Occupational segregation as a determinant of US worker health

Black Americans' Diminished Health Returns of Professional Occupations: A Thirty-Year Follow-Up Study of Middle-Aged and Older Adults

INTRODUCTION

Occupational classes exert substantial effects on both subjective and objective health outcomes. However, it remains unclear whether the health impact of similar occupational classes varies across racial groups among middle-aged and older adults in the United States.

AIM

Grounded in the theory of Minorities' Diminished Returns (MDRs), which posits that health benefits from resources such as employment are systematically weaker for racial minority populations, particularly Non-Latino Black individuals, this study tested Black-White disparities in the effects of similar occupational classes on health outcomes in middle-aged and older adults.

METHODS

Utilizing data from the Health and Retirement Study (HRS), we employed a 30-year longitudinal design with a nationally representative sample of middle-aged and older adults in the United States. Six occupational classes-operator, managerial, professional specialty, sales, clerical/admin, and service-served as the key predictor variables (independent variables), with race as the moderator. Various health outcomes, including self-rated health, chronic disease, body mass index (BMI), activities of daily living (ADL), and cognitive function, were measured longitudinally from wave 1 to wave 15 (from baseline to 30 years later). Statistical analyses, incorporating logistic regression models, were conducted to assess associations between occupational class and health outcomes overall and based on race.

RESULTS

Our analysis included 7538 Non-Latino White or Non-Latino Black participants followed for up to 30 years. Initial findings revealed positive health effects of professional occupations on cognitive function and self-rated health over 30 years of follow-uWe also identified significant interactions between race and professional occupational class on all health outcomes, indicating notable racial differences in the effects of professional occupations on health outcomes across domains. The effects of professional occupational class were weaker for Non-Latino Black individuals than for Non-Latino White individuals.

CONCLUSION

Consistent with the Minorities' Diminished Returns theory, our findings indicated less pronounced positive effects of professional occupations on a wide range of health outcomes for Non-Latino Black individuals compared to Non-Latino Whites. These disparities emphasize the critical need to address structural factors that contribute to the diminished returns of prestigious occupations for Non-Latino Black populations.

Assessing the role of social determinants of health in health disparities: The need for data on work

BACKGROUND

Work is a key social determinant of health. Without the collection of work-related information in public health data systems, the role of social determinants in creating and reinforcing health disparities cannot be fully assessed.

METHODS

The Centers for Disease Control and Prevention (CDC) maintains or supports a number of public health surveillance and health monitoring systems, including surveys, case-based disease and exposure systems, vital status records, and administrative data systems. We evaluated a convenience sample of these systems for inclusion of information in three work-related domains: employment status, industry and occupation, and working conditions.

RESULTS

While 12 of 39 data systems were identified as collecting work-related data, this information was often minimal (e.g., only employment status), restricted to a subset of respondents, or only gathered periodically. Information on working conditions was particularly sparse.

CONCLUSION

Historically, the limited and inconsistent collection of work-related information in public health data systems has hindered understanding of the role work plays in health disparities. Current CDC data modernization efforts present opportunities to enhance the identification and mitigation of health disparities by prioritizing inclusion of an expanded set of work-related data elements.

Disparities in job characteristics by race and sex in a Southern aluminum smelting facility

BACKGROUND

Former workers at a Southern aluminum smelting facility raised concerns that the most hazardous jobs were assigned to Black workers, but the role of workplace segregation had not been quantified or examined in the company town. Prior studies discuss race and gender disparities in working conditions, but few have documented them in the aluminum industry.

METHODS

We obtained workers' company records for 1985-2007 and characterized four job metrics: prestige (sociologic rankings), worker-defined danger (worker assessments), annual wage (1985 dollars), and estimated total particulate matter (TPM) exposure (job exposure matrix). Characteristics of job at hire and trajectories were compared by race and sex using linear binomial models.

RESULTS

Non-White males had the highest percentage of workers in low prestige and high danger jobs at hire and up to 20 years after. After 20 years tenure, 100% of White workers were in higher prestige and lower danger jobs. Most female workers, regardless of race, entered and remained in low-wage jobs, while 50% of all male workers maintained their initial higher-wage jobs. Non-White females had the highest prevalence of workers in low-wage jobs at hire and after 20 years-increasing from 63% (95% CI: 59-67) to 100% (95% CI: 78-100). All female workers were less likely to be in high TPM exposure jobs. Non-White males were most likely to be hired into high TPM exposure jobs, and this exposure prevalence increased as time accrued, while staying constant for other race-sex groups.

