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Original Article

Risk Factors for Work-related Fatigue in Students With School-YearEmployment

Luc Laberge, Ph.D.a,b,*, Elise Ledoux, Ph.D.c, Julie Auclair, M.Sc.a, Chlo Thuilier, D.E.S.S.c,Michal Gaudreault, B.Sc.a, Marco Gaudreault, M.A.a, Suzanne Veillette, Ph.D.a, andMichel Perron, Ph.D.a,d

a ECOBES Recherche et transfert, Cgep de Jonquire, Jonquire, Qubec, Canadab Dpartement des Sciences de lducation et de psychologie, Universit du Qubec Chicoutimi, Chicoutimi, Qubec, Canadac Institut de recherche Robert-Sauv en sant et en scurit du travail, Montral, Qubec, Canada

d Dpartement des Sciences humaines, Universit du Qubec Chicoutimi, Chicoutimi, Qubec, Canada

Article history: Received December 18, 2009; accepted July 6, 2010Keywords:Adolescence; Students; Young workers; Fatigue; Chronic fatigue; Sleep; Physical work factors

A B S T R A C T

Purpose:To explore potential risk factors for acute and chronic work-related fatigue in students working ata paid job while pursuing school studies. Although work-related fatigue was identified as a potential hazardfor youth health, academic achievement, and occupational safety, very few studies have specifically ad-dressed its correlates and possible predictors.Methods:Cross-sectional data from an ongoing prospective cohort study of health risk behaviors in adoles-cents was used to identify factors associated with increased levels of acute and chronic fatigue in 209

students aged 1718 years working during the school year. Multiple stepwise regression analyses wereperformed with acute and chronic fatigue levels as dependent variables, and demographic, work, and healthfactors as potential explanatory variables.Results:Average hours worked per week by students was 14.7 hours. It was observed that higher psycho-logical distress, poorer health perception, greater sleep debt, and higher exposure to physical work factorswere associated with higher levels of acute fatigue. Also, it was observed that higher psychological distress,poorer health perception, higher exposure to physical work factors, and holding multiple jobs were associ-ated with higher levels of chronic fatigue. The number of hours worked weekly was associated with neitheracute nor chronic work-related fatigue.Conclusions: Findings suggest that prevention strategies devised to minimize work-related fatigue instudents should consider exposure to physical work factors. Results also re-emphasize the importance ofobtaining sufficient sleep so as to prevent high levels of acute work-related fatigue.

Crown copyright 2011 Published by Elsevier Inc. on behalf of Society for Adolescent Health andMedicine. All rights reserved.

Over thepast three decades, it hasbeen noted that students inmany countries have increased the amount of time they dedicateto paid work during the school year[1].In 20042005, full-time1824-year-old Canadian students were working longer hours

than ever before while attending school, with an average of 16.5

hours devoted to paid work per week [2]. Moreover, working

while studying is everyday life for a substantial proportion of

European university students, varying between 48% in France

and 77% in the Netherlands[3].On an average, these working

students dedicate 11 hours per week in paid employment[4].

Among U.S. students enrolled in 4-year schools and in commu-

nity colleges, 45% and 60%, respectively, work extensive hours,

defined as more than 20 hours per week[5].

* Address correspondenceto: Luc Laberge, Ph.D., Dpartement des Sciencesdelducation et de psychologie, Universit du Qubec Chicoutimi, Chicoutimi,

Qubec, Canada G7H 2B1.E-mail address:luc.laberge@uqac.ca

Journal of Adolescent Health 48 (2011) 289 294

www.jahonline.org

1054-139X/$ - see front matter Crown copyright 2011 Published by Elsevier Inc. on behalf of Society for Adolescent Health and Medicine. All rights reserved.

