ARTICLE IN PRESS

Social Science & Medicine 58 (2004) 997–1005

Women, work and musculoskeletal health

Lyndall Strazdins*, Gabriele Bammer
National Centre for Epidemiology and Population Health, The Australian National University, Canberra ACT 0200, Australia

Abstract

Why are employed women at increased risk for upper limb musculoskeletal disorders and what can this tell us about
the way work and family life shape health? Despite increases in women’s labour force participation, gender differences
in work-related health conditions have received little research attention. This appears be the first study to examine why
employed women are much more likely than men to experience upper body musculoskeletal disorders.
A mailed self-report survey gathered data from 737 Australian Public Service employees (73% women). The majority
of respondents were clerical workers (73%). Eighty one per cent reported some upper body symptoms; of these, 20%
reported severe and continuous upper body pain. Upper body musculoskeletal symptoms were more prevalent and
more severe among women. The gender difference in symptom severity was explained by risk factors at work (repetitive
work, poor ergonomic equipment), and at home (having less opportunity to relax and exercise outside of work).
Parenthood exacerbated this gender difference, with mothers reporting the least time to relax or exercise. There was no
suggestion that women were more vulnerable than men to pain, nor was there evidence of systematic confounding
between perceptions of work conditions and reported health status.
Changes in the nature of work mean that more and more employees, especially women, use computers for significant
parts of their workday. The sex-segregation of women into sedentary, repetitive and routine work, and the persisting
gender imbalance in domestic work are interlinking factors that explain gender differences in musculoskeletal disorders.
r 2003 Elsevier Science Ltd. All rights reserved.

Keywords: Gender differences in health; Upper body musculoskeletal disorders; Repetitive strain injuries; Women’s health; Australia

Introduction and occupational overuse syndrome. These disorders

Musculoskeletal disorders, particularly those of the
upper body, are increasingly prevalent in Western
societies (Muggleton, Allen, & Chappell, 1999; Yassi,
1997). Although some studies have found levels as low
as 10%, in the working population levels of around 50%
and as high as 80% are more common (Ariens,
Borghouts, & Koes, 1999; Bammer & Blignault, 1988;
Blyth et al., 2001; LeResche, 1999; Putz-Anderson, 1988;
Unruh, 1996; van der Windt & Croft, 1999). Upper
body disorders cover a wide range of clinical symptoms
and conditions, grouped under general terms such as
repetitive strain injuries, cumulative trauma disorders
*Corresponding author. Tel.: +61-2-6125-2837;
fax: +61-2-6125-0740.
E-mail addresses: lyndall.strazdins@anu.edu.au
(L. Strazdins), gabriele.bammer@anu.edu.au (G. Bammer).
occur gradually, have a chronic course, and often go
untreated (Polanyi et al., 1997; Yassi, 1997). Typically,
pain becomes progressively severe and loss of function
occurs. The pain and disability may persist for many
years, and in some cases become intractable (Bammer &
Blignault, 1988; Keogh, Nuwayhid, Gordon, & Gucer,
2000; Putz-Anderson, 1988). Employed women are two
to five times more likely than men to report these sorts
of problems (Ariens et al., 1999; LeResche, 1999; Unruh,
1996).
Why are employed women at increased risk for upper
limb musculoskeletal disorders, and what can this tell us
about the way health differences are shaped between
men and women? In developed economies, the relation-
ship between work and health is changing for both men
and women. Now, most women are in paid employment
(Hatch & Moline, 1997), and the nature of work itself is
changing. These two social changes are likely to affect