CONCLUSIONS

There is evidence of job segregation by race and sex in this cohort of aluminum smelting workers. Documentation of disparities in occupational hazards is important for informing health interventions and research.

The impact of paid sick leave mandates on Women's health

The United States does not have a national program to provide job-protected paid leave to workers when they or a family member are ill or need to seek medical care. Many workers receive paid sick leave through their employers, but women, particularly parents, those without a college degree, and Latinas, are less likely than their counterparts to receive employer-provided paid sick leave (PSL). To address the shortfall in PSL coverage, several states and localities have passed laws mandating employers to provide PSL. I examine the impacts of three recent state-level paid sick leave policies on women's self-reported health using data from the Behavior Risk Factor Surveillance System. Using static and event-study difference-in-differences models, I find that PSL mandates decreased the proportion of women reporting fair or poor health by an average of 2.4 percentage points and reduced the number of days women reported their physical and mental health was not good by 0.68 days and 0.43 days in the past 30 days respectively. Effects were concentrated among parents, women without college degrees, and women of color. This study demonstrates that despite being a low-intensity policy, PSL improves women's health and well-being and that mandating workplace benefits may play a role in achieving health equity.

Geographic and Temporal Patterns in Covid-19 Mortality by Race and Ethnicity in the United States from March 2020 to February 2022

Prior research has established that American Indian, Alaska Native, Black, Hispanic, and Pacific Islander populations in the United States have experienced substantially higher mortality rates from Covid-19 compared to non-Hispanic white residents during the first year of the pandemic. What remains less clear is how mortality rates have changed for each of these racial/ethnic groups during 2021, given the increasing prevalence of vaccination. In particular, it is unknown how these changes in mortality have varied geographically. In this study, we used provisional data from the National Center for Health Statistics (NCHS) to produce age-standardized estimates of Covid-19 mortality by race/ethnicity in the United States from March 2020 to February 2022 in each metro-nonmetro category, Census region, and Census division. We calculated changes in mortality rates between the first and second years of the pandemic and examined mortality changes by month. We found that when Covid-19 first affected a geographic area, non-Hispanic Black and Hispanic populations experienced extremely high levels of Covid-19 mortality and racial/ethnic inequity that were not repeated at any other time during the pandemic. Between the first and second year of the pandemic, racial/ethnic inequities in Covid-19 mortality decreased-but were not eliminated-for Hispanic, non-Hispanic Black, and non-Hispanic AIAN residents. These inequities decreased due to reductions in mortality for these populations alongside increases in non-Hispanic white mortality. Though racial/ethnic inequities in Covid-19 mortality decreased, substantial inequities still existed in most geographic areas during the pandemic's second year: Non-Hispanic Black, non-Hispanic AIAN, and Hispanic residents reported higher Covid-19 death rates in rural areas than in urban areas, indicating that these communities are facing serious public health challenges. At the same time, the non-Hispanic white mortality rate worsened in rural areas during the second year of the pandemic, suggesting there may be unique factors driving mortality in this population. Finally, vaccination rates were associated with reductions in Covid-19 mortality for Hispanic, non-Hispanic Black, and non-Hispanic white residents, and increased vaccination may have contributed to the decreases in racial/ethnic inequities in Covid-19 mortality observed during the second year of the pandemic. Despite reductions in mortality, Covid-19 mortality remained elevated in nonmetro areas and increased for some racial/ethnic groups, highlighting the need for increased vaccination delivery and equitable public health measures especially in rural communities. Taken together, these findings highlight the continued need to prioritize health equity in the pandemic response and to modify the structures and policies through which systemic racism operates and has generated racial health inequities.

The Disparities on Loss of Employment Income by US Households During the COVID-19 Pandemic

