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Lundstrom EW, Asfaw A, Steege AL, Bhattacharya A, Groenewold M. Precarious employment and mental health in the United States: Results from the Medical Expenditure Panel Survey (MEPS), 2008-2021. Prev Med 2024; 186:108090. [PMID: 39098343 PMCID: PMC11370106 DOI: 10.1016/j.ypmed.2024.108090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Revised: 07/30/2024] [Accepted: 07/31/2024] [Indexed: 08/06/2024]
Abstract
OBJECTIVES To measure associations between employment precarity and mental health among United States (US) workers. METHODS This study used data from the US Medical Expenditure Panel Survey for 2008-2021. Multivariable generalized estimating equations were used to measure associations between employment precarity (operationalized as a multi-dimensional exposure) and self-rated mental health after adjusting for relevant confounders. Marginal effects analysis was used to assess potential dose-response relationships between precarity and mental health. RESULTS Our sample (n = 57,529) was representative of >106 million US workers employed throughout 2008-2021. Compared to those with low levels of employment precarity, those with medium and high levels of precarity had an increased odds of reporting poor/fair mental health (aOR = 1.21; 95% CI = 1.11, 1.32 and 1.51; 95% CI = 1.36, 1.68, respectively). Marginal effects analysis indicated that increasing levels of precarity were associated with an increased probability of reporting poor/fair mental health. CONCLUSIONS Increasing levels of employment precarity were associated with poor/fair self-rated mental health, findings potentially indicative of a dose-response relationship between the two. These nationally representative findings suggest employment precarity is an important social determinant of mental health. Future research could investigate how best to mitigate the negative effects of precarity on workers' lives and well-being, particularly regarding mental health.
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Affiliation(s)
- Eric W Lundstrom
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, United States of America; Health Informatics Branch, Division of Field Studies and Engineering, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, United States of America.
| | - Abay Asfaw
- Economics Research and Support Office, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, United States of America
| | - Andrea L Steege
- Health Informatics Branch, Division of Field Studies and Engineering, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, United States of America
| | - Anasua Bhattacharya
- Economics Research and Support Office, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, United States of America
| | - Matthew Groenewold
- Health Informatics Branch, Division of Field Studies and Engineering, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, United States of America
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Schaefer C, Ahonen E. Creating Shared Perspectives for Worker Well-being: A Community Health-Focused Certificate in Total Worker Health®. J Occup Environ Med 2024; 66:445-449. [PMID: 38335729 DOI: 10.1097/jom.0000000000003064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2024]
Abstract
OBJECTIVES This study aimed to highlight the utility of a new certificate program in Total Worker Health ® (TWH) designed for health professionals in other community health settings (OCHS). METHODS Stakeholder needs assessment, priority setting, and comparison with existing core competencies in TWH approaches were performed to identify learning objectives and curricular threads in alignment with adult learning principles. Faculty-student pairings were conducted for content and assessment development. RESULTS A free six-module training course that prepares OCHS professionals to collaborate with occupational safety and health (OSH) professionals. CONCLUSIONS TWH can be advanced through collaboration between OSH and OCHS professionals. In service of shared ground, OCHS professionals should articulate the influence of work on health, TWH principles, and OSH vocabulary and concepts. Such training is a necessary step toward facilitating groups for the benefit of all work and workers.
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Affiliation(s)
- Camie Schaefer
- From the Utah Center for Promotion of Work Equity Research, Department of Family and Preventive Medicine, University of Utah, Salt Lake City, Utah (C.S., E.A.); and Department of Family and Preventive Medicine, University of Utah, Salt Lake City, Utah (C.S., E.A.)
