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The aim of this study was to investigate whether job strain had an effect on the risk of occupational injury of workers at small- to medium-sized manufacturing companies.We conducted a prospective follow-up survey and finally 1,209 workers in South Korea were included in this study. At time X1, we measured job stress with the Job Demand and Decision Latitude Questionnaire; and at time X2 (after 6 months), we evaluated occupational injuries through a single question. Occupational injuries were assessed using the question "Have you ever been injured at work, including minor scratches and cuts, in the previous four-month period" by self-reporting in the previous 4-month period.For men, the high job-demand group (OR = 1.71, 95% CI= 1.13—2.59) and high strain group (OR= 1.79, 95% CI= 1.02—3.14) showed the increased risk of occupational injury. For women, high job-demand (OR = 2.11, 95% CI =1.18—3.78), low job control (OR = 1.80, 95% CI= 1.02-3.17), and high job strain (OR = 3.57, 95% CI = 1.62-7.86) were significantly associated with occupational injury.Workers under high job strain showed higher risk for occupational injury. The efforts to minimize stress-related occupational injuries should be required. Am. J. Ind. Med. 52:322-330, 2009. ©2009 Wiley-Liss, Inc.