time,’ ‘A little of the time’, and ‘None of the time.’ Scoring
of the individual questions was based on a scale of 0–4 (low
to high frequency of the problem). The six item responses
were then added to create a score which had a potential
range of 0–24. According to scoring criteria established by
Kessler, this score was used to establish serious mental ill-
ness (SMI) status. A score of ≥13 indicates likely cases of
serious mental illness (SMI) with a classification accuracy
of 0.92 [26, 27]. Subsequently, we examined each domain
of psychological distress individually and dichotomized
the responses to the six questions by combining ‘All of the
time’ and ‘Most of the time’ into “yes” and ‘Some of the
time,’ ‘A little of the time,’ and ‘None of the time’ into “no”
in relation to presence or absence of psychological distress
for each item [26, 27].
Data Analysis
All analyses were conducted with complex samples sur-
vey data analysis procedures in STATA software (version
14). Statistical significance was established at p < 0.01 to
minimize type I errors. First, we conducted descriptive
analyses of the demographic and employment characteris-
tics of study participants. In addition, the odds of report-
ing job insecurity were computed for participants based on
their demographic and employment characteristics. Second,
multivariate logistic regression analyses were conducted
to assess the association between job insecurity and life-
style behaviors, psychological distress, work-life, general
health, and chronic diseases for all study participants (i.e.
13
4 J Community Health
comparing individuals with or without job insecurity on
health outcomes). Demographic characteristics were used
as covariates in this procedure. Finally, the logistic regres-
sion analysis was stratified by gender to compare specific
health outcomes in males and females who reported job
insecurity (compared with males and females who did not
report job insecurity). Adjusted odds ratios (AORs) and
95 % confidence intervals (CIs) were computed. Analyses
were adjusted for age, race, gender, marital status, income,
and education.
Results
Job Insecurity and Demographic Characteristics
The total number of working adults included in this study
were 17,441 (75 % Whites, 51.5 % females, 19.7 % Hispan-
ics, 46.2 % married, 82.6 % were in the age range of 25–64
years, and 73.3 % worked for a private company). The
prevalence of perceived job insecurity was 32.6 % (95 %
CI 31.8−33.4 %) with the odds being higher for males (OR
1.14, p < 0.001), African-Americans (OR 1.25, p < 0.001),
Hispanics, (OR 2.13, p < 0.001), those who were divorced/
separated (OR 1.48, p < 0.001), and those who were paid
by the hour (OR 1.35, p < 0.001). Individuals with lower
educational attainment and annual household incomes were
more likely to perceive job insecurity than those with higher
education and household incomes. The odds of perceived
job insecurity were significantly lower for government
employees and those who worked for large organizations
with more than 10 employees (Table 1).
Association of Job Insecurity with Health Outcomes
Logistic regression analyses with adjusted odds ratios
(AORs) were computed to assess the association between
job insecurity and various health outcomes and health risk
behaviors (Table 2). Adjustments were made for age, race,
ethnicity, education, income, and marital status. Whether or
not an individual perceived job insecurity was the binary
independent variable (yes vs. no). Individuals who were job
insecure had statistically significantly higher odds of: being
obese, sleeping less than 6 h on an average day, and smok-
ing every day. In relation to work-life and health, individu-
als who were job insecure had significantly higher odds of:
reporting work loss days of greater than 2 weeks, bed days
of greater than 2 weeks, worsening of general health, and
greater work-family life imbalance in the past 12 months.
Individuals who were job insecure were significantly less
likely to be involved in vigorous physical activity, light to
moderate exercise, and strength training within the past
week. Also, job insecure individuals were less likely to see
13
a general practitioner in the past 12 months. In contrast, job
insecure workers were significantly more likely to receive
treatment in emergency rooms in the same time period. The
odds of having serious mental illness within the past 30 days
were almost five times higher in individuals who perceived
they were job insecure compared to those who did not. Job
insecure individuals were statistically significantly more
likely to have pain conditions within the past 3 months (i.e.
headaches, neck pain, and low back pain), and a lifetime
history of ulcers, diabetes, hypertension, angina pectoris,
and coronary heart disease.
Gender Differences in Health Outcomes for Job
Insecurity
Job insecurity was reported by both males and females
(34 vs. 31 %). Since, males had significantly higher odds
of reporting job insecurity, we assessed the differences in
health outcomes between males and females who perceived
they had job insecurity (compared to males and females
who did not) (Table 2). AORs were computed for the asso-
ciation between health outcomes and job insecurity. Poor
health outcomes were associated with job insecurity in both
males and females. However, there were some distinct pat-
terns for health risks. Compared to males who did not per-
ceive job insecurity, males who reported job insecurity were
statistically significantly more likely to: report >2 weeks of
bed days, >2 weeks work loss days, and receive treatment
in the ER in the past 12 months. They were also signifi-
cantly less likely to see a general practitioner in the past 12
months. In addition, they were significantly more likely to
have hypertension, angina pectoris, coronary heart disease,
and stroke (i.e. poorer cardiovascular health compared to
females who perceived job insecurity). While women who
perceived job insecurity (compared to women who did
not) had statistically significantly higher adjusted odds for:
smoking somedays and smoking every day, being obese and
overweight, sleeping less than 6 h on an average day, and
having asthma, diabetes, and work-family life imbalance.
These associations were statistically significantly stron-
ger in females, compared to males (Table 2). Finally, both
females and males who perceived they had job insecurity
had significantly higher odds of psychological distress and
likely serious mental illness in the past month, with the odds
higher for males than females.
Discussion
The level of job insecurity we found in the NHIS data was
almost twice the rate found in the previous studies examin-
ing American workers [7, 8]. There are a number of poten-
tial explanations for the difference in our findings. First, the
J Community Health 5