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Omari A, Siegel MR, Rocheleau CM, Fujishiro K, Van Buren K, Shi D, Agopian A, Gilboa SM, Romitti PA. Multiple Job Holding, Job Changes, and Associations with Gestational Diabetes and Pregnancy-Related Hypertension in the National Birth Defects Prevention Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:619. [PMID: 38791833 PMCID: PMC11121455 DOI: 10.3390/ijerph21050619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 05/03/2024] [Accepted: 05/09/2024] [Indexed: 05/26/2024]
Abstract
We used National Birth Defects Prevention Study data to investigate associations between working patterns shortly before and during pregnancy and gestational diabetes and pregnancy-related hypertension. We analyzed working patterns (multiple-job holders, job changers, single-job holders) during the three months before and during pregnancy for 8140 participants who delivered a live-born child without a birth defect. "Multiple-job holders" worked more than one job simultaneously, "job changers" worked more than one job with no overlap, and "single-job holders" (referent) worked one job. We used multivariable logistic regression to estimate associations between working pattern and each outcome, adjusting for maternal age and educational attainment at delivery. We explored effect measure modification by household income, peak weekly working hours, and maternal race/ethnicity. Multiple-job holders had higher odds of gestational diabetes (adjusted odds ratio [aOR]: 1.5; 95% confidence interval [CI]: 1.1-2.1) and pregnancy-related hypertension (aOR: 1.5; 95% CI: 1.0-2.2) compared with single-job holders. Multiple-job holders with a household income of more than 30,000 USD per year, 32-44 peak weekly working hours, and from racial/ethnic minority groups had higher odds of gestational diabetes compared with single-job holders in respective categories. Detailed occupational information is important for studies of occupation and maternal health.
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Affiliation(s)
- Amel Omari
- Division of Field Studies and Engineering, National Institute for Occupational Safety and Health, Cincinnati, OH 45213, USA (K.V.B.)
- Epidemic Intelligence Service Officer, Centers for Disease Control and Prevention (CDC), Atlanta, GA 30329, USA
| | - Miriam R. Siegel
- Division of Field Studies and Engineering, National Institute for Occupational Safety and Health, Cincinnati, OH 45213, USA (K.V.B.)
| | - Carissa M. Rocheleau
- Division of Field Studies and Engineering, National Institute for Occupational Safety and Health, Cincinnati, OH 45213, USA (K.V.B.)
| | - Kaori Fujishiro
- Division of Field Studies and Engineering, National Institute for Occupational Safety and Health, Cincinnati, OH 45213, USA (K.V.B.)
| | - Kristen Van Buren
- Division of Field Studies and Engineering, National Institute for Occupational Safety and Health, Cincinnati, OH 45213, USA (K.V.B.)
| | - Dallas Shi
- Division of Field Studies and Engineering, National Institute for Occupational Safety and Health, Cincinnati, OH 45213, USA (K.V.B.)
- Epidemic Intelligence Service Officer, Centers for Disease Control and Prevention (CDC), Atlanta, GA 30329, USA
| | - A.J. Agopian
- Department of Epidemiology, Human Genetics, and Environmental Sciences, UTHealth School of Public Health, Houston, TX 77030, USA
| | - Suzanne M. Gilboa
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention (CDC), Atlanta, GA 30329, USA
| | - Paul A. Romitti
- Department of Epidemiology, College of Public Health, The University of Iowa, Iowa City, IA 52242, USA;
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Hajat A, Andrea SB, Oddo VM, Winkler MR, Ahonen EQ. Ramifications of Precarious Employment for Health and Health Inequity: Emerging Trends from the Americas. Annu Rev Public Health 2024; 45:235-251. [PMID: 38012123 PMCID: PMC11128534 DOI: 10.1146/annurev-publhealth-071321-042437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
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.
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Affiliation(s)
- Anjum Hajat
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington, USA;
| | - Sarah B Andrea
- School of Public Health, Oregon Health and Sciences University-Portland State University, Portland, Oregon, USA
| | - Vanessa M Oddo
- Department of Kinesiology and Nutrition, College of Applied Health Sciences, University of Illinois Chicago, Chicago, Illinois, USA
| | - Megan R Winkler
- Department of Behavioral, Social and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Emily Q Ahonen
- Division of Occupational and Environmental Health, Department of Family and Preventive Medicine, School of Medicine, University of Utah, Salt Lake City, Utah, USA
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Bridger EK, Tufte-Hewett A, Comerford DA. Perceived health inequalities: are the UK and US public aware of occupation-related health inequality, and do they wish to see it reduced? BMC Public Health 2023; 23:2326. [PMID: 38001407 PMCID: PMC10668500 DOI: 10.1186/s12889-023-17120-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 10/31/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND One underexamined factor in the study of lay views of socioeconomic health inequalities is occupation-related health. Examining health by occupational social class has a long history in the UK but has been comparatively overlooked in US public health literatures, where the relationship between health and work has attended more to hazard exposure. METHODS Representative samples of the UK and US indicated the perceived and ideal lifespan of people working in "higher managerial/professional" and "routine" occupations. We examine perceptions of inequality and desires for equality across occupation groups as a function of country and key socio-demographic variables. RESULTS 67.8% of UK and 53.7% of US participants identified that professionals live longer than routine workers. Multivariate models indicated that US participants were markedly less likely to be aware of occupation-related inequalities after controlling for age, gender, and education. Awareness was negatively related to age (in the US) and recent voting behaviours (both samples). Desiring equal life expectancy was less likely in the US sample, and less likely across both samples among older participants and those with lower levels of education. CONCLUSION Employing a novel approach to measuring perceived and ideal life expectancy inequality, this is the first study to examine perceptions of lifespan inequality by occupational groups. It reports widespread understanding of the occupation-related gradient in lifespan and a desire that these inequalities be eliminated in the UK, but considerably less awareness and desire for equality in the US. Greater tolerance for social status inequalities in the US than other similar countries appear to also extend to differences in life expectancy.
