Work–Family Conflict and Self-Rated Health: the Role of Gender and Educational Level. Baseline Data from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil)
Int.J. Behav. Med.
Work-Family Conflict and Self-Rated Health: the Role of Gender and Educational Level. Baseline Data from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil)
Rosane Härter Griep 0 1 2 3 4 5 6
Susanna Toivanen 0 1 2 3 4 5 6
Cornelia van Diepen 0 1 2 3 4 5 6
Joanna M. N. Guimarães 0 1 2 3 4 5 6
Lidyane V. Camelo 0 1 2 3 4 5 6
Leidjaira Lopes Juvanhol 0 1 2 3 4 5 6
Estela M. Aquino 0 1 2 3 4 5 6
Dóra Chor 0 1 2 3 4 5 6
0 Centre for Health Equity Studies, Stockholm University and Karolinska Institutet , Stockholm , Sweden
1 Laboratory of Health and Environment Education, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Avenida Brasil , 4365, Manguinhos Rio de Janeiro 21040-360 , Brazil
2 Rosane Härter Griep
3 Institute of Collective Health, Federal University of Bahia , Salvador, Bahia , Brazil
4 Postgraduate Program in Public Health, Faculty of Medicine, Universidade Federal de Minas Gerais , Minas Gerais , Brazil
5 National School of Public Health , Oswaldo Cruz Foundation, Rio de Janeiro, Rio de Janeiro , Brazil
6 Department of Geography, Portsmouth University , Portsmouth , UK
Purpose This study examined gender differences in the association between work-family conflict and self-rated health and evaluated the effect of educational attainment. Method We used baseline data from ELSA-Brasil, a cohort study of civil servants from six Brazilian state capitals. Our samples included 12,017 active workers aged 34-72 years. Work-family conflict was measured by four indicators measuring effects of work on family, effects of family in work and lack of time for leisure and personal care. Results Women experienced more frequent work-family conflict, but in both genders, increased work-family conflict directly correlated with poorer self-rated health. Women's educational level interacted with three work-family conflict indicators. For time-based effects of work on family, highly educated women had higher odds of suboptimal self-rated health (OR=1.54; 95 % CI =1.19-1.99) than less educated women (OR=1.14; 95 % CI =0.92-1.42). For strain-based effects of work on family, women with higher and lower education levels had OR = 1.91 (95 % CI 1.48-2.47) and OR = 1.40 (95 % CI 1.12-1.75), respectively. For lack of time for leisure and personal care, women with higher and lower education levels had OR = 2.60 (95 % CI = 1.95-3.47) and OR = 1.11 (95 % CI =0.90-1.38), respectively. Conclusion Women's education level affects the relationship between work-family conflict and self-rated health. The results may contribute to prevention activities.
Gender; Work and family conflict; Self-rated health; Educational level; ELSA-Brasil cohort study
Published online: 23 November 2015
# The Author(s) 2015. This article is published with open access at Springerlink.com
With greater participation of women in the workforce over
recent decades in most parts of the world, both men and
women are involved in work and family life [
]. In Brazil,
women have only relatively recently entered the labour market, but
their contribution has grown rapidly. The proportion of
women in the workforce increased from 32 % in 1980 to 57 % in
2009. The female-to-male labour force participation rate also
increased from 52.2 % in 1990 to 73.3 % in 2010 and has
continued to increase steadily [
]. This is good for the
emancipation and economic independence of women but
can also have its drawbacks as women and men now need to
balance their responsibilities at home and work.
The division of household tasks and childcare
responsibility between working men and women, however, has not
undergone similar changes and is still unequal [
]. It also varies
by country and region [
]. For example, in Sweden, a country
with high gender equality, women carry out an average of 26 h
of unpaid work each week, whereas men do about 21 h [
Europe as a whole, women spend an average of 26 h per week
on care and household activities, compared with 9 h for men
(European Commission, Report on Progress on equality
between women and men in 2013). In Brazil, the average unpaid
work per week is 25 h for women and about 10 h for men [
Although men have slightly increased their participation in
housework and childcare in Brazil, women still perform most
family tasks and spend more time on unpaid domestic work
even if they are in full-time paid work [
1, 3, 8–11
Balancing work and family demands is challenging, and one
or other may require more time and attention than is available.