Table 1  Characteristics of study participants and their odds of reporting job insecurity

N (%) OR (95 % CI)

Demographic characteristics
Gender
Male 8463 (48.5) 1.14 (1.08–1.25)**
Female 8978 (51.2) 1 (Ref)
Age (years)
18–24 2036 (11.7) 1 (Ref)
25–44 7955 (45.6) 1.50 (1.32–1.71)**
45–64 6465 (37.0) 1.55 (1.35–1.77)**
≥65 985 (5.6) 0.46 (0.37–0.59)**
Race
White 13080 (75.0) 1 (Ref)
Black/African American 2713 (15.6) 1.25 (1.12–1.40)**
AIAN 137 (0.8) 0.91 (0.54–1.53)
Asian 1166 (6.7) 1.15 (0.98–1.35)
Multiple race 319 (1.8) 1.14 (0.86–1.52)
Ethnicity
Not Hispanic 13993 (80.2) 1 (Ref)
Hispanic/Spanish origin 3448 (19.7) 2.13 (1.95–2.33)**
Marital status
Married 8074 (46.2) 1 (Ref)
Never married 4638 (26.6) 1.04 (0.94–1.15)
Divorced/separated 2965 (17.0) 1.48 (1.32–1.66)**
Widowed 510 (2.9) 0.83 (0.67–1.04)
Living with a partner 1226 (7) 1.07 (0.94–1.22)
Educational attainment
<High school 2051 (9.1) 2.37 (2.11–2.67)**
High school diploma 3742 (21.3) 1.53 (1.39–1.68)**
Some college 6038 (35.6) 1.28 (1.18–1.39)**
≥College degree 5567 (34) 1 (Ref)
Annual household income
$0–$34,999 5711 (31.9) 2.19 (1.97–2.44)**
$35,000–$49,999 2595 (15.6) 1.72 (1.52–1.96)**
$50,000–$74,999 3132 (19.0) 1.46 (1.30–1.64)**
$75,000–$99,999 2009 (12.7) 1.27 (1.10–1.45)**
$100,000 and over 3233 (20.8) 1 (Ref)
Employment characteristics
Paid hourly
Yes 10413 (59.7) 1.35 (1.25–1.47)**
No 6993 (40.1) 1 (Ref)
Have more than one job
Yes 1331 (7.6) 1.06 (0.91–1.22)
No 14231 (81.6) 1 (Ref)
Employer type
Private company 12798 (73.3) 1 (Ref)
Federal government 543 (3.1) 0.42 (0.32–0.54)**
State government 1154 (6.6) 0.69 (0.59–0.81)**
Local government 1227 (7.0) 0.72 (0.61–0.85)**
Self-employed 1575 (9.0) 1.01 (0.88–1.14)

