Prevalence of workplace discrimination and mistreatment in a national sample of older U.S. workers: The REGARDS cohort study

From the Workroom to the Bedroom: Work-to-Home Spillover as a Mechanism Linking Work Characteristics to Sleep Health

Work may influence the home domain and subsequently impact employee sleep. Past work found that negative spillover mediated the relationship between perceived unfairness about work and insomnia symptoms across 20 years. As an extension of past work, this study investigated whether negative spillover and positive spillover mediate the relationship between job demands (perceived unfairness, job discrimination) and job resources (coworker and supervisor support) on multidimensional sleep health. Two waves of survey data from a subset of full-time workers were obtained from the Midlife in the United States Study approximately 10 years apart. A sleep health composite captured irregularity, dissatisfaction, nap frequency, inefficiency, and suboptimal sleep duration (higher=more sleep health problems). PROCESS Macro evaluated cross-sectional (T1) and sequential (T1 exposureàT1 mediatoràT2 outcome) mediation pathways, adjusting for sociodemographic characteristics, physical health, neuroticism, and work hours. Both cross-sectionally and prospectively, higher negative spillover mediated the association of higher unfairness with more sleep health problems, and the association between higher discrimination and more sleep health problems. There was no support for positive spillover as a mediator between job resources and sleep health cross-sectionally or prospectively. Findings suggest that organizations should reduce the amount of negative spillover by limiting instances of unfairness and discrimination at work to promote specific aspects of employee sleep health such as sleep irregularity, dissatisfaction, efficiency, and nap frequency.

Reflections of Black Married Working Mothers Managing Occupational Roles and Racism

Black married working mothers encounter forms of racism, on the job and in society. However, little attention is given to how these experiences affect their work and family lives. Qualitative thematic analysis was used to examine the narratives of 91 Black women, aged 20 to 55 years, to explore the effects of racism on their key occupational roles of wife, employee, and mother. Four major themes emerged for being a Black employee. Two themes were linked to Black mothering. Five themes were identified for being a Black wife. Also, two new culturally derived occupational roles emerged: advocate and pioneer. Findings suggest that Black married working mothers have unique transformative experiences in their occupational roles solely due to their minoritized status, which impacts their wellbeing. Occupation-based research should focus on racism's impact on the wellbeing of minoritized groups as they engage in desired and meaningful occupational roles.

Shiftwork, long working hours and markers of inflammation in a national US population-based sample of employed black and white men and women aged ≥45 years

OBJECTIVES

Work schedule demands contribute to circadian disruption and may influence health via an inflammatory response. We examined the impact of shiftwork and long work hours on inflammation in a national US sample.

METHODS

Participants included 12 487 employed black and white men and women aged ≥45 years enrolled in the REasons for Geographic and Racial Differences in Stroke Study who completed an occupational questionnaire (2011-2013) and clinical examination (2013-2016). Cross-sectional associations between shiftwork and work hours with log-transformed high-sensitivity C reactive protein (CRP) and white blood cell (WBC) count were examined by multiple linear regression analysis, overall and by race-sex subgroups.

RESULTS

Overall, rotating shift workers had higher log-CRP concentration compared with day workers (β=0.09, 95% CI:0.02 to 0.16) and findings for WBC were null. Black women had the highest geometric mean CRP (2.82 mg/L), while white men had the highest WBC (6.35×109/L). White men who worked afternoons had higher log-CRP compared with those who worked days (β=0.20, 95% CI: 0.08 to 0.33). Black men engaged in shiftwork <10 years working ≥55 hours/week had higher log-CRP and log-WBC compared with those working days <55 hours/week (β=0.33, 95% CI: 0.02 to 0.64 and β=0.10, 95% CI: 0.003 to 0.19). Among shift workers, non-retired white women working forward and backward shift rotations had higher log-CRP compared with those working forward only (β=0.49, 95% CI: 0.02 to 0.96).

CONCLUSIONS

Shift workers had higher inflammatory markers compared with day workers and race-sex disparities should be examined further. These findings highlight a potential biological pathway linking work schedule demands and chronic disease.

Applying a Health Equity Lens to Work-Related Motor Vehicle Safety in the United States

Motor vehicle crashes (MVCs) are the leading cause of fatal work-related injuries in the United States. Research assessing sociodemographic risk disparities for work-related MVCs is limited, yet structural and systemic inequities at work and during commutes likely contribute to disproportionate MVC risk. This paper summarizes the literature on risk disparities for work-related MVCs by sociodemographic and employment characteristics and identifies worker populations that have been largely excluded from previous research. The social-ecological model is used as a framework to identify potential causes of disparities at five levels-individual, interpersonal, organizational, community, and public policy. Expanded data collection and analyses of work-related MVCs are needed to understand and reduce disparities for pedestrian workers, workers from historically marginalized communities, workers with overlapping vulnerabilities, and workers not adequately covered by employer policies and safety regulations. In addition, there is a need for more data on commuting-related MVCs in the United States. Inadequate access to transportation, which disproportionately affects marginalized populations, may make travel to and from work less safe and limit individuals' access to employment. Identifying and remedying inequities in work-related MVCs, whether during the day or while commuting, will require the efforts of industry and multiple public sectors, including public health, transportation, and labor.

