Measuring Effort–Reward Imbalance in School Settings: A Novel Approach and Its Association With Self-Rated Health

BACKGROUND We attempted to apply the model of effort-reward imbalance (ERI) to school settings in order to measure students' psychosocial stress and analyze its association with self-rated health in adolescents. METHODS A cross-sectional survey was conducted in Kunming, China among 1004 Chinese students (468 boys and 536 girls) in grades 7 through 12, using a 19-item effort-reward imbalance questionnaire. RESULTS Satisfactory internal consistencies for the scales for effort and reward were obtained; the value for the scale for overcommitment was acceptable. Factor analysis replicated the theoretical structure of the ERI construct in this sample of Chinese students. All 3 scales were associated with an elevated odds ratio for diminished self-rated health, and the effect was strongest for the effort-reward ratio, as predicted by the theory. Sex and grade differences were also observed. CONCLUSIONS The ERI questionnaire is a valid instrument for identifying sources of stressful experience, in terms of effort-reward imbalance, among adolescents in school settings.