Is precarious employment more damaging to women's health than men's?

Financial unhealthiness predicts worse health outcomes: evidence from a sample of working Canadians

OBJECTIVE

This paper investigates how financial health associates with self-rated health, for a sample of working Canadians. Financial health is defined as an indicator of the proportionality of household consumption to its income.

STUDY DESIGN

The study draws on the Canadian General Social Survey of 2011, a cross-sectional data set.

METHODS

Multivariate regression analysis is employed.

RESULTS

The results show that financial unhealthiness is a statistically significant and strong predictor of worse physical and mental health outcomes, controlling for a wide array of characteristics, including income and job security implied by occupational category.

CONCLUSION

Policy implications are explored.

What should we know about precarious employment and health in 2025? Framing the agenda for the next decade of research

The generalization of flexible labour markets, the declining influence of unions and the degradation of social protection has led to the emergence of new forms of employment at the expense of the Standard Employment Relationship, as well as a considerable amount of research across social and scientific disciplines. Years ago we suggested the urgent need to disentangle the consequences of new types of employment for the health and well-being of workers, contending that the study of precarious employment and health is in its infancy. Today, research challenges include clearer, more precise definitions of the original concepts, a more detailed understanding of the pathways and mechanisms through which precarious employment harms worker health, stronger information systems for monitoring the problem and a complex systems approach to employment conditions and health research. All of these must be guided by the theoretical and policy debates linking precarious employment and health, and be geared towards developing better tools for the design, implementation and evaluation of policies intended to minimize precariousness in the labour market and its effects on public health and health inequalities. Our aim in this paper is to outline an agenda for the next decade of research on precarious employment and health, establishing a compelling programme that expands our understanding of complex causes and links.

Informal employment, unpaid care work, and health status in Spanish-speaking Central American countries: a gender-based approach

OBJECTIVES

To assess the relationship between paid work, family characteristics and health status in Central American workers; and to examine whether patterns of association differ by gender and informal or formal employment.

METHODS

Cross-sectional study of 8680 non-agricultural workers, based on the First Central American Survey of Working Conditions and Health (2011). Main explicative variables were paid working hours, marital status, caring for children, and caring for people with functional diversity or ill. Using Poisson regression models, adjusted prevalence ratios of poor self-perceived and mental health were calculated by sex and social security coverage (proxy of informal employment).

RESULTS

A clear pattern of association was observed for women in informal employment who were previously married, had care responsibilities, long working hours, or part-time work for both self-perceived and mental health. No other patterns were found.

CONCLUSIONS

Our results show health inequalities related to unpaid care work and paid work that depend on the interaction between gender and informal employment. To reduce these inequalities suitable policies should consider both the labor (increasing social security coverage) and domestic spheres (co-responsibility of care).

Sickness Absence and Precarious Employment: A Comparative Cross-National Study of Denmark, Finland, Sweden, and Norway

BACKGROUND

Precarious employment is a major social determinant of health and health inequalities with effects beyond the health of workers.

OBJECTIVE

To investigate the association between precarious employment and sickness absence in 4 Nordic countries, Denmark, Finland, Norway, and Sweden.

METHODS

Logistic regression analyses were conducted separately for each country on data from 4186 respondents aged 15-65 years in Denmark, Finland, Norway, and Sweden derived from the 2010 European Working Conditions Survey. Sickness absence was based on self-reports and defined as absence of seven or more day per year. Precarious employment was operationalized as a multidimensional construct of indicators. Analyses were also conducted separately for men and women.

RESULTS

The prevalence of sickness absence was lowest in Sweden (18%), and highest in Finland (28%). 3 precarious employment indicators were positively associated with sickness absence; the pattern being largely similar in the total sample. In the sex-disaggregated sample, 5 precarious employment indicators increased the likelihood of sickness absence; the pattern was heterogeneous, with women generally having significantly higher odds of sickness absence than men. "Low household income" and "sickness presenteeism" were strong predictors of sickness absence among both sexes in most of the 4 studied countries. Sickness absence varied between the Nordic countries in the sex-disaggregated analyses.

CONCLUSION

Precarious employment indicators predicted sickness absence in the Nordic countries. Findings emphasize the need to prioritize informed and monitored collective bargaining for all workers, increase working time flexibility, and improving work conditions.

A 'Balanced' Life: Work-Life Balance and Sickness Absence in Four Nordic Countries

Background:

Little attention has been given to the relationship between work-life balance and sickness absence.