This paper examines the role of the COVID-19 pandemic on the loss of employment income on different ethnic groups in the USA using weekly Household Pulse Survey (HPS) data from the US Census Bureau from August 19 to November 9, 2020. This study is significant for two reasons. First, it documents the loss of employment income on various households in the USA during the COVID-19 pandemic period from March 13, 2020, to November 9, 2020. Second, it examines the effect on the different ethnic groups based on demographic and socioeconomic status of these households. We specifically examine the role of income, employment, education, location, access to technology, and health insurance among the different age groups, race/ethnicity, and gender. We employ multivariate logistic regression analysis for the study. The study also employs Oaxaca-Blinder decomposition analysis to investigate the source of disparities in loss of employment income on the different racial/ethnic groups. The multivariate regression examines the effects of income, employment, education, location, health insurance, access to technology, different age groups, race/ethnicity, and gender. This method enables us to estimate the level of differences in loss of employment income outcomes among the various race/ethnic groups based on their socioeconomic status. Our a priori expectation is that loss of employment income and household income, educational status, and employment will be positively correlated. However, we have no a priori expectation of the correlation with location, race/ethnicity, and gender. Our results show that Hispanics, Blacks, Other, and Asians experienced a loss of employment income of 35.6%, 25.3%, 31.2%, and 6.2% higher than Whites, respectively. Equally important is that 45.9%, 40.3%, and 25.2% of the differences are unexplained or attributed to discrimination for Hispanics, Other, and Blacks, respectively.

The Impact of Supervisor Support on the Job Satisfaction of Immigrant and Minority Long-Term Care Workers

Previous research has demonstrated the effect of supervisor support on the job satisfaction of long-term care workers (LTCW); however, much less is known about how this effect differs among race/ethnicity or immigration groups. We examined how supervisor support mediates the associations between race/ethnicity, immigration status, and job satisfaction among nursing assistants (NAs). Data of 2749 NAs were extracted from the National Nursing Assistant Survey (2004). Findings indicated that NAs of non-Hispanic Black and other races and immigrant workers were more likely to be satisfied with their jobs compared to White and non-immigrant workers, and the associations were mediated by NAs' perceived supervisor support. Minority or immigrant LTCW may be more sensitive to supervisory support and more grateful if they received support from supervisors. Managers should be aware of these racial differences and by being supportive they may improve NAs job satisfaction and reduce turnover rates.

Occupational Segregation And Hypertension Inequity: The Implication Of The Inverse Hazard Law Among Healthcare Workers

In the United States (US), Black-particularly Black female-healthcare workers are more likely to hold occupations with high job demand, low job control with limited support from supervisors or coworkers and are more vulnerable to job loss than their white counterparts. These work-related factors increase the risk of hypertension. This study examines the extent to which occupational segregation explains the persistent racial inequity in hypertension in the healthcare workforce and the potential health impact of workforce desegregation policies. We simulated a US healthcare workforce with four occupational classes: health diagnosing professionals (i.e., highest status), health treating professionals, healthcare technicians, and healthcare aides (i.e., lowest status). We simulated occupational segregation by allocating 25-year-old workers to occupational classes with the race- and gender-specific probabilities estimated from the American Community Survey data. Our model used occupational class attributes and workers' health behaviors to predict hypertension over a 40-year career. We tracked the hypertension prevalence and the Black-white prevalence gap among the simulated workers under the staus quo condition (occupational segregation) and the experimental conditions in which occupational segregation was eliminated. We found that the Black-white hypertension prevalence gap became approximately one percentage point smaller in the experimental than in the status quo conditions. These findings suggest that policies designed to desegregate the healthcare workforce may reduce racial health inequities in this population. Our microsimulation may be used in future research to compare various desegregation policies as they may affect workers' health differently.

Supplementary Information

The online version contains supplementary material available at 10.1007/s41996-022-00098-5.

A Critical Review on the Complex Interplay between Social Determinants of Health and Maternal and Infant Mortality

Background: U.S. maternal and infant mortality rates constitute an important public health problem, because these rates surpass those in developed countries and are characterized by stark disparities for racial/ethnic minorities, rural residents, and individuals with less privileged socioeconomic status due to social determinants of health (SDoH). Methods: A critical review of the maternal and infant mortality literature was performed to determine multilevel SDoH factors leading to mortality disparities with a life course lens. Results: Black mothers and infants fared the worst in terms of mortality rates, likely due to the accumulation of SDoH experienced as a result of structural racism across the life course. Upstream SDoH are important contributors to disparities in maternal and infant mortality. More research is needed on the effectiveness of continuous quality improvement initiatives for the maternal–infant dyad, and expanding programs such as paid maternity leave, quality, stable and affordable housing, and social safety-nets (Medicaid, CHIP, WIC), in reducing maternal and infant mortality. Finally, it is important to address research gaps in individual, interpersonal, community, and societal factors, because they affect maternal and infant mortality and related disparities. Conclusion: Key SDoH at multiple levels affect maternal and infant health. These SDoH shape and perpetuate disparities across the lifespan and are implicated in maternal and infant mortality disparities.