doi:10.1016/j.jadohealth.2010.07.003

mailto:luc.laberge@uqac.camailto:luc.laberge@uqac.ca

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There has been a great debate over whether student employ-ment during the school year has mainly advantages, such asfinancial aid toward a postsecondary education, work experi-ence, increased sense of responsibility, and higher self-esteem;or negative effects, such as increased alcohol, tobacco, and druguse; lack of exercise; increased rates of dropping out of school;and decreased overall attainment [6,7]. An insufficiently ac-

knowledged factor of why employment may prove detrimentalto the academic achievement and health of students who workextensive hours is sleep curtailment[8]. Indeed, the dual duty ofattending school and working places these students at higherrisk of cumulative sleep deprivation, daytime sleepiness, andfatigue. In addition to the numerous socio-environmental socialfactors (such as paid work), a developmental delay of circadianphase contributes to the delay of sleeping times in adolescence,making the putative average sleep need of 9.25 hours per nightdifficult to fulfill for a majority of students [9]. Accordingly,adolescents andyoung adults (age, 1225 years) have been iden-tified as a population at high-risk for problem related to sleepi-ness[10].This lack of sufficient sleep and excessive sleepinessmay thus put students at risk for cognitive and emotional diffi-

culties, low academic performance, and injuries[9,11].Moreover, recent studies have documented the predictors of

persistent or prolonged fatigue in a substantial proportion ofadolescents[12,13].However, no study has been conducted toidentify the predictors of occupational or work-related fatigue inyoung workers despite the fact that this has repeatedly beenidentified as a potential hazard for their occupational safety andhealth[1416]. Indeed, young workers in most industrializedcountries are known to have higher rates of workplace injuriesthan older workers[7,14,17].In adult workers, prospective re-sults from the Maastricht Cohort Study of Fatigue at Workindicated that both acute and prolonged fatigue are independentrisk factors for occupational injuries and that physical and psy-chological demands at work, including low decision latitude,predict the onset of fatigue[18,19].Additional research is thuswarranted to explore the correlates of work-related fatigue inadolescents who work during the school year.

Methods

Sample and Procedure

Cross-sectionaldata used in this study were collected from anongoing longitudinal survey designed primarily to provide esti-mates of the prevalence of health risk behaviors such as schooldropout, low self-esteem, psychological distress,and drug use. In2002, a representative sample of 1,400 students aged 14 years,

attending all public and private high schools of the SaguenayLac-Saint-Jean region (northern Quebec), was selected by theMinistre de lEducation, du Loisir et du Sport du Qubec, tocomplete a questionnaire survey under the auspices of the re-gional public health authorities. In 2002, a nonrepresentativesubset of 615 students aged 14 years completed the question-naire at school and constituted the initial longitudinal sample.For the second wave of data collection that took place in 2004, atotal of 408 participants completed the questionnaire either atschool under the supervision of trained professionals or online.For the third wave of data collection that took place in 2006, atotal of 413 participants completed the questionnaire at schoolor through postal mail. It must be specified that education iscompulsory up to the age of 16 in the province of Quebec.

Before the third wave of data collection, questions pertainingto employment, work schedule, working conditions, physicalwork factors, psychosocial job characteristics, and other occupa-tional health problems were added to the survey instrument bythe Institut de recherche Robert-Sauv en sant et en scurit dutravail (IRSST) (Qubecs OHS Institute). At the time of the thirdwave, 209participants (84boys, 125girls) were attendingschool

and had one or more jobs. This sample of student workers aged1718 years is the focus of the present cross-sectional analyses.This study was approved by the Comit dthique de sant pub-lique du Ministre de la Sant et des Services sociaux, and in-formed consent was obtained from all participants.

Measures

Dependent variable

The Occupational Fatigue Exhaustion/Recovery (OFER) scalehas been developed specifically to measure and distinguish be-tween acute and chronic fatigue traits associated with work[20,21]. Its acute andchronic fatigue subscales (five items;range,0 100) identify and distinguish between acute end-of-shifts

states and chronic work-related traits (Table 1). Acute work-related fatigue is described as a state of reduced capacity and/orwillingness to engage in further activity as a direct consequenceof engagement in previous work activity. Chronic work-relatedfatigue refers to a global and enduring condition of reducedmotivation, depression, and enduring incapacity to continuewith work activity in a general way without great effort. Theo-retically, persistent low recovery from high levels of acute fa-tigue determines higher levels of chronic fatigue[21].The OFERscale possesses robust, gender-bias, free psychometric charac-teristics[20,21].The reliability of both subscales in this samplewas acceptable ( .79) (Table 1).