0277-9536/03/$ - see front matter r 2003 Elsevier Science Ltd. All rights reserved.
doi:10.1016/S0277-9536(03)00260-0
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998 L. Strazdins, G. Bammer / Social Science & Medicine 58 (2004) 997–1005
both men’s and women’s lives, but in differing ways.
Like other western nations, the Australian labour
market is characterised by an increase in part-time jobs,
reduced job security, contingent and uneven workforce
attachment, increased pace and workload, and, an
increased reliance on computer technology (ACIRRT,
1999). These changes have brought with them an array
of potentially new factors that could affect women’s
health. On the one hand, gender gaps in some health
outcomes might narrow as women’s participation in the
labour force comes nearer to men’s. On the other,
women and men may have vastly different experiences
of paid employment and its effects on family life,
especially once they become parents (Blane, Berney, &
Montgomery, 2001). The sex-segregation of the labour
force and the persistent gender imbalance in domestic
work means that employed women’s exposure to risk
factors from both work and family could differ widely
from employed men’s (Hunt & Annandale, 1999). This
exposure is likely to be daily and chronic. Musculoske-
letal disorders may thus reflect the accumulation of
difference in exposures at work and at home, providing
an opportunity to tease out the relationships between
work-related factors, domestic load and underlying
biological differences.
Prevailing explanations of women’s excess health risk
revolve around two basic propositions. Greater pre-
valence or severity of symptoms may be due to the
higher demands and constraints that women face, or
because women are more affected by, or vulnerable to,
the health impact of particular demands and constraints
(McDonough & Walters, 2001). Thus the difference
between women and men in exposure, at work and at
home, to risk factors for musculoskeletal disorders is
one model that may explain the markedly higher
prevalence of these disorders in women compared to
men. We call this the work and family demand model.
An alternative explanation is that women may be more
prone to developing musculoskeletal disorders due to
sex-linked biological factors such as hormones or
physiology, because the meaning of work and family
demands are different, or because women have less
resources to cope with these demands. We refer to this as
the vulnerability model. And, of course, both models
may be involved.
Gender differences in work and family demands
As we have outlined above, changes in technology,
and the emergence of the information and service
economy have altered the sorts of work women typically
do (Webster, 1996). Women tend to be clustered into
lower status jobs, often sedentary and involving
repetitive work and static load (holding the body in
one position for extended periods), with less job control
and less substantive complexity. These comprise the key
biomechanical and psychosocial risk factors for upper
body musculoskeletal disorders (Ariens et al., 1999;
Bernard, 1997; Carayon, Smith, & Haims, 1999; Latko
et al., 1999; Putz-Anderson, 1988). Many women work
with computers where these risk factors can be
exacerbated (Torgen & Kilbom, 2000; Webster, 1996).
Interlinked with the sex-segregation of the labour
force is the gender division of domestic work (Baxter,
Gibson, & Lynch-Blosse, 1990). Women’s domestic
work, especially once they become mothers, affects their
ability to participate in the labour market by imposing
time constraints that men generally do not share. This in
turn channels women into increasingly casualised, low-
skilled jobs (Webster, 1996), the sorts of jobs where
routine and repetitive work predominate. Furthermore,
the gender division of domestic work may mean that
employed women have less time outside of work for
activities that might ameliorate the health costs of their
jobs. Compared to fathers, mothers invest more time
and energy caring for children, helping others, and
doing housework (Bird, 1999). The resultant ‘time
poverty’ means that employed mothers have less time
for leisure, relaxation and exercise (Firestone & Shelton,
1988; Hildebrandt, Bongers, Dul, van Dijk, & Kemper,
2000; Lundberg, 1999; Ross & Bird, 1994).
Thus domestic work, per se, may be a risk factor for
musculoskeletal problems, and, more importantly, it
may constrain women’s ability to protect themselves
from the effects of their paid work. For example,
Lundberg (1999) argues that lack of relaxation impairs
recovery of the musculoskeletal system from repetitive
work demands. He proposes that domestic work and
stress from overload further exacerbate musculoskeletal
disorders because they interfere with the recovery
process. The health hazard of domestic work, in this
context, is time constraint, and this combines with the
hazard of repetitive and sedentary duties that many
women encounter in the workplace.
Gender differences in vulnerability
Pain severity and chronic duration of pain are central
symptoms of musculoskeletal disorders. Women appear
to be more sensitive to pain and consistently report
greater pain when it is experimentally induced (Filling-
ham, Edwards, & Powell, 1999). Furthermore, pain
sensitivity varies across stages in the menstrual cycle
suggesting that sex-linked hormones are involved in pain
