Precarious Work in Midlife: Long-Term Implications for the Health and Mortality of Women and Men

Cumulative Unionization and Physical Health Disparities among Older Adults

Whereas previous research shows that union membership is associated with improved health, static measurements have been used to test dynamic theories linking the two. We construct a novel measure of cumulative unionization, tracking individuals across their entire careers, to examine health consequences in older adulthood. We use data from the Panel Study of Income Dynamics (1970-2019) and predict self-rated health, functional limitations, and chronic health conditions in ages 60 to 79 using cumulative unionization measured during respondents' careers. Results from growth models show that unionized careers are associated with .25 SD to .30 SD improvements in health among older adults across all measures. Analyses of life course mechanisms reveal heterogeneous effects across unionization timing, age in older adulthood, and birth cohort. Moreover, subgroup analyses reveal unionization to partially, but not fully, ameliorate disparities based on privileged social positions. Our findings reveal a substantial and novel mechanism driving older adulthood health disparities.

Ramifications of Precarious Employment for Health and Health Inequity: Emerging Trends from the Americas

Precarious employment (PE), which encompasses the power relations between workers and employers, is a well-established social determinant of health that has strong ramifications for health and health inequity. In this review, we discuss advances in the measurement of this multidimensional construct and provide recommendations for overcoming continued measurement challenges. We then evaluate recent evidence of the negative health impacts of PE, with a focus on the burgeoning studies from North America and South America. We also establish the role of PE in maintaining and perpetuating health inequities and review potential policy solutions to help alleviate its health burden. Last, we discuss future research directions with a call for a better understanding of the heterogeneity within PE and for research that focuses both on upstream drivers that shape PE and its impacts on health, as well as on the mechanisms by which PE causes poor health.

The Covid-19 pandemic as an accelerator of economic worries and labor-related mental health polarization in Germany? A longitudinal interacted mediation analysis with a difference-in-difference comparison

Objectives

Labor-related mental health polarization refers to exposure to low-paid employment and unemployment decreasing mental health. Previous research identified economic worries as a key mediator. Against this background, the Covid-19 pandemic is often assumed to have accelerated already existing processes and affected vulnerable populations the most. Our study sought to investigate whether the Covid-19 pandemic accelerated the mediation by economic worries between employment type and mental health.

Method

Using the German Socioeconomic Panel (GSOEP) from 2016 onwards, we created a pre-Covid-19 sample (N = 8266) and a per-Covid-19 sample (N = 7294), with each having a t0 wave (2016/2018) and a t1 wave (2018/2020). We applied the mediational g-formula for longitudinal mediation with exposure-mediator (XM) interaction between employment type (X) and economic worries (M). We decomposed the total effect into a direct, indirect, and interacted effect of employment on mental health and provided a difference-in-difference comparison of the effects.

Results

During the Covid-19 pandemic, economic worries increased, and mental health decreased. However, the mediation by economic worries reduced by approx. 18.0% (e.g., from 35.0% to 28.9%). A decreased indirect effect caused the reduction in mediation, while the direct and interacted effect remained rather stable. We also found stark gender differences towards males having a higher total effect but a lower mediated effect during the Covid-19 pandemic.

Conclusion

Our results highlight that mediators competing to economic worries must have emerged during the Covid-19 pandemic. Such mediators could be the risk of infection at the workplace, the possibility of remote work, and gender-specific mediators. Our study is also the first to extend the mediational g-formula with the difference-in-difference approach. It can be used as a blueprint for researchers interested in evaluating the impact of events, such as the Covid-19 pandemic, on preexisting processes.

Mortality in Women across the FMR1 CGG Repeat Range: The Neuroprotective Effect of Higher Education

Higher education has been shown to have neuroprotective effects, reducing the risk of Alzheimer's and Parkinson's diseases, slowing the rate of age-related cognitive decline, and is associated with lower rates of early mortality. In the present study, the association between higher education, fragile X messenger ribonucleoprotein 1 (FMR1) cytosine-guanine-guanine (CGG) repeat number, and mortality before life expectancy was investigated in a population cohort of women born in 1939. The findings revealed a significant interaction between years of higher education and CGG repeat number. Counter to the study's hypothesis, the effects of higher education became more pronounced as the number of CGG repeats increased. There was no effect of years of higher education on early mortality for women who had 25 repeats, while each year of higher education decreased the hazard of early mortality by 8% for women who had 30 repeats. For women with 41 repeats, the hazard was decreased by 14% for each additional year of higher education. The interaction remained significant after controlling for IQ and family socioeconomic status (SES) measured during high school, as well as factors measured during adulthood (family, psychosocial, health, and financial factors). The results are interpreted in the context of differential sensitivity to the environment, a conceptualization that posits that some people are more reactive to both negative and positive environmental conditions. Expansions in CGG repeats have been shown in previous FMR1 research to manifest such a differential sensitivity pattern.

