The Health of Permanent Workers and Workers with Precarious Employment: A Literature Review

Inequality in workplace support for various types of precarious workers compared with permanent workers in Japan: A cross-sectional study

OBJECTIVES

The purpose of this study was to examine, by sex, whether precarious workers in Japan receive less support in the workplace than permanent workers.

METHODS

We conducted a cross-sectional study using an online questionnaire in 2022. We stratified participants by sex and performed modified Poisson regression analysis. The outcomes were support from supervisors, co-workers, occupational health professionals, and no one. Adjusted prevalence ratios (aPR) were calculated for contract workers, part-time workers, and dispatched workers, using permanent workers as reference.

RESULTS

This study had 21 047 participants. For men, 87.9% were permanent workers; for women, 50.7% were permanent workers and 37.3% were part-time workers. For workplace support, 47.5% of men and 45.2% of women selected superiors; 41.8% of men and 50.5% of women selected colleagues; 16.8% of men and 6.2% of women selected occupational health professionals. Female contract workers were less likely to receive support from their supervisors (aPR 0.88) or co-workers (aPR 0.89). Male part-time workers were less likely to be supported by their co-workers (aPR 0.86). Dispatched workers were less likely to be supported by their supervisors (men aPR 0.71, women aPR 0.84) and co-workers (men aPR 0.73, women aPR 0.77). Part-time and dispatched workers were less likely to receive support from occupational health professionals.

CONCLUSIONS

Precarious workers could get less workplace support than permanent workers. This may contribute to occupational health problems with precarious workers.

Co-exposures to physical and psychosocial work factors increase the occurrence of workplace injuries among French care workers

Objective

The aim of this study was to analyze the effect of co-exposures to physical and psychosocial factors (PSF) regarding the incidence of workplace injuries (WI) among care workers. Additional objective was to identify the work factors associated with the co-exposure combinations leading to the highest rates of WI.

Methods

The study sample consisted of 4,418 care workers participating to the French Working Conditions Survey both in 2013 and 2016. WI were assessed during the 4-year follow-up by matching the databases of the National Health Insurance Funds' compensation system. We assessed exposure for physical factors and PSF using factorial analyses and hierarchical clustering. We implemented a Poisson regression model with the WI incidence as the outcome and the clusters as independent variables of interest. Logistic regression model allowed identifying the work factors that predicted co-exposure combinations with a WI rate > 40%.

Results

WI were highly related to both physical and psychosocial exposures. With low exposure to one or the other, there was no increased risk of WI. Physical factors and PSF potentiated each other and their co-exposure significantly increased the risk of WI, with model predicted rates per 1,000 persons-year for those most exposed to physical risk of 14.6 [4.5-24.8] with low PSF and 38.0 [29.8-46.3] with high PSF. Work factors that predicted co-exposure combinations with a rate > 40 WI% were: working as nursing assistant or hospital services officer, lack of predictability and flexibility of schedules, overtime, controlled schedules, work-family imbalance and insufficient preventive measures.

Conclusions

Our findings highlight the need to take into account psychosocial factors in addition of only considering physical factors when analyzing WI occurrence, as usually done. Prevention actions must be taken to reduce both physical and psychosocial exposure. These results provide keys points for the prevention of WI among care workers.

The measure of precarious employment and its impact on the mental health of workers: A systematic review 2007–2020