Objective:

To investigate the association between poor work-life balance and sickness absence in 4 Nordic welfare states.

Methods:

Multivariable logistic regression analysis was performed on pooled cross-sectional data of workers aged 15–65 years from Denmark, Finland, Sweden, and Norway (n=4186) obtained from the 2010 European Working Conditions Survey (EWCS). Poor work-life balance was defined based on the fit between working hours and family or social commitments outside work. Self-reported sickness absence was measured as absence for ≥7 days from work for health reasons.

Results:

Poor work-life balance was associated with elevated odds (OR 1.38, 95% CI 1.06 to 1.80) of self-reported sickness absence and more health problems in the 4 Nordic countries, even after adjusting for several important confounding factors. Work-related characteristics, no determination over schedule (OR 1.26, 95% CI 1.04 to 1.53), and job insecurity (OR 1.56, 95% CI 1.21 to 2.02) increased the likelihood of sickness absence, and household characteristics-cohabitation status (OR 0.75, 95% CI 0.58 to 0.96) reduced this likelihood. The associations were non-significant when performed separately for women and men.

Conclusion:

Sickness absence is predicted by poor work-life balance. Implementation of measures that prevent employee difficulties in combining work and family life seems necessary

Changes in the labour market and health inequalities during the years of the recent economic downturn in Italy

There is widespread concern that episodes of unemployment and unstable working conditions adversely affect health. We add to the debate by focusing on the relationship between work trajectory and the self-reported health of Italian men and women during the present economic downturn. Relying on Italian data in the EU-SILC project (from 2007 to 2010), our sample includes all individuals aged 30 to 60 in 2010, and uses multivariate binomial regression models for preliminary analyses and the Structural Equations modelling (SEM) to observe the cumulative effects of health status according to different job trajectories. Our main findings show similar pictures for men and women. Individuals who are unemployed, ejected or in precarious occupational positions have a higher risk of worsening their health status during these years.

Decent Work: A Psychological Perspective

This contribution, which serves as the lead article for the Research Topic entitled “From Meaning of Working to Meaningful Lives: The Challenges of Expanding Decent Work,” explores current challenges in the development and operationalization of decent work. Based on an initiative from the International Labor Organization [ILO] (1999) decent work represents an aspirational statement about the quality of work that should be available to all people who seek to work around the globe. Within recent years, several critiques have been raised about decent work from various disciplines, highlighting concerns about a retreat from the social justice ethos that had initially defined the concept. In addition, other scholars have observed that decent work has not included a focus on the role of meaning and purpose at work. To address these concerns, we propose that a psychological perspective can help to revitalize the decent work agenda by infusing a more specific focus on individual experiences and by reconnecting decent work to its social justice origins. As an illustration of the advantages of a psychological perspective, we explore the rise of precarious work and also connect the decent work agenda to the Psychology-of-Working Framework and Theory (Blustein, 2006; Duffy et al., 2016).

Employment insecurity and mental health during the economic recession: An analysis of the young adult labour force in Italy

BACKGROUND AND OBJECTIVE

A growing body of scientific literature highlights the negative consequences of employment insecurity on several life domains. This study focuses on the young adult labour force in Italy, investigating the relationship between employment insecurity and mental health and whether this has changed after years of economic downturn. It enhances understanding by addressing differences in mental health according to several employment characteristics; and by exploring the role of respondents' economic situation and educational level.

DATA AND METHODS

Data from a large-scale, nationally representative health survey are used to estimate the relationship between employment insecurity and the Mental Health Inventory (MHI), by means of multiple linear regressions.

RESULTS AND CONCLUSIONS

The study demonstrates that employment insecurity is associated with poorer mental health. Moreover, neither temporary workers nor unemployed individuals are a homogeneous group. Previous job experience is important in differentiating the mental health risks of unemployed individuals; and the effects on mental health vary according to occupational status and to the amount of time spent in a condition of insecurity. Further, the experience of financial difficulties partly explains the relationship between employment insecurity and mental health; and different mental health outcomes depend on respondents' educational level. Lastly, the risks of reporting poorer mental health were higher in 2013 than in 2005.

Relating Factors for Depression in Korean Working Women: Secondary Analysis of the Fifth Korean National Health and Nutrition Examination Survey (KNHANES V)

PURPOSE

The purpose of this study was to investigate the health behaviors and risk factors for self-reported depression in Korean working women.