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Affiliation(s)
- Emma K Bridger
- School of Psychology and Vision Sciences, University of Leicester, Leicester, England
| | | | - David A Comerford
- Behavioural Science Centre, University of Stirling, Stirling, Scotland.
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Melton-Fant C. Corporate influenced state preemption and health: A legal mapping analysis of workers' rights preemption bills in the US south. Soc Sci Med 2023; 336:116255. [PMID: 37742540 DOI: 10.1016/j.socscimed.2023.116255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 09/13/2023] [Accepted: 09/15/2023] [Indexed: 09/26/2023]
Abstract
Work is a structural determinant of health. As local governments have taken the lead on implementing workers' rights policies, state governments have increasingly been using preemption to block local them. These policies would improve work and employment conditions, particularly for Black, Brown, immigrant, and low-wage workers. Thus, preemption of workers' right policies is an important health equity issue. Legal epidemiology methods were used to analyze and quantify worker's rights preemption bills introduced in southern state legislatures between 2009 and 2019. Between 2009 and 2019, over 100 workers' rights preemption bills were introduced in southern state legislatures, and there was significant variation between states. Preemption of local paid leave and minimum wage ordinances were the most common. Textual analysis of the bills revealed that states prioritize the perspectives of employers instead of workers. State labor policies are prioritizing the perspectives of businesses over workers resulting in a labor environment that creates structural advantages for employers and is hostile to the well-being of workers. Preemption is part of the political and social context that is shaping the association between work and health in and is likely re (creating) racial and economic inequities.
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Affiliation(s)
- Courtnee Melton-Fant
- University of Memphis, School of Public Health, 130 Robison Hall, Memphis, TN, 38152, USA.
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Buchbinder M, Jenkins T, Staley J, Berlinger N, Buchbinder L, Goldberg L. Multidimensional stressors and protective factors shaping physicians' work environments and work-related well-being in two large US cities during COVID-19. Am J Ind Med 2023; 66:854-865. [PMID: 37488786 PMCID: PMC10793871 DOI: 10.1002/ajim.23520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 06/29/2023] [Accepted: 07/13/2023] [Indexed: 07/26/2023]
Abstract
INTRODUCTION Clinician burnout and poor work-related well-being reached a critical inflection point during the COVID-19 pandemic. This article applies a novel conceptual model informed by the Total Worker Health® approach to identify and describe multilevel stressors and protective factors that affected frontline physicians' work environments and work-related well-being. METHODS We conducted a qualitative study of hospital-based physicians from multiple hospital types in Los Angeles and Miami who cared for COVID-19 patients. Semistructured interviews lasting 60-90 min were conducted over Zoom. Interview transcripts were thematically coded using Dedoose qualitative software. RESULTS The final sample of 66 physicians worked in 20 hospitals. Stressors in the social, political, and economic environment included dealing with the politicization of COVID-19, including vaccine hesitancy; state and federal governmental COVID-19 policies and messaging; and shifting CDC guidance. Employment and labor pattern stressors included the national nursing shortage, different policies for paid time off, furloughs, reduced pay, and layoffs. Organizational-level stressors included institutional policies, staffing constraints and high patient volume (i.e., increased number of cases and longer lengths of stay), and perceived poor leadership. At the individual worker level, stressors included concerns about viral transmission to family, strained personal relationships, and work-life fit, particularly for those with young children. Respondents identified promising protective factors at multiple levels, including responsive state leadership, job security, concrete opportunities to provide input into institutional policy, strong leadership and communication, and feeling cared for by one's institution. CONCLUSION Findings support a multi-level strategy that acknowledges internal organizational and external factors shaping clinicians' work-related well-being, consistent with the Total Worker Health® approach.