The work–family conflict is defined as ‘a form of interrole
conflict in which the role pressures from the work and family
domains are mutually incompatible in some respect’ [
imbalance is also conceptualized as work–life conflict or work–
life imbalance [
]. Although correlated, work–family
conflict and work–life conflict measures are, however, different .
The work–family conflict is more related to the lack of
boundaries between work and family spheres and could be moderated
by family status. Work–life imbalance research focuses on the
spillover effect in a broader context, in which work influences
experiences in the non-work sphere (for example, time for
leisure, friends and family life) [
]. In the present study, we
focused on work–family boundary management (rather than
broader work–life issues) in two basic directions:
work-tofamily or family-to-work conflict [
]. Most previous studies
have focused on work-to-family conflict, viewed as resulting
from occupational conditions [
17, 19, 20, 22, 23
]. Less often,
family-to-work conflict has been investigated, and is viewed as
arising from home and life circumstances [
authors have postulated that family-to-work conflict could have
more long-term consequences than work-to-family conflict [
] and also have a greater influence on women’s health [
Other studies have also discussed work-to-family conflict as
being more detrimental to women’s health than to men’s health [
]. A few studies have described characteristics of work–family
conflict as two distinguishable forms: time-based (time devoted
to one role makes it difficult to participate in another) and
strainbased (excessive effort to perform in one domain affects
performance in the other) [
]. An additional form of conflict,
behaviour-based work–family conflict, refers to specific
behaviours in one role being incompatible with behaviours in the other
17, 19, 21
]. However, little is known about gender-based
antecedents or outcomes for each of these forms [
17, 19, 22
More recently, some authors have suggested that work and
non-work are no longer separate domains and can
simultaneously affect quality of life, leisure and health, with a different
pattern according to gender [
2, 18–20, 24, 29
]. Based on this
literature, we included a measure in the present study of both
domains (work and family) simultaneously affecting leisure
time and self-care.
Previous studies have investigated the association between
work–family conflict and health status, such as common
symptoms, mental health or depression [
16, 19, 30–32
whether work–family conflict may reduce the well-being
benefits of employment [
]. Some studies have also reported
an association between work–family conflict and poorer
selfrated health [
]. Self-rated health expresses
subjective as well as objective aspects of health and could reflect
gender differences in stress response. It has been shown to be a
predictor of future morbidity and mortality, functional decline
and disability and higher utilization of health care [
Much of the literature shows that gender differences in
work environment and family characteristics affect the
association between work–family conflict and health [
19, 27, 31,
]. Gender is an essential determinant of inequalities in
work–family conflict . Most previous studies have
distinguished between genders, and the results generally show a
higher prevalence of work–family conflict and suboptimal
self-rated health among women [
36, 40, 41
], although some
studies found similar results in men and women [
27, 32, 34
Educational level also affects the experience of
work–family conflict and the resulting mental health consequences [
]. Individuals with higher educational attainment tend to
express more work–family conflict. This might be due to
high-pressure jobs and working longer hours than people with
lower levels of education . Educational level is also
closely related to inequalities in health and is often used as a proxy
for occupational prestige [
]. Groups with lower levels of
education have a higher risk of mortality [
] and worse
self-rated health than highly educated groups [
]. It is
therefore possible that education level might modify the association
between work–family conflict and self-rated health. To our
knowledge, no previous studies have investigated this
interaction considering gender stratification.
The association between work–family conflict and health
status has been well-studied, mostly in western Europe and
North America. In Brazil, the most populous country in South
America, income and gender inequality remain high [
studies about influence of work–family conflict on health are
scarce. This study therefore aims to investigate gender
differences in the association between work–family conflict and
selfrated health, and to evaluate whether educational attainment
modifies this association, using data from the baseline of the
Brazilian Longitudinal Study of Adult Health (ELSA-Brasil).
The ELSA-Brasil design and concepts have been detailed
]. The study population consisted of 15,105 civil
servants (46 % men, with ages ranging from 34 to 75 years).
The ELSA-Brasil cohort comprised voluntary participants.
