Occupation, Hours Worked, Caregiving, and Leisure Time Physical Activity

Abstract

This study hypothesized that occupational variation in leisure-time physical activity or exercise may be due to differential caregiving demands on blue versus white-collar female employees. Data from the 2000 Kings County Genuine Progress Indicators Survey (1,900 respondents aged 15 years and older) were analyzed. Results indicate that variation in LTPA is accounted for by caregiving to dependent children at home and health status and not by occupational status. Implications for health promotion strategies are discussed.

Stephanie L. Kuiack, Ph.D. is Assistant Professor, Department of Family Studies, Brescia University College, London, Ontario, Canada, N6G1H2. Electronic mail may be sent via the Internet to [email protected].

Key Words: Caregiving, leisure-time physical activity, occupational status

Many studies have found that caregivers tend to neglect their own health care needs (Acton, 2001; Castro, King, Bacak, Housemann, Gardiner, & Brownson, 2003; Janevic & Connell, 2001). This neglect comes in many forms, but one of considerable interest is neglect of leisure time physical activity (LTPA) and exercise. Caregivers who do not exercise regularly miss out on many well documented benefits of regular physical exercise including improved overall health, decreases in blood pressure, improvements in lipid profile, weight control, helps in diabetes control, reduction of stress, promotion of relaxation, as well as a number of positive psychological effects.

It is essential that caregivers make time to provide care for themselves, including sufficient LTPA. The entire experience of caregiving can be undermined when the caregiver does not take sufficient care of themselves. Compromised caregiver health has been linked to potentially harmful behaviors by caregivers, including screaming, yelling, insulting, swearing, threatening to send to a nursing home and withholding food (Beach, Schulz, Williamson, Miller, Weiner, & Lance, 2005). Karlin (2004) concluded that lack of LTPA or exercise during care-giving periods predicted higher levels of caregiver burden. Alternatively, Rabinowitz, Cardenas, Mausback, Gray and Ambler (2003) found that overall burden was predictive of poor health behaviors for caregivers. Exercise programs directed to caregivers have shown success in reducing sense of caregiver burden (Boise, Congleton & Schmall, 2000; Castro, Wilcox, O’Sullivan, Baumann, & King, 2002).

The exploration of the barriers to regular LTPA for caregivers has revealed regional variation (Wilcox, Castro, King, Housemann, & Brownson, 2006) in that rural caregivers are more sedentary than their urban counterparts. Rural women cited care-giving duties as their top barrier to LTPA as compared to lack of time for the urban women. Variation has also been reported due to ethnicity, age, and education level (King, Castro, Wilcox, Eyler, Sallis, & Brownson, 2006). For all ethnic subgroups, care-giving duties ranked among the top four most frequently reported barriers to LTPA. The exploration of why some caregivers cannot engage in regular LTPA has incorporated the fact that caregiving and LTPA may be mediated by other factors. Caregivers often have multiple competing demands for their time including providing care to their own children as well as employment (Burton & Turrell, 2000).

Methods

Analysis

We used logistic regression analyses to examine the associations between physical

activities, occupational status, hours worked and hours spent providing unpaid care for an elderly relative or friend, or an adult child. These associations were adjusted for age and marital status. We adjusted for these variables because previous studies have shown that they are associated with physical activity, occupation, and care-giving. All statistical analyses were conducted using STATA 8.2 (StataCorp, 2003).

Results

Table 1 presents the characteristics of the study sample. Of the 490 women, the majority (37.4%) were between 35 and 44 years of age. Most women were married or in common law relationships (78.2%), and 36.9% had dependent children living in their households. The majority of women perceived their physical health as good (89.8%), were non-smokers (74.5%), and slightly fewer than half (46.9%) were of healthy weight (BMI of < 25). Most women (68.2%) participated in insufficient physical activity (i.e., less than five days per week) and worked 30 or more hours per week (65.5%). Only 10% of women provided at least one hour per week of unpaid care for an elderly relative or friend, or an adult child, who lived either with them or outside their home. Almost half of the women (49.8%) were in white collar occupations, followed by 41.4% and 8.8% in professional and blue collar occupations, respectively.

Table 2 reports the results of the logistic regression analyses that examined the associations between physical activity, occupational status, hours worked and hours spent providing unpaid care for an elderly relative or friend, or an adult child. Results in Model 1 indicate that, controlling for age and marital status, occupational status was significantly associated with participation in physical activity. More specifically, the odds of participation in insufficient physical activity (less than 5 times per week) were greater among women in blue collar occupations (OR = 2.43 [95% CI = 1.01-5.84]), than among women in professional occupations. As shown in Model 2, the association between physical activity and occupational status remained significant with adjustment for hours spent working at a job. Model 3 shows that time spend providing unpaid care for an elderly relative or friend, or an adult child also did not significantly change the relationship between physical activity and occupational status.