Independent variables

Work measures. Job decision latitude was measured using thenine-item decision latitude scale developed by Robert Karasekfor which psychometric qualities have been demonstrated[2224].Scores ranged from 24 to 96. The decision latitude reflectsopportunities for learning, autonomy, and participation in thedecision-making process. Participants with decision latitudescore72 were considered as having low decision latitude[25].Reliability for decision latitude in this sample was high ( .82).

Theintensity of work wasmeasuredby hours of paid work perweek. Participants were asked to provide data on the number ofjobs they held by responding to the following question: How

Table 1Occupational Fatigue Exhaustion Recovery (OFER) Scale

Acute Fatigue Subscale Items (Cronbachs alpha .79)

After a typical work period I have little energy leftI usually feel exhausted when I get home from work

My work drains my energy completely every dayI usually have lots of energy to give to my family and friendsI usually have plenty of energy left for my hobbies and other activities

after I finish workChronic Fatigue Subscale Items (Cronbachs alpha .79)

I often feel I am at the end of my rope with my workI often dread waking up to another day of my workI often wonder how long I can keep going at my work

I feel that most of the time I am just Living to workToo much is expected of me in my work

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many jobs do you currently have? Work schedule was assessedby asking participants the following question: Considering yourcurrent job(s), which of the following situation best describes

your usual work schedule? day shifts, evening shifts, night shifts,alternatingday/evening shifts, alternatingday/night shifts, alter-nating day/evening/night shifts, split shifts, irregular shifts, on-call schedules, miscellaneous. Finally, participants answered

questions about the frequency of exposure (never, rarely, often,always) to physical work factors at work, including repetitivework, high-speed work, handling of heavy loads, strain fromusing tools and machinery, postural constraints, articular con-

straints, thermal constraints, noise, vibrations, and handling ofdangerous substances[26].

Health measures. Psychological distress was measured usingthe Indice de Dtresse Psychologique de lEnqute Sant Qubec(IDPESQ), an adaptation of the Psychiatric Symptom Index [27].Its 14 items record symptoms of anxiety, depression, aggressive-ness, andcognitive impairments. Symptom intensityis rated on a

4-point Likert scale. Scores ranging between 14 and 56 are trans-formedinto scoresfrom 0 to 100by linear transformation.A highlevel of psychological distress was defined as symptom ratingsfalling into the highest quintile. The IDPESQ has considerableinternal consistency and construct validity [28]. Reliabilityin thissample was high ( .88).

Health perception was assessed by asking participants thefollowing question: In general, is your health excellent, verygood, good, fair or poor? Body mass index (BMI) was computedby using self-reported weight and height. Subjects were catego-rized as nonobese (BMI 25 kg/m2) or obese (BMI 25 kg/m2).Sleep debt was defined as total sleep time participants estimated

they needed to be at their best minus self-reported intervalbetween habitual bedtime and wake time[29].Insomnia symp-toms were defined as having difficulty initiating sleep and/or

maintaining sleep.

