Objectives The aim of the study was to examine whether exposure to workplace bullying and violence is associated with changes in health-related behaviors over time.

Methods This multi-cohort study included four cohorts from Sweden, Denmark, Finland, and Norway, comprising 78 624 participants aged 18–65 years at baseline between 2004 and 2016. The data were analyzed using an emulated trial design. The main analysis ascertained both onset of workplace bullying and violence (exposures) and changes in health-related behaviors (outcome) using data from time T_X and T_X+1 (concurrent analysis). To clarify temporality, changes in health-related behaviors were further calculated at time T_X+1 to T_X+2 (longitudinal analysis). We applied logistic regression with generalized estimating equations. Subgroup differences by sex were examined.

Results Among 125 854 participant-observations across 2–3 study phases of the 78 624 participants, 6–8% experienced onset of workplace bullying and 9–14% reported onset of workplace violence over 1–2 years. The strongest association was observed between onset of violence and becoming obese, with an odds ratio (OR) of 1.13 [95% confidence interval (CI) 1.00–1.27] in the concurrent and 1.31 (95% CI 1.05–1.64) in the longitudinal analysis. In addition, onset of bullying (OR 1.23, 95% CI 1.06–1.44) and violence (OR 1.11, 95% CI 0.99–1.24) were concurrently associated with initiation of excessive alcohol use, with weaker associations in the longitudinal analysis. Exposure–response relationships were observed for all aforementioned associations and findings were consistent across cohorts. Men were more likely to initiate excessive alcohol use than women after experiencing violence (P=0.008).

Conclusion Exposure to workplace bullying and violence was associated with adverse changes in health-related behaviors.

Key terms bullying; health-related behavior; multi-cohort study; stress; violence; workplace bullying; workplace violence

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