METHODS

This study adopted a secondary analysis from the fifth Korean National Health and Nutrition Examination Survey (KNHANES-V) for the Health Examination Survey and Health Behavior Survey, using stratified, multi-stage, cluster-sampling design to obtain a nationally representative sample. Data were gathered on extensive information including sociodemographic, occupational characteristics, health behaviors and depression. Multiple logistic regression analysis was employed to compute the odds ratio (OR) between health behaviors and depression to identify the health behaviors and the risk factors for depression with adjustment for the complex sample design of the survey.

RESULTS

The prevalence rate of depression was 15.5% among working women. Depression was more common in older female workers and in those with part-time job. Current smokers were significantly more likely to be depression-positive. In a multiple logistic regression analysis, significant variables of depression were marital status (OR = 2.02; 95% CI [1.05, 3.89]), smoking status (OR = 1.55; 95% CI [1.01, 2.38]), stress (OR = 0.20; 95% CI [0.15, 0.26]), employment condition (OR = 1.77; 95% CI [1.34, 2.33]) and health status (OR = 2.10; 95% CI [1.53, 2.87]).

CONCLUSIONS

Based on the study, factors leading to depression were marital status, current smoking, stress, employment condition and self-reported health status. Further studies are expected to unravel the characteristics of stress. Health care providers for women need to evaluate underreported depression and change their associated health behaviors. Also it is necessary to establish preventive strategies for female workers to control the negative effect of depression in the workplace.

[Multidimensional measurement of precarious employment: social distribution and its association with health in Catalonia (Spain)]

OBJECTIVE

To show the prevalence of precarious employment in Catalonia (Spain) for the first time and its association with mental and self-rated health, measured with a multidimensional scale.

METHOD

A cross-sectional study was conducted using data from the II Catalan Working Conditions Survey (2010) with a subsample of employed workers with a contract. The prevalence of precarious employment using a multidimensional scale and its association with health was calculated using multivariate log-binomial regression stratified by gender.

RESULTS

The prevalence of precarious employment in Catalonia was high (42.6%). We found higher precariousness in women, youth, immigrants, and manual and less educated workers. There was a positive gradient in the association between precarious employment and poor health.

CONCLUSIONS

Precarious employment is associated with poor health in the working population. Working conditions surveys should include questions on precarious employment and health indicators, which would allow monitoring and subsequent analyses of health inequalities.

Gender Influences on Return to Work After Mild Traumatic Brain Injury

OBJECTIVE

To examine the influence of gender on the return to work experience of workers who sustained a work-related mild traumatic brain injury (TBI).

DESIGN

Qualitative study using in-depth telephone interviews.

SETTING

Community.

PARTICIPANTS

Purposive sampling was used to recruit participants. Participants were adults (N=12; males, n=6, females, n=6) with a diagnosis of mild TBI sustained through a workplace injury.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Not applicable.

RESULTS

Our findings suggest that gender impacts return to work experiences in multiple ways. Occupational and breadwinner roles were significant for both men and women after work-related mild TBI. Women in this study were more proactive than men in seeking and requesting medical and rehabilitation services; however, the workplace culture may contribute to whether and how health issues are discussed. Among our participants, those who worked in supportive, nurturing (eg, feminine) workplaces reported more positive return to work (RTW) experiences than participants employed in traditionally masculine work environments. For all participants, employer and coworker relations were critical elements in RTW outcomes.

CONCLUSIONS

The application of a gender analysis in this preliminary exploratory study revealed that gender is implicated in the RTW process on many levels for men and women alike. Further examination of the work reintegration processes that takes gender into account is necessary for the development of successful policy and practice for RTW after work-related MTBI.

Contemporary employment arrangements and mental well-being in men and women across Europe: a cross-sectional study

Introduction

There is the tendency in occupational health research of approximating the ‘changed world of work’ with a sole focus on the intrinsic characteristics of the work task, encompassing the job content and working conditions. This is insufficient to explain the mental health risks associated with contemporary paid work as not only the nature of work tasks have changed but also the terms and conditions of employment. The main aim of the present study is to investigate whether a set of indicators referring to quality of the employment arrangement is associated with the well-being of people in salaried employment. Associations between the quality of contemporary employment arrangements and mental well-being in salaried workers are investigated through a multidimensional set of indicators for employment quality (contract type; income; irregular and/or unsocial working hours; employment status; training; participation; and representation). The second and third aim are to investigate whether the relation between employment quality and mental well-being is different for employed men and women and across different welfare regimes.