Data Analysis

Bivariate correlations were computed for all potential explan-atory variables, with acute and chronic work-related fatiguebeing the dependent variables. Stepwise multiple regressionswere conducted to verify whether some combination of inde-pendent variables would increase the proportion of varianceaccounted for and to determine what the R2 change wouldbe foradditional variables entering into the regression equation. Be-

cause little research exists on the predictors of work-relatedfatigue in adolescents, potential explanatory work and health

variables were identified on the basis of prior studies on fatiguein adolescents and work-related fatigue in adults. Gender, workintensity, BMI, health perception, sleep debt, insomnia symp-toms, psychological distress, multiple job holding, physical workfactors, work schedule, and decision latitude were used as inde-pendent variables in the regression. Gender and intensity of

work, considered as control variables, were forced into the equa-tion first. Other work and health variables were introduced oneat a time in the model to see the incremental gain. Stepwisecriteria were a probability of fixed factor (F) to enter .05 and aprobability of fixed factor (F) to remove.25. The sample size forthe fully adjusted model was 187 (74 boys, 113 girls). Statisticalanalyses were performed using SPSS version 15.0 for Windows(SPSS, Chicago, IL).

Results

Characteristics of Working Students

The mean (SD) acute and chronic work-related fatigue scoreswere 32.4 (19.1) and 29.2 (19.8), respectively. Table 2presentsdemographic, work, and health factors of students. Mean (SD)age of the participants was 17.9 (.3) years. The proportion ofparticipants who were in high school and who had undertakenpostsecondary education were 17.1% and 82.9%, respectively.Finally, the following four types of jobs accounted for more than60% of the occupations most often held by the participants:cashiers (23.0%), salesmen/saleswomen (22.5%), amusement andrecreational services (12.8%), and food service (10.2%).

Correlates of Acute and Chronic Work-related Fatigue

Table 3presents the stepwise multiple regression results foracute work-related fatigue (adjustedR2 .35,p .001). Signifi-cant factors associated with higher acute fatigue levels werehigher psychological distress (p .001), poorer health percep-tion (p .001), higher sleep debt (p .01), and exposure to agreater number of physical work factors (p .05).

Table 4presents the stepwise multiple regression results forchronic work-related fatigue (adjusted R2 .35,p .001). Sig-nificant factors associated with higher chronic fatigue levelswere higher psychological distress (p .001), poorer healthperception (p .001), exposure to a greater number of physicalwork factors (p .01), and holding multiple jobs (p .05).

Discussion

To our knowledge, the present study is the first to investigatefactors associated with work-related fatigue in adolescentsworking at a paid job while attending school, a population at riskof sleep deprivation, sleepiness, fatigue, and occupational inju-ries[710,14,17].This cohort[26]is comparable with Canadianstudent workers of the same age group as they are mainly em-ployed in two sectors of the economy, retail andwholesale trade,as well as accommodation and food services[2],and in terms ofaverage weekly hours worked[2].

Table 2Demographic, work, and health factors of students (n 187)

Characteristics

Females, % (n) 60.4 (113)

Age in years, mean (SD) 17.9 (.3)Work intensity in hours, mean (SD) 14.7 (7.6)

Multiple concurrent jobs, % (n) 18.7 (35)

Nu mber of physical work fact ors, mean (SD) 6.0 (2.9)Non-daytime shifts, % (n) 18.7 (35)

Low decision latitude, % (n) 73.3 (137)Health perception, % (n)

Excellent 27.8 (52)Very good 36.4 (68)Good 24.1 (45)

Fair 10.2 (19)Poor 1.6 (3)

Sleep debt, % (n) 48.7 (91)Insomnia symptoms, % (n) 56.1 (105)Obesity, % (n) 17.1 (32)

High psychological distress, % (n) 16.0 (30)

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Consistent with the previous findings obtained in adult work-ers [30,31], the stepwise multiple regression analyses revealed apositive relationship between fatigue and psychological distressin these young workers aged 1718 years. More particularly,psychological distress was the strongest associated factor forboth acute and chronic work-related fatigue. In addition, thestepwise regression models revealed a substantial associationbetween fatigue and a second health variable, namely self-ratedhealth status. Students reporting a poorer health status hadhigher levels of both acute and chronic fatigue as compared withthose reporting a better health status. In a random general pop-ulation sample of British adolescents[32],both anxiety and de-pression were prospectively showed to predict fatigue andchronic fatigue. Whether emotional difficulties, such as psycho-logical distress, constitute a vulnerability factor for work-relatedfatigue in adolescents who work during the school year is animportant question for which a longitudinal study design isneeded.

