
The increasing proportion of the service industry has intensified interest in personnel who interact directly with customers during their consumption activities. In 2015, the National Human Rights Commission of Korea surveyed emotional workers to investigate their current status, which led to a request for legislation on relevant regulations to improve their working conditions. Consequently, a new clause (Article 26-2 of the Occupational Safety and Health Act) was established to protect emotional workers, which was implemented on October 18, 2018. According to the definition by the American sociologist Hochschild1), emotional labor refers to “the labor that manages emotions such as maintaining appearance and facial expressions to create a feeling that consumers are friendly and cared for, suppressing their actual feelings or expressing them differently from their actual feelings.” The Korea Occupational Safety and Health Agency2) defines emotional labor as “the labor of responding to customers who exhibit only the emotions and expressions required by the working place to customers even if their feelings are good, sad, or angry when they are dealing with customers in their occupation”. The estimated number of workers engaged in emotional labor in Korea is approximately 5.6 to 7.4 million3).
The negative effects of emotional labor have been studied in terms of organizational, mental, physical, and health behavior. Organizationally, work absence and intention to change jobs have been studied4,5), and the mental aspects of emotional labor have been studied as well including depression6), suicide impulsivity7) and post-traumatic stress disorder8). The physical, health, and behavioral aspects of emotional labor have also been studied, including musculoskeletal disorders9), increased inflammatory indicators of cardiovascular diseases10), and drinking11) and smoking12).
Notably, emotional labor is a major contributor to job-related stress13), which in turn has significant implications for oral health. Increased job stress has been associated with periodontal disease, dental caries, and bruxism14-16), highlighting the bidirectional relationship between stress and oral health outcomes.
Work absence due to physical and mental symptoms in industrial fields can cause social and economic losses due to reduced productivity17,18). Conversely, oral health is an important component of health, and the oral health of workers is essential for a healthy life19). Therefore, reducing work absence due to dental diseases in industrial fields is an important task for improving workers’ lives and socio-economic productivity.
Several studies in the United States have found that oral health problems are associated with a loss of 0.25 to 1.5 hours per population and a loss of productivity of more than $800 million. Similarly, in the UK, due to oral health problems, 415,000 workers per year are out of work for one day, and the annual productivity loss is £36 million20-24). In Canada, oral problems potentially cost more than 40 million hours of treatment per year, resulting in a potential loss of productivity of over $1 billion, and the estimated loss of productivity for Australian workers was $880 million, combined with lost time and the cost of dental visits24-26).
Previous studies have examined absenteeism from work due to oral diseases, such as tooth loss, dental caries and poor periodontal status27). In addition, psychological stress is known to be a potential risk factor for dental diseases28). Unfortunately, there is insufficient research on the impact of emotional labor on absenteeism due to dental diseases. Therefore, this study was conducted under the hypothesis that emotional labor negatively affects continued workplace performance due to deteriorating oral health.
The present study aimed to examine the association between emotional labor and absenteeism due to dental diseases and assess the role of various factors in the paths between emotional labor and absenteeism due to dental diseases. By analyzing the relevance and related factors of absenteeism caused by emotional labor and dental diseases, we aimed to improve the oral health of workers.
Data were collected from 1,120 workers in Korea between May and October 2018 using a cross-sectional and nationwide survey. Initially, 120 sample workplaces were randomly selected, based on their industry (manufacturing and non-manufacturing) and size (large, medium, and small), with the cooperation of the Ministry of Employment and Labor and the Korea Occupational Safety & Health Agency. After explaining the purpose of the survey to the health manager of the workplace, the number of workers at each workplace was divided into 20 (large), five (medium), and three workers (small), and a questionnaire was distributed to them. Questionnaires were distributed to 1,120 workers, of which 516 (46%) returned and were included in this study. The survey was conducted using individual self-reported questionnaires, and only participants who provided voluntary consent were included. A total of 483 survey results were analyzed, with 33 excluded due to missing or insufficient responses. The study was approved by the Institutional Review Board of the School of Dentistry, Seoul National University for human subjects (approval number: S-020180024).
The survey questionnaires included self-reported information on various aspects related to the workers, including the general (age, sex, and education level), occupational (emotional labor, work type, employment type, and absenteeism due to dental diseases), and psychological characteristics (stress).