BACKGROUND: Precarious employment conditions can influence the worker’s mental health; however, there is no consensus regarding the definition of precarious employment or the way it is measured. OBJECTIVE: The objective is to identify existing research of the conceptual framework, the ways to measure precarious employment and its impact on the mental health of workers. METHODS: A systematic review with the strategic search for observational-empirical and qualitative studies published between 2007 and 2020 in Embase, Scopus and PubMed, full text, in English and Spanish. Studies were selected and excluded, according to eligibility criteria. Two independent reviewers and one arbitrator evaluated the quality of selected papers with the STROBE guidelines for observational studies and SRQR for qualitative ones. RESULTS: 408 studies were obtained, 21 met inclusion criteria, in 14 studies precarious employment was measured one-dimensionally. Of these, 11 with the dimension of temporality and three with insecurity. Four studies it was measured in a multidimensional way, with the Employment Precariousness Scale (EPRES) and in three qualitative designs, with different categories of analysis. Mental health was measured with SF-36 (n = 4), GHQ-12 (n = 3) and CES-D (n = 3). CONCLUSIONS: The concept of precarious employment requires a multidimensional construct, although the tendency to measure precarious employment is one-dimensional. Regardless of how is measured, this has a negative impact on the mental health of workers. The outcomes related to this social determinant included depression, depressive symptoms, psychological distress, stress, and suicidal thoughts. Youths, women, people with low levels of education and immigrants are the groups that show the major precariousness.

Associations between Workers' Health and Working Conditions: Would the Physical and Mental Health of Nonregular Employees Improve If Their Income Was Adjusted?

Precarious employment can negatively affect health, but workers may be healthy if they earn enough income. This study uses equivalent disposable income and examines the interaction between income classes and employment types to clarify whether workers’ health improves as the income classes rise. In Japan, nonstandard workers, called nonregular employees, have remained high since 2013. Therefore, using data from the national cross-sectional Comprehensive Survey of Living Conditions 2013, an official survey performed in Japan, we targeted a sample of employees aged 18 to 45 who graduated during the economic recession. Our final sample included 8282 employees (4444 males and 3838 females). The health (general and mental) status indicators used the dichotomized self-rated health and scores of the K6 questionnaires scored in the national survey. The association between income and health was almost proportional. Female workers tended to improve their health as their income class increased; however, this tendency was not observed in male workers, especially nonregular employees. Although the associations were weakened by added income information on the regression models, nonregular employees always showed inferior health to regular employees. The health status of nonregular employees, especially female nonregular employees, is statistically significantly lower than that of regular employees, even when the economic class is similar. In conclusion, improving low incomes for nonregular employees could improve health challenges, but income alone may not result in the same health status for regular and nonregular employees.

Precarious employment and health in the context of COVID-19: a rapid scoping umbrella review

Background

There are widespread concerns that workers in precarious employment have suffered the most in the COVID-19 pandemic and merit special attention. The aim of this rapid scoping umbrella review was to examine what evidence exists about how COVID-19 has affected the health of this highly vulnerable group, and what gaps remain to be investigated.

Methods

Five databases were searched for systematic or scoping reviews from January 2020 to May 2021. The quality of the included reviews was determined using A MeaSurement Tool to Assess systematic Reviews.

Results

We identified 6 reviews that reported 30 unique relevant primary studies. The included studies indicate that essential (non-health) workers are at greater risk of COVID-19 infection and case fatality than others in their surrounding community. The occupational risk of exposure to COVID-19 also seems to be greater among more precarious categories of workers, including younger workers and workers in low-income and low-skilled occupations. Further, hazardous working conditions faced by many essential workers appear to have amplified the pandemic, as several occupational sites became ‘super-spreaders’, due to an inability to socially distance at work and high contact rates among workers. Finally, employment and financial insecurity generated by the pandemic appears to be associated with negative mental health outcomes. The quality of the included reviews however, and their primary studies, were generally weak and many gaps remain in the evidence base.

Conclusions

Our study highlights that COVID-19 is creating new health risks for precarious workers as well as exacerbating the pre-existing health risks of precarious employment.

Association Between Area-level Risk of Job Instability and Workers' Health: A Multi-level Analysis Using Population-based Survey Data From Japan

Background

Precarious job status is negatively related with workers’ health. Research has yet to address whether and to what extent the area-level risk of precarious employment is associated with workers’ health, independently from their job status. We addressed this issue in the present study.

Methods

We estimated multi-level logistic regression models using repeated cross-sectional data comprising 253,048 men and 210,761 women aged 20–59 years who were living in 47 prefectures. This data were obtained from population-based surveys conducted in 2010, 2013, and 2016 in Japan.