Do supportive work environments matter for minority aging? Work stress and subjective cognitive impairment among middle-age and older lesbian, gay, bisexual, transgender, and queer adults

Research has documented how people's experiences at work affect their cognitive health outcomes, but how these processes unfold for minority groups, particularly lesbian, gay, bisexual, transgender, and queer (LGBTQ+) populations, is unclear. This study builds on the nascent literature by employing generalized structural equation models to test how experiencing major problems at work and working with LGBTQ+ supportive coworkers affect subjective cognitive impairment among middle-age and older LGBTQ+ adults. We also test for mediated and indirect effects of support and problems at work operating via vascular disease, sleep problems, and depression symptoms. Experiencing major problems at work is associated with a higher likelihood of reporting cognitive symptoms consistent with mild cognitive impairment, but this relationship is mediated by depression symptoms and sleep problems. Having LGBTQ+ supportive coworkers does not have direct effects on mild cognitive impairment, but does operate indirectly by decreasing problems at work and, in turn, decreases the likelihood of reporting cognitive symptoms consistent with mild cognitive impairment. Overall, we find that workplace stressors contribute to cognitive health directly and through mediated and indirect pathways and that supportive contexts reduce exposure to problems at work. We conclude with suggested possibilities to reorganize workplaces to improve long-term cognitive health outcomes for older adults, especially those who are LGBTQ+-identified.

A Person-Centered Approach to Job Insecurity: Is There a Reciprocal Relationship between the Quantitative and Qualitative Dimensions of Job Insecurity?

Radical transformations in the current work model induce qualitative job insecurity (i.e., a threat to job characteristics) and strengthen quantitative job insecurity (i.e., a threat to job loss). Both dimensions are separate yet interdependent work stressors. Although organisational changes are often the core source for both types of job insecurity, it is predominantly a subjective experience-individual perception ultimately determines the risk and the consequences of these threats. So far, the between-person analysis suggests that the relationship between the two dimensions is in both directions. However, it is not clear whether these associations also reflect within-person processes. This study proposes and tests the reciprocal relationship between quantitative and qualitative job insecurity at the within-person level. We employed a multiple indicator random-intercept cross-lagged panel model (RI-CLPM) to test these associations within-person while controlling for between-person differences. We used three-wave longitudinal data (6 months' time lag) collected from a Belgian working population (N = 3694). The results suggest a unidirectional relationship (from quantitative to qualitative job insecurity). Furthermore, the results reveal significant within-person carry-over effects of quantitative job insecurity but not for qualitative job insecurity. Overall, these results suggest that a change in the experience of threats to job loss (i.e., higher-than-usual quantitative job insecurity) not only anticipates higher-than-usual threats to job loss (autoregressive paths) but also higher-than-usual threats to job characteristics (i.e., qualitative job insecurity), six months later. This study contributes to the ongoing discussion on how job insecurity dimensions influence each other. Given these results and the continuous changes to how we work, we call for further research to better understand the within-person processes of job insecurity development.

History of Low Hourly Wage and All-Cause Mortality Among Middle-aged Workers

Importance

Earning a low wage is an increasingly recognized public health concern, yet little research exists on the long-term health consequences of sustained low-wage earning.

Objective

To examine the association of sustained low-wage earning and mortality in a sample of workers with hourly wage reported biennially during peak midlife earning years.

Design, Setting, and Participants

This longitudinal study included 4002 US participants, aged 50 years or older, from 2 subcohorts of the Health and Retirement Study (1992-2018) who worked for pay and reported earning hourly wages at 3 or more time points during a 12-year period during their midlife (1992-2004 or 1998-2010). Outcome follow-up occurred from the end of the respective exposure periods until 2018.