perception (Fillingham et al., 1999; Fillingham & Ness,
2000; LeResche, 1999). Women also tend to see their
pain problems as more threatening, and to cope
differently compared to men, suggesting that there
may also be some gender differences in the meaning of
pain and in the resources that men and women bring to
bear in coping with pain (Jensen, Nygren, Gamberale,
Goldie, & Westerholm, 1994; Keefe et al., 2000). Thus
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L. Strazdins, G. Bammer / Social Science & Medicine 58 (2004) 997–1005
the gender gap in musculoskeletal disorders is possibly
due to women’s greater pain sensitivity, or women’s
tendency to perceive and cope with pain differently.
This study provided an opportunity to test both the
work and family demands and vulnerability models for
explaining the gender difference in musculoskeletal
disorders. If women are at greater risk because of the
combination of their work and family demands, then the
association between gender and symptom severity
should disappear once these demands are included in
the analysis. If a gender excess persists, or if work and
family risk factors affect women more that they affect
men, this suggests that sex-linked vulnerabilities are
exerting an influence.
Methodological problems studying work conditions and
health
Studying work conditions and health poses particular
methodological problems. Associations found between
work and health from cross-sectional studies have been
challenged because having a health condition could
predispose workers to perceive or report on their work
conditions negatively (Emslie et al., 1999).
The present study is also unique in addressing this
limitation in cross-sectional research, which was possible
because workers were organised into teams. We
compared individuals with their team’s aggregated
ratings of the shared workplace environment to see the
extent of consensus within teams, and whether indivi-
duals with poorer health perceived the workplace
differently. General features of the work environment
that all team members shared were rated, such as overall
building and equipment design. Then comparisons were
made within work teams of team members with high or
low musculoskeletal conditions. If workers with and
without a musculoskeletal condition rate general char-
acteristics of the workplace differently, it would suggest
that their health status is influencing their perceptions of
work. On the other hand, if there are no differences in
these general workplace ratings, we can be more
confident that associations found between individual’s
specific work conditions (e.g., degree of control,
repetitive workload) and their symptom severity reflects
the influence of work conditions on health, and not the
reverse.
Method
Sample
Respondents were sampled from two government
organisations spread across three eastern states of
Australia. We sampled across the organisational hier-
archy to include a range of occupational levels and work
999
conditions and to sample enough men and women to
make meaningful comparisons. Focus groups were held
initially to refine the questionnaire. Then, surveys were
distributed to randomly selected branch offices. Partici-
pation was voluntary and responses were anonymous.
The response rate was 50%, resulting in 737 question-
naires returned.
Occupational status was coded using the Australian
Standard Classification of Occupations (ASCO 1st
Edition, ABS, 1986). As expected from the nature of
the organisations, which primarily administered and
delivered government benefits to the public, clerical and
service jobs predominated; 77% worked in clerical
and customer service jobs, 16% in managerial jobs,
7% in professional jobs, and 1% in unskilled jobs.
The mean age was 36 years (SD=9.55). Most
employees were Australian born (73%), 12% were of
European origin, and 9% were of Asian origin. Just
under a third of the sample (32%) had completed 10
years or less education, another 32% had 12 years of
completed education, 17% had obtained trade or
technical qualifications or an undergraduate diploma,
13% a Bachelor degree and 5% a post graduate diploma
or higher degree. Nearly 60% of the sample were either
married or living with a partner. Forty three per cent of
employees were parents with at least one dependent
child living at home.
Women and men differed on several demographic
variables. Men were more likely to be older (the average
age of men was 37710 years, while the average age of
women was 3579 years, (t (642)=2.65, po0:01). Men
were also likely to be better educated (w2=38.89,
po0:01). Only 16% of men had attained 10 years or
less of education, compared to 38% of women. In terms
of tertiary qualifications, 25% of men compared to 15%
of women had attained a Bachelors Degree or higher.
Men also worked in higher status occupations (30%
worked in professional or managerial positions com-
pared to 17% of women, w2=21.57, po0:01). Women
were more likely to be parents of dependent children
(47% women, 34% men, w2=10.65, po0:01) and to be
employed part-time rather than full-time (20% of
women were employed part-time compared with 5% of
men, w2=30.05, po0:01). The differences in occupa-
tional status and part-time employment reflect the sex-
segregated nature of work (Labour Force Statistics,
ABS, 1997).
Measures
Upper body musculoskeletal symptoms
Following Browne, Nolan, and Faithfull’s (1984)