The present results also suggest that work characteristicssuchas physical work demands maybe more important than the

average number of hours worked per week as regards work-related fatigue. This is consistent with several studies of adultworkers that have documented relationships between highphysical workload or high work demands and high levels offatigue [30,31,33]. More importantly, Sluiter et al [34] havefound strong associations between work demands and acutework-related fatigue in 3,820 adult workers with different occu-pations, and have also shown, on the basis of prospective data,the prognostic value of acute work-related fatigue in relation tosubjective health complaints, including chronic or prolongedfatigue. In their view, work-related fatigue is the link in thecausal string of events that is assumed to exist between adversework demands and potential health problems. Sluiter et al fur-ther added that occupationally induced fatigue should not be a

problem if sufficient recovery time is available between workperiods[34]. Meijman[35] earlier established that chronic orprolonged fatigue is not easily reversible and not task specific ascompared with acute fatigue; the compensating mechanismsthat areusefulin reducing acute fatigue areno longereffective. Inthis regard, a recent study by Oginska and Pokorski found norelationship between chronic sleep reduction and chronic fa-

tigue in school children, university students, and young employ-ees[36].Our finding which shows an association between sleepdebt and acute fatigue but not with chronic fatigue is in keepingwith these results. Also, in this study, multiple jobholders exhib-ited significantly higher levels of chronic work-related fatigue.Data from the Second European Workforce Survey suggestedthat holding multiple concurrent jobs may partially explain thatprecarious employees report greater fatigue[37].

Multiple sources of evidence demonstrated that workersaged 24 or youngerare exposed to higher levelsof physical workdemands [17,38] andsuffer work-related injuryat a much higherrate[7,14,17]than those aged 25 and older. An analysis of therelationship between exposure to physical work demands andincidence of workplace injuries by Gervais et al revealed that the

rate of injury increases proportionally to the number of physicalwork factors, even more so in young workers[38].In this line ofevidence, Frone had previously identified exposition to physicalhazards, heavy workloads, and boring job tasks as significantpredictors of occupational injuries in employed adolescents aged1619 years. He hypothesized that such environmental condi-tions mayincreaseinjury rates through elevationsin such factorsas fatigue or distraction [39]. In sum, knowing about the physicalwork demands in thework environmentof adolescents may helpto prevent occupational injuries indirectly through reduction ofwork-related fatigue.

Table 3Stepwise multiple regression predicting acute work-related fatigue in studentswho work during the school year

B (SE) R2 R2 Fchange Sign.F

change

Constant 1.9 (8.3)Control variables

Gendera

2. 9 (2. 4) .03 8 . 038 7.27 .008Work intensityb .1 (.2) .046 .008 1.51 .221

StepwisePsychological distressc . 4* (.1 ) .2 45 .19 9 4 8.25 .000Health perceptiond 4.3* (1.2) .296 .051 13.15 .000

Sleep debte 2 .7** (. 9) .3 37 .041 11.28 .001Physical work factorsf 1.1*** (.4) .361 .024 6.80 .010

Multiple concurrent jobsg 4. 9 (2. 7) .3 70 .009 2.44 .120Insomnia symptomsh 3. 5 (2. 4) .3 76 .006 1.81 .180Decision latitudei .1 (.9) .381 .005 1.44 .232

Final model:R2 .38;R2 adjusted .35;F(9,177) 12.11*.a Gender: 0 female, 1 male.b Higher scores indicate higher number of hours worked per week.c Higher scores indicate greater psychological distress.d Lower scores indicate better health.e Higher scores indicate greater sleep debt.f

Higher scores indicateexposition to a larger number of physical workfactors.g Multiple job holding: 0 no, 1 yes.h Higher scores indicate greater severity of insomnia symptoms.i Higher scores reflect greater job decision latitude.