Free agents or cogs in the machine? Classed, gendered, and racialized inequities in hazardous working conditions

INTRODUCTION

Few epidemiologic studies have used relational social class measures based on control over productive assets and others' labor to analyze inequities in health-affecting working conditions. Moreover, these studies have often neglected the gendered and racialized dimensions of class relations, dimensions which are essential to understanding population patterns of health inequities. Our study fills these gaps.

METHODS

Using data from the 2002-2018 U.S. General Social Survey, we assigned respondents to the worker, manager, petit bourgeois, or capitalist classes based on their supervisory authority and self-employment status. Next, we estimated class, class-by-gender, and class-by-race inequities in compensation/safety, the labor process, control, and conflict, using Poisson models. We also estimated gender-by-race inequities among workers.

RESULTS

We identified substantial class inequities, with worse conditions for workers, which is the largest class within genders and racialized groups, but also disproportionately consists of women and people of color (POC), particularly women of color (WOC). For example, relative to workers, capitalists were less likely to report that safety is not a priority (prevalence ratio [PR]: 0.41, 95% confidence interval [CI]: 0.21, 0.82), repetitive tasks (PR: 0.36, 95% CI: 0.21, 0.61), and lacking freedom (PR: 0.11, 95% CI: 0.05, 0.24). We also identified inequities among workers, with women and POC, particularly WOC, reporting worse conditions than white male workers, especially greater discrimination/harassment (WOC PR: 1.70, 95% CI: 1.36, 2.13).

CONCLUSION

We identified substantial inequities in working conditions across intersecting classes, genders, and racialized groups. These inequities threaten workers' health, particularly among women and POC.

Physical and psychosocial demand at work: inequities related to race/skin color

This cross-sectional study investigated the association between self-reported race/skin color and two outcomes - psychosocial demand and physical demand at work - in 1,032 workers in an urban cleaning services company and two footwear manufacturers, located in the State of Bahia, Brazil. Psychosocial demand was measured through the Job Content Questionnaire and physical demand was measured through questions about postures and cargo handling. A Cox regression analysis provided prevalence ratios (PR) adjusted by age, gender, and educational level. Among blacks, there is a higher proportion of garbage collectors and a lower proportion of supervisory positions. Black workers are more subject to high psychological demand and low job control and, consequently, to high strain (PR=1.65). Also, they are more exposed to work with arms above shoulder level (PR=1.93), and material handling (PR=1.62), compared to white workers. Brown workers are more exposed to low job control (PR=1.36), work with arms above shoulder level (PR=1.48), and material handling (PR=1.25), also compared with whites. Social support is lower among blacks and brown. The study demonstrated inequities in psychosocial and physical exposures at work that are in line with the structural conception of racism. This evidence can contribute to the adoption of practices that increase equity in the world of work.

The Serpent of Their Agonies: Exploitation as Structural Determinant of Mental Illness

BACKGROUND

Social stratification is a well-documented determinant of mental health. Traditional measures of stratification (e.g., socioeconomic status) reduce dynamic social processes to individual attributes downstream of mechanisms that generate stratification. In this study, we measure one process theorized to generate and reproduce social stratification-economic exploitation-and explore its association with mental health.

METHODS

Data are from the 1983 to 2017 waves of the Panel Study of Income Dynamics, a nationally representative cohort study (baseline N = 3059). We operationalized "unconcealed exploitation" as the percentage of individuals' labor income they were hypothetically not paid for productive hours. We ascertained psychologic distress and mental illness with the Kessler-6 (K6) scale.

RESULTS

We fit inverse probability-weighted marginal structural models and found that for each unit increase in unconcealed exploitation, psychologic distress increased by 1.6 points (95% confidence interval = 0.71, 2.5) on the K6 scale and the odds of mental illness tripled (odds ratio = 3.0, 95% confidence interval = 1.5, 6.1). Results were not driven entirely by overwork and were robust to different inverse probability-weighted estimation strategies and sensitivity analyses.

CONCLUSIONS

Exploitation is associated with mental illness. Focusing on exploitation rather than its consequences (e.g., socioeconomic status), shifts attention to a structural process that may be a more appropriate explanatory mechanism, and a more pragmatic intervention target, for mental illness.