description of upper body repetitive strain injury, the
17 item measure assessed a variety of symptoms, their
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location and degree of pain persistence. Symptoms
included pain, aching, stiffness, cramp, swelling, sore-
ness, weakness, tingling and numbness, and respondents
rated the extent symptoms were present while they
worked (response categories ranged from never to
continuously). Respondents were then asked to rate
the extent of pain and pain persistence in their upper
back, neck, shoulders, arms, elbows, forearms, wrists,
and fingers. The response categories were no pain
(scored 0), pain present but gone by the next morning
(scored 1), pain present at work, persists to the following
morning, but is gone after the weekend (scored 2), and
pain is present and continuous all the time which is the
most severe category (scored 3). Scores were summed to
form the scale (a ¼ 0:92). A zero score indicated no
symptoms in the upper body, whereas high scores
indicated more severe symptoms. For example, neck
pain that persisted after work but was gone by the next
morning would be given a score of 2. If respondents
described their neck pain as continuos the score would
be 4. Scores would be higher if multiple upper body
areas were involved. While the measure uses criteria
developed for treatment and rehabilitation of upper
body musculoskeletal disorders, high scores are not
diagnostic of specific clinical conditions.
General workplace rating
This was assessed using two items; ‘Compared to
other workplaces, do you think your workplace provides
employees with comfortable and well-designed equip-
ment, where the work is not too repetitive, not too
stressful, not too boring, and the amount and pace of
work is not too much?’ and; ‘In general, how physically
stressful is your workplace? Is it likely that your
workplace is the sort of place where people could
develop muscle tensions, strains and overuse problems?’
Response categories, respectively, ranged from very
comfortable (scored 1) through intolerably uncomfor-
table (scored 6); and not at all (scored 1) through
extremely physically stressful (scored 6). The two items
were summed and averaged with low scores representing
positive evaluations of the workplace and high scores
negative evaluations (item r ¼ 0:65).
Risk factors
Repetitive work demands: Seven items assessed the
extent work duties involved repetitive movements,
keyboarding, computer use, and holding an uncomfor-
table posture or body position (e.g., on a routine day
how often do you have to make repetitive movements
with your head, neck, arms, hands or fingers). Response
categories ranged from 1=never to 5=all the time.
Items were summed and averaged to form the scale
(a ¼ 0:80).
Poor ergonomic equipment: A single item assessed
comfort and ergonomic design of work equipment and
work environment. Response categories ranged from
1=very comfortable and well designed to 5=very
uncomfortable and poorly designed.
Job control: A four item scale measured control over
work load, pace, duties and decisions (e.g., ‘how often
does your workplace give you control over the pace of
your work?’). Response categories ranged from 1=very
seldom to 4=almost always. Items were summed and
averaged to form the scale (a ¼ 0:82).
Relaxation and exercise: Two items assessed time
spent on exercise, leisure and relaxation over the last six
months (‘yhow often have you set aside time just for
physical activities (leisure or exercise)’ and ‘yhow often
have you set aside time just to relax?’). Response
categories were 1=not at all, 2=some or a little of the
time (about once a month or more), 3=occasionally or a
moderate amount of time (about once a week or more),
4=often or a lot of the time (about once a day) and
5=frequently (more than once a day). These items were
highly intercorrelated (r ¼ 0:66) and were summed and
averaged to form the measure.
Results
Gender differences in musculoskeletal health
Age adjusted means for musculoskeletal health for
men and women are presented in Table 1. Proportion-
ally more women reported at least one symptom (83%
of women compared to 77% of men, w2=13.38,
po0:01). Women also reported more severe symptoms
(23% of women reported continuous pain in their upper
body compared to 12% of men).
Gender differences in work and family demands
According to the demands hypothesis, the gender gap
in musculoskeletal health occurs because women en-
counter more risk factors. To test for this, age adjusted
mean differences in risk factors for men and women
were compared (see Table 1) and statistically significant
differences were found for all but one risk factor.
Women’s work conditions were more likely to involve
physically repetitive work demands. For example 34%
of women compared to 21% of men sat in the same
position for long periods of time, 81% of women
compared to 73% of men worked longer than 5 hours
per day on a computer, and 30% of women compared to
16% of men reported that their job involved making
repetitive movements all of the time. Women were also
more likely to work in poorly designed and uncomfor-
table environments. Fifteen per cent of women, com-
pared to 10% of men described their work environments
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Table 1
Age-adjusted gender differences in mean scores for upper body musculoskeletal symptoms and risk factors