* p .001.** p .01.

*** p .05.

Table 4Stepwise multiple regression predicting chronic work-related fatigue in

students who work during the school year

B (SE) R2 R2 Fchange Sign.F

change

Constant 6.6 (7.4)

Control variablesGendera 1.7 (2.5) .013 .013 2. 42 .1 21Work intensityb .1 (.2) .026 .013 2.50 .115

StepwisePsychological distressc .4* (.1) .228 .202 47 .96 . 000

Health perceptiond 6.0* (1.3) .307 .079 20.64 .000Physical work factorse 1.2** (.4) .336 .029 8.04 .005Multiple concurrent jobsf 6. 6*** (2.8) .362 .026 7. 26 . 008

Sleep debtg 1.1 (.9) .369 .007 1.96 .163Insomnia symptomsh 3.2 (2.5) .375 .005 1. 55 .2 14

Daytime shiftsi 4.0 (3.1) .380 .006 1. 62 . 204Obesityj 3.7 (3.2) .385 .005 1. 33 .2 50

Final model:R2 0.39;R2 adjusted 0.35;F(10,176) 11.01*.a Gender: 0 female, 1 male.b Higher scores indicate higher number of hours worked per week.c Higher scores indicate greater ps ychological distress.d Lower scores indicate better health.e Higher scores indicateexposition to a larger number of physicalwork factors.f Multiple job holding: 0 no, 1 yes.

g Higher scores indicate greater sleep debt.h Higher scores indicate greater severity of insomnia symptoms.i Daytime shifts: 0 no, 1 yes.

j Obese: 0 no, 1 yes.

* p .001.** p .01

*** p .05

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Our findings should be interpreted with caution. First, boththe independent and dependent variables were assessed usingself-reported measures and are thus subject to accuracy of recall.Also, one main disadvantage of cross-sectional research designsis that they preclude the determination of a cause and effectrelationship. Longitudinal studies are thus needed to compare,for example, different exposure to physical work factors under

the same work schedule studied systematically in terms of howthey contribute to acute and chronic work-related fatigue. Fi-nally, generalizability of the results may be limited to similarpopulations of students.

A major contribution of this study is the identification ofpotentially modifiablerisk factors that maydiminish thelevelsofacute and chronic work-related fatigue in adolescents aged1718 years attending school and working at a paid job. Therelationship between self-rated health, psychological distress,and work-related fatigue suggests that interventions designed toprevent fatigue in student workers should address emotionalwell-being. Moreover, health providers must inform adolescentpatients andtheir parents about the elevated injury risk faced byyoung workers[40]and risks associated with work-related fa-

tigue, exposure to high physical demands at work, and multiplejob holding. Finally, the importance of getting enough sleep andhaving recovery periods should be reemphasized as a means tosafeguard the health andwell-being of students who work whileattending school.

Acknowledgments

This work was supported by the Programme daide la re-cherche sur lenseignement et lapprentissage (PAREA) of theMinistre de lEducation, du Loisir et du Sport du Qubec, theInstitut de recherche Robert-Sauv en sant et en scurit dutravail (IRSST), and the Syndicat des chargs et des charges decours de lUniversit du Qubec Chicoutimi (SCCCUQAC). Weexpress our appreciation to the adolescents for their generousparticipation in this study. Finally, technical support from RobertDle is gratefully acknowledged.

References

[1] Laplante B, StreetMC, MoulinS, etal. Educational pathways andpaid work:A longitudinalapproach. Montral, Quebec, Canada: Universit du Qubec Montral, 2010.

[2] Usalcas J, Bowlby G. Students in the labour market. Education matters:insights on education, learning and training in Canada. 2006;3:1. StatisticsCanada Catalogue no. 81-004-XIE.

[3] Hakkinen I. Working while enrolled in a university: Does it pay? LabourEcon 2006;13:16789.

