Supporting Employee Health at Work: How Perceptions Differ Across Wage Category

Abstract

Purpose:

This study examines the association between sources of stress and perceptions of organizational and supervisor support for health and well-being.

Design:

Retrospective, cross-sectional analysis.

Setting:

Large university in the mid-western United States.

Sample:

This study focused on university employees with complete data for all variables (organizational support/N = 19,536; supervisor support/N = 20,287).

Measures:

2019 socioeconomic and demographic characteristics, count of chronic conditions, sources of stress and perceptions of organizational and supervisor support.

Analysis:

For the multivariate analyzes, linear regression models were analyzed separately by wage bands (low ≤$46,100; middle >$46,100-$62,800; high >$62,800).

Results:

For all employees, workplace stressors, including problematic relationships at work and heavy job responsibilities, were negatively associated with perceptions of supervisor and organizational support. In comparison, the most salient home-based stressors were negatively associated with perceptions of supervisor support for the lowest-wage band (the death of a loved one, b = −0.13) and middle-wage band (personal illness or injury, b = −0.09), while the one for the highest-wage band (illness or injury of a loved one, b = 0.07) was positively associated with perceptions of supervisor support.

Conclusion:

Stressful job responsibilities and work relationships are associated with lower perceptions of supervisor and organizational support for health and well-being across all wage bands. Favorable perceived support for personal stressors only among high wage earning employees may suggest a need for improved equity of perceived support for these stressors among lower wage workers.

Keywords

low income workplace social health population health stress management organizational support culture of health health disparities economics and health

Purpose

Research suggests that strong leadership support is an important component of a comprehensive workplace health promotion (WHP) program¹ and a robust culture of health^2,3 where employees thrive.^4,5 Supervisor support encourages WHP by buffering employees from excessive job demands, emphasizing healthy behaviors, and helping workers cope with stressors from work-family conflict.^6,7

However, organizational policies that provide work-life flexibility are unevenly distributed across employees.⁸ Lower-wage employees have less flexibility to control when, where, or how they work⁹ thus contributing to work and home stress.¹⁰ This lack of work control, particularly among low-wage workers, may be associated with lower perceptions of organizational and supervisor support. Low-wage, compared to high wage, workers are also less likely to have access to or to use WHP programs, despite the potential benefit for their HWB.^11,12 Understanding the differential impact of home-based stressors on employees’ perceptions of support could better focus programs to enhance employee HWB.

In this paper, we examine how work- (e.g., job demands and relationships) and home-based stressors (e.g., one’s physical or mental health or that of close family members), are associated with perceptions of supervisor and organizational support.¹³ We hypothesize that work-based stressors will be negatively associated with employees’ perceptions of support across all wages, but that home-based ones, will differ across wage bands.

Methods

Design

This study used a retrospective, cross-sectional study design. This research is not regulated by the University’s Institutional Review Board (HUM00183354). Participants were not required to complete an informed consent.

Perception of organizational and supervisor support for HWB, sources of stress and count of chronic conditions were all collected annually using the StayWell^® Health Management Health Risk Appraisal (HRA). Voluntary completion of the HRA was part of an employee incentive program used to promote HWB at a large mid-western university. Race, gender, age, campus, union and faculty status data were individually linked and sent on separate files to a third party vendor for de-identification prior to analysis, preserving employee confidentiality.

Sample

This study focused on active, full-time University of Michigan employees with complete data for all variables (organizational support/N = 19,536; supervisor support/N = 20,287) in 2018. Approximately 41% of benefits eligible employees took the HRA. This sample is relatively representative of the university with only a 1% difference across racial and ethnic groups, 7% or less difference in the wage categories and 10% fewer males participating in the survey than the university as a whole.