Variable Gender Adj. mean 95% confidence interval Difference p

Upper body symptoms Men 7.14 (5.97, 8.31) 2.74 0.001

Women 9.88 (9.16, 10.61)
Repetitive work Men 3.47 (3.37, 3.60) 0.30 0.001
Women 3.77 (3.71, 3.84)
Poor ergonomic equipment Men 2.36 (2.23, 2.50) 0.18 0.022
Women 2.55 (2.47, 2.63)
Job control Men 2.20 (2.08, 2.31) 0.06 0.326
Women 2.131 (2.06, 2.20)
Relaxation and exercise time Men 3.01 (2.88, 3.13) 0.32 0.001
Women 2.68 (2.61, 2.76)

as either uncomfortable or very uncomfortable. In
addition, women spent considerably less time than
men exercising or relaxing. Twenty per cent of women
did no exercise at all and 14% did not spend time
relaxing, over the previous month. This compares to
12% and 10%, respectively, for men. There was,
however, no evidence that women experienced less job
control than men. For example, 51% of men compared
to 60% of women reported that they often or almost
always made decisions about their work, 65% of men
and 62% women reported that they often or almost
always had control over the pace that they worked, and
67% of men compared to 64% of women reported they
often or almost always had control over the amount of
work that they did.
Multiple regression analyses testing the vulnerability and
demand models
A hierarchical regression equation (OLS) tested the
model that gender differences in upper body musculos-
keletal symptoms were due to women’s poorer work
conditions (repetitive work demands and poor ergo-
nomic equipment) and greater constraints on time to
relax or exercise. A reduction in the size of the
standardised b coefficient or beta weight for gender
after entry of the risk factors would provide support for
this model (Baron & Kenny, 1986). Pearson product–
moment correlations among predictor variables are
appended and show that they are not highly inter-
correlated.
Table 2 summarises the change in association between
gender and upper body musculoskeletal problems after
the exposure variables were included in the equation.
The beta weight for gender dropped to become non-
significant, indicating that the gender gap is due to
women encountering more risk factors for musculoske-
letal problems at work and at home. Following
Karasek’s model of demand and control (Theorell &
Karasek, 1996) interactive effects of repetitive work
demands and job control were also tested, and were non-
significant.
However, vulnerability factors may also be important
and may modify the effects of work conditions and time
to relax and exercise for men and women. After
centering all predictor variables to reduce multi-colli-
nearity (Aiken & West, 1991), cross-product terms for
gender with each of the predictor variables were entered
into the equation. Only one significant interactive effect
for the predictor variables was found, namely time to
relax and exercise, which was more strongly associated
with women’s upper body musculoskeletal symptoms
than men’s. Beta weights in separate sex regressions were
b 0.18, po0:01; for women and b 0.00, ns, for men.1
In summary, we found no evidence that women are
more affected than men by repetitive work or poor work
conditions, nor was there evidence of a persisting gender
difference due to unmeasured sex-linked factors such as
pain sensitivity or pain perception. Instead, the gender
gap appears to be explained by employed women’s
greater exposure to risk factors at work and the
difficulty these women face finding time to relax or
exercise outside of work.
Parenthood and time
The gender difference in time to exercise or relax may
be due to the gender division of domestic work, which
becomes most marked for mothers. If this is the case,
then being a parent should have different effects on
men’s and women’s time. Simultaneous regression
analyses (OLS) with centred variables provided support
1
The sample was also stratified (upper quartile compared to
lower three quartiles) in terms of symptom severity. Both
groups showed similar patterns of associations between risk
factors and symptoms, with one exception. Time to relax or
exercise showed a stronger association in the more symptomatic
group (beta coefficient 0.25, po0:001) compared to the lower
symptom group (beta coefficient 0.03, ns).
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Table 2 Table 3
Summary of hierarchical regression analyses testing demand Summary of simultaneous regression analyses testing for gender
and vulnerability models of gender differences in upper body differences in the effects of parent status on time to relax and
musculoskeletal symptoms (n ¼ 665) exercise (n ¼ 665)