Methods

Cross-sectional data of salaried workers aged 15–65 from 21 EU-member states (n =11,940) were obtained from the 2010 European Social Survey. Linear regression analyses were performed.

Results

For both men and women, and irrespective of welfare regime, several sub-dimensions of low employment quality are significantly related with poor mental well-being. Most of the significant relations persist after controlling for intrinsic job characteristics. An insufficient household income and irregular and/or unsocial working hours are the strongest predictors of poor mental well-being. A differential vulnerability of employed men and women to the sub-dimensions of employment quality is found in Traditional family and Southern European welfare regimes.

Conclusions

There are significant relations between indicators of low employment quality and poor mental well-being, also when intrinsic characteristics of the work task are controlled. Gender differences are least pronounced in Earner-carer countries.

Perceived job insecurity as a risk factor for incident coronary heart disease: systematic review and meta-analysis

OBJECTIVE

To determine the association between self reported job insecurity and incident coronary heart disease.

DESIGN

A meta-analysis combining individual level data from a collaborative consortium and published studies identified by a systematic review.

DATA SOURCES

We obtained individual level data from 13 cohort studies participating in the Individual-Participant-Data Meta-analysis in Working Populations Consortium. Four published prospective cohort studies were identified by searches of Medline (to August 2012) and Embase databases (to October 2012), supplemented by manual searches.

REVIEW METHODS

Prospective cohort studies that reported risk estimates for clinically verified incident coronary heart disease by the level of self reported job insecurity. Two independent reviewers extracted published data. Summary estimates of association were obtained using random effects models.

RESULTS

The literature search yielded four cohort studies. Together with 13 cohort studies with individual participant data, the meta-analysis comprised up to 174,438 participants with a mean follow-up of 9.7 years and 1892 incident cases of coronary heart disease. Age adjusted relative risk of high versus low job insecurity was 1.32 (95% confidence interval 1.09 to 1.59). The relative risk of job insecurity adjusted for sociodemographic and risk factors was 1.19 (1.00 to 1.42). There was no evidence of significant differences in this association by sex, age (<50 v ≥ 50 years), national unemployment rate, welfare regime, or job insecurity measure.

CONCLUSIONS

The modest association between perceived job insecurity and incident coronary heart disease is partly attributable to poorer socioeconomic circumstances and less favourable risk factor profiles among people with job insecurity.

Employment precariousness and poor mental health: evidence from Spain on a new social determinant of health

BACKGROUND

Evidence on the health-damaging effects of precarious employment is limited by the use of one-dimensional approaches focused on employment instability. This study assesses the association between precarious employment and poor mental health using the multidimensional Employment Precariousness Scale.

METHODS

Cross-sectional study of 5679 temporary and permanent workers from the population-based Psychosocial Factors Survey was carried out in 2004-2005 in Spain. Poor mental health was defined as SF-36 mental health scores below the 25th percentile of the Spanish reference for each respondent's sex and age. Prevalence proportion ratios (PPRs) of poor mental health across quintiles of employment precariousness (reference: 1st quintile) were calculated with log-binomial regressions, separately for women and men.

RESULTS

Crude PPRs showed a gradient association with poor mental health and remained generally unchanged after adjustments for age, immigrant status, socioeconomic position, and previous unemployment. Fully adjusted PPRs for the 5th quintile were 2.54 (95% CI: 1.95-3.31) for women and 2.23 (95% CI: 1.86-2.68) for men.

CONCLUSION

The study finds a gradient association between employment precariousness and poor mental health, which was somewhat stronger among women, suggesting an interaction with gender-related power asymmetries. Further research is needed to strengthen the epidemiological evidence base and to inform labour market policy-making.

The association between long-term accumulation of temporary employment, the cortisol awakening response and circadian cortisol levels