13
6 J Community Health
Table 1 (continued)
Work schedule
Not regular
Regular day shift
Regular evening shift
Regular night shift
Number of employees
1–9
10–99
100–999
>1000
N = 17,441, numbers in columns may not add up to 100 % due to missing values, Ref reference group, OR 95 % CI odds ratios with 95 % confi-
dence intervals for reporting job insecurity.
*p < 0.01 and **p < 0.001
time differences in which the data were collected may have
caused the difference in the findings. Second, the NHIS data
was a large national sample and the previous three studies
were either state or regional which may have caused the dif-
ference in findings between our studies and others.
We firmly believe that perceived job insecurity is an
additional stressor that is added to the other common bur-
dens experienced by many American workers. Like the
studies of perceived job insecurity in European popula-
tions, we found strong associations between perceived
job insecurity and emotional disturbances, psychological
distress, sleep disorders, obesity, hypertension, pain con-
ditions, worsening general health, and coronary heart dis-
eases [9, 10, 14–18].
Research has shown a dose response relationship such
that 3 or more exposures to stressors more than doubles the
risk that workers will develop the metabolic syndrome [19,
28]. However, such studies frequently adjust their analysis
for cardiovascular risk factors which ends up attenuating the
relationship between perceive job insecurity and associated
morbidities [14, 17–19]. We think adjusting data analyses
for health risk factors among workers unduly reduces the
evidence for the negative associations of the greater prev-
alence of health risk factors on poor health outcomes of
stressed workers. In our study, we studied poor cardiovas-
cular health outcomes and health risk factors that lead to
these outcomes independently in those who perceived their
jobs to be insecure.
Most American households face stagnant wages and
increasing debt, add to that job insecurity and many Ameri-
cans will be in an environment that will exceed their capaci-
ties to adapt in a positive manner [29, 30]. Evidence shows
that lower wage workers with higher stress levels often
engage in higher rates of health risk behaviors, including
becoming more sedentary, eating more, drinking more alco-
hol, and smoking more [14–18, 29, 30]. These are prominent
13
N (%) OR (95 % CI)
3378 (19.4) 1 (Ref)
12482 (71.6) 1.04 (0.95–1.14)
902 (5.2) 1.12 (0.92–1.34)
666 (3.8) 1.15 (0.94–1.40)
4548 (26.1) 1 (Ref)
6137 (35.1) 0.84 (0.76–0.92)**
4044 (23.1) 0.75 (0.67–0.84)**
2123 (12.1) 0.67 (0.58–0.77)**
risk factors for chronic diseases. The chronicity of stressors
such as those associated with job insecurity increase the
likelihood of physical and mental health problems.
In our study, we were able with the cross-sectional data
to only show associations between perceived job insecurity
and negative health outcomes. However, we believe there
is likely to exist a cause and effect relationship between the
two. In fact, a cross-lagged effects study of job insecurity
on mental health complaints 1 year later was found to be
significant, whereas the reverse effects of mental and physi-
cal health complaints on subsequent perceived job insecu-
rity were not significant, supporting the cause and effect
theory [31]. In addition, the prominent Whitehall studies
in the United Kingdom also found that there was no evi-
dence for an effect of mental or physical health on changes
in employment grade [9, 10, 28, 32]. In contrast, those who
find the cause and effect theory as lacking sufficient evi-
dence continue to point out the possibility of reverse causa-
tion theory, in part, due to health selection effects. In other
words, workers who regularly engage in health risk behav-
iors develop debilitating health problems and their quality
and quantity of work is compromised, making them feel less
secure and less productive in their jobs. Additionally, people
with poorer health and health risk behaviors may be limited
in terms of improving their social position and tend to have
lower quality jobs (i.e. poor health-related social mobility
reflected in job designation, rank, pay scale, benefits, and
security) [28–32]. Overall, the evidence for the reverse cau-
sation theory is sparse. Results from many studies suggest
that the development of social gradients in health may not be
primarily explained in terms of a health selection effect [9,
28, 31–33]. In our study, the population used was a working
American adult population of which a significant proportion
perceived they were job insecure which may have led to
engagement in health risk behaviors leading to poor health
outcomes.
J Community Health 7

Table 2  Association of job insecurity with health outcomes in the total population

Health outcomes AOR (95 % CI) total population AOR (95 % CI) females AOR (95 % CI) males

Lifestyle behaviors (current)

