THE INFLUENCE OF WORK PATTERNS ON LIFESTYLE BEHAVIOURS AND CARDIOVASCULAR RISK IN FEMALE HOSPITAL WORKERS. by Megan Kirk A thesis submitted to the School of Nursing In conformity with the requirements for the degree of Master’s of Science. Queen’s University Kingston, Ontario, Canada (September, 2009) Copyright © Megan Kirk, 2009 Library and Archives Bibliothèque et Canada Archives Canada Published Heritage Direction du Branch Patrimoine de l’édition 395 Wellington Street 395, rue Wellington Ottawa ON K1A 0N4 Ottawa ON K1A 0N4 Canada Canada Your file Votre référence ISBN: 978-0-494-65207-7 Our file Notre référence ISBN: 978-0-494-65207-7 NOTICE: AVIS: The author has granted a non- L’auteur a accordé une licence non exclusive exclusive license allowing Library and permettant à la Bibliothèque et Archives Archives Canada to reproduce, Canada de reproduire, publier, archiver, publish, archive, preserve, conserve, sauvegarder, conserver, transmettre au public communicate to the public by par télécommunication ou par l’Internet, prêter, telecommunication or on the Internet, distribuer et vendre des thèses partout dans le loan, distribute and sell theses monde, à des fins commerciales ou autres, sur worldwide, for commercial or non- support microforme, papier, électronique et/ou commercial purposes, in microform, autres formats. paper, electronic and/or any other formats. The author retains copyright L’auteur conserve la propriété du droit d’auteur ownership and moral rights in this et des droits moraux qui protège cette thèse. Ni thesis. Neither the thesis nor la thèse ni des extraits substantiels de celle-ci substantial extracts from it may be ne doivent être imprimés ou autrement printed or otherwise reproduced reproduits sans son autorisation. without the author’s permission. In compliance with the Canadian Conformément à la loi canadienne sur la Privacy Act some supporting forms protection de la vie privée, quelques may have been removed from this formulaires secondaires ont été enlevés de thesis. cette thèse. While these forms may be included Bien que ces formulaires aient inclus dans in the document page count, their la pagination, il n’y aura aucun contenu removal does not represent any loss manquant. of content from the thesis. Abstract BACKGROUND: The prevalence and burden of cardiovascular disease (CVD) is a concern. While CVD events will occur later in a woman’s life, modifiable risk factors for CVD occur earlier during adult years. While, there is strong evidence linking modifiable risk factors to CVD, the influence of the work environment on CVD risk is poorly understood. OBJECTIVES: The study objectives were to: 1) determine the prevalence of cardiovascular risk indicators; 2) determine the relationships between work patterns and lifestyle behaviours in female hospital workers; 3) determine the relationships between work patterns and cardiovascular risk indicators; and 4) determine the relationships between work patterns, lifestyle behaviours and cardiovascular risk while controlling for covariates. METHODS: Participants were female hospital workers (N= 466) from 2 hospital sites in Southeastern Ontario. Cardiovascular risk data were obtained through anthropometric measurements, blood sampling and self-report. Work pattern data were collected through self-report and linked with hospital administrative work data. Lifestyle behaviour data were obtained through self-report using validated questionnaires. Metabolic syndrome was classified in accordance with the National Cholesterol Education Program Adult Treatment Panel (NCEP ATP) (III) guidelines. RESULTS: Approximately 1 in 4 female participants had the metabolic syndrome, with elevated waist circumference being the most common CVD risk factor. After adjustments, the multivariate analysis found a few key significant associations between irregular work patterns, specifically extended shifts and elevated systolic and diastolic ii blood pressure. Consistent with the literature, the bivariate analyses revealed that after 6 or more years of shift work, female workers were more likely to develop the metabolic syndrome (OR 1.9, 95% CI 1.12, 3.17) and abdominally obesity (OR = 2.0, 95% CI, 1.31, 3.11). CONCLUSIONS: The findings from this study suggest that generally work patterns do not influence the development of unhealthy behaviours and cardiovascular risk when controlling for age and other known factors. Further research is needed to elucidate the mechanisms linking harmful and protective work pattern characteristics to CVD risk, as the findings suggest relationships between work characteristics and risk. Given the prevalence of abdominal obesity and overall CVD risk, hospital decision-makers should consider cardiovascular health promotion within their healthy workplace