Results

For male workers, the estimated odds of reporting poor self-rated health, subjective symptoms, and problems in activities of daily living for those residing in the prefectures in the highest tertile of the proportion of precarious employees were 1.10 (95% confidence interval [CI], 1.01–1.18), 1.12 (95% CI, 1.05–1.19), and 1.15 (95% CI, 1.04–1.28) times, respectively, higher than those living in the prefectures in the lowest tertile, even after controlling for individuals’ job status and key covariates. The results remained largely similar, despite focusing on the sample with information about household income, which was available from the survey, and controlling for it. In contrast, the results indicated that women’s health outcomes were not associated with the prefecture-level proportion of precarious employees.

Conclusions

The area-level risk of precarious employment matters for male workers’ health independently from their job status, underscoring the importance of policy measures aimed to reduce the adverse impacts of precarious employment on workers’ health.

Characterising near misses and injuries in the temporary agency construction workforce: qualitative study approach

OBJECTIVES

To understand and characterise the construct of 'near misses' from the perspective of temporary construction workers and to describe the safety and health risks associated with and contributing to near misses and injuries in temporary workers in the construction industry.

METHODS

Six semistructured language-sensitive (ie, English and Spanish) focus group discussions were conducted with workers (n=43) employed with temporary staffing agencies in South Florida. This convenience sample completed a demographic questionnaire prior to the focus group discussion. A general inductive approach was used to examine near misses in the construction industry and the unique safety and health concerns of temporary workers.

RESULTS

Four broad themes describing near misses, reporting practices and workplace safety hazards in the construction industry were derived from the group discussions: (1) non-standard workers in the construction industry draw a clear distinction between near misses and injury and believe their best protections from both occur at the worker level; (2) social network structure on construction worksites is an effective way to protect workers against injury and near misses; (3) safety and health priorities and policies at the organisational level differ from those at the worker level, which contributes to workplace injury; and (4) reporting of safety concerns and near misses is influenced by injury severity.

CONCLUSIONS

Temporary workers in the construction industry are familiar with near misses but have limited resources to protect themselves against potential health and safety hazards. These non-standard workers addressed unique barriers to staying safe at work and identified potential improvements.

Associations of occupation, employment type and company size with actions related to health examinations among Japanese employees

Taking action in response to health examination results is important to stay healthy. We aimed to investigate the associations between occupation, employment type and company size, and having a health examination and taking action in response to the results among Japanese employees. We focused on three particular actions by employees in response to health examination results: paying attention to one's health, receiving health guidance, and visiting a medical institution. We used anonymous data from the 2010 Comprehensive Survey of Living Conditions of Japan, a self-administered nationwide questionnaire survey. The data of 23,963 employees (12,938 male and 11,025 female) aged 20-64 yr were analyzed using logistic regression models adjusted by covariates. There were significant changes in odds ratios for receiving a health examination by occupation, employment type and company size. We found significant odds ratios for receiving health guidance by occupation and company size, but there was almost no significant association with paying attention to one's health and visiting a medical institution. These results confirmed that receiving a health examination was associated with occupational factors, and suggested that receiving health guidance after health examination results was associated with occupation and company size.

Associations between working environment and weight control efforts among workers with obesity in Korea

Objective The aim of this study was to investigate the relationship between working environment and weight control efforts among obese workers in Korea. Methods This study was based on the 2011 3rd Korean Working Conditions Survey, which was conducted on workers aged 15 years or older. A sample of 484 obese workers was included in the study. Multivariable logistic regression analysis was used to investigate the relationship between working environment and weight control efforts after controlling for individual variables. Adjusted odds ratios (ORs) and 95% confidence intervals were calculated. Results Of the participants, 63.4% reported that they made efforts to control their weight. After controlling for personal factors, the OR of weight control efforts for individuals working 40-49 hours per week was 2.4 times that for individuals working 60 hours or more per week. The OR of regular employment workers was 2.2 times that of non-regular workers. Conclusion We established that working hours and employment type were significantly related to weight control efforts. Therefore, we recommend that working conditions should be considered in designing effective workplace health promotion programs.