According to the Health Insurance Review and Assessment Service’s data on the number of outpatient dental visits by age, approximately 20 million patients were in the 30s, then exceeded 30 million from the 40s, and reached 40 million in the 50s and 60s29). Therefore, we categorized age as “under 40/over 40”. Sex was categorized as binary (male/female). Educational level was surveyed as “middle school or lower/high school/college/university/graduate school or higher” and was later converted to binary as “high school or lower/college or higher” for analysis. The questions included “What is your current work type” and surveyed as “daytime work/shift work/other,” which was later converted to “daytime work/shift work or other” for analysis. Employment type was categorized as “What is your employment type” and surveyed as “regular/irregular.” Stress was categorized as “How much stress do you usually feel?” and was surveyed as “very much/much/a little/hardly at all,” which was later converted to “high/low.” Emotional labor was framed as “Do you have to hide your feelings when you work?” and surveyed as “Not at all/a little/much/very much,” which was later converted to a binary variable for analysis as “yes/no.” Work absence due to dental treatment was the outcome variable, assessed as “absence” or “no absence,” while emotional labor was the independent variable. General characteristics were considered confounders, and work type, employment type, and stress were treated as mediators in the analysis.
First, the study computed frequency analysis and percentages for workers’ socio-demographic characteristics (age, sex, and education), occupational characteristics (work and employment types), stress, and emotional labor. Chi-square tests were then used to examine the association between each variable and absenteeism due to dental treatment. Second, chi-square tests were conducted to determine the association between the socio-demographic characteristics, occupational characteristics, emotional labor, and stress. Third, serial logistic regression analyses were employed to estimate the association between emotional labor and absenteeism due to dental treatment, while evaluating the impact of mediating factors such as education, work type, employment type, and stress on this relationship. The associations were presented as odds ratios (ORs) with 95% confidence intervals (CIs). The role of mediators was evaluated with the percentage (%) excess odds explained, which was calculated as [(ORadjusted for age and sex–ORadjusted for age and sex+mediators)/(ORadjusted for age and sex–1)]. The percentage (%) excess odds explained indicated the extent to which the mediator explains the association between emotional labor and absenteeism due to dental treatment. All analyses were performed using SPSS ver. 25.0 (IBM SPSS Statistics for Windows; IBM Corp., Armonk, NY, USA). A p-value of <0.05 was considered statistically significant in all analyses.
Table 1 presents the distribution of the socio-demographic, occupational characteristics, stress, and emotional labor according to work absence due to dental treatment. Work absence due to dental treatment was significantly higher among daytime workers and those experiencing emotional labor.
Characteristics of the Population by Work Absence Due to Dental Treatment
No work absence due to dental treatment (n=391) | Work absence due to dental treatment (n=91) | p-value | |
---|---|---|---|
Age (y) | 0.16 | ||
<40 | 229 (58.6) | 46 (50.5) | |
≥40 | 162 (41.4) | 45 (49.5) | |
Sex | 0.76 | ||
Male | 286 (73.1) | 68 (74.7) | |
Female | 105 (26.9) | 23 (25.3) | |
Education | 0.67 | ||
Under high school | 124 (31.7) | 31 (34.1) | |
College or more | 267 (68.3) | 60 (65.9) | |
Work type | 0.04 |
||
Shift work or other | 39 (10.0) | 3 (3.3) | |
Day work | 352 (90.0) | 88 (96.7) | |
Employment type | 0.97 | ||
Regular | 280 (71.6) | 65 (71.4) | |
Irregular | 111 (28.4) | 26 (28.6) | |
Stress | 0.54 | ||
High | 129 (33.0) | 27 (29.7) | |
Low | 262 (67.0) | 64 (70.3) | |
Emotional labor | 0.03 |
||
No | 196 (50.1) | 34 (37.4) | |
Yes | 195 (49.9) | 57 (62.6) |
Values are presented as n (%).
p-values areobtained by the chi-square test for categorical variables.
aStatistical significance at p<0.05.
Table 2 presents the distribution of the socio-demographic, occupational characteristics, and emotional labor according to stress levels. Emotional labor was significantly more prevalent in the high-stress group compared to the low-stress group.