[4] EuroStudent 2000. Social and economic conditions of student lifein Europe

2000. Synopsis and national profiles for Austria, Belgium (Flemish county),Belgium(Wallonia-BrusselsCommunity),Finland,France,Ireland,Italy andThe Netherlands. Hannover, Germany: HIHS Hochschul-Informations-System, 2002.

[5] U.S. Department of Education. 20072008 National Postsecondary StudentAid Study. In: Orozco V, Cauthen NK, eds. Work Less, Study More andSucceed: HowFinancialSupports Can Improve PostsecondarySuccess.NewYork, NY: Demos, 2009.

[6] Mortimer JT, Finch MD, Ryu S, et al. The effects of work intensity onadolescent mental health, achievement, and behavioral adjustment: Newevidence from a prospective study. Child Dev 1996;67:124361.

[7] Committee on the Health and Safety Implications of Child Labor, NationalResearch Council and Institute of Medicine. Protecting youth at work:Health, safety, and development of working childrenand adolescents in theUnited States. Washington, DC: National Academy Press, 1998.

[8] Teixeira LR, Fischer FM, Lowden A. Sleep deprivation of working adoles-centsa hidden work hazard. Scand J Work Environ Health 2006;32:32830.

[9] CarskadonMA. Adolescent sleeppatterns: Biological, social, andpsycholog-ical influences. Cambridge, United Kingdom: Cambridge University Press,2002.

[10] National Institutes of Health, National Center on Sleep Disorders Researchand Office of Prevention, Education, and Control. Working Group Report onProblem Sleepiness, 1997.

[11] Dahl RE, Lewin DS. Pathways to adolescent health sleep regulation andbehavior. J Adolesc Health 2002;31:17584.

[12] Mears CJ, Taylor RR, Jordan KM, et al. Sociodemographic and symptom

correlates of fatigue in an adolescent primary care sample. J Adolesc Health2004;35:528e 5216.[13] Viner RM, Clark C, Taylor SJ, et al. Longitudinal risk factors for persistent

fatigue in adolescents. Arch Pediatr Adolesc Med 2008;162:46975.[14] National Institute for Occupational Safety and Health. Special hazard re-

view: Child laborresearch needs. Washington, DC:US Government PrintingOffice, 1997. DHHS Publication No. NIOSH 97-143.

[15] McCall BP, Horwitz IB, Carr BS. Adolescent occupational injuries and work-placerisks: An analysis of Oregon workers compensation data 19901997.

J Adolesc Health 2007;41:248 55.[16] Runyan CW, Schulman M, Dal Santo J, et al. Work-related hazards and

workplace safety of US adolescents employed in the retail and servicesectors. Pediatrics 2007;119:52634.

[17] European Agency for Safety and Health at Work. OSH in figures: YoungworkersFacts and figures. European Risk Observation Report. Luxem-bourg: Office for the Official Publications of the European Communities,2007.

[18] Bultmann U, Kant IJ, Vanden BrandtPA, et al. Psychosocialwork character-

istics as risk factors for the onset of fatigue and psychological distress:Prospective results from the Maastricht Cohort Study. Psychol Med 2002;32:33345.

[19] SwaenGM, VanAmelsvoortLG, BultmannU, etal. Fatigue as a risk factorforbeing injured in an occupational accident: Results from the MaastrichtCohort Study. Occup Environ Med 2003;60 (Suppl 1): i8892.

[20] Winwood PC, Lushington K, Winefield AH. Further development and vali-dation of the Occupational Fatigue Exhaustion Recovery (OFER) scale. JOccup Environ Med 2006;48:3819.

[21] WinwoodPC, WinefieldAH, Dawson D, et al. Developmentand validation ofa scale to measure work-related fatigue and recovery: The OccupationalFatigue Exhaustion/Recovery Scale (OFER). J Occup Environ Med 2005;47:594606.

[22] Karasek R, Brisson C, Kawakami N, et al. The Job Content Questionnaire(JCQ): An instrument for internationally comparative assessments of psy-chosocial job characteristics. J Occup Health Psychol 1998;3:32255.