Various Types of Perceived Job Discrimination and Sleep Health Among Working Women: Findings From the Sister Study

Job discrimination, a social stressor, may lead to sleep health disparities among workers; yet, limited research has examined this relationship and specific sources of job discrimination. We used a US sample of working women (n = 26,085), participants in the Sister Study (2008-2016), to examine the associations of perceived job discrimination due to sex, race, age, health conditions, and/or sexual orientation with sleep health. Cross-sectionally, linear or logistic regression models revealed that each source of job discrimination was independently associated with different sleep problems after controlling for other sources of job discrimination. Longitudinally, among participants without short sleep (<7 hours/night) at time 1 (2012-2014), age-specific job discrimination was associated with 21% increased odds of new-onset short sleep (odds ratio = 1.21, 95% confidence interval: 1.03, 1.43) at time 2 (2014-2016). Among those without insomnia symptoms at time 1, race-specific job discrimination was associated with 37% increased odds of new-onset insomnia symptoms (odds ratio = 1.37, 95% confidence interval: 1.07, 1.75) at time 2. Sex- and health-specific job discrimination also predicted new-onset sleepiness. There were dose-response relationships such that a greater number of sources of job discrimination (≥3) was associated with greater odds of prevalent and incident sleep problems. Perceived job discrimination may contribute to working women's poor sleep health over time, raising concerns about sleep health disparities emanating from the workplace.

Mental illness, drinking, and the social division and structure of labor in the United States: 2003-2015

BACKGROUND

We draw on a relational theoretical perspective to investigate how the social division and structure of labor are associated with serious and moderate mental illness and binge and heavy drinking.

METHODS

The Panel Study of Income Dynamics and the Occupational Information Network were linked to explore how occupation, the productivity-to-pay gap, unemployment, the gendered division of domestic labor, and factor-analytic and theory-derived dimensions of work are related to mental illness and drinking outcomes.

RESULTS

Occupations involving manual labor and customer interaction, entertainment, sales, or other service-oriented labor were associated with increased odds of mental illness and drinking outcomes. Looking for work, more hours of housework, and a higher productivity-to-pay gap were associated with increased odds of mental illness. Physical/risky work was associated with binge and heavy drinking and serious mental illness; technical/craft work and automation were associated with binge drinking. Work characterized by higher authority, autonomy, and expertise was associated with lower odds of mental illness and drinking outcomes.

CONCLUSIONS

Situating work-related risk factors within their material context can help us better understand them as determinants of mental illness and identify appropriate targets for social change.

Improving Occupational Health Disparity Research: Testing a method to estimate race and ethnicity in a working population

BACKGROUND

Race and ethnicity data are often absent from administrative and health insurance databases. Indirect estimation methods to assign probability scores for race and ethnicity to insurance records may help identify occupational health inequities.

METHODS

We compared race and ethnicity estimates from the Bayesian Improved Surname Geocoding (BISG) formula to self-reported race and ethnicity from 1132 workers.

RESULTS

The accuracy of the BISG using gender stratified regression models adjusted for worker age and industry were excellent for White and Latino males and Latino females, good for Black and Asian Pacific Islander males and White and Asian Pacific Islander females. American Indian/Alaskan Native and those who indicated they were "Other" or "More than one race" were poorly identified.

CONCLUSION

The BISG estimation method was accurate for White, Black, Latino, and Asian Pacific Islanders in a sample of workers. Using the BISG in administrative datasets will expand research into occupational health disparities.

Explaining racial/ethnic differences in all-cause mortality in the Multi-Ethnic Study of Atherosclerosis (MESA): Substantive complexity and hazardous working conditions as mediating factors

Research on racial/ethnic health disparities and socioeconomic position has not fully considered occupation. However, because occupations are racially patterned, certain occupational characteristics may explain racial/ethnic difference in health. This study examines the role of occupational characteristics in racial/ethnic disparities in all-cause mortality. Data are from a U.S. community-based cohort study (n=6342, median follow-up: 12.2 years), in which 893 deaths (14.1%) occurred. We estimated mortality hazard ratios (HRs) for African Americans, Hispanics, and Chinese Americans compared with whites. We also estimated the proportion of the HR mediated by each of two occupational characteristics, substantive complexity of work (e.g., problem solving, inductive/deductive reasoning on the job) and hazardous conditions (e.g., noise, extreme temperature, chemicals), derived from the Occupational Information Network database (O*NET). Analyses were adjusted for age, sex, nativity, working status at baseline, and study sites. African Americans had a higher rate of all-cause death (HR 1.41; 95% confidence interval [CI]: 1.19–1.66) than whites. Chinese-American ethnicity was protective (HR 0.59, CI: 0.40–0.85); Hispanic ethnicity was not significantly different from whites (HR 0.88; CI: 0.67–1.17). Substantive complexity of work mediated 30% of the higher rate of death for African Americans compared with whites. For other groups, mediation was not significant. Hazardous conditions did not significantly mediate mortality in any racial/ethnic group. Lower levels of substantive complexity of work mediate a substantial part of the health disadvantage in African Americans. This job characteristic may be an important factor in explaining racial health disparities.