Effort was made to recruit similar proportions of both genders,
as well as predefined proportions of specific age groups and
distinct occupational categories, to permit a wide
socioeconomic gradient across the sample. Participants were recruited
from five universities and one research institute in six
Brazilian state capitals (Federal Universities of Bahia,
Espírito Santo, Minas Gerais, and Rio Grande do Sul, the
University of São Paulo, and the Oswaldo Cruz Foundation).
Baseline assessment (2008–2010) included comprehensive
questionnaire interviews conducted by trained personnel and
clinical and laboratory measurements [
]. The population
in our study included only active workers (n=12,096) and
missing values on these central variables were excluded (n=
79). This resulted in a sample of 12,017 valid subjects
(99.3 %) for analysis.
Self-rated health was evaluated by a single question: In
general, compared with other people your age, how would you
rate your health? The respondents answered on a five-point
scale, later dichotomized into ‘good’ (good and very good)
and ‘suboptimal’ (fair, poor and very poor).
Four indicators of work–family conflict were measured. The
three first items were based on the model designed by Frone
and colleagues [
], and the psychometric properties have
been previously shown . The first statement, assessing
time-based work-to-family conflict, stated: Demands
(requirements or requests) from work keep you from spending the
a m o u n t o f t i m e y o u w o u l d l i k e w i t h y o u r f a m i l y
(kappa=0.63; confidence interval [CI] 0.52–0.71). The
second statement, assessing strain-based work-to-family conflict,
stated: Demands (requirements or requests) from work make it
difficult to fulfil domestic responsibilities, such as caring for
the house and children (kappa=0.56; CI 0.45–0.67). The third
statement, assessing family-to-work conflict, stated: Demands
(requirements or requests) from your family interfere with
your responsibilities at work, such as getting to work on time,
accomplishing daily tasks, travelling for work, and attending
meetings outside the regular work schedule (kappa=0.46; CI
0.32–0.58). The fourth statement was designed by
ELSABrasil researchers to cover the simultaneous effects of both
work and family on lack of time for leisure and self-care
: Demands (requirements or requests) from your family
and work keep you from spending the amount of time you
would like on your own care and leisure activities (kappa=
0.70; CI 0.63–0.77). Each statement used a five-point
frequency-based response scale: never to almost never, rarely,
sometimes, frequently and very frequently. The categories were
grouped into three levels: 1 was ‘never to rarely’ (reference
category), 2 was ‘sometimes’ and 3 ‘frequently’.
The covariates examined were the following: age
(continuous); education (‘lower’ lower than complete
university degree or ‘higher’ complete university degree or above);
marital status (married or living together; divorced, separated
or widowed; or single living without partner); the presence of
children under the age of five in the household (yes/no); the
presence of a maid in the household (yes/no); hours worked
per week (continuous); shift work (daytime employment
without weekends, dayshifts which included weekends, and
mostly nightshifts or mixed shifts); and self-reported medical
diagnosis of chronic diseases (if respondents reported at least one
of the following diseases, they were coded as ‘yes’, otherwise
‘no’ hypertension, diabetes, myocardial infarction, stroke and
We performed all analyses separately for women and men.
Chi-squared and t tests were used for descriptive analyses of
covariates and work–family conflict. All covariates associated
with the outcome (p≤0.05) were included in multiple logistic
regression analysis to estimate odds ratios (OR) and 95 % CI.
The collinearity between the covariates was tested by
generalized variance inflation factor (GVIF) . Because of the
risk of over-adjusting the four areas of work–family conflict,
all covariates were tested individually to determine their effect
on the association between each area of work–family conflict
and self-rated health. To evaluate the importance of each
variable in the model, we used deviance statistics and the Akaike
information criterion (AIC). Lower values were considered a
Multiplicative interaction between work–family conflict
indicators and education was assessed by the inclusion of an
interaction term in the full adjusted regression models (work–
family conflict*education). When the interaction term was
significant (p<0.1), the OR was estimated again with the
effect of the interaction between the work–family conflict
indicator and education .
All analyses were conducted in SPSS 22.0 for Windows
and free software R, version 3.1.2 (R Development Core
Team, Vienna, Austria).