Temporary employment is an increasingly common contract type, which has not been investigated in a psychoneuroendocrinological context despite previous observations of associations between adverse work and employment conditions and hypothalamic-pituitary-adrenal (HPA) axis dysregulations. The present study aims to examine whether the 12-year accumulation of temporary employment is related to circadian cortisol levels, and if any association is independent of current employment conditions. Participants were drawn from the prospective Northern Swedish Cohort (n=791, 74% of the original cohort). At age 43 years, retrospective reports of employments over the last 12 years and of current social conditions were collected by questionnaire, and one-day salivary cortisol profile was measured (at awakening, +15 min post-awakening, pre-lunch, bedtime). Results indicated a gradually higher magnitude of the cortisol awakening response (CAR) in subjects with no (0 months in temporary employment; mean CAR=34%), moderate (1-25 months in temporary employment; mean CAR=41%) and heavy (>25 months in temporary employment; mean CAR=51%) exposure (p=.020), remaining after adjustment for potential confounders and for current employment conditions (p=.028). The higher CAR was explained by lower awakening rather than higher post-awakening cortisol levels. Cortisol levels at all times of the day except post-awakening displayed tendencies to negative relations to temporary employment; as indicated by a lower Area Under of Curve (regression coefficient=5.0%, p=.038 after adjustment). This study thus suggests that the long-term exposure to temporary employment might confer HPA dysregulations in the form of increased dynamics of the CAR and circadian suppression.

[Labor market status and the use of healthcare services in Brazil]

This study compares the use of health services among economically active men according to labor market status in the years 1998, 2003, 2008 and investigates whether both are associated after adjustment for socio-demographic characteristics and health indicators. All males aged 15 to 64, participating in the National Household Survey 1998, 2003 and 2008 were included. The association between labor market status and use of services in 2008 was estimated by Poisson regression. 33,726 males were surveyed and the prevalence of medical and dental care use was found to be higher among workers with social protection. The frequency of health care use increased over the period, but remained significantly higher among formally employed workers. Unemployment and work without social protection were negatively associated with medical and dental care visits. The socio-economic structure that establishes different social groups with unequal health conditions also affects the use of health services. Further investigation into the social and physical barriers to health care use by the unemployed and informal workers is required in order to reduce perceived health inequities.

Psychosocial and other working conditions: variation by employment arrangement in a sample of working Australians

BACKGROUND

The evidence linking precarious employment with poor health is mixed. Self-reported occupational exposures in a population-based Australian sample were assessed to investigate the potential for differential exposure to psychosocial and other occupational hazards to contribute to such a relationship, hypothesizing that exposures are worse under more precarious employment arrangements (EA).

METHODS

Various psychoscial and other working conditions were modeled in relation to eight empirically derived EA categories with Permanent Full-Time (PFT) as the reference category (N = 925), controlling for sex, age, and occupational skill level.

RESULTS

More precarious EA were associated with higher odds of adverse exposures. Casual Full-Time workers had the worst exposure profile, showing the lowest job control, as well as the highest odds of multiple job holding, shift work, and exposure to four or more additional occupational hazards. Fixed-Term Contract workers stood out as the most likely to report job insecurity. Self-employed workers showed the highest job control, but also the highest odds of long working hours.

CONCLUSIONS

Psychosocial and other working conditions were generally worse under more precarious EA, but patterns of adverse occupational exposures differ between groups of precariously employed workers.

Is the core-periphery labour market structure related to perceived health? findings of the Northern Swedish Cohort

Background

There is controversy as to whether peripheral employment is related to poor health status or not. This study aims at examining whether 1) the accumulation of time in peripheral labour market positions is associated with psychological distress and poor or average self-rated health; 2) the proposed association is different among women than among men.

Method

Participants in the 1995 and 2007 follow-up surveys of the Northern Swedish Cohort (n = 985) completed self-administered questionnaires about psychological and general health and about employment positions during the follow-up years. Associations between 12 year peripheral labour market positions (no, low, medium and high exposure) and health were examined using logistic regression.

Results

Exposure to peripheral employment was positively related to psychological distress in both women and men (p-values for trend < 0.001). Adjustment for sociodemographics and psychological distress at baseline, as well as for unemployment and being out of the labour market at the follow-up, resulted in attenuation of the odds ratios, particularly in the group with high exposure to peripheral employment, although results remained significant in men in the fully adjusted model. Women and men with high exposure to peripheral employment had high odds of poor or average self-rated health, but the association was rendered non-significant after adjustment for the covariates.

Conclusions

Our findings suggest that exposure to peripheral employment positions has an impact particularly on mental health, partly due to the over-representation of other unfavourable social and employment conditions among those with substantial exposure to peripheral employment.