Temporary employment and tooth loss: a cross-sectional study from the J-SHINE study

Background

Temporary employment leads to psychological distress and higher mortality, but data on its associations with oral health is limited. We examined whether having the experience of temporary employment was associated with tooth loss among working adults in Japan.

Methods

We conducted a cross-sectional study from the 2010–2011 Japanese Study on Stratification, Health, Income, and Neighborhood study that analyzed 2652 participants aged 25–50 years (men = 1394; women = 1258). Independent variable was changes in employment status (continuous regular employment and the experience of temporary employment). Dependent variable was self-reported tooth loss (none, 1 tooth, 2 teeth, 3 teeth, 4 teeth, and more than 4 teeth). Covariates were sex, age, years of education, self-rated household economic status in early life at 5 years old, marital status, number of family members in the household, history of diabetes, and body mass index. We conducted a negative binomial regression analysis to estimate prevalence rate ratios (PRRs) and 95% confidence intervals (95%CIs) for tooth loss. We also confirmed the interaction term between changes in employment status and sex.

Results

The median age of the participants was 37 years. The percentages of men and women who experienced temporary employment were 14.5% and 61.3%, respectively. Compared with continuous regular employment, the experience of temporary employment was significantly associated with tooth loss in both sexes after adjusting for the covariates (men: PRR = 1.50 [95%CI = 1.13, 2.00]; women: PRR = 1.42 [95%CI = 1.14, 1.76]). The interaction term between employment status and sex was not significant (p = 0.71).

Conclusions

Temporary employment is adversely associated with oral health.

Preventive measures and lifestyle habits against exertional heat illness in radiation decontamination workers

Objectives:

The aim of this study was to reveal the current state of preventive measures and lifestyle habits against heat illness in radiation decontamination workers and to examine whether young radiation decontamination workers take less preventive measures and have worse lifestyle habits than the elder workers.

Methods:

This was a cross-sectional study. Self-administered questionnaires were sent to 1,505 radiation decontamination workers in Fukushima, Japan. Five hundred fifty-eight men who replied and answered all questions were included in the statistical analysis. The questionnaire included age, duration of decontamination work, previous occupation, lifestyle habit, and preventive measures for heat illness. We classified age of the respondents into five groups: <30, 30-39, 40-49, 50-59, and ≥60 years and defined the workers under 30 years of age as young workers. Logistic regression analysis was used to reveal the factors associated with each lifestyle habit and preventive measures.

Results:

In comparison with young workers, 50-59-year-old workers were significantly associated with refraining from drinking alcohol. Workers 40 years of age or older were significantly associated with cooling their bodies with refrigerant. Furthermore, 30-39-year-old workers and 40-49-year-old workers were significantly associated with adequate consumption of water compared to young workers.

Conclusion:

The results of our study suggests that young decontamination workers are more likely to have worse lifestyle habits and take insufficient preventive measures for heat illness. This may be the cause of higher incidence of heat illness among young workers.

Changes in the Employment Status and Risk of Stroke and Stroke Types

Background and Purpose—

Because of limited evidence, we investigated a long-term impact of changes in employment status on risk of stroke.

Methods—

This was a prospective study of 21 902 Japanese men and 19 826 women aged 40 to 59 years from 9 public health centers across Japan. Participants were followed up from 1990 to 1993 to the end of 2009 to 2014. Cox proportional hazard ratio of stroke (incidence and mortality) and its types (hemorrhagic and ischemic) was calculated according to changes in the employment status within 5 years interval between 1990 to 1993 and 1995 to 1998 (continuously employed, job loss, reemployed, and continuously unemployed).

