specific. Perceived muscular tension is hypothesized to be an early sign of musculoskeletal symptoms. Neck pain is common among workers, affecting 13−48% of workers annually 1,2) . Office workers, defined as those working in an office environment with their main tasks involving computer use, participation in meetings, presentations, reading, and making and receiving telephone calls 3) , are among those with the highest frequency of neck pain 4) . Previous studies showed that between 42 and 69% of office workers experienced neck pain in the preceding 12 months 5−8) and that about 34 to 49% of office workers reported a new onset of neck pain during a one-year followup 9−11) . Neck pain is viewed as an episodic occurrence over a lifetime with variable recovery between episodes 12) . It has been found to increase the risk for future long-term sickness absence among white-collar workers 13) . Consequently, neck pain in effect constitutes a great socioeconomic burden on patients and society 14,15) . Nonspecific neck pain is neck pain (with or without radiation) without any specific systematic disease being detected as the underlying cause of the complaint 16) . The etiology of musculoskeletal disorders is widely accepted to be multifactorial, including individual, physical, and psychosocial factors 14, 17−19) . Different occupations are exposed to different working conditions, and the nature of the work influences the health of workers 14, 20−22) . Predisposing factors for neck pain are likely to be population specific. A recent systematic review of prospective cohort studies identified several risk factors for neck pain in office workers, including female gender, history of neck complaints, pain initially felt after an accident, irregular head and body posture, duration of employment in same job <1 year (for males only), poor computer The etiology of nonspecific neck pain is widely accepted to be multifactorial. Each risk factor has not only direct effects on neck pain but may also exert effects indirectly through other risk factors. This study aimed to test this hypothesized model in office workers. Methods: A one-year prospective cohort study of 559 healthy office workers was conducted. At baseline, a self-administered questionnaire and standardized physical examination were employed to gather biopsychosocial data. Follow-up data were collected every month for the incidence of neck pain. A regression model was built to analyze factors predicting the onset of neck pain. Path analysis was performed to examine direct and indirect associations between identified risk factors and neck pain. Results: The onset of neck pain was predicted by female gender, having a history of neck pain, monitor position not being level with the eyes, and frequently perceived muscular tension, of which perceived muscular tension was the strongest effector on the onset of neck pain. Gender, history of neck pain, and monitor height had indirect effects on neck pain that were mediated through perceived muscular tension. History of neck pa...