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Affiliation(s)
- Mara Buchbinder
- Department of Social Medicine and Center for Bioethics, School of Medicine, UNC-Chapel Hill
| | | | - John Staley
- Department of Environmental Sciences and Engineering and NC Occupational Safety and Health Education and Research Center, Gillings School of Public Health, UNC-Chapel Hill
| | | | - Liza Buchbinder
- Center for Social Medicine and Humanities and Semel Institute, UCLA
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Hawkinson CB, Andrea SB, Hajat A, Minh A, Owens S, Blaikie K, Seiler J, Molino AR, Oddo VM. A cross-sectional analysis of work schedule notice and depressive symptoms in the United States. SSM Popul Health 2023; 22:101413. [PMID: 37223751 PMCID: PMC10200964 DOI: 10.1016/j.ssmph.2023.101413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 03/29/2023] [Accepted: 04/22/2023] [Indexed: 05/25/2023] Open
Abstract
The implementation of last-minute work scheduling practices, including fluctuations in work hours, shift cancellations, and short notice, reflects a new norm in employment in the United States. This study aimed to investigate whether work schedule notice of ≤2 weeks was associated with high depressive symptoms. We used data from the 2019 cycle of the National Longitudinal Survey of Youth 1997 (N = 4963 adults aged 37-42 years). Using adjusted gender-stratified modified Poisson models, we tested the association between schedule notice (≤2 weeks, >2 weeks, consistent scheduling) and high depressive symptoms. Presence of high depressive symptoms was assessed using the 7-item Center for Epidemiologic Studies Depression (CES-D) Short-Form scale and defined as CES-D-SF ≥8. Respondents reporting >2 weeks schedule notice (versus ≤2 weeks) were disproportionately non-Hispanic Black or Hispanic and resided in the South and/or in a rural area. High depressive symptoms were 39% more prevalent among women with schedule notice of ≤2 weeks compared to those with >2 weeks notice (Prevalence Ratio [PR]: 1.39, 95% Confidence Interval (CI): 1.07, 1.80). We did not observe an association among men (PR: 1.06, 95% CI: 0.75, 1.50). Schedule notice of ≤2 weeks was associated with a greater burden of high depressive symptoms among US women. Policies to reduce precarious work scheduling practices should be further evaluated for their impacts on mental health.
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Affiliation(s)
| | | | - Anjum Hajat
- University of Washington School of Public Health, Department of Epidemiology, Seattle, WA, USA
| | - Anita Minh
- University of Washington School of Public Health, Department of Epidemiology, Seattle, WA, USA
- University of British Columbia, Department of Sociology, Vancouver, British Columbia, Canada
| | - Shanise Owens
- University of Washington School of Public Health, Department of Health Systems and Population Health, Seattle, WA, USA
| | - Kieran Blaikie
- University of Washington School of Public Health, Department of Epidemiology, Seattle, WA, USA
| | - Jessie Seiler
- University of Washington School of Public Health, Department of Epidemiology, Seattle, WA, USA
| | - Andrea R. Molino
- University of Washington School of Public Health, Department of Epidemiology, Seattle, WA, USA
| | - Vanessa M. Oddo
- University of Illinois Chicago, Department of Kinesiology and Nutrition, Chicago, IL, USA
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9
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Jones RM. Occupational Health and COVID-19: A Special Issue. Ann Work Expo Health 2023; 67:1-3. [PMID: 36398849 DOI: 10.1093/annweh/wxac081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Rachael M Jones
- Department of Environmental Health Sciences, Fielding School of Public Health, University of California, 650 Charles E Young Dr S, Los Angeles, CA 90095, USA
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10
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Ahonen EQ, Winkler MR, Hajat A. Work, Health, and the Ongoing Pursuit of Health Equity. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph192114047. [PMID: 36360925 PMCID: PMC9657065 DOI: 10.3390/ijerph192114047] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 10/24/2022] [Indexed: 06/12/2023]
Abstract
The many facets of work, including employment relationships and attendant employment quality, the day-to-day conditions experienced in any given job, and the evolution of one's working circumstances over time can support or detract from health, and combine in myriad ways to impact worker well-being [...].
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Affiliation(s)
- Emily Q. Ahonen
- Division of Occupational and Environmental Health, Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, UT 84108, USA
| | - Megan R. Winkler
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA
| | - Anjum Hajat
- Department of Epidemiology, University of Washington School of Public Health, Seattle, WA 98105, USA
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