The mean age was similar for men and women. Women
generally had higher levels of education; they were more likely to
be divorced, separated, widowed or single, worked fewer
hours per week and more often in day shifts. The frequency of
self-reported chronic diseases was lower among women.
Similar proportions of men and women reported having
children under 5 years of age and having a maid (Table 1). Over
90 % of women vs 70 % of men worked in non-manual jobs.
The occupational nature of a participant’s present job
(classified into four levels: routine/manual; non-routine/manual;
routine/non-manual; and non-routine/non-manual) were
strongly correlated with educational level for both women
and men (Spearman’s correlation coefficient 0.68 and 0.76,
respectively, p< 0.001) (data not shown).
The overall prevalence of suboptimal self-rated health was
18.7 % and comparable in men and women (18.7 and 18.4 %,
respectively; p=0.72). Men and women who reported
suboptimal health were older, had lower educational levels and worked
fewer hours per week than those with good self-rated health.
Higher levels of suboptimal health were observed in divorced,
separated or widowed respondents, those who had no maid and
those who reported chronic diseases. Type of work shift and
presence of children under 5 years of age were not associated
with higher levels of suboptimal health (p>0.05) (Table 1).
In general, women reported frequent work–family conflicts
more often than men. For both genders, participants with higher
education reported work–family conflict more often. An
exception was observed for family-to-work conflict, which was
similar for both genders with those with lower education commonly
reporting more frequent conflict. In men, frequent
family-towork conflict was associated with a higher level of suboptimal
health (p<0.001). For women, the same tendency was observed
for three out of four work–family conflict indicators:
work-tofamily strain-based, family-to-work conflict and lack of time for
leisure and personal care (Table 2).
*significant at p≤0.05; **significant at p≤0.005; ***significant at p≤0.001 in chi-square test or t test
a The self-reported chronic diseases used in this analysis are the following: hypertension, diabetes, myocardial infarction, stroke and heart failure
In men, the crude analyses showed frequent
family-towork conflict was associated with greater odds of suboptimal
self-reported health (OR 1.75; 95 % CI 1.39–2.20; Table 3).
After adjustment for covariates, all work–family conflict
indicators were associated with suboptimal self-rated health, in a
dose–response gradient. This gradient was statistically
significant in the case of the family-to-work and lack of time for
leisure and personal care indicators. Higher frequency of
conflicts in those domains gave increased chances of suboptimal
self-reported health. Adjustment by age and education had a
mild effect on the association. Working hours and presence of
disease showed the highest influence on the association
(Table 3). The interaction terms by chi-square test indicated
no influence of educational level on the association between
work–family conflict indicators and suboptimal self-rated
health among men (p>0.10).
Higher odds of suboptimal self-reported health in crude
analyses were observed for women who reported frequent
work-to-family strain-based (OR=1.24; 95 % CI=1.06–1.44)
or family-to-work (OR=1.46; 95 % CI=1.16–1.85) conflict
(Table 4). Like men, after adjustment for covariates, women
with frequent work–family conflict, as measured by all
indicators had greater odds of suboptimal self-reported health, and we
also observed a dose–response gradient except in lack of time
for leisure and personal care. Adjustment for education showed
the highest influence on the association between work–family
conflict and suboptimal self-rated health (Table 4, Model 3). In
fact, educational level interacted with three out of four work–
family conflict indicators among women (time-based
work-tofamily conflict p=0.08; strain-based work-to-family conflict p=
0.07; and lack of time for leisure and personal care p<0.001),
but there was no evidence of interaction among women for
family-to-work conflict (p=0.26).
Table 5 shows the fully adjusted regression models,
including a multiplicative interaction term for women. The results
show that the association between frequent work–family
conflict and suboptimal self-reported health was stronger in
women with higher levels of education. For work-to-family
timebased conflict, women with higher levels of education had
higher odds for suboptimal self-related health (OR = 1.54;
95 % CI =1.19–1.99) than less educated women (OR=1.14;
95 % CI = 0.92–1.42). Similarly, for work-to-family
strainbased conflict, women with higher and lower levels of
education had OR=1.91 (95 % CI =1.48–2.47) and OR=1.40 (95 %
CI=1.12–1.75). For lack of time for leisure and personal care,
women with higher and lower educational levels had OR=
2.60 (95 % CI =1.95–3.47) and OR=1.11 (95 % CI =0.90–
Our findings showed that women had a higher prevalence of
work–family conflict and lack of time for leisure and personal
Model 1: unadjusted. Model 2: adjusted by age, model 3: Model 2+educational level; Model 4: Model 3+working hours; Model 5: Model 4+presence
of self-reported chronic diseases
care than men. Work–family conflict, as measured by the four
indicators, was associated with higher odds of suboptimal
health in both genders. The association differs by educational
level only among women. More educated women with
frequent work–family conflict in the work-to-family time-based,
work-to-family strain-based and lack of time for leisure and
personal care indicators had the highest odds of suboptimal
health compared with women with lower levels of education.