Measures

Sources of stress

As part of the HRA, respondents were asked: “In the past year, which of the following have been major sources of stress for you?” Response options were: death of a spouse, life partner or other loved one; illness or injury of a loved one; personal illness / injury; care of elderly parent; dealing with child care; divorce or separation; family problem; finances / loan / mortgage; legal problems; job responsibilities; relationships at work; coping with too much to do and other major source of stress. Respondents could check all that applied.

Perception of organizational and supervisor support for HWB

Perceptions of supervisor and organizational support for HWB were assessed with two HRA questions: 1) “The person I report to is supportive of workplace HWB activities”, and 2) “Overall, the University actively supports a work culture and environment that promotes the HWB of its faculty and staff.” Response choices were: strongly agree, agree, slightly agree, slightly disagree, disagree, strongly disagree and don’t know. Don’t know responses were removed from the analysis.

Wage

In order to compare the association of sources of stress on perception of organizational and supervisor support for HWB across wage categories, a categorical measure of respondent’s annualized wage was defined according to the university’s Benefits Administration Office criteria as less than or equal to $46,100 (reference); greater than $46,100-$62,800; and greater than $62,800.

Covariates

Because perceptions of organizational and supervisor support for HWB may differ by socioeconomic and demographic factors and health, these variables were included as covariates. Age was categorized as 18-29 (reference), 30-44, 45-64 and 65 +. Gender was coded as female or male. Race and ethnicity were combined into the following categories: White, African-American, Asian or Hispanic (reference = White). Employee status was categorized as to their campus work location, union or non-union, and faculty or staff status. To assess health status, a count of 19 chronic conditions was included based on this question: “Has a doctor told you that you have any of these conditions?” Respondents were asked to check all that apply. The natural logarithm of one’s count of chronic conditions was used in the analyses to linearize the effect of the skewed distribution.

Analysis

For the multivariate analyses, the linear models regressing sources of stress on perceived organizational and supervisor support controlled for gender, age, race/ethnicity, campus location, union and faculty status, and count of chronic conditions. The statistical package used for these analyses was SAS (Release 9.4).

Results

The results focus on key points in Tables 1 and 2 and are further addressed in the Discussion section. Table 1 shows the association of socioeconomic and demographic characteristics, count of chronic conditions and sources of stress on perceptions of supervisor’s support for employee HWB activities across 3 wage bands. The percentage of employees in each wage band are: ≤$46,100 = 27.4%, >$46,100-$62,800 = 27.8% and >$62,800 = 44.8%.

Table 1.

The Association Between Socioeconomic and Demographic Characteristics, Count of Chronic Conditions and Sources of Stress on Perceptions of Supervisor Support for Health and Well-Being Activities, Across 3 Wage Bands.

	Employees with wages of less than or equal to $46,100	Employees with wages of greater than $46,100 to $62,800	Employees with wages of greater than $62,800
	N = 5,295	N = 5,470	N = 8,771
Female	−0.01	0.02	0.01
Age (in years) 18-29 30-44 45-64 65 +
	Ref.	Ref.	Ref.
	−0.06*	−0.04	−0.02
	0.08	0.09	0.02
	0.42**	0.2	0.15
Race/ethnicity White Asian Black Hispanic
	Ref.	Ref.	Ref.
	−0.04	−0.07	−0.01
	−0.07	−0.01	−0.01
	0.02	−0.06	0.06
Campus location Campus 1 Campus 2 Campus 3 Campus 4
	Ref.	Ref.	Ref.
	0.09	0.25**	−0.12
	0.06	0.14	−0.02
	−0.25***	−0.10***	−0.20***
Union member	−0.29***	−0.27***	−0.16***
Faculty member	0.24	−0.07	−0.16***
Count of chronic condition	−0.02	−0.02	−0.01
Source of stress Relationships at work Coping with too much to do Personal illness / injury Other major source of stress Legal problem Job responsibilities Family problem Illness or injury of loved one Death of a spouse, life partner or other loved one Care of elderly parent Divorce or separation Dealing with child care Finances / loan / mortgage
	−0.50***	−0.50***	−0.50***
	−0.02	−0.01	−0.02
	−0.05	−0.09*	−0.05
	−0.06	−0.01	−0.06
	0.13	0.05	−0.02
	−0.16***	−0.14***	−0.13***
	−0.06	−0.01	−0.08**
	0.01	0.04	0.07*
	−0.13**	−0.02	−0.06
	−0.01	0.01	−0.02
	−0.02	−0.09	−0.06
	0.01	−0.06	−0.02
	−0.04	−0.01	−0.03

Notes: OLS regression coefficients are presented.