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Health disparities research rarely considers occupational characteristics.

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Occupation is strongly patterned by race/ethnicity in the United States.

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Different working conditions may explain racial health disparities.

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Complexity of the job explains one-third of black-white mortality difference.

Racial/ethnic disparities in self-reported short sleep duration among US-born and foreign-born adults

OBJECTIVE

Racial/ethnic health disparities are infrequently considered by nativity status in the United States, although the immigrant population has practically doubled since 1990. We investigated the modifying role of nativity status (US- vs. foreign-born) on racial/ethnic disparities in short sleep duration (<7 h), which has serious health consequences.

DESIGN

Cross-sectional data from 23,505 US-born and 4,326 foreign-born adults aged ≥ 18 years from the 2012 National Health Interview Survey and multivariable log-linear regression were used to estimate prevalence ratios (PR) for reporting short sleep duration and their corresponding 95% confidence intervals (CI).

RESULTS

After controlling for sociodemographic covariates, short sleep was more prevalent among blacks (PR 1.29, 95% CI: 1.21-1.37), Hispanics (PR 1.18, 95% CI: 1.08, 1.29), and Asians (PR 1.37, 95% CI: 1.16-1.61) than whites among US-born adults. Short sleep was more prevalent among blacks (PR 1.71, 95% CI: 1.38, 2.13) and Asians (PR 1.23, 95% CI: 1.02, 1.47) than whites among the foreign-born.

CONCLUSION

Among both US- and foreign-born adults, blacks and Asians had a higher likelihood of short sleep compared to whites. US-born Hispanics, but not foreign-born Hispanics, had a higher likelihood than their white counterparts. Future research should aim to uncover mechanisms underlying these disparities.

Work and health among Latina mothers in farmworker families

BACKGROUND

Work organization is important for the health of vulnerable workers, particularly women. This analysis describes work organization for Latinas in farmworker families and delineates the associations of work organization with health indicators.

METHODS

Up to 220 Latina women in farmworker families completed interviews from October 2012 to July 2013. Interviews addressed job structure, job demand, job control, and job support. Health measures included stress, depressive symptoms, physical activity, family conflict, and family economic security.

RESULTS

Three fifths of the women were employed. Several work organization dimensions, including shift, psychological demand, work safety climate, and benefits, were associated with participant health as expected, on the basis of the work organization and job demands-control-support models.

CONCLUSIONS

Research should address women's health and specific work responsibilities. Occupational safety policy must consider the importance of work organization in the health of vulnerable workers.

Workplace psychosocial factors associated with hypertension in the U.S. workforce: a cross-sectional study based on the 2010 national health interview survey

OBJECTIVE

To explore associations between self-reported hypertension and workplace psychosocial factors that are common among U.S. workers and to identify industries and occupations (I&Os) that are associated with a high prevalence of hypertension, even after adjustment for common known risk factors.

METHODS

Data from the 2010 National Health Interview Survey were used to examine relationships between the prevalence of self-reported hypertension and job insecurity, hostile work environment, work- family imbalance, work hours and I&O.

RESULTS

Job insecurity (adjusted prevalence ratio (aPR): 1.11; 95% confidence interval (CI): 1.04-1.19)) and hostile work environment (aPR: 1.15; 95% CI: 1.03-1.29) were significantly associated with hypertension. Hypertension prevalence was significantly elevated among those employed in Healthcare Support occupations and Public Administration industries.

CONCLUSION

Addressing hostile work environments and the stress associated with job insecurity may improve workers' health. Other occupational factors that contribute to the variation in prevalence of hypertension by I&O should be sought.

The effects of work organization on the health of immigrant manual workers: A longitudinal analysis

This analysis uses a longitudinal design to examine the associations of work organization and health outcomes among Latino manual workers. Participants included 247 Latino workers who completed baseline and 1-year follow-up interviews and clinical examinations. Health outcome measures were epicondylitis, rotator cuff syndrome, back pain, and depressive symptoms. Independent measures were measures of job demand, job control, and job support. Workers commonly experienced rotator cuff syndrome (6.5%), back pain (8.9%), and depressive symptoms (11.2%); fewer experienced epicondylitis (2.4%). Psychological demand was associated with rotator cuff syndrome; awkward position and decision latitude were associated with back pain. Decreased skill variety but increased decision latitude was associated with elevated depressive symptoms. Work context factors are important for health outcomes among vulnerable workers. Further research is needed to expand upon this work, particularly cultural perspectives on job support.