Social factors and mental health symptoms among women who have experienced involuntary job loss

The growing proportion of women in the labor force and the current economic crisis has made women a target population for job loss. In that situation, they are likely to experience recurrent layoffs, which force them to cope with multiple job loss and with unemployment. The present study aimed to examine sociodemographic factors that help women succeed in coping with single or multiple experiences of job loss, and that even enhance their self-efficacy in returning to work. The population of participants consisted of 134 Israeli women aged 30-45 who had been laid off. The findings indicate that the women who had experienced multiple job loss expressed a stronger desire to return to work than did those who had been laid off only once. Married women showed a greater tendency to become accustomed to stress after being laid off than did never-married women. However, even though multiple job loss might be a forced solution to home-work conflict, never-married women were found to be at risk for distress responses after being laid off. There is a need to develop responses for women who are at risk for multiple job loss, and to enhance employers' awareness of the situation faced by women who are laid off.

Precarious employment, working hours, work-life conflict and health in hotel work

Precarious or temporary work is associated with adverse outcomes including low control over working hours, work-life conflict and stress. The rise in precarious employment is most marked in the service sector but little research has been done on its health effects in this sector. This study compares permanent and temporary workers in the hotel industry, where working hours are highly variable. Survey data from 150 workers from eight 3-Star hotels in urban and regional areas around Sydney were analyzed. Forty-five per cent were male and 52 per cent were female. Fifty four per cent were permanent full-time and 46 per cent were temporary workers. The effects of employment status on perceived job security, control over working hours, and work-life conflict are investigated using PLS-Graph 3.0. The effects of control over working hours, on work-life conflict and subsequent health outcomes are also explored. Temporary workers perceived themselves as less in control of their working hours, than permanent workers (β = .27). However, they also reported lower levels of work intensity (β = .25) and working hours (β = .38). The effects of low hours control (β = .20), work intensity (β = .29), and excessive hours (β = .39) on work-life conflict (r² = .50), and subsequent health effects (r² = .30), are illustrated in the final structural equation model.

Job insecurity and health: a study of 16 European countries

Although the number of insecure jobs has increased considerably over the recent decades, relatively little is known about the health consequences of job insecurity, their international pattern, and factors that may modify them. In this paper, we investigated the association between job insecurity and self-rated health, and whether the relationship differs by country or individual-level characteristics. Cross-sectional data from 3 population-based studies on job insecurity, self-rated health, demographic, socioeconomic, work-related and behavioural factors and lifetime chronic diseases in 23,245 working subjects aged 45-70 years from 16 European countries were analysed using logistic regression and meta-analysis. In fully adjusted models, job insecurity was significantly associated with an increased risk of poor health in the Czech Republic, Denmark, Germany, Greece, Hungary, Israel, the Netherlands, Poland and Russia, with odds ratios ranging between 1.3 and 2.0. Similar, but not significant, associations were observed in Austria, France, Italy, Spain and Switzerland. We found no effect of job insecurity in Belgium and Sweden. In the pooled data, the odds ratio of poor health by job insecurity was 1.39. The association between job insecurity and health did not differ significantly by age, sex, education, and marital status. Persons with insecure jobs were at an increased risk of poor health in most of the countries included in the analysis. Given these results and trends towards increasing frequency of insecure jobs, attention needs to be paid to the public health consequences of job insecurity.

Associations between contractual status, part-time work, and intent to leave among professional caregivers for older people: results of a national cross-sectional survey in Japan

BACKGROUND

Despite a growing number of studies on leaving the organization or long-term care among professional caregivers for older people, little is known about the impact of types of employment on leaving.

OBJECTIVES

To examine the association between the type of employment and intent to leave among Japanese professional caregivers.

DESIGN AND SETTINGS

Secondary analysis of data from the 2006 Working Conditions Survey in Long-term Care, a nationally representative cross-sectional survey done in Japan.

PARTICIPANTS

10,107 professional caregivers aged 18 years and older.

METHODS

Predictor of intent to leave was type of employment (full-time permanent, full-time precarious, and part-time precarious). Precarious work was defined as employment that failed to meet the standard of full-time permanent employment, including fixed-term, temporary agency, and part-time work. Covariates included demographics, home or facility care, tenure in the profession, national qualification for caregivers, having other jobs, overtime work, and night shift work. We used multinomial logit models to estimate the strength of the association between the type of employment and intent to leave and to explore the possible mechanisms explaining this association.

RESULTS

In the unadjusted model, when compared to part-time precarious workers, full-time permanent workers (OR=2.37; 95% CI=2.06, 2.72) and full-time precarious workers (OR=2.41; 95% CI=2.01, 2.88) were more likely to report intent to leave. After adjustment for covariates, these odds ratios were attenuated, but nevertheless remained significant. Overtime work greatly attenuated these odds ratios in both full-time precarious and full-time permanent workers, and having national qualification for caregivers only did in the case of full-time permanent workers.