* p < .05.

** p < .01.

*** p < .001.

Work-based sources of stress, including stressful relationships at work (b = −0.50, P < .0001 across all wage bands) and stressful job responsibilities (b = −0.16, b = −0.14, b = −0.13 respectively; P < .0001 across all wage bands) were consistently associated with lower perceptions of supervisor support for employee HWB activities across all wage bands. However, home-based sources of stress differed by wage band. For employees with annual wages less than or equal to $46,100 (b = −0.13, P = .008), stress from the death of a spouse, life partner or other loved one was statistically significantly associated with lower perceptions of supervisor support. For employees with wages between $46,100 and $62,800, stress associated with personal illness/injury was significantly associated with lower perceptions of supervisor support (b = −0.09, P = .030). For employees with annual wages above $62,800, though, stress resulting from illness or injury of a loved one is associated with higher perceptions of supervisor support (b = 0.07, P = .008).

Table 2 shows the association between socioeconomic and demographic characteristics, count of chronic conditions and sources of stress and perceptions of organizational support for a work culture and environment that promotes the HWB of employees.

Table 2.

The Association Between Socioeconomic and Demographic Characteristics, Count of Chronic Conditions and Sources of Stress on Perceptions of Organizational Support for a Work Culture and Environment That Promotes the Health and Well-Being of Its Faculty and Staff, Across 3 Wage Bands.

	Employees with wages of less than or equal to $46,100	Employees with wages of greater than $46,100 to $62,800	Employees with wages of greater than $62,800
	N = 5,524	N = 5,633	N = 9,130
Female	−0.01	0.01	0.02
Age (in years) 18-29 30-44 45-64 65 +
	Ref.	Ref.	Ref.
	−0.05*	−0.03	0.01
	0.15**	0.19***	0.04
	0.37**	0.31**	0.25**
Race/ethnicity White Asian Black Hispanic
	Ref.	Ref.	Ref.
	0.03	0.12**	0.13***
	0.04	0.07	0.13**
	0.03	−0.03	0.11*
Campus location Campus 1 Campus 2 Campus 3 Campus 4
	Ref.	Ref.	Ref.
	0.01	0.13	0.09
	−0.01	0.29**	0.14
	−0.15***	−0.04	−0.24***
Union member	−0.16***	−0.23***	−0.10***
Faculty member	0.04	−0.16*	−0.32***
Count of chronic condition	−0.03**	−0.02*	−0.01
Source of stress Relationships at work Coping with too much to do Personal illness / injury Other major source of stress Legal problem Job responsibilities Family problem Illness or injury of loved one Death of a spouse, life partner or other loved one Care of elderly parent Divorce or separation Dealing with child care Finances / loan / mortgage
	−0.36***	−0.41***	−0.36***
	−0.04	−0.08*	−0.05*
	−0.09*	−0.12**	−0.10**
	−0.06	0.02	−0.07**
	0.1	−0.07	−0.10
	−0.20***	−0.14***	−0.18***
	−0.05	−0.01	−0.04
	0.02	0.02	0.06*
	−0.03	−0.05	−0.05
	−0.03	−0.06	−0.05
	−0.06	−0.02	0.01
	0.01	−0.04	−0.01
	0.01	−0.04	−0.03

Notes: OLS regression coefficients are presented.

* p < .05.

