Occupational Health Disparities Research Articles

"Caminando Con Riesgo": perceptions of occupational injury, workplace safety and workers rights among Spanish-speaking hospitalized patients.

Occupational health disparities are well documented among immigrant populations and occupational injury remains a high cause of morbidity and mortality among immigrant populations. There are several factors that contribute to the high prevalence of work-related injury among this population and those without legal status are more likely to experience abusive labor practices that can lead to injury. While the work-related injuries and experiences of Spanish-speaking workers have been explored previously, there is a paucity of literature documenting injury among hospitalized patients. Additionally, there are few documented hospital-based occupational injury prevention programs and no programs that implement workers rights information. The purpose of this study was to further explore the context of work related injuries primarily experienced by Spanish speaking patients and knowledge of their rights in the workplace. This was a semi-structured qualitative interview study with Spanish speaking patients admitted to the hospital for work related injuries. The study team member conducting interviews was bilingual and trained in qualitative methodology. An interview guide was utilized for all interviews and was developed with an immigrant workers rights organization and study team expertise, and factors documented in the literature. Participants were asked about the type and context of the injury sustained, access and perceptions of workplace safety, and knowledge of participants rights as workers. All interviews were conducted in Spanish, recorded, transcribed in Spanish and then translated into English. A codebook was developed and refined iteratively and two independent coders coded all English transcripts using Dedoose. Interviews were conducted until thematic saturation was reached and data was analyzed using a thematic analysis approach. A total of eight interviews were completed. All participants reported working in hazardous conditions that resulted in an injury. Participants expressed a relative acceptance that their workplace environment was dangerous and acknowledged that injuries were common, essentially normalizing the risk of injury. There were varying reports of access to and utilization of safety information and equipment and employer engagement in safety was perceived as a facilitator to safety. Most participants did have some familiarity with Occupational Safety and Health Administration (OSHA) inspections but were not as familiar with OSHA procedures and their rights as workers. We identified several themes related to workplace injury among Spanish speaking patients, many of which raise concerns about access to workplace safety, re-injury and long-term recovery. The context around immigration is particularly important to consider and may lead to unique risk factors for injury, recovery, and re-injury both in the workplace and beyond the workplace, suggesting that perhaps immigration status alone may serve as a predisposition to injury. Thus, it is critical to understand the context around work related injuries in this population considering the tremendous impact of employment on one's health and financial stability. Further research on this topic is warranted, specifically the exploration of multiple intersecting layers of exposure to injury among immigrant populations. Future work should focus on hospital-based strategies for injury prevention and know your rights education tailored to Spanish speaking populations.

Cardiovascular risk, social vigilance, and stress profiles of male law enforcement officers versus civilians.

This study examined the cardiovascular disease (CVD) risk profiles of male law enforcement officers (LEOs) and civilians. CVD risk profiles were based on data collected using traditional objective (e.g., resting BP, cholesterol), novel objective (e.g., ambulatory BP) and self-report measures (e.g., EMA social vigilance). A subset of male LEOs (n = 30, M age = 41.47, SD = 8.03) and male civilians (n = 120, M age = 40.73, SD = 13.52) from a larger study were included in analyses. Results indicated LEOs had significantly higher body mass index [BMI], 31.17kg/m2 versus 28.87kg/m2, and exhibited significantly higher trait and state social vigilance across multiple measures, whereas perceived stress was higher among civilians. Findings highlight the need for future research examining CVD risk associated with occupational health disparities, including attributes of individuals entering certain professions as well as experiential and environmental demands of the work.