BMI
Normal weight Ref Ref Ref
Underweight 0.82 (0.58–1.18) 0.91 (0.60–1.36) 0.63 (0.31–1.29)
Overweight 1.08 (0.97–1.10) 1.16 (1.02–1.32)* 1.02 (0.89–1.17)
Obese 1.21 (1.10–1.35)* 1.23 (1.06–1.43)* 1.18 (1.03–1.34)*
Sleep
6–8 h Ref Ref Ref
<6 h 1.20 (1.10–1.32)* 1.33 (1.18–1.49)** 1.09 (0.96–1.25)
>8 h 1.10 (0.93–1.31) 1.12 (0.90–1.38) 1.11 (0.88–1.44)
Current tobacco and alcohol use
Smoking every day 1.38 (1.22–1.57)** 1.50 (1.29–1.76)** 1.36 (0.99–1.83)
Smoking some days 1.15 (0.94–1.39) 1.45 (1.23–1.72)** 1.11 (0.86–1.44)
Current heavy drinking 1.03 (0.85–1.27) 0.93 (0.75–1.15) 1.04 (0.86–1.34)
Vigorous physical activity
Never Ref Ref Ref
Less than once a week 0.85 (0.68–1.01) 0.67 (0.48–0.95)** 0.69 (0.51–1.04)
1–28 times a week 0.79 (0.72–0.89)** 0.79 (0.72–0.89)** 0.77 (0.69–0.86)**
Light to moderate physical activity
Never Ref Ref Ref
Less than once a week 0.90 (0.69–1.18) 0.99 (0.68–1.44) 0.86 (0.61–1.27)
1–28 times a week 0.77 (0.71–0.85)** 0.78 (0.70–0.88)** 0.76 (0.65–0.89)**
Strength activity
Never Ref Ref Ref
Less than once a week 1.08 (0.81–1.44) 1.02 (0.65–1.61) 1.10 (0.74–1.63)
1–28 times a week 0.78 (0.70–0.89)** 0.72 (0.64–0.81)** 0.81 (0.73–0.92)*
Health and work (past 12 months)
Work loss days (>2 weeks) 1.31 (1.09–1.56)* 1.20 (0.95–1.51) 1.54 (1.18–1.98)**
Bed days (>2 weeks) 1.70 (1.39–2.09)** 1.41 (0.99–1.91) 2.10 (1.46–3.04)**
General health worsened 1.79 (1.47–2.11)** 1.80 (1.44–2.27)** 1.79 (1.40–2.27)**
Seen/talked to a general doctor 0.89 (0.81–0.96)* 1.03 (0.90–1.15) 0.80 (0.71–0.90)**
Received treatment in ER 1.26 (1.15–1.39)** 1.22 (0.98–1.32) 1.34 (1.09–1.47)**
Work family life imbalance 1.76 (1.59–1.95)** 1.90 (1.63–2.18)** 1.63 (1.43–1.89)**
Chronic diseases
Pain conditions (past 3 months)
Headache (yes vs. no) 1.38 (1.26–1.54)** 1.39 (1.24–1.56)** 1.37 (1.17–1.61)**
Neck pain (yes vs. no) 1.57 (1.41–1.74)** 1.58 (1.34–1.86)** 1.57 (1.36–1.80)**
Low back pain (yes vs. no) 1.39 (1.27–1.52)** 1.41 (1.25–1.59)** 1.38 (1.23–1.55)**
Cardiovascular disease (ever diagnosed)
Hypertension (yes vs. no) 1.17 (1.03–1.30)* 1.10 (0.97–1.30) 1.27 (1.08–1.39)*
Angina pectoris (yes vs. no) 1.42 (1.06–2.09)* 1.34 (0.88–2.18) 1.57 (1.02–2.83)*
Heart attack (yes vs. no) 1.26 (0.93–1.72) 1.08 (0.67–1.72) 1.39 (0.93–2.07)
Coronary heart disease (yes vs. no) 1.34 (1.05–1.72)* 1.27 (0.95–1.78) 1.54 (1.04–2.34)*
Stroke (yes vs. no) 1.39 (0.97–2.08) 0.82 (0.47–1.44) 2.23 (1.27–3.99)**
Other diseases (ever diagnosed)
Asthma (yes vs. no) 1.08 (0.96–1.23) 1.27 (1.10–1.48)* 0.89 (0.73–1.08)
Ulcer (yes vs. no) 1.69 (1.43–2.03)** 1.69 (1.36–2.11)** 1.72 (1.30–2.27)**

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Table 2 (continued)

