Date on Master's Thesis/Doctoral Dissertation


Document Type

Doctoral Dissertation

Degree Name

Ph. D.


Health Management and Systems Sciences

Degree Program

Public Health Sciences with a specialization in Health Management, PhD

Committee Chair

Johnson, Christopher

Committee Co-Chair (if applicable)

Karimi, Seyed

Committee Member

Karimi, Seyed

Committee Member

Antimisiaris, Demetra

Committee Member

Lorenz, Doug

Author's Keywords

sedatives; sleep aid; sleep disorders; extra medical use


BACKGROUND: Meeting the needs of a round-the-clock and globalized society has led to an increase in long working hours. This trend has been accompanied by a corresponding rise in sleep disorders and subsequent use of sedating medications. Overtime hours have been associated with adverse health outcomes such as cardiovascular diseases, symptoms of psychological distress, and health behaviors, including risky intake of alcohol and smoking. Hence, the main objectives of this three-paper dissertation were to examine the multi-faceted relationship between working hours, the use of prescription sleep aids, the onset of psychological distress, and the use of health care services. METHODS: The 2010-2019 Medical Expenditure Panel Survey (MEPS) data was utilized. The first paper investigated the relationship between working hours and the use of prescribed sedating medications. Different regression models were employed, ranging from multivariable linear regression, Tobit regression, Heckman regression, and multivariable logistic regression. The second paper utilized a fixed-effect linear model in evaluating the relationship between working hours and the onset of psychological distress. The third paper also employed fixed-effect estimators in modeling the association between working hours, health care utilization, and the use of sedating medications. FINDINGS: Long working hours were associated with increased odds of using sleep aids and medications with sedative properties. Females had a higher likelihood of using sleep aids when compared to males. Also, professional services had the highest likelihood of using sleep medications. Over time hours was associated with the onset of psychological distress, with differences in the risk of onset across gender. Respondents working very long hours had the highest odds of using outpatient medical services. This association between very long hours and the use of outpatient services was significantly more pronounced in respondents using medications with sedating side effects. CONCLUSIONS: Long working hours were associated with an elevated risk of using sedating medications, developing psychological distress, and healthcare utilization. This highlights the probable negative impact of overtime hours on the health status of individuals. Implementing policies that encourage work-life balance and aid interventions that decrease work-related stress may help in mitigating risks associated with long work hours.