Aldalooj, Esraa; (2018) Psychosocial work environment and oral health in the English Longitudinal Study of Ageing. Doctoral thesis (Ph.D), UCL (University College London).

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Abstract

BACKGROUND: A growing body of literature shows that psychosocial work environment influences the health of employees and their quality of life. A few studies also suggest that psychosocial work environment might influence oral health. However, the evidence for an association between work stress and oral health is very limited and inconclusive in terms of temporality, as the current literature was exclusively based on crosssectional designs. Given the increasing proportion of older adults in the population and workforce, there is a need to investigate the potential role of psychosocial work factors as a broader determinant of oral health. AIM: The aim of this thesis was to examine whether psychosocial work environment was a determinant of oral health among older working adults, and whether this association was explained by demographic, socio-economic and behavioural factors. METHODS: Secondary analysis of data from the English Longitudinal Study of Ageing (ELSA) waves 3 (2006-07), 4 (2008-09) and 5 (2010-11) was conducted. The sample comprised a total of 1,854 adults aged 50 to 65 years in the cross-sectional analysis, and 1,542 and 1,058, respectively, in two different sets of longitudinal analyses. Two key measures of psychosocial work environment were derived from the ELSA self-report questionnaire, reflecting on the work demand-control model (work control) and the effort-reward imbalance model (work quality). Oral health outcomes were assessed using self-rated oral health, oral health-related quality of life (OHRQoL) and selfreported edentulousness. Logistic regression models were used to estimate the odds ratio of poor oral health outcomes for different psychosocial work environment exposures, sequentially adjusted for age, gender, marital status, education, income, type of work and smoking status. RESULTS: When compared to those with high levels of work control, those at low levels had higher odds of poor self-rated oral health (OR 1.44; 95% CI: 1.08-1.93) and poor OHRQoL (OR 1.91; 95% CI: 1.10-3.31) in the cross-sectional analysis. Similarly, low work quality was associated with poor self-rated oral health (OR 1.48; 95% CI: 1.08- 2.03) and OHRQoL (OR 1.91; 95% CI: 1.15-3.15). In the longitudinal analysis, low quality of work at wave 3 also predicted poor self-rated oral health (OR 1.43; 95% CI: 1.01-2.04) and OHRQoL (OR 1.65; 95% CI: 1.06-2.57) four years later when compared to high quality of work, though the association between quality of work and OHRQoL was weaker in the longitudinal analysis compared to the cross-sectional. Some evidence was found between repeated exposure to low quality of work at waves 3 and 4 with worse OHRQoL at wave 5 with OR 2.38 (95% CI: 1.09-5.20). All associations were independent from selected covariates at wave 3. CONCLUSION: The role of psychosocial work environment on poor oral health appears to be limited among older English working adults. The study found some evidence of associations between work quality and OHRQoL in the cross-sectional, longitudinal and repeated exposure analyses. There was some weak evidence for the association between work control and oral health status. This thesis contributes to the understanding of the links between psychosocial work conditions and oral health in later life.

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