Characteristics of the Population by Stress
Low stress (n=326) | High stress (n=156) | p-value | |
---|---|---|---|
Age (y) | |||
<40 | 183 (56.1) | 92 (59.0) | 0.56 |
≥40 | 143 (43.9) | 64 (41.0) | |
Sex | |||
Male | 243 (74.5) | 111 (71.2) | 0.43 |
Female | 83 (25.5) | 45 (28.8) | |
Education | |||
Under high school | 104 (31.9) | 51 (32.7) | 0.86 |
College or more | 222 (68.1) | 105 (67.3) | |
Work type | |||
Daytime work | 295 (90.5) | 145 (92.9) | 0.37 |
Shift work or other | 31 (9.5) | 11 (7.1) | |
Employment type | |||
Regular | 240 (73.6) | 105 (67.3) | 0.15 |
Irregular | 86 (26.4) | 51 (32.7) | |
Emotional labor | |||
No | 178 (54.6) | 52 (33.3) | <0.001 |
Yes | 148 (45.4) | 104 (66.7) |
Values are presented as n (%).
p-values areobtained by the chi-square test for categorical variables.
aStatistical significance at p<0.05.
Table 3 presents the association between emotional labor and work absence due to dental treatment among Korean workers. Model 1 is the base model adjusting only for age and sex. The risk of work absence due to dental treatment for those who experienced emotional labor was 1.66 times higher (95% CI 1.04∼2.67) than those who did not. The ORs of emotional labor were 1.67 (95% CI 1.04∼2.69), 1.64 (95% CI 1.03∼2.64), and 1.75 (95% CI 1.08∼2.83) in models 2, 3, and 4, respectively. The impact of stress was 13.64% in the association between emotional labor and work absence due to dental treatment.
Association between Emotional Labor and Work Absence Due to Dental Treatment
OR (95% CI) | ΔOR (%) | |
---|---|---|
Model 1 | 1.66 (1.04∼2.67) |
|
Model 2 | 1.67 (1.04∼2.69) |
–1.52 |
Model 3 | 1.64 (1.03∼2.64) |
3.03 |
Model 4 | 1.75 (1.08∼2.83) |
–13.64 |
Model 1 is adjusted for age and sex. Model 2 is adjusted for age, sex (Model 1) plus education. Model 3 is adjusted for age, sex (Model 1) plus work type, and employment type. Model 4 is adjusted for age, sex (Model 1) plus stress.
ΔOR=[(ORmodel x–ORmodel 1)/(ORmodel 1–1)]×100%.
OR: odds ratio, CI: confidence interval.
aStatistical significance at p<0.05.
Table 4 presents the association between emotional labor and absenteeism due to dental treatment by stress level. Although the results were not significant, among those with high stress, absenteeism due to dental treatment was 2.01 times higher (95% CI 0.98∼2.95) among those who engage in emotional labor compared to those who do not. Conversely, among those with low stress, absenteeism due to dental treatment is 1.70 times higher (95% CI 0.74∼5.45) among those who do emotional labor compared to those who do not do emotional labor.
Association between Emotional Labor and Work Absence Due to Dental Treatment based on Stress Levels
Stress level | Emotional labor | OR (95% CI) |
---|---|---|
Low stress | Emotional labor | 1.70 (0.98∼2.95) |
No emotional labor | 1 (reference) | |
High stress | Emotional labor | 2.01 (0.74∼5.45) |
No emotional labor | 1 (reference) |
The model is adjusted for age and sex.
OR: odds ratio, CI: confidence interval.
This study aimed to analyze the effect of emotional labor on absenteeism in the workplace, with a focus on absenteeism due to dental treatment. To the best of our knowledge, no previous studies have examined this relationship. The assumption was that emotional labor would worsen oral health, making it difficult to work, and ways to improve the oral health of workplaces were suggested.
Job stress is highly correlated with emotional labor, and legal measures such as the Industrial Safety and Health Act, which includes protective measures for emotional workers, are being strengthened. Research in this area continues, Ryu and Kwon30) found based on a survey of public sector workers, that job stress increases as emotional inconsistency increases. Sohn et al.31) reported a positive correlation between the Korea Standard Occupational Stress Scale and the Emotional Labor Scale (p<0.05). Katayama13) also reported a strong positive relationship between emotional labor and job stress, as confirmed by the relationship between the Job Stress Scale according the Nurse’s Emotional Labor Scale.
This study found a significant association between emotional labor and absenteeism due to dental treatment. After adjusting for all covariates, including stress, the OR was 1.75 (95% CI: 1.08∼2.83), showing that those who experienced emotional labor were significantly more likely to have dental-related absences. Moreover, the target group for emotional labor was found to experience high stress. Based on this study and previous findings, because job stress increases as emotional labor increases, stress was set as a parameter to determine whether emotional labor leads to absenteeism for dental treatment.