Findings Compared with Other Studies
The women in our study reported fewer hours worked per
week, but more frequent work-to-family conflict (both
timeand strain-based) and lack of time for leisure and personal care
than men. Although men generally spent more hours in paid
work and on commuting than women, women tended to have
less time available for leisure and personal care, because they
spent more time on unpaid duties .
Women in our study were also more educated and more
likely to be separated, widowed or single than men, which
might indicate why they are in the labour market, and also
that they could have less social support at home than men.
Higher prevalence of work–family conflict among women
has also been reported in previous studies [
32, 34, 36, 52
Research shows that the ability to balance work and private
life remains problematic, especially for women [
studies found that women’s well-being is positively associated
with time spent on paid work, and negatively associated with
time spent taking care of home duties [
generally still have more responsibility for household duties,
childcare and caring for older relatives, even in countries with
gender mainstreaming and family-friendly policies. In a study
among Swedish workers [
], multiple demands from work
and private life increased the risk of fatigue in both genders,
but only women reported that they wanted to reduce their
working hours owing to the burden of managing multiple
social roles. For cultural reasons, women may feel compelled
to direct their energy and time towards the family and men
may believe that their primary goal should be to maintain their
position at work [
]. When the demands of work and home
are combined, women have more responsibilities and work
longer hours than men, and consequently experience stress
more often [
Despite more frequent work-to-family conflict among
women, the association between work–family conflict and
suboptimal self-rated health was observed in both genders.
Model 1: unadjusted. Model 2: adjusted by age, model 3: Model 2+educational level; Model 4: Model 3+presence of maid; Model 5: Model 4+working
hours; Model 6: Model 5+Presence of self-reported chronic diseases
Similar results have been found in other studies of different
31, 32, 34, 36
]. As more women participate in
the workforce, both men and women need to operate in
both work and family domains and to balance the demands
of the two in a limited amount of time. Balancing the
demands of work and family in modern life is a source
of stress in adulthood and could influence the ranking of
priorities for women and men and also reduce the time
available for themselves, which can affect health and
Work-family conflict indicators
OR (CI 95%)a
Low educated (N=2788)
High educated (N=3494)
Table 5 Full adjusted logistic
regression models of the
association between work–family
conflict indicators and suboptimal
self-rated health including
multiplicative interaction term
(WFC*educational level) among
Work to family time-based
Never to rarely
Work to family strain-based
Never to rarely
Lack of leisure time and personal care
Never to rarely
ELSA-Brasil baseline, 2008–10
a Adjusted by age, educational level, presence of maid, working hours and presence of self-reported chronic
Some researchers have pointed out the relevance of
distinguishing the direction of the conflict; in other words,
whether family life interferes with work or vice versa. This
increases understanding of the aspects influencing the work–
family conflict, and their health consequences [
]. In line
with previous findings, our results suggest both
work-tofamily and family-to-work conflicts affected self-rated health
among men and women [
Self-rated health is a multidimensional indicator that can
reflect not only physical health, but also state of mind . It
is possible that work–family conflicts affect both physical and
mental health through the stress cascade. Chronic exposure to
stress increases the activities of physiological systems causing
‘wear and tear’, referred to as allostatic load, which is
associated with stress hormones protecting the body through
shortterm adaptation. In the long run, however, this causes mental
and physical alterations that increase the risk of disease.