Predictor B SE B ba Predictor B SE B ba

Step 1 Gender 0.23** 0.08 0.11**

Gender 0.17** 0.04 0.16** Age 0.00 0.00 0.05
Step 2 NESB 0.32** 0.08 0.15**
Gender 0.07 0.04 0.07 Education 0.02 0.02 0.05
Job control 0.04 0.11 0.08 Occupation 0.03 0.02 0.05
Repetitive work 0.27** 0.08 0.43** Workhours 0.00 0.01 0.06
Poor ergonomics 0.09** 0.02 0.19** Parent status 0.25** 0.07 0.14**
Relaxation and exercise time 0.07** 0.02 0.13** Gender  parent status 0.32* 0.16 0.08*

Adjusted R2 ¼ 0:20; po0:01: R2 change 0.03, po0:01 for set
one (gender only), R2 change 0.29, po0:01; for set 2 (all
predictors). Gender scored 0=male, 1=female. Age, ethnicity,
education, occupational status, workhours and parent status
were entered in a second set after gender to control for possible
confounding (coefficients not shown). This set of variables did
not contribute significantly to the prediction of upper body
musculoskeletal pain (R2 change 0.02, ns) or affect the beta
coefficient for gender. Missing data deleted listwise.
**po0:01:
a Even though the small size of some teams would have
b standardized beta coefficients.
for this hypothesis. Gender and parent status interacted
in their effect on time relaxing and exercising (see Table
3). On average, women were less likely than men to
exercise or relax regularly. However, this gender
difference varied between parents and non-parents.
The gender difference was relatively narrow among
non-parents and widened among parents. Mothers were
the least likely to take time to relax or exercise, whereas
fatherhood made little difference to men’s time.
Comparing ratings of the workplace by respondents with
and without musculoskeletal disorders
A possible explanation for the associations we have
found is that severe musculoskeletal symptoms affected
the way respondents viewed their workplaces. To see if
such a perceptual bias was present, we dichotomised
respondents on the basis of their symptom levels; those
who had no or mild musculoskeletal symptoms, and
those with severe or continuous pain. We compared the
ratings of respondents within work teams because they
were likely to share the same workplace environment.
Twenty-five teams, ranging in size from 7 to 31 members
were identified. Workplace ratings of team members
with and without severe symptoms were compared using
t-tests (because of the number of comparisons, the
significance level was set to 0.01). Of the 25 compar-
isons, only one significant difference between ratings was
observed (M low symptoms=2.80, SD=0.27, M high
Adjusted R2 ¼ 0:09; po0:01: Gender scored 0=male, 1=
female, NESB scored English speaking background=0,
non-English speaking background=1, Parent scored non-
parent=0, parent=1. Missing data deleted listwise.
po0:05;   po0:01:
a
b standardized beta coefficients.
symptoms=4.50, SD=0.87, tð7Þ ¼ 4:25; po0:01).
reduced power to detect significant differences, it is
noteworthy that no differences in how the workplace
environment was viewed were found in the larger teams.
These analyses suggest that the effects of workplace
factors on health are unlikely to be greatly confounded
by the effects of health status on the reporting of
workplace conditions.
Discussion
This is one of the first studies to explain why women
have an excess risk for upper body musculoskeletal
disorders. We compared men and women employed in
white collar clerical and service occupations—the
occupations where women tend to predominate, and
where upper body musculoskeletal problems are pre-
valent. Women in our sample were more likely to report
symptoms in their upper body, with nearly a quarter
reporting continuous pain suggestive of advanced
disorder. We tested the possibility that women were
prone to musculoskeletal problems, either because of a
propensity to report more pain, or because risk factors
affected them more than men. We found that women’s
excess risk was due to the different demands that they
faced at work and at home. At work, women spent more
time using computers, did more repetitive movements,
and reported poorer and less comfortable equipment.
Outside of work, women bore the brunt of the unpaid
work involved in parenting, and to accommodate the
time squeeze, cut back on their exercise and relaxation.
In this way, they lost access to activities that protect
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against, or at least may help ameliorate, upper body
musculoskeletal disorders. This pressure on women’s
time is likely to continue as western economies respond
to globalised labour markets and the pace of work
intensifies.
This study is also one of the first to address a common
concern with cross-sectional research on work and
health. If the presence of musculoskeletal symptoms
systematically alters perceptions of work conditions, it
might suggest that the associations we found between
work conditions and symptoms reflect a perceptual bias
rather than a causal relationship. Thus we compared,
within work teams, the way employees with high and
low symptoms rated the teams’ shared workplace
environment. We found no evidence that having a
musculoskeletal disorder systematically alters the way
workplaces are perceived, lending more confidence to
our interpretation that work conditions act as risk
factors. However, longitudinal studies are needed,
especially because upper body musculoskeletal disorders
are cumulative, likely to evolve over time and intensify
during particular life course stages.
Study limitations
More studies are needed to test the model in different
countries, sectors and organisations. The sample was
white-collar government employees, limiting generalisa-
bility to private companies and organisations, or to
other industries and occupations with different types of
repetitive work demands, such as manufacturing, pack-
ing, etc. In addition, the relatively small sample size may
have affected our power to detect differences, especially
for the men in the sample. The response rate may also
mean that some self-selection bias occurred. Perhaps
employees who volunteered were more likely to have a
concern with their health or dissatisfaction with their
workplace and possibly some gender-based bias in
responding occurred. We do not have information on
non-respondents and cannot assess the extent to which
self-selection may have biased our sample. These
limitations may have inflated the prevalence of upper
body problems, or meant that the workplace was rated
more negatively. We checked for the possibility of an
effect on the nature of the association between
symptoms and risk factors by stratifying the sample by
gender and symptom severity, and found little difference
in effects, with one exception. Constraints on time to
relax or exercise was more important for those
respondents reporting relatively more severe symptoms,
thus our results may be most applicable to high
symptom groups. Finally, the study was cross sectional
in design, therefore the associations that we report
cannot be considered causal.
Changes in the nature of work, the sex-segregation of
women into sedentary, repetitive and routine work, and
the persistent gender imbalance in domestic work, are
interlinking factors affecting the health of women in
contemporary Western economies. This study illumi-
nates one way that these factors combine to explain
gender differences in musculoskeletal health.
Acknowledgements
We would like to thank the men and women who
participated in this study, as well as Monika Reinhart
and Brian Wilson for their help in conducting the study,
Comcare Australia for access to the data, Dr. Dorothy
Broom, Dr. Rennie D’Souza, Dr. Mark Clements,
Karen Lees and Marluce Silva for their helpful
comments.