Racial/ethnic disparities in short sleep duration by occupation: the contribution of immigrant status

Sleep duration, associated with increased morbidity/mortality, has been shown to vary by race and occupation. Few studies have examined the additional influence of immigrant status. Using a nationally-representative sample of 175,244 US adults from the National Health Interview Survey from 2004 to 2011, we estimated prevalence ratios (PRs) for short sleep duration (<7 h/per day) among US- and non-US born Blacks and Latinos by occupation compared to their White counterparts using adjusted Poisson regression models with robust variance. Non-US born participants' mean age was 46 years, 55% were men, 58% were Latino, and 65% lived in the US ≥ 15 years. Short sleep prevalence was highest among US- and non-US born Blacks in all occupations, and the prevalence generally increased with increasing professional/management roles in Blacks and Latinos while it decreased among Whites. Adjusted short sleep was more prevalent in US-born Blacks compared to Whites in professional/management (PR = 1.52 [95% confidence interval (CI): 1.42-1.63]), support services (PR = 1.31 [95% CI: 1.26-1.37]), and laborers (PR = 1.11 [95% CI: 1.06-1.16]). The Black-White comparison was even higher for non-US born Black laborers (PR = 1.50 [95% CI: 1.24-1.80]). Similar for non-US born Latinos, Latinos born in the US had a higher short sleep prevalence in professional/management (PR = 1.14 [95% CI: 1.04-1.24]) and support services (PR = 1.06 [95% CI: 1.01-1.11]), but a lower prevalence among laborers (PR = 0.77 [95% CI: 0.74-0.81]) compared to Whites. Short sleep varied within and between immigrant status for some ethnicities in particular occupations, further illuminating the need for tailored interventions to address sleep disparities among US workers.

Race-based job discrimination, disparities in job control, and their joint effects on health

OBJECTIVES

To examine disparities between job control scores in Black and White subjects and attempt to discern whether self-rated low job control in Blacks may arise from structural segregation into different jobs, or represents individual responses to race-based discrimination in hiring or promotion.

METHODS

Data from the National Survey of Midlife in the United States (MIDUS) were analyzed by mixed-effects linear regression and variance regression to determine the effects of grouping by occupation, and racial discrimination in hiring or promotion, on control scores from the Job Content Questionnaire in Black and White subjects. Path analyses were constructed to determine the mediating effect of discrimination on pathways from education and job control to self-rated health.

RESULTS

Black subjects exhibited lower mean job control scores compared to Whites (mean score difference 2.26, P < 0.001) adjusted for age, sex, education, and income. This difference narrowed to 1.86 when adjusted for clustering by occupation, and was greatly reduced by conditioning on race-based discrimination (score difference 1.03, P = 0.12). Path analyses showed greater reported discrimination in Blacks with increasing education, and a stronger effect of job control on health in Black subjects.

CONCLUSIONS

Individual racially-based discrimination appears a stronger determinant than structural segregation in reduced job control in Black workers, and may contribute to health disparities consequent on work.

Musculoskeletal and neurological injuries associated with work organization among immigrant Latino women manual workers in North Carolina

BACKGROUND

This analysis examines the associations of work organization attributes among Latino women in manual occupations with musculoskeletal and neurological injuries.

METHODS

Participants included 234 women in western North Carolina. Outcome measures included epicondylitis, rotator cuff syndrome, back pain, and carpal tunnel syndrome. Independent measures included indicators of job demand, job control, and job support, as well as personal characteristics.

RESULTS

Latina workers commonly experienced epicondylitis, rotator cuff syndrome, back pain, and CTS. Awkward posture and decision latitude were associated with epicondylitis. Rotator cuff syndrome was associated with awkward posture and psychological demand. Awkward posture and psychological demand, and decreased skill variety and job control were related to CTS.

CONCLUSIONS

Work organization factors are potentially important for musculoskeletal and neurological injury among vulnerable workers. Research is required to understand the associations of work and health outcomes of these women. Policy initiatives need to consider how work organization affects health.