Exposure to stress can also affect health indirectly by inducing
a profile of adverse behaviours, such as smoking, sedentary
habits, unhealthy diet and alcohol consumption . Further
research is necessary to determine which mechanisms cause
the association between work–family conflict and health
Self-Rated Health and Educational Level
We found that work–family conflict was more strongly
associated with suboptimal self-rated health in more highly educated
women, suggesting that education modifies the association
between work–family conflict and self-rated health. This
modification effect was not observed in men. Those in higher status
occupations are more likely to have high-pressure jobs, flexible
working hours and more responsibilities at work [
all these characteristics are related to work–family conflict .
Workers in routine jobs, however, probably have greater
segmentation of work and family roles, and they are more likely to
know when work begins and ends, so they can experience
lower permeability and flexibility between work and private
]. It is also possible that in the work environment of
universities and research institutions, women with higher levels
of education have jobs with high control and high demands, as
well as a high competitive edge and expectations. They may
also have extensive working hours with the boundaries
between work and private life less clearly defined . The
balance between work and personal life reflects changes in the
nature of work and workplaces related to general competition
and trends . The academic environment is increasingly
investing in information technology to improve knowledge
creation and distribution. Researchers and teachers are often
asked to perform tasks in very short time periods, and as a
consequence, work pressure increasingly spills over into their
personal life [57, 59]. This situation could be even more critical
among women, who generally have less autonomy to manage
their time for self-care because they are often more involved
with household tasks than men [
]. Previous studies also
identified that the combination of high-powered job and family
demands appears more challenging for women than men in
higher white-collar occupations [
] or with higher educational
]. All these elements could explain our findings that
education modified the association between work–family
conflict and self-reported health in women, but not men.
Research into work–life balance has mainly been with
white-collar populations. The situation may, however, look
different among blue-collar workers and those with lower
levels of education [
]. As this study shows, work–family
conflicts differ among women with lower and higher levels of
education. This is an important finding showing that the social
determinants are expressed differently in women with
different levels of education.
Some specifics of the Brazilian culture might have
influenced the results. It is difficult to determine if there is a
discourse on work–family conflict in Brazil, which has a long
history of gender inequality. If so, it is possible that this
discourse has been more assimilated by women with higher
levels of education. Lewis et al.  stated that the discourse
is mostly present in western societies and that ‘developing’
countries have such different cultures that work–family
conflict might be present but is difficult to uncover. The
continuation of ELSA-Brasil with its longitudinal design, and other
cohort studies, would give more insight in the directionality.
Strengths and Weaknesses of the Study
The main strength of this study is that it is based on detailed
data collected from a large sample of current workers as part
of the ELSA-Brasil cohort study. The data provided is an
excellent opportunity to study work–family conflict in a
middle income country where this issue has hardly been
investigated. To the best of our knowledge, this is the first large-scale
study examining work–family conflict in relation to
selfreported health in Brazil. Besides, this study included one
indicator that has not been used in work–family conflict
research before. This indicator considered the influence of both
domains simultaneously (work and family) on lack of time for
leisure and personal care. This can be seen as an additional
strength because this indicator presents new information about
important aspects of modern life and may cast new light on
studies of work–family conflict [
]. Our study highlights the
importance of examining the interaction effect of educational
level and the direction of work-to-family and family-to-work
conflict, as well as the effect of both conflicts simultaneously
in separate scales. We also investigated the influence of
workto-family conflict by time-based and strain-based conflicts,
which have not been the focus of many previous
]. The behaviour-based conflict was not included
in our study; according to some authors  few studies have
investigated this dimension, and the meaning of
behaviourbased conflict needs to be clarified.
Nevertheless, the study also has some limitations. This is a
cross-sectional analysis, and temporality cannot be established.
The temporal direction of the association is therefore less clear,
and the associations may be bidirectional or resulting from
common causes. ELSA-Brasil comprises a particular
population (civil servants), so it may not be possible to generalize the
results. However, the results may reflect the broader population
in the same situation, for example, middle class-employed
individuals or general civil servants who live in the larger
metropolitan areas in Brazil. Moreover, given the nature of our
sample, we did not have a substantial variation in terms of job
levels, which may be considered a further limitation . Our
sample was homogeneous in terms of job tenure, and all
participants were salaried employees from the public sector. Even
so, our study sample had enough socioeconomic variability to
capture gender differences in work–family conflict and the
relationship with self-rated health across levels of education.