CONCLUSIONS

In contrast to people in other professions, full-time caregivers are more likely to have intent to leave than part-time caregivers. This study highlights the importance of policy strategies for retaining full-time workers by reducing their overtime work and rewarding caregivers who have national qualifications.

Encounters with unemployment in occupational health care: Nurses' constructions of clients without work

This study explores occupational health nurses' encounters with unemployed clients in Finland. It involved setting up and evaluating a new service, Career Health Care, that resembled occupational health care, except that clients were recruited from among job seekers who were participating in one of three active labour market policy measures: vocational training, subsidised employment in the public sector, or participatory training for entering the labour market. Our main interest focused on nurses' perceptions of the unemployed and their professional practices in the context of Career Health Care. The analysis revealed four overlapping discourses with regard to clients: the client as a casualty of unemployment, the client as unemployed but active, the client as a deviant in the labour market, and the client as a skilled user of the system. Each discourse had implications for professional practice. The risk of negative stereotyping and consequent exclusion from services is discussed here. In conclusion, we stress the complexity of providing health services that can match the increasing diversity of contemporary labour market trajectories.

Depressive symptoms and atypical jobs in France, from the 2003 Decennial health survey

BACKGROUND

The objective is to study the relations between depressive symptoms and atypical jobs in the working population in France and to determine if these associations might be linked with psychosocial and organizational constraints.

METHODS

The data come from the 2003 Decennial health survey and concern 11,895 workers. Depressive symptoms were measured by the CES-D scale. Atypical jobs were defined by employment status (fixed-term or temporary job contract, permanent job contract, self-employed) and by part-time work during working life (involuntary or chosen). Working conditions related to atypical hours and psychosocial factors were also studied.

RESULTS

For both sexes, involuntary part-time work was associated with a higher frequency of depressive symptoms, but part-time work by choice was not. Fixed-term contracts were associated with depressive symptoms only in women. All of these associations persisted after adjustment for psychosocial and organizational factors.

CONCLUSION

The associations between atypical jobs and depressive symptoms differ for job status according to sex and do not seem to be associated with the worst psychosocial working conditions. The interpretation of these results is nonetheless limited in part by the cross-sectional nature of the survey.

Unwanted sexual advances at work: variations by employment arrangement in a sample of working Australians

OBJECTIVE

We tested the hypothesis that the risk of experiencing unwanted sexual advances at work (UWSA) is greater for precariously-employed workers in comparison to those in permanent or continuing employment.

METHODS

A cross-sectional population-based telephone survey was conducted in Victoria (66% response rate, N=1,101). Employment arrangements were analysed using eight differentiated categories, as well as a four-category collapsed measure to address small cell sizes. Self-report of unwanted sexual advances at work was modelled using multiple logistic regression in relation to employment arrangement, controlling for gender, age, and occupational skill level.

RESULTS

Forty-seven respondents reported UWSA in our sample (4.3%), mainly among women (37 of 47). Risk of UWSA was higher for younger respondents, but did not vary significantly by occupational skill level or education. In comparison to Permanent Full-Time, three employment arrangements were strongly associated with UWSA after adjustment for age, gender, and occupational skill level: Casual Full-Time OR = 7.2 (95% Confidence Interval 1.7-30.2); Fixed-Term Contract OR = 11.4 (95% CI 3.4-38.8); and Own-Account Self-Employed OR = 3.8 (95% CI 1.2-11.7). In analyses of females only, the magnitude of these associations was further increased.

CONCLUSIONS

Respondents employed in precarious arrangements were more likely to report being exposed to UWSA, even after adjustment for age and gender.

IMPLICATIONS

Greater protections from UWSA are likely needed for precariously employed workers.

Social patterns of pay systems and their associations with psychosocial job characteristics and burnout among paid employees in Taiwan