Results—

During the follow-up period, 973 incident cases and 275 deaths from stroke in men and 460 cases and 131 deaths in women were documented. Experiencing 1 spell of unemployment was associated with higher risks of morbidity and mortality from total, hemorrhagic, and ischemic stroke in both men and women, even after propensity score matching. Compared with continuously employed subjects, the multivariable hazard ratio (95% confidence interval) for total stroke incidence in job lost men was 1.58 (1.18–2.13) and in job lost women was 1.51 (1.08–2.29), and those for total stroke mortality were 2.22 (1.34–3.68) in men and 2.48 (1.26–4.77) in women. The respective hazard ratio (95% confidence interval) in reemployed men was 2.96 (1.89–4.62) for total stroke incidence and 4.21 (1.97–8.97) for mortality, whereas those in reemployed women were 1.30 (0.98–1.69) for incidence and 1.28 (0.76–2.17) for mortality.

Conclusions—

Job lost men and women and reemployed men had increased risks for both hemorrhagic and ischemic stroke incidence and mortality.

Therapeutic Work as a Facilitator for Return to Paid Work in Cancer Survivors

Purpose The increase of flexible employment in European labour markets has contributed to workers' risk of job loss. For sick-listed workers with chronic illnesses, such as cancer, and especially those without an employment contract, participation in therapeutic work may be an important step towards paid employment. The purpose of this study was to determine the role of therapeutic employment as facilitator for return to paid work, in a cohort of sick-listed cancer survivors (CSs) with and without an employment contract. Methods In this longitudinal study, data were used from a cohort of Dutch CSs (N = 192), who applied for disability benefits after 2 years of sick leave. The primary outcome measure was return to paid work after 1 year. Logistic regression analysis was applied. Results Of the participating CSs (mean age 50.7 years, 33 % male), 69 % had an employment contract at baseline. CSs without an employment contract participated significantly less in therapeutic work (p < 0.001) and were less likely to return to paid work after 1 year (p = 0.001), than those with a contract. Participation in therapeutic work significantly increased the chance of return to paid work after 1 year (OR 6.97; 95 % CI 2.94-16.51), adjusted for age, gender, level of work disability and having an employment contract. Conclusions Participation in therapeutic work could be an important facilitator for return to paid work in sick-listed CSs. The effectiveness of therapeutic work as a means to return to paid employment for sick-listed workers should be studied in an experimental setting.

Relationship between non-standard work arrangements and work-related accident absence in Belgium

Objectives:

The main objective of this study is to examine the relationship between indicators of non-standard work arrangements, including precarious contract, long working hours, multiple jobs, shift work, and work-related accident absence, using a representative Belgian sample and considering several socio-demographic and work characteristics.

Methods:

This study was based on the data of the fifth European Working Conditions Survey (EWCS). For the analysis, the sample was restricted to 3343 respondents from Belgium who were all employed workers. The associations between non-standard work arrangements and work-related accident absence were studied with multivariate logistic regression modeling techniques while adjusting for several confounders.

Results:

During the last 12 months, about 11.7% of workers were absent from work because of work-related accident. A multivariate regression model showed an increased injury risk for those performing shift work (OR 1.546, 95% CI 1.074-2.224). The relationship between contract type and occupational injuries was not significant (OR 1.163, 95% CI 0.739-1.831). Furthermore, no statistically significant differences were observed for those performing long working hours (OR 1.217, 95% CI 0.638-2.321) and those performing multiple jobs (OR 1.361, 95% CI 0.827-2.240) in relation to work-related accident absence. Those who rated their health as bad, low educated workers, workers from the construction sector, and those exposed to biomechanical exposure (BM) were more frequent victims of work-related accident absence. No significant gender difference was observed.

Conclusion:

Indicators of non-standard work arrangements under this study, except shift work, were not significantly associated with work-related accident absence. To reduce the burden of occupational injuries, not only risk reduction strategies and interventions are needed but also policy efforts are to be undertaken to limit shift work. In general, preventive measures and more training on the job are needed to ensure the safety and well-being of all workers.