Retirement and cognitive aging in a racially diverse sample of older Americans

BACKGROUND

Retirement represents a crucial transitional period for many adults with possible consequences for cognitive aging. We examined trajectories of cognitive change before and after retirement in Black and White adults.

METHODS

Longitudinal examination of up to 10 years (mean = 7.1 ± 2.2 years) using data from the REasons for Geographic and Racial Differences in Stroke (REGARDS) study-a national, longitudinal study of Black and White adults ≥45 years of age. Data were from 2226 members of the REGARDS study who retired around the time when an occupational ancillary survey was administered. Cognitive function was an average of z-scores for tests of verbal fluency, memory, and global function.

RESULTS

Cognitive functioning was stable before retirement (Estimate = 0.05, p = 0.322), followed by a significant decline after retirement (Estimate = -0.15, p < 0.001). The decline was particularly pronounced in White (Estimate = -0.19, p < 0.001) compared with Black (Estimate = -0.07, p = 0.077) participants, twice as large in men (Estimate = -0.20, p < 0.001) compared with women (Estimate = -0.11, p < 0.001), highest among White men (Estimate = -0.22, p < 0.001) and lowest in Black women (Estimate = -0.04, p = 0.457). Greater post-retirement cognitive decline was also observed among participants who attended college (Estimate = -0.14, p = 0.016). While greater work complexity (Estimate = 0.92, p < 0.05) and higher income (Estimate = 1.03, p < 0.05) were related to better cognitive function at retirement, neither was significantly related to cognitive change after retirement.

CONCLUSION

Cognitive functioning may decline at an accelerated rate immediately post-retirement, more so in White adults and men than Black adults and women. Lifelong structural inequalities including occupational segregation and other social determinants of cognitive health may obscure the role of retirement in cognitive aging.

Racism as a Public Health Issue for Nurses of Color in Clinical and Academic Settings: Ten Nurses Tell Their Stories

AIM

The aim of this study was to bring awareness to how racism and discrimination, accompanied by bullying and incivility, negatively impact the health of nurses of color.

BACKGROUND

Racism and discrimination encountered in the daily lives of nurses of color present risk for psychological and physiological damage to their health. Repeated exposure to racism and discrimination leads to cumulative stress that may pose a negative impact on the health status of affected nurses.

METHODS

Phenomenology served as the methodology for this research study. The principal investigator transcribed and coded data from 10 nurse participants.

RESULTS

Data illustrate a pattern of nurses of color experiencing discrimination and racism, with racism being a potential public health issue. Their stories may empower others to make positive, productive decisions and persevere.

CONCLUSION

Long-term exposure to racism and its related potential effects on nurses' health presents a grave concern for nurses of color.

Work as an Understudied Driver of Racial Inequities in Breastfeeding

Breastfeeding inequities by race are a persistent public health problem in the United States. Inequities in occupation and working conditions likely contribute to relatively less breastfeeding among Black compared to White mothers, yet little research has addressed these interrelationships. Here, we offer a critical review of the literature and a conceptual framework to guide future research about work and racial inequities in breastfeeding. There is a strong public health case for promoting breastfeeding equity for mothers across race groups and occupation types. Existing theory suggests that employment opportunities and working conditions are a likely pathway that connects structural racism to Black-White breastfeeding inequities, in addition to other known factors. We propose a new conceptual model for studying the interrelationships among work, race, and breastfeeding outcomes.

Low Job Control and Racial Disparities in Breastfeeding

BACKGROUND

Low job control may predict shorter breastfeeding (BF) among working mothers and may contribute to racial disparities in BF.

METHODS

We used demographic, employment, and health data for n = 631 observations from the Panel Study of Income Dynamics. Job control scores came from a job-exposure matrix.Using path analysis, we assessed whether job control predicted BF and mediated Black-White BF differences. We controlled for education, working hours, marital status, and low birthweight.

RESULTS

Lower job control predicted decreased odds of BF for at least 6 months (odds ratio, 0.61; 95% confidence interval, 0.31-0.90; reference, no BF). Low job control explained 31% of the Black-White difference for both shorter-term and longer-term BF.

CONCLUSIONS

Low job contributes to shorter BF and to BF disparities by race. Intervening to enhance job control could improve BF.

Young women's food consumption and mental health: the role of employment

Objectives

This study explores the relationship between young women’s consumption of healthy and unhealthy food and depression and examines the moderating effect of their employment status on the relationship.

