Background: Emotional labor, the management of feelings to create organizationally desired emotional displays, has been consistently associated with adverse health outcomes in Western populations. However, cultural context may fundamentally alter these relationships in Asian service economies. Objectives: To examine temporal trends in emotional labor prevalence and investigate associations between emotional labor and health outcomes among Korean service workers over a 17-year period. Design: Repeated cross-sectional study. Methods: We analyzed data from seven waves of the Korean Working Conditions Survey (2006-2023), comprising 271,039 observations. Emotional labor was assessed using validated items measuring frequency of hiding feelings and managing customer emotions. Health outcomes included psychological symptoms (depression, anxiety, fatigue) and physical symptoms (musculoskeletal disorders, headaches, gastrointestinal problems). We employed multivariable logistic regression, fixed-effects models, and mediation analyses, adjusting for sociodemographic and occupational factors. Results: Emotional labor exposure remained stable at approximately 3.0 (5- point scale) from 2014-2023. Health problem prevalence was consistently around 60% across all survey years. Contrary to hypotheses, emotional labor showed no significant association with health problems (OR=0.999, 95% CI: 0.993-1.005, P=0.735). These null findings persisted in fixed-effects analyses (β=-0.0003, P=0.736), gender-stratified models, and interaction tests. The Cochran-Armitage trend test revealed no temporal trends (P=0.865). Mediation analysis found no indirect effects through psychological hazards. Notably, this finding represents a paradoxical discovery that challenges Western-centric assumptions about the universality of emotional labor's health effects. Conclusion: Despite high statistical power and comprehensive methodology, we found no evidence linking emotional labor to health problems in Korean workers. These unexpected findings challenge the assumed universality of emotional labor's health effects and suggest cultural factors may fundamentally modify occupational stress pathways. Western-derived theoretical models may require substantial adaptation for Asian contexts where emotional regulation represents normative social behavior rather than occupational burden.

INTRODUCTION
Theoretical Background and Literature Review
    Conceptual Evolution of Emotional Labor
    Health Associations of Emotional Labor: EmpiricalEvidence
    The Korean Context: Cultural and Occupational Factors
Methods
    Study Design and Data Source
    Study Population
    Measurement of Emotional Labor
    Health Outcome Assessment
    Covariates
    Statistical Analysis
    Mediation and Sensitivity Analysis
    Ethical Considerations
RESULTS
    Sample Characteristics
    Temporal Trends in Emotional Labor and HealthOutcomes
    Association Between Emotional Labor and HealthOutcomes
    Fixed Effects Analysis
    Stratified and Interaction Analysis
    Mediation Analysis
    Summary of Key Findings
DISCUSSION
    Clinical and Practical Implications
    Policy Implications
FUNDING
CONFLICTS OF INTEREST
AUTHOR CONTRIBUTIONS
REFERENCES

• Wansuk Choi(Department of Physical Therapy, Kyungwoon University, Gumi, Republic of Korea)
• Hyungsoo Shin(Department of Physical Therapy, Kyungwoon University, Gumi, Republic of Korea)
• Heejoon Shin(Department of Physical Therapy, Kyungwoon University, Gumi, Republic of Korea)
• Hongrae Kim(Department of Physical Therapy, Kyungwoon University, Gumi, Republic of Korea)
• Jaewon Choi(Department of Industrial Disaster Safety, Kyungwoon University, Gumi, Republic of Korea)
• Seoa Park(Department of Nursing, Kyungwoon University, Gumi, Republic of Korea)
• Myeongchul Park(School of Software, Kyungwoon University, Gumi, Republic of Korea) Corresponding author