Previous research has demonstrated that work absence represents a long-term consequence of emotional labor. Findings from this research indicate that emotional labor affects work absence, and emotional indifference may further exacerbate it32-34). Additionally, the degree of emotional labor has been found to influence absenteeism rates related to health problems35,36). However, our study is unique in that it focused on absenteeism specifically due to dental treatment, compared to previous studies that dealt with workers’ absences due to comprehensive health problems. The absence rate of workers engaged in emotional labor at work was 1.66 times higher (CI=1.04∼2.66) than those who did not engage in emotional labor. Although there are no existing studies directly comparing emotional labor and absenteeism due to dental treatment, previous research37) reported that 81% of industrial workers experienced absenteeism due to dental treatment, with significant differences observed among those with lower perceived oral health. Based on these findings, it is necessary to further investigate how workers’ subjective experiences and psychological states influence their oral health and absenteeism from work.
The findings of this study indicate that stress had a notable impact on absenteeism due to oral disease, when compared to the effects of education level, work type, and employment type. Consequently, the research hypothesis that emotional labor contributes to elevated stress levels, which in turn result in work absence due to dental treatment, is supported. Furthermore, supplementary analyses were conducted to ascertain the impact of emotional labor on work absence due to dental treatment by stress level. Despite the non-statistical significance of the results, it was observed that elevated stress levels were correlated with increased dental absenteeism due to emotional labor. This indicates that stress levels should be a primary consideration when developing future oral health screening programs.
Although our study had several strengths, some limitations were encountered. First, we were unable to compare the differences between the emotional labor experiences of workers according to job characteristics. Second, the data collected in this study were based on self-reported responses, and there is a possibility of response bias, making it difficult to accurately assess the emotional labor or stress levels of the workers Additionally, the study used one question to measure the outcome, which may limit the reliability and depth of the findings. Third, due to the nature of the questionnaire, it was not possible to investigate the causes of work type and employment type-specific emotional labor. Lastly, this study used data from 2018, reflecting the situation before the outbreak of the novel coronavirus. Consequently, changes in the dental environment and oral health behaviors following the outbreak are not reflected in the findings. This represents a limitation of the study, and future research should incorporate post-outbreak data to analyze these changes more comprehensively. However, the findings of this study can be meaningful in that emotional labor leads to stress level and dental treatment, thereby affecting work absence.
While various counseling programs have been developed to reduce job stress and emotional labor, oral health diagnostic programs are often overlooked due to a lack of awareness that stress from emotional labor can negatively impact oral health. Therefore, we suggest developing regular oral health diagnosis programs to improve workers’ health and overall work performance in the workplace.
The study found a significant association between emotional labor and work absenteeism due to dental treatment, indicating that stress may have the greatest impact. Although the interaction between emotional labor and stress level on work absence due to dental treatment did not show statistical significance, the observed trends suggest a potential relationship that warrants further investigation. Future research should focus on larger and more diverse populations to confirm these findings and develop targeted interventions. The findings suggest that workplaces should incorporate regular oral health screenings and stress management programs to reduce absenteeism.
The authors would like to express their appreciation to the Ministry of Employment Labor and the Korea Occupational Safety & Health Agency for their support. Additionally, the authors are grateful to all the participants for their contribution in providing the data for this study.
Conflict of interest
No potential conflict of interest relevant to this article was reported.
Ethical approval
The study was approved by the Institutional Review Board of the School of Dentistry, Seoul National University for human subjects (approval number: S-020180024).
Author contributions
Conceptualization: Se-Hwan Jung, Jae-In Ryu, and Dong-Hun Han. Data acquisition: Ji-Young Son. Formal analysis: Dong-Hun Han and Ji-Young Son. Funding: Se-Hwan Jung. Supervision: Se-Hwan Jung, Jae-In Ryu, and Dong-Hun Han. Writing-original draft: Ji-Young Son and Dong-Hun Han. Writing-review & editing: Se-Hwan Jung, Jae-In Ryu, and Dong-Hun Han.
Funding
This research was funded by the Korea Occupational Safety & Health Agency (number 2018-researcher-792).
Data availability
The data that support the findings of this study will be made available to interested parties upon reasonable request to the corresponding author. However, due to the need to protect the privacy of research participants and to comply with ethical standards, the data will not be made publicly available.
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