Health outcomes AOR (95 % CI) total population AOR (95 % CI) females AOR (95 % CI) males
Diabetes (yes vs. no) 1.32 (1.13–1.54)* 1.36 (1.07–1.66)* 1.30 (1.05–1.61)*
Psychological distress symptoms all of the time
or most of the time in the previous 30 days
(vs. some, little, or none of the time) [Kessler’s 6 scale]
Persistent sadness 3.49 (2.76–4.43)** 3.21 (2.30–4.45)** 3.97 (2.75–5.61)**
Nervousness 3.31 (2.67–4.10)** 3.03 (2.32–3.97)** 3.73 (2.64–5.26)**
Restless/fidgety 2.39 (1.99–2.87)** 2.34 (1.84–2.97)** 2.45 (1.85–3.24)**
Hopelessness 4.65 (3.31–6.54)** 4.13 (2.40–7.14)** 5.14 (3.37–7.83)**
Everything is an effort 2.48 (2.12–2.91)** 2.40 (1.85–3.13)** 2.53 (2.03–3.16)**
Worthlessness 4.96 (3.45–7.12)** 3.38 (2.17–5.27)** 9.30 (4.74–18.27)**
Likely serious mental illness (yes vs. no) 4.88 (3.42–6.03)** 4.33 (3.05–6.04)** 4.93 (3.06–7.99)**
(based on Kessler’s 6 item scale above)
AOR 95 % CI adjusted odds ratios with 95 % confidence intervals for a particular outcome in those who reported job insecurity. Adjustments
were made for demographic characteristics in Table 1 found to be associated with job insecurity (i.e. race, ethnicity, gender, age, education,
income, and marital status). Column 2 indicates comparison of total population reporting job insecurity vs. those who did not; column 3
indicates comparison of females reporting job insecurity vs. females who did not and column 4 indicates comparison of males reporting job
insecurity vs. males who did not
*p < 0.01, **p < 0.001

Despite the relationship between perceived job insecurity
and negative health outcomes, workplace health promotion
programs have the potential to ameliorate the stresses of job
insecurity [14]. A variety of workplace wellness programs
have been found to successfully reduce job stresses, includ-
ing physical activity programs and mindfulness training
programs [34–36]. Organizations can also help reduce job
insecurity stress in a variety of other ways. Among the activi-
ties organizations can adopt are: improving communication
between management and workers; reducing conflicting or
uncertain job responsibilities; establishing a program to rec-
ognize workers’ accomplishments; provide opportunities
for workers to participate in company decisions and actions
affecting their jobs; establishing employee assistance pro-
grams (EAPs); assisting workers with improving work-life
balance by using flex time, job sharing, work from home, and
eldercare and child support programs, just to name a few. In
a recent review, Keim and colleagues discuss the affective
(fear of job loss) and cognitive (likelihood of job loss) aspects
of job insecurity in addition to the variety of predictors of
job insecurity (subjective and objective). They describe the
concept of “psychological contracts” as a strategy to reduce
the detrimental effects of job insecurity [4]. For employees,
a psychological contract involves job security, fair wages,
adequate benefits and rewards, appreciation for performance,
and decreased role conflict or ambiguity. In return, employ-
ers can recruit and retain a talented pool of employees who
are satisfied with their jobs, perform well, and are commit-
ted to their organizations as a part of psychological contracts.
Another successful way to reduce work stressors is for orga-
nizations to change their operation as usual mentality and for
organizations to help workers learn to manage their stresses
[34–37]. It is important for workplaces to address workplace
stress for their own economic well-being since it has been
estimated that the majority of employee primary care medi-
cal visits include stress-related health complaints. In addition,
job insecurity has been found to negatively affect all dimen-
sions of employee productivity [21, 38].
In spite of the fact that our study has demonstrated robust
relationships between job insecurity and numerous health
outcomes in a large nationally representative sample of
working American adults, the results of the study should be
considered in the light of several potential limitations. First,
our study suffers from all traditional limitations of cross-sec-
tional study design (e.g. reliance on self-reported behaviors,
recall bias in participants and socially desirable responses,
and the inability to establish cause and effect relation-
ships). Socially desirable responses may have undermined
the reported prevalence of job insecurity and the strength of
the association between health risk factors and job insecu-
rity. Second, our study assessed job insecurity at one point
in time and therefore, we were not able to assess temporary
or chronic job insecurity. Furthermore, the entire timeframe
considered was the past 12 months which would preclude
the estimation of effects of long term job insecurity. Third,
work and employment often have a variety of simultaneous
stressors impacting the health of employees [6–10]. Mea-
suring these factors could possibly influence the strength of
relationships found between job insecurity and health out-
comes in our study. Finally, the NHIS one item assessment
may have been a rather crude estimation of job insecurity.
However, a single item measure may be acceptable if the
item represents a homogenous and unidimensional construct
(e.g. workplace harassment or job satisfaction) [26, 39].

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J Community Health 9

In conclusion, our results provide a clear pattern of asso- Official Publication of the American College of Neuropsycho-
pharmacology, 22(2), 108–124.
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Acknowledgments  Authors thank the National Center for Health
Prospective study of job insecurity and coronary heart disease in
Statistics for providing the data.
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Compliance with Ethical Standards
(2013). Association between work-related health problems and
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Conflict of Interest  The authors have no conflicts of interests to
Occupational and Environmental Medicine, 25(1), 1.
declare.
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