Exposures

Low-wage-less than the hourly wage for full-time, full-year work at the federal poverty line-earning history was categorized as never earning a low wage, intermittently earning a low wage, and sustained earning a low wage.

Main Outcomes and Measures

Cox proportional hazards and additive hazards regression models sequentially adjusted for sociodemographics, and economic and health covariates were used to estimate associations between low-wage history and all-cause mortality. We examined interaction with sex or employment stability on multiplicative and additive scales.

Results

Of the 4002 workers (aged 50-57 years at the beginning of exposure period and 61-69 years at the end), 1854 (46.3%) were female; 718 (17.9%) experienced employment instability; 366 (9.1%) had a history of sustained low-wage earning; 1288 (32.2%) had intermittent low-wage earning periods; and 2348 (58.7%) had never earned a low wage. In unadjusted analyses, those who had never earned low wages experienced 199 deaths per 10 000 person-years, those with intermittent low wages, 208 deaths per 10 000 person-years, and those with sustained low wages, 275 deaths per 10 000 person-years. In models adjusted for key sociodemographic variables, sustained low-wage earning was associated with mortality (hazard ratio [HR], 1.35; 95% CI, 1.07-1.71) and excess deaths (66; 95% CI, 6.6-125); these findings were attenuated with additional adjustments for economic and health covariates. Significant excess death and elevated mortality risk were observed for workers with sustained low-wage exposure and employment fluctuations (eg, for sustained low-wage × employment fluctuated, HR, 2.18; 95% CI, 1.35-3.53; for sustained low-wage × stable employment, HR, 1.17; 95% CI, 0.89,-1.54; P for interaction = .003).

Conclusions and Relevance

Sustained low-wage earning may be associated with elevated mortality risk and excess deaths, especially when experienced alongside unstable employment. If causal, our findings suggest that social and economic policies that improve the financial standing of low-wage workers (eg, minimum wage laws) could improve mortality outcomes.

Precarious Employment and Well-Being: Insights from the COVID-19 Pandemic

While precarious employment is not a new concept, it has been brought to the center of scholarly and public discourse worldwide by the unprecedented COVID-19 pandemic. This essay delineates how precarious employment shapes well-being and situates that relationship in the context of the COVID-19 pandemic. The essay also provides an overview of how the nine articles boldly investigate how these two layers of global risk-precarious employment and the pandemic-interact to shape individuals' well-being. In addition to advancing theoretical and empirical knowledge by analyzing timely data from diverse sources and populations, these articles call for more efforts on worker protection reforms and government financial support.

The Emergence of Precarious Employment as a Determinant of Health in Europe and the Relevance of Contextual Factors: A Critical Research Synthesis

Precarious employment as a determinant of health remains on the rise in Europe, in contrast to the European Pillar of Social Rights. Research in epidemiology, public health, and occupational health research has debated the health impacts of precarious employment. A number of studies have concluded that precarious employment contributes to poor health. More recent research has focused on the contextual influences of the association between precarious employment and health. Accordingly, we argue that the welfare state and the specific institutional arrangements on the national level determine and mediate the extent of the association between precarious employment and health. This research synthesis: (a) debates explanations for the rise of precarious employment in Europe, (b) illustrates how precarious employment has risen in Europe since the 1980s, (c) indicates empirical findings of the association between precarious employment and health in Europe, (d) discusses how research explains between-country differences of the association between precarious employment and health, and (e) presents empirical findings on the contextual determinants of the association between precarious employment and health in Europe.

Precarious work and heath: Do occupation- and state-specific unemployment rates matter for women and for men?

Precarious work has the potential to undermine workers' health and well-being, and linkages between precarious work and health may depend on contextual measures of unemployment. The present study uses data from the Current Population Survey (CPS; 2001-2019) to examine whether several characteristics of precarious work are associated with self-rated health, with attention to differences in these associations by occupation- and state-specific unemployment rates. Findings indicate that experiences of unemployment, part-time work, and poor work quality (limited social benefits and low wages) are associated with worse self-rated health for working women and men. Moreover, associations between some measures of precarious work and health are weaker at higher levels of occupation- and state-specific unemployment for men, but not for women. The present study points to precarious work as a chronic stressor for many workers that must be considered within broader economic contexts.