Development of the health literacy on social determinants of health questionnaire in Japanese adults

BACKGROUND

Health inequities are increasing worldwide, with mounting evidence showing that the greatest cause of which are social determinants of health. To reduce inequities, a lot of citizens need to be able to access, understand, appraise, and apply information on the social determinants; that is, they need to improve health literacy on social determinants of health. However, only a limited number of scales focus on these considerations; hence, we developed the Health Literacy on Social Determinants of Health Questionnaire (HL-SDHQ) and examined its psychometric properties.

METHODS

We extracted domains of the social determinants of health from "the solid facts" and related articles, operationalizing the following ten domains: "the social gradient," "early life," "social exclusion," "work," "unemployment," "social support," "social capital," "addiction," "food," and "transport," Next, we developed the scale items in the ten extracted domains based on the literature and included four aspects of health literacy (ability to access, understand, appraise, and apply social determinants of health-related information) in the items. We also evaluated the ease of response and content validity. The self-administered questionnaire consisted of 33 items. The reliability and construct validity were verified among 831 Japanese adults in an internet survey.

RESULTS

The scale items had high reliability with a Cronbach's alpha of 0.92, and also adequate results were obtained for the internal consistency of the information-processing dimensions (Cronbach's alpha values were 0.82, 0.91, 0.84, and 0.92 for accessing, understanding, appraising, and applying, respectively). The goodness of fit by confirmatory factor analysis based on the four dimensions was an acceptable value (comparative fit index = 0.901; root mean square error of approximation = 0.058). Furthermore, the bivariate relationship between HL-SDHQ and the frequency of participation in citizen's activities was similar to the theoretical results.

CONCLUSIONS

HL-SDHQ clarifies the relationship between the ten domains of the social determinants of health and health in each domain and is able to measure whether it is possible to access, understand, appraise, and apply related information. The reliability and validity of the scale were adequate.

Association between employment status and self-rated health: Korean working conditions survey

Background

This research was conducted with an aim of determining the association between employment status and self-rated health.

Methods

Using the data from the Third Korean Working Conditions Survey conducted in 2011, We included data from 34,783 respondents, excluding employers, self-employed workers, unpaid family workers, others. Self-rated health was compared according to employment status and a logistic regression analysis was performed.

Results

Among the 34,783 workers, the number of permanent and non-permanent workers was 27,564 (79.2 %) and 7,219 (20.8 %). The risk that the self-rated health of non-permanent workers was poor was 1.20 times higher when both socio-demographic factors, work environment and work hazards were corrected.

Conclusions

In this study, perceived health was found to be worse in the non-permanent workers than permanent workers. Additional research should investigate whether other factors mediate the relationship between employment status and perceived health.

Prevalence of depression and its relationship with work characteristics in a sample of public workers

Occupation is a fundamental right, enabling social interaction and financial support for the individual. However, it is an undeniable source of stress, with consequences for physical and mental health. The prevalence of depression and somatic complaints were assessed in 1,013 public workers using the Beck Depression Inventory and a questionnaire investigating for the presence of somatic problems designed by the research team. The results were related to demographic characteristics, history of previous depressive episodes, work schedule (day work, night and day rotating shift work, day rotating shift work), and duration of current work schedule. There were more cases of moderate depression in the day rotating shift workers (84%) than in those working at night (83%). More women had mild or moderate depression than men (22% and 4% versus 10% and 3%, respectively). Severe depression was found only in men. Nearly 10% of depressed individuals reported previous depressive episodes. A link between depression and somatic complaints was also found. In particular, 59% of depressed subjects reported gastrointestinal complaints and 41% did not (P<0.001). In conclusion, the occurrence of depressive symptoms could be facilitated by occupation. A history of depressive symptoms should not be neglected, given the risk of recurrence. Somatic complaints could represent a "wake-up call" regarding depression. Global assessment and effective support are fundamental for promotion of a better quality of life in the at-risk category of workers.