Risk exposure to SARS-CoV-2 and workers’ risk perception in non-healthcare setting in Hong Kong, Nanjing and Wuhan: A qualitative multi-site study

Introducción: Understanding risk perception that hinges on health-protective behaviors is central to strategies for prevention. Aim: To classify the pattern of potential risk of worker exposure to SARS-CoV-2, and to assess association with risk perception among non-healthcare workers Methods: In a multi-site, qualitative study, we conducted individual in-depth interviews and mini focus group discussions with employees, managerial staff and self-employees from Hong Kong (n=87), Nanjing (n=60), and Wuhan (n=60) between June 2020 and March 2021. Audios were transcribed and categorized by themes following Grounded Theory approach. Results: We identified seven major types of potential risk exposure pattern by category of parameters. The risk perceptions decreased among Type A workers, working at fixed location in office, and no/little contacts with clients/customers, and increased among workers having the concern of asymptomatic characteristics of SAR-CoV-2, daily contact with large size of the unfamiliar crowds, unhygienic behaviors of clients/customers, and use of public transportation to commute to work. The notion that the sense of safety deriving from the implementation and adherence with safety measures despite stringency, and trust with the government was most frequently reported in Nanjing and Wuhan. Conclusion: Study examines COVID-19 risks and risk perceptions among non-healthcare workers in three cities. Variations in risk perceptions were found, influenced by factors such as work patterns and safety measures. Trust in government and concerns about international contacts were common themes. The findings emphasize the need for targeted interventions, mental health support, and inclusive policies to address occupational health disparities and promote workplace safety.

A staffing perspective on barriers to and facilitators of temporary worker safety and health.

Research has documented occupational health disparities, including higher rates of work-related injuries, among temporary workers compared with workers in standard employment arrangements. According to guidance from the Occupational Safety and Health Administration (OSHA) and the National Institute for Occupational Safety and Health (NIOSH), both staffing companies and host employers are responsible for protecting the occupational safety and health (OSH) of temporary workers. To date, there has been little qualitative research on temporary worker OSH in the United States and a lack of evidence-based OSH programs designed to meet the needs of temporary workers. The aim of this study was to better understand the barriers to and facilitators of temporary worker OSH from the perspective of US staffing companies. In-depth interviews were conducted with a convenience sample of representatives from 15 US staffing companies. Interviews were audio recorded, transcribed verbatim, and analyzed through a three-step process. Commonly mentioned barriers to temporary worker OSH include differential treatment of temporary workers by host employers; lack of understanding among host employers and staffing companies of joint OSH responsibilities; and workers' fear of job loss or other negative repercussions if they report an injury or illness or voice OSH concerns. Commonly mentioned facilitators of temporary worker OSH include conducting client assessments and site visits and fostering strong communication and relationships with both host employers and temporary workers. These findings can help inform the tailoring of OSH programs to promote health equity in temporary workers.

Changes in occupational class differences in leisure-time physical activity and the contribution of retirement.

Occupational class differences in leisure-time physical activity (LTPA) are well recognized. Less is known about how these differences develop as individuals age, and how retirement is associated with this change. We investigated how occupational class differences in LTPA change in a cohort over a 15-17 years follow-up. We further examined, how the transition into mandatory or disability retirement contributed to the change in LTPA levels and occupational class differences. We used the data from the Helsinki Health Study surveying the aging City of Helsinki employees. In all, 8773 individuals were included in the analyses. We evaluated LTPA levels using weekly metabolic equivalent task (MET) hours and used generalized linear mixed effect models (GLMM) to estimate the development of LTPA levels. Commuting was included in the LTPA measure. Occupational class differences in LTPA emerged and widened during the follow-up. The physical activity levels decreased in the lower occupational class and slightly increased in the higher occupational class, resulting in a difference of 4.3 MET-hours at the end of follow-up, accounting for 50 min of brisk walking per week. The occupational class differences emerged during transition into mandatory retirement and persisted after this. Transition into disability retirement temporarily widened the occupational class differences in LTPA levels, but the differences diminished during the follow-up. Research on interventions to counteract the declining LTPA is needed to discover ways to prevent the widening of occupational health disparities during aging. The transition into old-age retirement could be an optimal period for focusing these interventions.

Thinking on your feet: Beauty and auto small businesses maneuver the risks of the COVID-19 pandemic.