The Use of Lifestyle and Behavioral Modification Approaches in Obesity Interventions for Black Women: A Literature Review

The alarming obesity prevalence in Black women is well documented yet poorly understood. Obesity interventions for Black women have failed to produce long-term reductions in weight. Recommendations to incorporate a lifestyle and behavioral modification approach have been made to address obesity in this population. The purpose of this article was to provide a comprehensive review of the literature to identify lifestyle and behavioral modification obesity intervention studies for Black women. We included articles published between February 1992 and January 2013. This search identified 28 articles from the PsycInfo, MEDLINE, CINAHL, and SPORTDiscus databases. Results of these studies were summarized primarily into six categories. The importance of modest improvements in health outcomes that result from adapting healthier behaviors was highlighted. Future research is required for identifying the most salient intervention component or combination of components that lead to the best outcomes for ensuring intervention success and minimizing weight regain postintervention.

Racial disparities in job strain among American and immigrant long-term care workers

BACKGROUND

Nursing homes are occupational settings, with an increasing minority and immigrant workforce where several psychosocial stressors intersect.

AIM

This study aimed to examine racial/ethnic differences in job strain between Black (n = 127) and White (n = 110) immigrant and American direct-care workers at nursing homes (total n = 237).

METHODS

Cross-sectional study with data collected at four nursing homes in Massachusetts during 2006-2007. We contrasted Black and White workers within higher-skilled occupations such as registered nurses or licensed practical nurses (n = 82) and lower-skilled staff such as certified nursing assistants (CNAs, n = 155).

RESULTS

Almost all Black workers (96%) were immigrants. After adjusting for demographic and occupational characteristics, Black employees were more likely to report job strain, compared with Whites [relative risk (RR): 2.9, 95% confidence interval (CI) 1.3 to 6.6]. Analyses stratified by occupation showed that Black CNAs were more likely to report job strain, compared with White CNAs (RR: 3.1, 95% CI: 1.0 to 9.4). Black workers were also more likely to report low control (RR: 2.1, 95% CI: 1.1 to 4.0). Additionally, Black workers earned $2.58 less per hour and worked 7.1 more hours per week on average, controlling for potential confounders.

CONCLUSION

Black immigrant workers were 2.9 times more likely to report job strain than White workers, with greater differences among CNAs. These findings may reflect differential organizational or individual characteristics but also interpersonal or institutional racial/ethnic discrimination. Further research should consider the role of race/ethnicity in shaping patterns of occupational stress.

Racial and ethnic disparities in work-related injuries and socio-economic resources among nursing assistants employed in US nursing homes

BACKGROUND

We aimed to estimate the proportion of nursing assistants (NAs) in the US with work-related injuries and insufficient socio-economic resources by race/ethnicity.

METHODS

Data from the 2004 National Nursing Assistant Survey (NNAS), a nationally representative sample survey of NAs employed in United States nursing homes, were analyzed accounting for the complex survey design.

RESULTS

Among 2,880 participants, 44% reported "scratch, open wounds, or cuts" followed by "back injuries" (17%), "black eyes or other types of bruising" (16%), and "human bites" (12%). When compared to non-Hispanic white NAs, the adjusted rate ratio (RR) for wound/cut was 0.74 for non-Hispanic black NAs (95% confidence interval [CI]: 0.65-0.85). RRs for black eyes/bruises were 0.18 for non-Hispanic black NAs (95% CI: 0.12-0.26), and 0.55 for Hispanic NAs (95% CI: 0.37-0.82).

CONCLUSIONS

Minority racial and ethnic groups were less likely to report having experienced injuries compared with non-Hispanic white NAs. Future research should focus on identifying preventable risk factors, such as differences by race and ethnicity in the nature of NA jobs and the extent of their engagement in assisting patients with activities of daily living.

Assessing the contribution of working conditions to socioeconomic disparities in health: a commentary

INTRODUCTION

Occupational health researchers can play a pivotal role in increasing our understanding of the role of physical and psychosocial working conditions in producing socioeconomic health disparities and trends of increasing socioeconomic health disparities, contributing to interventions to reduce such disparities, and helping to improve public education materials on this subject. However, a number of methodological challenges in this field need to be considered.

METHODS

Commentary, including a review of selected studies.

RESULTS/CONCLUSION

Research needs to be guided by models of the associations between social (socioeconomic position (SEP), race/ethnicity, immigration status, and gender) and occupational variables and health, to avoid inappropriate control for confounding, and to specify causal pathways (mediation) and interaction effects. Different approaches to the theory and measurement of SEP also need to be tested.