** p < .01.

*** p < .001.

Here, too, work-related sources of stress, including stressful relationships at work (b = −0.36, P < .0001; b = −0.41, P < .0001 and b = −0.36, P < .0001, respectively), and stressful job responsibilities (b = −0.20, b = −0.14, b = −0.18 respectively) are consistently and significantly (P < .0001) associated with lower perceptions of organizational support for a work culture and environment that promotes the HWB of its employees across all wage bands. In contrast to supervisor support, home-based stress from personal illness / injury (b = −0.09, P = .010; b = −0.12, P = .002 and b = −0.10, P = .001) was consistently associated with lower perceptions of organizational support for a work culture and environment that promotes the HWB of its employees across all wage bands. Among employees with wages between $46,100 and $62,800 (b = −0.08, P = .010) and wages greater than $62,800 (b = −0.05, P = .030), stress associated with coping with too much to do was associated with lower perceptions of Organizational support.

Discussion

Summary

This study provides evidence of wage-based differences among employee perceptions of supervisor support for employee HWB, as well as organizational support for a work culture and environment that promotes employee HWB. Despite some general parallels in response trends among HRA respondents, the magnitude and direction of the home-based responses varied by wage category.

These results provide objective evidence that employees in different wage categories experience different home-based stressors, which can impact their perceptions of support at work. This is consistent with findings that suggest that work-family and family-work conflict are associated longitudinally and that if organizations focus on their employees’ home lives, it could improve work as well.¹⁴ In addition, employers may need to concentrate on the social determinants of health¹² when creating an effective culture of HWB.¹⁵ To that end, employers may benefit from thoughtful incorporation of feedback from employees in different wage and demographic groups to improve the likelihood that organizational efforts are meeting broader workforce needs. For example, access to WHP programs may provide the only source of HWB services to low-wage workers whereas higher wage workers may perceive HWB programs as a perk or supplemental to services offered outside of the workplace. Allowing more role flexibility might also be useful for low-wage workers. This data-driven approach may also inform supervisor training to enhance employee support to reduce workplace and personal stressors.

Limitations

These results should be interpreted in the context of potential limitations of this study. First, only results from HRA respondents were included, limiting generalizability to the broader population. Second, the results from a single employer may not be generalizable to employers in other locations or industries. Organizational culture, including perceptions of the importance of employee HWB, as well as wellness programs scope and effectiveness may have a differential impact for each employer within the organization as a whole, as well as at specific work locations. Third, survey questions regarding employee perceptions may have been written too generally, with respondents answering based on their understanding of the intent of the question. For example, the measure regarding supervisor support (i.e., the person I report to is supportive of workplace HWB activities) may be interpreted in a number of ways. Other measures of supervisor support may focus on more specific aspects of this construct. Similarly, there are various ways one may assess health status other than a sum of self-reported diagnosed conditions. In the future, researchers may consider incorporating such measures into employee health and wellbeing health questionnaires that may allow for a more streamlined data collection process. Fourth, these data are cross-sectional and therefore cannot assess causality. In turn, there are a variety of interpretations for the observed findings. However, these findings are consistent with a growing literature suggesting that factors outside of work, including the social determinants of health, can impact employees’ perceptions of work and their HWB.

Significance

Our study aligns with research highlighting the role of supervisor and organizational support to help employees cope with work-family conflicts.⁶ Our findings suggest that employers could improve access to HWB activities across all wage groups by evaluating existing policies that enable or inhibit employees at different wage levels from participating in HWB activities and aligning supervisors’ responsibilities with an emphasis on employees’ HWB. Researchers may build on these findings to explore the relationship between sources of stress and perceptions of organizational and supervisor support for HWB and other outcomes such as absenteeism and productivity among various wage groups.

SO WHAT?

What is already known on this topic?

Direct workplace social support reduces work-family conflict which impacts human resource outcomes.

What does this article add?

This article adds to the literature by finding that university employees in 3 wage bands experience unique home-based stressors that are associated with divergent perceptions of support from the organization and supervisor.