On March 11, 2020, the World Health Organization officially declared SARS-CoV-2 a pandemic, and governments and health institutions enacted various public health measures to decrease its transmission rate. The COVID-19 pandemic made occupational health disparities for small businesses more visible and created an unprecedented financial burden, particularly for those located in communities of color. In part, communities of color experienced disproportionate mortality and morbidity rates from COVID-19 due to their increased exposure. The COVID-19 pandemic has prompted the public to reflect on risks daily. Risk perception is a critical factor influencing how risk gets communicated and perceived by individuals, groups, and communities. This study explores competing risk perceptions regarding COVID-19, economic impacts, vaccination, and disinfectant exposures of workers at beauty salons and auto shops in Tucson, Arizona, using a perceived risk score measured on a scale of 1–10, with higher scores indicating more perceived risk. The primary differences between respondents at beauty salons and auto shops regarding their perceived risks of COVID-19 vaccination were between the vaccinated and unvaccinated. For every group except the unvaccinated, the perceived risk score of getting the COVID-19 vaccine was low, and the score of not getting the COVID-19 vaccine was high. Study participants in different demographic groups ranked economic risk the highest compared to the other five categories: getting the COVID-19 vaccine, not getting the COVID-19 vaccine, COVID-19, disinfection, and general. A meaningful increase of four points in the perceived risk score of not getting the COVID-19 vaccine was associated with a 227% (95% CI: 27%, 740%) increase in the odds of being vaccinated. Analyzing these data collected during the coronavirus pandemic may provide insight into how to promote the health-protective behavior of high-risk workers and employers in the service sector during times of new novel threats (such as a future pandemic or crisis) and how they process competing risks.

About the Contributors

About the Contributors

Occupations and Sickness-Related Absences during the COVID-19 Pandemic.

Pandemic frontline occupations consist of disproportionately low socioeconomic status and racial minority workers. Documenting occupational health disparities is therefore crucial for understanding COVID-19-related health inequalities in the United States. This study uses Current Population Survey microdata to estimate occupational differences in sickness-related absences (SAs) from work in March through June 2020 and their contribution to educational, racial-ethnic, and nativity health disparities. We find that there has been an unprecedented rise in SAs concentrated in transportation, food-related, and personal care and service occupations. SA rates were 6 times higher in these occupations than in non-health-care professions. The greatest increases were in occupations that are unsuitable for remote work, require workers to work close to others, pay low wages, and rarely provide health insurance. Workers in these occupations are disproportionately Black, Hispanic, indigenous, and immigrants. Occupation contributes 41% of the total of Black/white differences and 54% of educational differences in SAs.

Occupational Health Disparities among Racial and Ethnic Minorities: Lessons from Diverse Research Frameworks

The current paper aims to advance research on occupational health disparities among racial and ethnic minorities. We review the historical context and development of the field of occupational health disparities, and review a diverse set of national research frameworks. Our work is based on the Diversified Portfolio Model (DPM) of adaptability (Chandra and Leong 2016) which maintains that diversification promotes greater adaptability. Since diversification bestows adaptive advantages in multiple arenas of human endeavor, we proposed that an analysis of diverse theoretical models for studying occupational health disparities would also benefit the field of Occupational Health Science. The theoretical frameworks reviewed include: (a) The National Institute of Aging’s (NIA) health disparities framework, (b) An Epidemiological Framework, (c) The Transformation for Health Framework, and (d) The Cultural Adaptations Framework. We summarize lessons and highlight the need for incorporating change perspectives, prevention-oriented approaches, and mixed-methods approaches to address occupational health disparities.

Update: COVID-19 Among Workers in Meat and Poultry Processing Facilities ― United States, April–May 2020