Methods

The National Longitudinal Survey of Youth 79 for Children and Young Adults (NLSY79 CY) was used for this study. The final sample included a total of 1524 young women aged from 18 to 35 years. Multiple Linear Regression was conducted to answer the research questions.

Results

Fast food consumption was related to higher levels of depression among young women while fruit intake was associated with lower levels of depression. Employment status moderated the relationship between young women’s fruit consumption and depression.

Conclusions

Young women are encouraged to consume more fruit and less fast food in order to ameliorate depression. Programs that target young women’s mental health should consider addressing their nutritional needs, through, for example, vouchers for fresh, nutritious foods; nutrition or cooking education; or having a certified nutrition specialist on staff.

Epidemiology of respiratory diseases and associated factors among female textile workers in Pakistan

Objective. The study aimed to estimate the prevalence of byssinosis and other respiratory symptoms among women textile workers and the associated risk factors in 18 spinning mills of Faisalabad and Lahore districts of Punjab, Pakistan. Method. In this case-control study of 1054 female workers, we used the dose-response function to measure the association between dust level and respiratory disorders in cotton textile workers. Results. Working overtime and long working hours per week are significantly associated with self-reported symptoms of byssinosis. Women's age, marital status and wages were significantly associated with mitigating actions (seeing the doctor), while the education of the women was significantly associated with averting action (use of a mask). Conclusion. Regulating working hours and ensuring employees' compliance with the safety standards are expected to mitigate the health problems of female workers.

Unfair labour practice on staff in primary health care facilities, North West province, South Africa: A qualitative study

Background

Unfair labour practices on staff is a worldwide concern which creates conflicts and disharmony among health workers in the workplace. It is found that, nursing staff members are unfairly treated without valid reasons in primary health care (PHC) facilities and predominantly in the developing countries and South Africa is not an exception.

Objectives

The purpose of the study was to explore and describe the experiences of operational managers regarding unfair labour practices on staff by their local health area managers, and describe the perceptions of operational managers towards such treatment.

Method

A qualitative, descriptive, exploratory and contextual research approach was considered appropriate for the study. The population of the study comprised operational managers working in PHC facilities in the North West province, South Africa. Purposive sampling was used to select participants for the study and focus group interviews used to interview 23 operational managers. Ethical measures were applied throughout the study.

Results

The six phases of thematic analysis were used to analyse the data collected for the study. Two themes that emerged are experiences of factors related to unfair labour practices in the PHC facilities and the perceptions regarding how to improve their working conditions. The categories that were found in the first themes were favouritism and discrimination. In the second theme, in-service training and transparency regarding staff training and development emerged. Recommendations comprised, among others, training on the concepts of equality in the workplace, and reinforcement of transparency regarding granting of study leave and attending workshops.

Conclusion

Operational managers in the PHC facilities experienced unfair labour practices as evidenced by favouritism and discrimination.

Prevalence of Discrimination, Abuse, and Harassment in Emergency Medicine Residency Training in the US

IMPORTANCE

The prevalence of workplace mistreatment and its association with the well-being of emergency medicine (EM) residents is unclear. More information about the sources of mistreatment might encourage residency leadership to develop and implement more effective strategies to improve professional well-being not only during residency but also throughout the physician's career.

OBJECTIVE

To examine the prevalence, types, and sources of perceived workplace mistreatment during training among EM residents in the US and the association between mistreatment and suicidal ideation.

DESIGN, SETTING, AND PARTICIPANTS

In this survey study conducted from February 25 to 29, 2020, all residents enrolled in EM residencies accredited by the Accreditation Council for Graduate Medical Education (ACGME) who participated in the 2020 American Board of Emergency Medicine computer-based In-training Examination were invited to participate. A multiple-choice, 35-item survey was administered after the examination asking residents to self-report the frequency, sources, and types of mistreatment experienced during residency training and whether they had suicidal thoughts.

MAIN OUTCOMES AND MEASURES

The types and frequency of workplace mistreatment and the sources of the mistreatment were identified, and rates of self-reported suicidality were obtained. Multivariable logistic regression models were used to examine resident and program characteristics associated with suicidal thoughts.

