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This study tests associations between stressful working conditions in terms of effort‐reward imbalance and reported physical symptoms in public transport workers. We hypothesize that bus‐ and subway drivers suffer from relatively highest level of ill health as compared to repair service workers and administrative personnel, and that a substantial part of this association is due to the imbalance experienced between high effort and low reward. 1337 employees participated in the present study. Measures of effort‐reward imbalance were constructed from a large battery of standardized Likert‐scaled items, and factor‐based symptom scales were computed. After adjustment for relevant confounders multivariate logistic regression analysis revealed significantly elevated prevalence odds ratios in bus‐ and subway drivers suffering from effort‐reward imbalance (in four out of five factor based symptoms scores). Similar, but less pronounced effects were observed in repair service personnel while elevated risk in administrative personnel suffering from effort‐reward imbalance was observed only with regard to one symptom score: gastro‐intestinal symptoms. In conclusion, stressful working conditions as defined by effort‐reward imbalance are associated with high rates of reported symptoms in public transport workers, especially so in professional drivers. In view of long‐term costs and reduced quality of life associated with high rates of reported symptoms, these results call for improved worksite health promotion in specific target groups of public transport workers. © 1998 John Wiley & Sons, Ltd.

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A prospective intervention study was conducted to evaluate an employer/union-sponsored physical and psychological health program, which was offered to 125 transit operators aged >45 years with >15 years of job seniority. The one-year, biweekly program included physical exercise, relaxation, back school, and work-related stress management and diet counseling. A control group (n = 26) was available for comparison. Twenty-seven operators dropped out of the study. WHO cardiovascular risk survey methods, ergometry, Minnesota ECG coding, standardized low-back tests, blood lipids, lead, and carboxyhemoglobin were measured. Before the intervention, the ten-year cardiovascular-disease risk of all study subjects (15.1%) was greater than that of the general reference population (14.0%). After the intervention it fell to 12.9%, but not significantly compared with that of a non-exercising control group, which also showed a reduction. The prevalence and the self-rated intensity of back problems were reduced after the intervention: 55.4% of low-back-pain sufferers reported substantial improvement, and only 12.3% reported substantial worsening. The multidisciplinary intervention program appeared to be effective for musculoskeletal conditions, but not for overall cardiovascular risk, compared with the controls.

Changes in work ability and work interest (meaning) after the participation in a health promotion program were perceived and evaluated. Drivers of the Munich Transport Authority (n = 122) of an average age of 50 years participated in 20 health days during working time over 1 year. The evaluation instruments of the health promotion program were the Work Ability Index (WAI) developed by the Finnish Institute of Occupational Health (FIOH) and the Effect Typology developed by the Institute of Occupational Health Promotion (IBG Austria). No changes were found in the WAI score. The Effect Typology evaluated the optimal effect "evolution," i.e., psychological and noetic (mental) changes, for 50% of the participants. A variance analysis of the WAI pre-post differences according to the effect classes of the Effect Typology showed significant differences, namely an increase in the WAI in the evolution group and a drop in the recovery group. The Effect Typology is suitable for the evaluation of occupational health promotion and for the further understanding and development of the WAI.