Table 4
Intercorrelations among independent variables (n ¼ 665)

Predictors 1 2 3 4 5 6 7 8 9 10 11

1. Gender — 0.09 0.05 0.17 0.16 0.21 0.12 0.19 0.10 0.03 0.17
2. Age — 0.10 0.02 0.14 0.04 0.22 0.08 0.02 0.05 0.05
3. NESB — 0.12 0.04 0.04 0.05 0.03 0.04 0.01 0.17
4. Education — 0.15 0.13 0.13 0.10 0.01 0.08 0.08
5. Occupation — 0.14 0.02 0.23 0.05 0.27 0.11
6. Workhours — 0.29 0.10 0.01 0.15 0.14
7. Parent — 0.05 0.02 0.07 0.17
8. Repetitive work — 0.31 0.27 0.06
9. Equipment — 0.15 0.12
10. Job control — 0.08
11. Time —

Note: Gender scored 0=male, 1=female, NESB scored English speaking background = 0, non-English speaking background=1,
Parent scored non-parent=0, parent=1. ‘Time’ denotes relaxation and exercise time. Bolded correlation coefficients are significant at
the po0:05 level (two tailed). Missing data deleted listwise.
 ARTICLE IN PRESS
1004 L. Strazdins, G. Bammer / Social Science & Medicine 58 (2004) 997–1005
Appendix A
Bivariate intercorrelation matrix of independent vari-
ables predicting upper body musculoskeletal pain is
given in Table 4.
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