RESULTS

Of 8162 eligible EM residents, 7680 (94.1%) responded to at least 1 question on the survey; 6503 (79.7%) completed the survey in its entirety. A total of 243 ACGME-accredited residency programs participated, and 1 did not. The study cohort included 4768 male residents (62.1%), 2698 female residents (35.1%), 4919 non-Hispanic White residents (64.0%), 2620 residents from other racial/ethnic groups (Alaska Native, American Indian, Asian or Pacific Islander, African American, Mexican American, Native Hawaiian, Puerto Rican, other Hispanic, or mixed or other race) (34.1%), 483 residents who identified as lesbian, gay, bisexual, transgender, queer, or other (LGBTQ+) (6.3%), and 5951 residents who were married or in a relationship (77.5%). Of the total participants, 3463 (45.1%) reported exposure to some type of workplace mistreatment (eg, discrimination, abuse, or harassment) during the most recent academic year. A frequent source of mistreatment was identified as patients and/or patients' families; 1234 respondents (58.7%) reported gender discrimination, 867 (67.5%) racial discrimination, 282 (85.2%) physical abuse, and 723 (69.1%) sexual harassment from patients and/or family members. Suicidal thoughts occurring during the past year were reported by 178 residents (2.5%), with similar prevalence by gender (108 men [2.4%]; 59 women [2.4%]) and race/ethnicity (113 non-Hispanic White residents [2.4%]; 65 residents from other racial/ethnic groups [2.7%]).

CONCLUSIONS AND RELEVANCE

In this survey study, EM residents reported that workplace mistreatment occurred frequently. The findings suggest common sources of mistreatment for which educational interventions may be developed to help ensure resident wellness and career satisfaction.

Work, race and breastfeeding outcomes for mothers in the United States

Background

In the United States, mothers’ employment status and occupation are related to breastfeeding. However, it is unclear whether not working leads to longer breastfeeding duration even when compared to professional/managerial jobs, which tend to accommodate breastfeeding better than service/manual labor jobs. Furthermore, occupation and breastfeeding are racially patterned, and it is possible that race could moderate the relationships between mother’s work and breastfeeding.

Methods

Using data from the Panel Study of Income Dynamics, we modeled breastfeeding duration based on mother’s employment/occupation (not working, professional/managerial work, or service/labor work) during the first 6 months postpartum, as well as mother’s race (White, Black or other) and other potential confounders. We used zero-inflated negative binomial regression models and tested an interaction between employment/occupation type and race. Predictive margins were used to compare breastfeeding duration among subgroups.

Results

Mothers working in service/labor occupations had the shortest breastfeeding duration of the three employment/occupation groups, and there was no significant difference in duration between not working and professional/managerial occupation. White mothers had longer breastfeeding duration than Black mothers on average. When we included an interaction between employment/occupation and race, we found that among White mothers, non-working mothers breastfed the longest, while mothers in service/labor work breastfed for the shortest duration, but among Black mothers, mothers in professional/managerial work breastfed for longer than mothers in the other two work categories.

Discussion

Race moderated the relationship between employment status/occupation type and breastfeeding such that, for White mothers, not working was the most advantageous circumstance for breastfeeding, in line with traditional work-family conflict theory. In contrast, for Black mothers, professional/managerial work was the most advantageous circumstance. These findings support the idea of the Market-Family Matrix, which allows that different work scenarios may be more or less advantageous for parenting behaviors like breastfeeding, depending on mothers’ circumstances.

Disparities in food insecurity at the intersection of race and sexual orientation: A population-based study of adult women in the United States

Food insecurity affects 1 in 8 American adults annually, and is more prevalent in Black and sexual minority women. We applied an intersectional approach to investigate food insecurity prevalence in women with intersecting minority race and sexual orientation. We used two United States surveillance systems-National Health Interview Survey (NHIS) 2013-2018 and National Health and Nutrition Examination Survey (NHANES) 2005-2014, to estimate how race and sexual orientation jointly influence food insecurity prevalence in women aged 18-59 years (NHIS: N = 47596; NHANES: N = 5106). All analyses were stratified for Supplemental Nutrition Assistance Program (SNAP) use. Relative measures estimated weighted prevalence ratios (PR) comparing Black and White sexual minority women (SMW) to heterosexual White women. Absolute prevalence measures estimated the excess prevalence of food insecurity due to multiple marginalization. Patterns of food insecurity prevalence were similar across NHIS and NHANES, and differed only for non-SNAP users. Relative prevalence of food insecurity was greater in Black SMW than heterosexual White women in NHIS (PR: 2.16; 95% confidence interval [CI], 1.41-3.30) and NHANES (PR: 2.79; 95% CI, 1.73-4.51). The strength of the association between multiple marginalization and food insecurity was stronger for Black SMW than White SMW. Absolute measures were significant only for NHIS and did not support our a priori hypothesis: For non-SNAP users, being Black and sexual minority reduced the joint disparity in food insecurity by approximately 50% (Synergy Index: 0.52; 95% CI, 0.11-0.93). Overall, our study illuminated population-level differences in food insecurity among women of diverse minority races and sexual orientations. Black SMW experienced high rates of food insecurity, which may contribute to chronic disease disparities. Yet, intersecting minority social positions (race and sexual orientation) reduced food insecurity; these findings are unexpected and must be further investigated. Increasing SNAP use among multiply marginalized women may attenuate food insecurity disparities.