Levels of psychological demand and control (latitude) or job strain, were measured using the Job Content Questionnaire (JCQ) developed by Karasek [Karasek et al 1998], high strain was defined among individuals with high psychological demands and low decision latitude with cut points at the median for the study population. The JCQ includes scales to assess social support, physical job demands, isometric load (sustained awkward work postures) SH job insecurity and dissatisfaction; these scales were dichotomized at the population median.