New systems of work organization, such as lean production and total quality management, have been introduced by employers throughout the industrialized world to improve productivity, quality, and profitability. However, few studies have examined the impact of such systems on occupational injuries or illnesses or on job characteristics related to job strain, which has been linked to hypertension and cardiovascular disease. The studies reviewed provide little evidence to support the hypothesis that lean production "empowers" auto workers. In fact, auto industry studies suggest that lean production creates intensified work pace and demands. Increases in decision authority and skill levels are modest or temporary, whereas decision latitude typically remains low. Thus, such work can be considered to have job strain. In jobs with ergonomic stressors, intensification of labor appears to lead to increases in musculoskeletal disorders. The evidence for adverse health effects remains inconclusive for related new work systems in other industries, such as modular manufacturing or patient-focused care.

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In the United States, most efforts to reduce occupational stress continue to focus primarily on personal stress management. However, there has been a growing awareness that personal coping techniques have limited effectiveness and that sources of stress in the work environment need to be altered. Research on workplace sources of stress has been spurred and guided by Karasek's "job strain" or "job demands-control" model, and the University of Michigan model of the stress process. In addition, a model of occupational stress interventions developed by Karasek provides a useful framework for stress prevention activities. U.S. labor unions have undertaken a variety of activities at all stages of the stress process described by this stress intervention model to reduce or prevent the health hazards associated with occupational stress. These programs and strategies include employee assistance programs, educational programs, stress surveys, medical studies, stress committees, collective bargaining, organizing and public awareness, and lobbying and political action. These programs are described and analyzed in relation to models of occupational stress, as well as to the economic context faced by labor unions today, and continuing obstacles to work environment reform.

A sample of 4,018 U.S. Post Office mailhandlers nationwide completed a questionnaire assessing job demands, decision latitude, hazardous conditions, supervisory support, physical exertion, physical/psychological strain, sleeping problems, muscle strain, and job dissatisfaction. Scales were obtained from Karasek's Job Content Questionnaire. Comparative data were available from the U.S. Quality of Employment Surveys (for "mail carriers and handlers") and two samples of contemporary working populations. Hierarchical multiple regressions controlled for age, sex, education, length of postal service, Vietnam veteran status, and marital status. Mailhandlers reported significantly higher levels of negative job characteristics than both the national and contemporary samples, and their levels of job demands and decision latitude place them in the "high strain" quadrant of Karasek's model. Women not only reported higher strain, job dissatisfaction, and sleeping problems than men, but also higher levels of negative job characteristics. While other demographic variables, particularly Vietnam veteran status, were associated with stress-related outcomes, structural aspects of the work environment were more strongly associated with outcome. The authors conclude that postal mailhandlers face a highly stressful work environment.