The mediating role of unhealthy behaviors and body mass index in the relationship between high job strain and self-rated poor health among lower educated workers

OBJECTIVES: The objective of this study is to examine the mediating role of unhealthy behaviors and body mass index (BMI) in the relationship between high job strain and self-rated poor health in workers with a low education. METHODS: A total of 8369 low educated workers, who participated in the Lifelines cohort study during the period 2012–2017, were included. Self-reported job strain, health behaviors (smoking, physical activity, and fruit and vegetable consumption), and BMI were assessed at baseline, and self-rated health after 2 years. To assess mediation by the health behaviors and BMI, structural equation modeling with logistic and multinomial regression analyses were performed. RESULTS: Workers with high job strain had a higher odds of poor health (OR 1.34; 95% CI 1.13–1.60) compared to those with low job strain. Workers with high job strain were more likely to have a lack of physical activity (OR 1.14; 95% CI 1.01–1.28), but were not more likely to smoke, to be overweight or obese, or to have a low fruit or vegetable consumption. Workers who smoke, have a lack of physical activity or are overweight or obese are more likely to report poor health (OR 1.37; 95% CI 1.16–1.60, OR 1.25; 95% CI 1.08–1.43, OR 1.37; 95% CI 1.16–1.61, OR 2.25; 95% CI 1.86–2.72). Indirect (mediating) effects of unhealthy behaviors and BMI in the relationship between high job strain and poor health were small and not statistically significant. CONCLUSIONS: No mediating effects of unhealthy behaviors or BMI were found in the relationship between high job strain and self-rated poor health among workers with a low educational level.