title: Work stress, family stress and asthma: a cross-sectional study among women in China.
abstract: OBJECTIVE
  Research addressing links of work stress or family stress with asthma is constrained by (1) inconsistent evidence, (2) failure to consider the combined exposure to work stress and family stress, and (3) its primary focus on Western study populations. We aimed to address these knowledge gaps.
  
  
  METHODS
  We used cross-sectional data collected in 2015 among 7816 women from five professional groups in five Chinese cities. Work stress was measured by the 10-item effort-reward imbalance (ERI) questionnaire. Family stress was assessed by a psychometrically evaluated instrument comprising five items on, e.g., familial conflicts or domestic workload. Asthma was operationalized by self-reports of a physician diagnosis. Associations were examined by multivariable logistic regression estimating odds ratios (ORs) and 95% confidence intervals (CIs).
  
  
  RESULTS
  Both high work stress (i.e., ERI score >1) and high family stress (i.e., score above the median) were associated with asthma (OR 1.66, 95% CI 1.22-2.27 and OR 1.48, 95% CI 1.10-1.99, respectively). Women with combined exposure (versus none) had somewhat higher odds of asthma (OR 2.13, 95% CI 1.42-3.19) than those with sole exposure to either work stress (OR 1.89, 95% CI 1.20-2.96) or family stress (OR 1.71, 95% CI 1.03-2.84). Interaction terms were significant for continuous variables (p = 0.046), but not for dichotomized variables (p = 0.199).
  
  
  CONCLUSIONS
  The present study suggests that both work stress and family stress are positively associated with asthma in women in China. Further, the combined exposure may be associated with a further excess of asthma occurrence. Longitudinal studies are needed to confirm our findings and to explore potential temporal relationships.
authors.affiliation: Institute of Occupational, Social and Environmental Medicine, Centre for Health and Society, Faculty of Medicine, University of Düsseldorf, Düsseldorf, Germany.
authors.forename: Adrian
authors.initials: A
authors.lastname: Loerbroks
authors.affiliation: Beijing Obstetrics and Gynecology Hospital, Capital Medical University, 251 Yaojiayuan Road, 100026, Beijing, People's Republic of China. dingdingumea@163.com.|School of Public Health, Capital Medical University, Beijing, People's Republic of China. dingdingumea@163.com.
authors.forename: Hui
authors.initials: H
authors.lastname: Ding
authors.affiliation: Shaanxi Provincial People's Hospital, Xi'an, People's Republic of China.
authors.forename: Wei
authors.initials: W
authors.lastname: Han
authors.affiliation: Shenzhen Maternity and Child Health Care Hospital, Shenzhen, People's Republic of China.
authors.forename: Hong
authors.initials: H
authors.lastname: Wang
authors.affiliation: Nanjing Maternity and Child Health Care Hospital, Nanjing, People's Republic of China.
authors.forename: Jiang-Ping
authors.initials: JP
authors.lastname: Wu
authors.affiliation: Shenyang Women and Children Health Care Center, Shenyang, People's Republic of China.
authors.forename: Liu
authors.initials: L
authors.lastname: Yang
authors.affiliation: Institute of Occupational, Social and Environmental Medicine, Centre for Health and Society, Faculty of Medicine, University of Düsseldorf, Düsseldorf, Germany.
authors.forename: Peter
authors.initials: P
authors.lastname: Angerer
authors.affiliation: Institute of Occupational, Social and Environmental Medicine, Centre for Health and Society, Faculty of Medicine, University of Düsseldorf, Düsseldorf, Germany.
authors.forename: Jian
authors.initials: J
authors.lastname: Li
mesh_terms: D000328:Adult; D001249:Asthma / Q000453:epidemiology* / Q000523:psychology; D002681:China / Q000453:epidemiology; D003430:Cross-Sectional Studies; D005190:Family; D005260:Female; D006801:Humans; D008875:Middle Aged; D016272:Occupational Health; D012201:Reward; D012307:Risk Factors; D013315:Stress, Psychological / Q000523:psychology*; D011795:Surveys and Questionnaires; D016526:Workload / Q000523:psychology
keywords: Asthma; China; Effort–reward imbalance; Family stress; Women’s health; Work stress