[23] Karasek RA. Job content questionnaire and users guide. Los Angeles, CA:Department of industrial and system engineering, University of Southern

California, 1985.[24] Bu J, Coutrot T, Guignon N, et al. Les facteurs de risques psychosociaux autravail. Une approche quantitative par lenqute Sumer. Rev Fr Aff Soc2008;4570.

[25] Sant Qubec. Et votre coeur,a va?Rapport de lenqutequbcoisesur lasant cardiovasculaire. Qubec, Canada: Gouvernement du Qubec, 1994.

[26] LedouxE, Laberge L, ThuilierC, etal. Etudieret travailler en rgion 18 ans.Quels sont les risques de SST? Une tude exploratoire. Montral, Quebec,Canada: Etudes et recherches/RapportR-560, Institutde rechercheen santet en scurit du travail (IRSST) (Quebecs Occupational Health and SafetyResearch Institute), 2008.

[27] Ilfeld FW. Further validation of a psychiatric symptom index in a normalpopulation. Psychol Rep 1976;39:121528.

[28] Deschesnes M. Etude de la validite et de la fidelite de lIndice de detressepsychologique de Santeq Uebec (IDPSQ-14), chez une population adoles-cente. Can Psychol 1998;39:28898.

[29] Regestein Q, Natarajan V, Pavlova M, et al. Sleep debt and depression infemale college students. Psychiatry Res 2010;176:349.

[30] Bultmann U, Kant IJ, Schroer CA, et al. The relationship between psychoso-cial work characteristics and fatigue and psychological distress. Int ArchOccup Environ Health 2002;75:25966.

[31] HardyGE, Shapiro DA,BorrillCS. Fatiguein theworkforce ofNationalHealthService Trusts: Levels of symptomatology and links with minor psychiatricdisorder, demographic, occupational and work role factors. J PsychosomRes 1997;43:8392.

[32] RimesKA, Goodman R,Hotopf M, etal. Incidence, prognosis,andriskfactorsfor fatigue and chronic fatigue syndrome in adolescents: A prospectivecommunity study. Pediatrics 2007;119:e6039.

[33] Akerstedt T, Fredlund P, Gillberg M, et al. Work load and work hours inrelation to disturbed sleep and fatigue in a large representative sample.

J Psychosom Res 2002;53:585 8.[34] Sluiter JK, Frings-Dresen MH, van der Beek AJ, et al. The relation between

work-induced neuroendocrine reactivity and recovery, subjective need forrecovery, and health status. J Psychosom Res 2001;50:2937.

[35] Meijman TF. Over vermoeidheid: Arbeidspsychologische studies naar debeleving van belastingseffecten [Fatigue: Studies on the perception of

L. Laberge et al. / Journal of Adolescent Health 48 (2011) 289294 293

8/13/2019 Laberge Et Al 2011

6/6

workload effects]. Amsterdam, the Netherlands: University of Amsterdam,1991.

[36] Oginska H, Pokorski J. Fatigue and mood correlates of sleep length in threeage-socialgroups: School children,students, andemployees. Chronobiol Int2006;23:131728.

[37] Benavides FG, Benach J, Diez-Roux AV, et al. How do types of employ-ment relate to health indicators? Findings from the second Europeansurvey on working conditions. J Epidemiol Community Health 2000;54:494501.

[38] Gervais M, Massicotte P, Champoux D. Conditions de travail, de sant et descurit des travailleurs du Qubec. Montral, Quebec, Canada. Etudes etrecherches/Rapport R-449, Institut de recherche en sant et en scurit dutravail (IRSST) (Quebecs Occupational Health and Safety Research Insti-tute), 2006.

[39] Frone MR. Predictors of work injuries among employed adolescents. J ApplPsychol 1998;83:56576.

[40] RunyanCW. Advocating theinclusion ofadolescent workexperienceas partof routine preventive care. J Adolesc Health 2007;41:2213.

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