Results in Model 4 illustrate that when the additional independent variables were added to the model, the association of occupational status with physical activity became non-significant. Only the presence of dependent children in the household and perceived health was significantly associated with participation in physical activity. Women who resided in households with dependent children were more likely to be insufficiently active (OR = 1.68 [95% CI = 1.03-2.73]) than their counterparts who resided in households without dependent children. In addition, perceived heath was significant, with lower odds of participation in insufficient physical activity among women who perceived their health as good (OR = 0.38 [95% CI = 0.17-0.84]) compared with women who perceived their health as poor. These findings suggest that the presence of dependent children in the household and perceived health status are two important factors that help to explain the association between occupational status and participation in regular physical activity among women.

Discussion

The objective of this study was to examine occupation, hours worked, caregiving demands and LTPA. In keeping with previous research findings (Burton & Turrell, 2000), participation in insufficient physical activity (less than 5 times per week) was greater among women in blue collar occupations than among women in professional occupations. Contrary to our hypothesis, time spent providing unpaid care for an elderly relative or friend, or an adult child did not significantly change the relationship between occupational status and physical activity. Only the presence of dependent children in the household and perceived health were significantly associated with participation in LTPA.

These results suggest that care-giving to dependent children interferes more with the pursuit of LTPA than caregiving to others, regardless of occupational status. It may be that care-giving needs to be understood in terms of the care receiver. Nearly 37% of the sample had dependent children at home, while only 10% provided care to an elderly relative, friend, or an adult child. This finding must be considered in the context of how caregiving was measured. Those women who were coded as caregivers indicated they provided one or more hours of care per week versus those who did not. Perhaps a more sensitive measure of time spent on care-giving would reveal the critical point in terms of time where caregiving responsibilities interfere with LTPA.

It is important to note that the majority of the women in this sample worked more than 30 hours per week at paid employment. Many caregivers to the elderly or infirm either reduce the number of hours they work or quit work to care for the patient (Covinsky, Eng Lui, Sands, Sehgal, Walter, Wieland et al., 2001). It may be reasonable to surmise that if caregiving does not interfere with paid employment, or at least warrant a reduction in work hours, then it is not so demanding as to rob time away from LTPA pursuits. Alternatively, caregivers may maintain their work hours but engage in care-giving rather than pursue LTPA or exercise. Future studies should specifically ask caregivers how they spend their time versus how they would like to spend their time to begin to appreciate if caregiving per se is replacing activities such as LTPA or exercise.

Interestingly, perceived heath was a significant motivator for LTPA. Women who perceive their health to be good were more likely to engage in LTPA than those who did not. Regarding one’s health to be compromised may act as a barrier to LTPA due to fatigue. One may choose to avoid LTPA or exercise as a caution to not aggravate an existing condition. Our sample was clustered into two groups; those reporting good health versus those reporting poor health. Perhaps a greater understanding of the conditions that warrant a rating of fair or poor health may provide a better picture of why LTPA is avoided. However, our measurement of physical activity included activities such as swimming, bicycling, walking for exercise, and gardening which may be engaged in despite ailments which lead to a rating of fair or poor health.

Burton and Turrell (2000) demonstrated that time spent at work does not explain variation in occupational status and LTPA. This present study has demonstrated that occupational variability in LTPA also cannot be explained by the addition of caregiving responsibility to the elderly or infirm for women. Motherhood or the care of dependent children in the home does have an important bearing on LTPA, as does perception of poor health status. Methodologies must be developed to examine the reason why blue collar caregivers are engaging in less LTPA than their counterparts. If it is not because they are busier with work or caregiving, we must continue to explore this issue in order to close the gap in health status between the occupational groups. In the meantime, health promotion strategies to increase the rate of participation in LTPA or exercise for women must take into consideration the competing demands on their time. Awareness raising campaigns to encourage women to exercise may need to directly address perceived obstacles to LTPA including lack of time due to motherhood or health status in order to reduce the variation in LTPA pursuits recognized between occupational status groups.

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Table 1: Characteristics of the Study Sample (n=490).

Table 2: Logistic Regression Results of the Association Between Occupation, Hours Worked, Hours Spent Caregiving and Physical Activity Among Women Aged 18 to 64 (n=490).