initiatives. iii Co-Authorship This thesis presents the research of Megan Kirk in collaboration with her thesis supervisor Dr. Joan Tranmer and thesis committee Dr. Ian Janssen and Dr. Elizabeth Van Den Kerkhof. Manuscript 1: The relationships between work patterns and modifiable lifestyle behaviours in female hospital workers. The original idea to explore the influence of work patterns on lifestyle behaviours in female hospital workers was M. Kirk’s. Dr. Tranmer had identified the need to study the influence of work environment, inclusive of work schedules on cardiovascular (CV) health in female hospital workers. I. Janssen and E. Van Den Kerkhof provided content, methodological and statistical advice. The larger study, entitled, Health and Work Study (HWS), was conducted by a research team led by Dr. Tranmer. The HWS team contacted participants, administered the questionnaire package and received administrative work data from Human Resources (HR) at both hospital sites. M. Kirk carried out the statistical analyses with guidance from Dr. Tranmer and Wilma Hopman, a research facilitator based at the Clinical Research Centre, Kingston General Hospital. Composing of the manuscript and interpretation of the results was completed by M. Kirk with modifications by thesis committee. Manuscript 2: The influence of work patterns on cardiovascular risk factors in female hospital workers. M. Kirk was responsible for the idea for this manuscript topic. Dr. Tranmer had previously identified the need to study the influence of work environments, including the influence of work schedules on female hospital worker’s cardiovascular iv health and designed the original cohort study. The HWS team met with participants, completed anthropometric measurements and provided blood requisitions for fasting blood work. M. Kirk completed primary data collection to gather work history data from the original cohort. I. Janssen and E. Van Den Kerkhof provided content, methodological and statistical advice. The larger study, entitled, Health and Work Study (HWS), was conducted by a research team led by Dr. Tranmer. The HWS team contacted participants, administered the questionnaire package and received administrative work data from Human Resources (HR) at both hospital sites. M. Kirk carried out the statistical analyses with guidance from Dr. Tranmer and Wilma Hopman, a research facilitator based at the Clinical Research Centre, Kingston General Hospital. Composing of the manuscript and interpretation of the results was completed by M. Kirk with modifications by thesis committee. All other sections of this thesis (Introduction, Literature Review, General Discussion, and Appendices) were written by M. Kirk with editorial changes provided by thesis committee. v Acknowledgements Firstly, I would like to extend my up-most gratitude to my thesis supervisor Dr. Tranmer who provided me with continuous support and encouragement. Dr. Tranmer provided me with an opportunity to research a topic in which I am greatly interested in and inspired me as a researcher. From the beginning, her expertise and range of research projects provided me a breadth of opportunity and respect for nursing research. Dr. Tranmer is an icon for nursing research, and a pleasure to learn from. I am truly honoured to have had this opportunity, and I not only grew as a researcher, but as a person as well. Next, I would like to thank my thesis committee, Dr. Ian Janssen and Dr. Elizabeth Van Den Kerkhof, for their individual contributions and support. They have helped to improve my study in many ways and I greatly appreciate their time and efforts. I would like to acknowledge the Heart and Stroke Foundation Canada for the Master’s Studentship Award and Dr. Tranmer for providing me with a research assistantship. To my classmates I call friends, supporter, advocates, and colleagues. I need to take this moment to thank each and every one of you. We laughed together, cried together, and supported one another. This network of friends enriched my experience and I hope to work with you all in future endeavors. vi Lastly, I would like to extend my endless appreciation and love to my family. My father’s support and encouragement has provided me the strength to believe in myself. My father listens with patience and interest, and I appreciate this support. To my partner, you always believe in me and provide continuous support. To my family, you are my foundation and strength; I dedicate this thesis to you. vii Table of Contents Abstract............................................................................................................................................ii Co-Authorship ................................................................................................................................iv