Today, performance-based pay systems, also known as variable pay systems, are commonly implemented in workplaces as a business strategy to improve workers' performance and reduce labor costs. However, their impact on workers' job stress and stress-related health outcomes has rarely been investigated. By utilizing data from a nationally representative sample of paid employees in Taiwan, we examined the distribution of variable pay systems across socio-demographic categories and employment sectors. We also examined the associations of pay systems with psychosocial job characteristics (assessed by Karasek's Demand-Control model) and self-reported burnout status (measured by the Chinese version of the Copenhagen Burnout Inventory). A total of 8906 men and 6382 women aged 25-65 years were studied, and pay systems were classified into three categories, i.e., fixed salary, performance-based pay (with a basic salary), and piece-rated or time-based pay (without a basic salary). Results indicated that in men, 57% of employees were given a fixed salary, 24% were given a performance-based pay, and 19% were remunerated through a piece-rated or time-based pay. In women, the distributions of the 3 pay systems were 64%, 20% and 15%, respectively. Among the three pay systems, employees earning through a performance-based pay were found to have the longest working hours, highest level of job control, and highest percentage of workers who perceived high stress at work. Those remunerated through a piece-rated/time-based pay were found to have the lowest job control, shortest working hours, highest job insecurity, lowest potential for career growth, and lowest job satisfaction. The results of multivariate regression analyses showed that employees earning through performance-based and piece-rated pay systems showed higher scores for personal burnout and work-related burnout, as compared to those who were given fixed salaries, after adjusting for age, education, marital status, employment grade, job characteristics, and family care workloads. As variable pay systems have gained in popularity, findings from this study call for more attention on the tradeoff between the widely discussed management advantages of such pay systems and the health burden they place on employees.

Working at night and work ability among nursing personnel: when precarious employment makes the difference

PURPOSE

To test the association between night work and work ability, and verify whether the type of contractual employment has any influence over this association.

METHODS

Permanent workers (N = 642) and workers with precarious jobs (temporary contract or outsourced; N = 552) were interviewed and filled out questionnaires concerning work hours and work ability index. They were classified into: never worked at night, ex-night workers, currently working up to five nights, and currently working at least six nights/2-week span.

RESULTS

After adjusting for socio-demography and work variables, current night work was significantly associated with inadequate WAI (vs. day work with no experience in night work) only for precarious workers (OR 2.00, CI 1.01-3.95 and OR 1.85, CI 1.09-3.13 for those working up to five nights and those working at least six nights in 2 weeks, respectively).

CONCLUSIONS

Unequal opportunities at work and little experience in night work among precarious workers may explain their higher susceptibility to night work.

Gender, precarious work, and chronic diseases in South Korea

OBJECTIVE

In view of the growing number of nonstandard workers in South Korea, this study examined whether nonstandard workers reported poorer health compared to standard workers and assessed whether there were gender differences in the association between employment status and chronic health outcomes.

METHOD

Data were taken from a representative-weighted sample of 1,563 men and 1,045 women aged 20-64, from the 2001 National Health and Nutrition Examination Survey. Nonstandard employment included part-time work, temporary work, and day labor. Self-rated health and self-reported chronic disease conditions were used as health measures.

MAIN RESULTS

Nonstandard employment was significantly associated with higher risk of self-rated health and chronic conditions after adjusting for socioeconomic position (education, occupational class, and income) and health behaviors (cigarette smoking, alcohol consumption, regular exercise, and health examinations). However, the pattern in the relation between nonstandard work and specific health problems greatly differed by gender. Among men, nonstandard work arrangements were significantly associated with musculoskeletal disorders (OR 1.97, 95% CI 1.24-3.19) and liver disease (OR 2.83, 95% CI 1.27-6.32). Among women, nonstandard employment was related to mental disorders (OR 3.25, 95% CI 1.40-7.56).

CONCLUSION

The findings clearly indicate the need for further study of the observed associations, particularly prospective and analytical studies.

Under Pressure, Out of Control, or Home Alone? Reviewing Research and Policy Debates on the Occupational Health and Safety Effects of Outsourcing and Home-Based Work

The practice of outsourcing or subcontracting of work has grown rapidly in most countries over the past two decades. Outsourcing, de-institutionalization, and a range of other practices have also resulted in a growth of home-based work. Home-based workers, even when not part of a subcontracting process, operate in an isolated situation remote from their employer and other workers. Do such work arrangements expose workers to greater risk of injury, illness, or assault? The authors reviewed international studies of the occupational health and safety (OHS) effects of subcontracting and home-based work undertaken over the past 20 years. Of the 25 studies analyzed, 92 percent found poorer OHS outcomes. The studies were examined for clues about the reasons for these negative outcomes. The authors also identified similarities and differences between subcontracting and home-based work. Despite the evidence of poor OHS outcomes, research into outsourcing has stalled in recent years. With notable exceptions, governments have taken little account of findings on these work arrangements in their laws and policies, in part because neoliberal ideas dominate national and global policy agendas. The authors examine policy challenges and regulatory responses and make suggestions for future research and policy interventions.