Although there is extensive research about work–family
conflict, there is no consensus on the best way to measure this
]. The literature describes different instruments
and high variability in the number of dimensions and
items, content, and presence of directionality of conflict
17, 27, 31, 32, 36, 40, 60
]. It is possible that the work–
family conflict indicators used in this paper only partly
represent the whole work–life conflict model because
isolated items were used to measure complex dimensions of a
higher construct; this is an important limitation of our
study. It is, however, an important strength of our study
that the work–family conflict indicators are not combined.
Including different pathways in a single question, or
combining pathways would make it difficult to understand the
effect of the work–family conflict indicators on self-rated
health. The indicators each show their own connections to
self-rated health and the results are limited to the
directionality and internal category.
Our findings are in line with previous research showing an
association between work–family conflict and health. More
frequent work–family conflict was associated with suboptimal
self-rated health by all the work–family conflict indicators
tested. We also found that educational level modified these
associations, but only among women.
Future research should incorporate the role of cultural
differences around gender in a Brazilian context, to show how
this affects family and work spheres for both genders. It is also
necessary to understand the effect of decision latitude, social
support and other relevant moderating effects on the
relationship between work–family conflicts and health, according to
socioeconomic position and job occupation, and across
gender groups. We believe that the opportunity for personal
development for both genders and enrichment of everyday
family life will be guaranteed by higher gender equality in taking
care of home duties and looking after children. This change
might decrease stress levels and positively influence priorities
for women and men in the use of time for themselves,
improving health and well-being. This is especially important in
countries like Brazil, where large gender inequalities interact
with other social and economic inequalities. Handling the
spillover between job and family demands in modern life,
especially in big cities, is a great challenge and more than
individual (or family) arrangements are necessary.
Macrolevel and organizational policies are also necessary to promote
changes in traditional patterns of behaviour and to foster
gender equality and social justice.
Acknowledgments The authors thank the ELSA-Brasil participants
who agreed to take part in this study. The ELSA-Brasil baseline study
was supported by Brazil’s Ministry of Health (Department of Science
and Technology) and Ministry of Science and Technology (Study and
Project Funding Agency-FINEP and National Research Council-CNPq)
(grants 01 06 0010.00 RS, 01 06 0212.00 BA, 01 06 0300.00 ES, 01 06
0278.00 MG, 01 06 0115.00 SP, and 01 06 0071.00 RJ). This work was
conducted during a Joint Brazilian–Swedish Research Collaboration
supported by the International Cooperation Program CAPES/STINT. Financed
by CAPES—Brazilian Federal Agency for Support and Evaluation of
Graduate Education within the Ministry of Education of Brazil. This paper
was prepared while RG was a visiting researcher at CHESS (Forte 2014–
2680). ST is a senior researcher at CHESS (Forte 2012–0615). RHG, DC
and EMA are research fellows of the National Research Council (CNPq).
The funding source had no influence over the study design, data collection,
analysis and interpretation, writing the paper or the decision to publish.
Authors’ Contributions RG participated in study design, statistical
analysis and data interpretation and drafted the manuscript. LJ
participated in statistical analysis and data interpretation of data. ST, CvD, LC and
JG participated in data interpretation, contributed with intellectual content
to the paper and final review of the paper. EMLAA and DC participated in
study design, data interpretation and final review of the paper. All the
authors have read and approved the final manuscript.
Compliance with Ethical Standards
Conflict of Interest The authors declare that they have no competing
Informed Consent All procedures followed were in accordance with
the ethical standards of the Helsinki Declaration of 1975, as revised in
2000. The study was approved by the National Research Ethics
Commission (Comissão Nacional de Ética em Pesquisa, CONEP; No.
976/2006) and by all institutions involved in the study. Informed consent
was obtained from all participants for being included in the study.
Open Access This article is distributed under the terms of the
Creative Commons Attribution 4.0 International License (http://
creativecommons.org/licenses/by/4.0/), which permits unrestricted use,
distribution, and reproduction in any medium, provided you give
appropriate credit to the original author(s) and the source, provide a link to the
Creative Commons license, and indicate if changes were made.
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