What are the implications for health promotion practice or research?

With these data, employers may be better able to highlight the differences in perceived support at different wage levels. This is true especially among lower wage earnering employees who perceive less support when impacted by home-based stressors such as personal illness/injury or death of a loved one.

Organizations may also want to review supervisor/organizational practices that impair worker health within different wage categories.

Researchers may build upon these findings to explore organizational/supervisor support as mediators of WHP program participation by individuals in different wage categories.

Footnotes

Authors’ Note

Kristi Rahrig Jenkins performed the data analysis and drafted the data and methods sections. Kristi Rahrig Jenkins, Emily Stiehl and Bruce Sherman, and Susan Bales, all contributed to the drafting of all other sections as well as the editing and revising of the entire manuscript. All contributing authors met the 4 ICMJE criteria for authorship.

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

ORCID iDs

Kristi Rahrig Jenkins, PhD

Emily Stiehl, PhD

Bruce W. Sherman, MD

References

Leadership Support. Centers for disease control and prevention website. Reviewed August 14, 2019. Accessed June 9, 2020. https://www.cdc.gov/workplacehealthpromotion/planning/leadership.html

Payne

Cluff

Lang

Matson-Koffman

Morgan-Lopez

. Elements of a workplace culture of health, perceived organizational support for health, and lifestyle risk. Am J Health Promot. 2018;32(7):1555–1567.

Schein

How leaders embed and transmit culture. In: Schein

, ed. Organizational Culture and Leadership. 4th ed. Jossey-Bass; 2010.

Edington

Pitts

. Shared Values—Shared Results. Edington Associates; 2015.

Edington

Schultz

Pitts

Camilleri

The future of health promotion in the 21st century: a focus on the working population. Am J Lifestyle Med. 2016;10(4):242–252. doi:10.1177/1559827615605789

Kossek

Pichler

Bodner

Hammer

. Workplace social support and work—family conflict: a meta-analysis clarifying the influence of general and work—family-specific supervisor and organizational support. Pers Psychol. 2011;64(2):289–313.

Kim

Mullins

. How does supervisor support and diversity management affect employee participation in work/family policies? Rev Public Pers Adm. 2016;36(1):80–105. doi:10.1177/0734371X14553883

Kossek

Lautsch

. Work—life flexibility for whom? Occupational status and work—life inequality in upper, middle, and lower level jobs. Acad Manag Ann. 2017;12(1):5–36.

Swanberg

McKechnie

Ojha

James

. Schedule control, supervisor support and work engagement: a winning combination for workers in hourly jobs? J Vocat Behav. 2011;79(3):613–624.

10.

Lefrançois

Messing

Saint-Charles

. Time control, job execution and information access: work/family strategies in the context of low-wage work and 24/7 schedules. Community Work Fam. 2017;20(5):600–622. doi:10.1080/13668803.2017.1379950

11.

Stiehl

Shivaprakash

Thatcher

, et al. Worksite health promotion for low-wage workers: a scoping literature review. Am J Health Promot. 2018;32(2):359–373. doi:10.1177/890117117728607.

12.

Sherman

Stiehl

. Health Management in commercially insured populations: it is time to include social determinants of health. J Occup Environ Med. 2018;60(8):688–692. doi:10.1097/JOM.0000000000001344

13.

Hoert

Herd

Hambrick

. The role of leadership support for health promotion in employee wellness program participation, perceived job stress, and health behaviors. Am J Health Promot. 2018;32(4):1054–1061. doi:10.1177/0890117116677798

14.

Huang

Y-h

Hammer

Neal

Perrin

. The relationship between work-to-family conflict and family-to-work conflict: a longitudinal study. J Fam Econ Issues. 2004;25(1):79–100.

15.

Quelch

Boudreau

. Building a Culture of Health: A New Imperative for Business. Springer International Publishing; 2016:17.