title: Work stress and hair cortisol levels among workers in a Bangladeshi ready-made garment factory - Results from a cross-sectional study.
abstract: Evidence on the association of work stress with cortisol levels is inconsistent and mostly stems from Western countries, with limited generalizability to other regions of the world. These inconsistencies may partly be due to methodological limitations associated with the measurement of cortisol secretion in saliva, serum or urine. The present study set out to explore associations of work stress with long-term integrated cortisol levels in hair among 175 workers of an export oriented ready-made garment (RMG) factory in Dhaka, Bangladesh. Work-related demands (WD), interpersonal resources (IR) and work-related values (WV) were assessed using a psychometrically evaluated interview. WD consisted of four items on physical demands, time pressure, worries about mistakes and exposure to abusive language. IR comprised five items addressing support, recognition, adequate payment, workers' trust in the management, and the management's trust in workers, as perceived by the workers. WV captured job security, promotion prospects and job latitude by three items. Hair cortisol concentrations (HCC) were analyzed by liquid chromatography-mass spectrometry. Stepwise multivariable linear regression models (backward elimination of predictors) were used to estimate associations of HCC with the three work stress components. For significant work stress component(s), further multivariable linear regression analyses were conducted to explore whether, and if so, which individual item(s) contributed most. The mean HCC equaled 3.27 (SD 2.58) pg/mg. HCC were found to be significantly associated with WV (beta=0.209, p=0.021). Additional analyses of the three WV items revealed that this association was largely driven the item on "promotion prospects" (beta=0.230, p=0.007) implying that the perception of good promotion prospects was associated with higher HCC. The finding of elevated HCC with good promotion prospects may initially seem counter-intuitive, but is supported by research documenting that job promotion may result in poorer mental well-being. Moreover, being promoted in the Bangladeshi RMG industry may represent a stressful experience: job promotions are rare in this setting and are associated with the need to meet exceptional job-related demands. Further research from ethnic and culturally diverse occupational settings is needed to test this hypothesis, to shed light on the reproducibility of our findings and to improve our understanding of the psychobiological implications of psychosocial working conditions across cultures and contexts.
authors.affiliation: Mannheim Institute of Public Health, Social and Preventive Medicine, Mannheim Medical Faculty, Heidelberg University, Ludolf-Krehl-Str. 7-11, 68167 Mannheim, Germany; Cluster of Excellence "Asia and Europe in a Global Context, Shifting Asymmetries in Cultural Flows", Heidelberg University, Voßstr. 2, 69115 Heidelberg, Germany.
authors.forename: Maria
authors.initials: M
authors.lastname: Steinisch
authors.affiliation: Centre for Health, Population and Development, Independent University, Bangladesh, Plot #16, Block B, Aftabuddin Ahmed Road, Bashundhara R/A, Dhaka 1229, Bangladesh; School of Life Sciences, Independent University, Bangladesh, Plot #16, Block B, Aftabuddin Ahmed Road, Bashundhara R/A, Dhaka 1229, Bangladesh.
authors.forename: Rita
authors.initials: R
authors.lastname: Yusuf
authors.affiliation: Institute of Occupational and Social Medicine, Centre for Health and Society, Faculty of Medicine, University of Düsseldorf, Moorenstraße 5, 40225 Düsseldorf, Germany.
authors.forename: Jian
authors.initials: J
authors.lastname: Li
authors.affiliation: Department of Psychology, Technical University of Dresden, 01062 Dresden, Germany.
authors.forename: Tobias
authors.initials: T
authors.lastname: Stalder
authors.affiliation: Mannheim Institute of Public Health, Social and Preventive Medicine, Mannheim Medical Faculty, Heidelberg University, Ludolf-Krehl-Str. 7-11, 68167 Mannheim, Germany; Department of Psychology, University of Amsterdam, Weesperplein 4, 1018 XA Amsterdam, The Netherlands.
authors.forename: Jos A
authors.initials: JA
authors.lastname: Bosch
authors.affiliation: Centre for Health, Population and Development, Independent University, Bangladesh, Plot #16, Block B, Aftabuddin Ahmed Road, Bashundhara R/A, Dhaka 1229, Bangladesh; School of Public Health, Independent University, Bangladesh, Plot #16, Block B, Aftabuddin Ahmed Road, Bashundhara R/A, Dhaka 1229, Bangladesh.
authors.forename: Omar
authors.initials: O
authors.lastname: Rahman
authors.affiliation: Cluster of Excellence "Asia and Europe in a Global Context, Shifting Asymmetries in Cultural Flows", Heidelberg University, Voßstr. 2, 69115 Heidelberg, Germany; Department of Anthropology, South Asia Institute, Heidelberg University, Im Neuenheimer Feld 330, 69120 Heidelberg, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Strümpell
authors.affiliation: Cluster of Excellence "Asia and Europe in a Global Context, Shifting Asymmetries in Cultural Flows", Heidelberg University, Voßstr. 2, 69115 Heidelberg, Germany; Department of Anthropology, South Asia Institute, Heidelberg University, Im Neuenheimer Feld 330, 69120 Heidelberg, Germany; Health, Care and Body Programme Group, Amsterdam Institute of Social Science Research, University of Amsterdam, Kloveniersburgwal 48, 1012 CX Amsterdam, The Netherlands.
authors.forename: Hasan
authors.initials: H
authors.lastname: Ashraf
authors.affiliation: Mannheim Institute of Public Health, Social and Preventive Medicine, Mannheim Medical Faculty, Heidelberg University, Ludolf-Krehl-Str. 7-11, 68167 Mannheim, Germany; Cluster of Excellence "Asia and Europe in a Global Context, Shifting Asymmetries in Cultural Flows", Heidelberg University, Voßstr. 2, 69115 Heidelberg, Germany.
authors.forename: Joachim E
authors.initials: JE
authors.lastname: Fischer
authors.affiliation: Mannheim Institute of Public Health, Social and Preventive Medicine, Mannheim Medical Faculty, Heidelberg University, Ludolf-Krehl-Str. 7-11, 68167 Mannheim, Germany; Cluster of Excellence "Asia and Europe in a Global Context, Shifting Asymmetries in Cultural Flows", Heidelberg University, Voßstr. 2, 69115 Heidelberg, Germany; Institute of Occupational and Social Medicine, Centre for Health and Society, Faculty of Medicine, University of Düsseldorf, Moorenstraße 5, 40225 Düsseldorf, Germany. Electronic address: Adrian.Loerbroks@uni-duesseldorf.de.
authors.forename: Adrian
authors.initials: A
authors.lastname: Loerbroks
mesh_terms: D000328:Adult; D001459:Bangladesh; D003430:Cross-Sectional Studies; D005260:Female; D006197:Hair / Q000737:chemistry*; D006801:Humans; D006854:Hydrocortisone / Q000032:analysis*; D008297:Male; D008875:Middle Aged; D009790:Occupations; D013315:Stress, Psychological / Q000503:physiopathology* / Q000523:psychology; D011795:Surveys and Questionnaires; D017132:Workplace / Q000523:psychology*; D055815:Young Adult
chemical_list: D006854:Hydrocortisone
keywords: Bangladesh; Cortisol; Global garment industry; Hair; Psychosocial working conditions; Work stress