Meat and poultry processing facilities face distinctive challenges in the control of infectious diseases, including coronavirus disease 2019 (COVID-19) (1). COVID-19 outbreaks among meat and poultry processing facility workers can rapidly affect large numbers of persons. Assessment of COVID-19 cases among workers in 115 meat and poultry processing facilities through April 27, 2020, documented 4,913 cases and 20 deaths reported by 19 states (1). This report provides updated aggregate data from states regarding the number of meat and poultry processing facilities affected by COVID-19, the number and demographic characteristics of affected workers, and the number of COVID-19-associated deaths among workers, as well as descriptions of interventions and prevention efforts at these facilities. Aggregate data on confirmed COVID-19 cases and deaths among workers identified and reported through May 31, 2020, were obtained from 239 affected facilities (those with a laboratory-confirmed COVID-19 case in one or more workers) in 23 states.* COVID-19 was confirmed in 16,233 workers, including 86 COVID-19-related deaths. Among 14 states reporting the total number of workers in affected meat and poultry processing facilities (112,616), COVID-19 was diagnosed in 9.1% of workers. Among 9,919 (61%) cases in 21 states with reported race/ethnicity, 87% occurred among racial and ethnic minority workers. Commonly reported interventions and prevention efforts at facilities included implementing worker temperature or symptom screening and COVID-19 education, mandating face coverings, adding hand hygiene stations, and adding physical barriers between workers. Targeted workplace interventions and prevention efforts that are appropriately tailored to the groups most affected by COVID-19 are critical to reducing both COVID-19-associated occupational risk and health disparities among vulnerable populations. Implementation of these interventions and prevention efforts† across meat and poultry processing facilities nationally could help protect workers in this critical infrastructure industry.

Participation of Workers of Asian Ancestry in High-Risk Occupations in the United States: 2009 to 2017.

Risk for workplace injury varies by occupation. Participation in high-risk occupations is non-randomly distributed as a function of demographic characteristics. Enhancing understanding of occupational health and safety disparities allows for the creation of actionable knowledge to advance health equity. The specific aim of our analysis was to examine between-group differences in participation in high-risk occupations among workers with an Asian Indian, Chinese, Filipino, Japanese, Korean, and Vietnamese ancestry. Analysis included workers who reported one of the following ancestries: Asian Indian; Chinese; Filipino; Japanese; Korean; or Vietnamese. Observational study used American Community Survey (ACS) Public Use Microdata Sample (PUMS) single-year files from 2009 through 2017. Data on the analytic sample (unweighted = 480,170) was used to estimate per Full-Time Equivalents (FTEs) by year and Asian ancestry. Analysis used the replicate weight method to estimate margins of error. Statistical analysis indicated workers with a Filipino ancestry engage in high-risk occupations at the highest proportion. Observed between-group differences merit further scientific inquiry. Advancing metrology is crucial to promoting the health equity of understudied populations.

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

Race and ethnicity data are often absent from administrative and health insurance databases. Indirect estimation methods to assign probability scores for race and ethnicity to insurance records may help identify occupational health inequities. We compared race and ethnicity estimates from the Bayesian Improved Surname Geocoding (BISG) formula to self-reported race and ethnicity from 1132 workers. The accuracy of the BISG using gender stratified regression models adjusted for worker age and industry were excellent for White and Latino males and Latino females, good for Black and Asian Pacific Islander males and White and Asian Pacific Islander females. American Indian/Alaskan Native and those who indicated they were "Other" or "More than one race" were poorly identified. The BISG estimation method was accurate for White, Black, Latino, and Asian Pacific Islanders in a sample of workers. Using the BISG in administrative datasets will expand research into occupational health disparities.

Bringing a structural perspective to work: Framing occupational safety and health disparities for nursing assistants with work-related musculoskeletal disorders.

Certified Nursing Assistants (CNAs) experience a high risk of work-related musculoskeletal disorders (WMSDs) and are further made vulnerable by their situation in low levels of workplace and societal hierarchies of power and privilege. This study applies structural vulnerability theory to CNA WMSD experiences in order to identify structural factors that may influence such injuries. A sample of CNAs (n = 26) working in Nursing and Residential Care Facilities (NRCFs) was selected from workers who filed a claim during 2011-2014 for a WMSD of the back, shoulder, knee, or hand/wrist in the Washington State Department of Labor & Industries workers' compensation system. Interviews included questions about workers' injury experiences and work contexts. Qualitative data was analyzed for themes related to structural vulnerability theory and occupational safety and health (OSH) models. Themes illustrate a work environment in NRCFs with major organizational deficiencies for CNA safety and a broader structural environment that appears to mediate them. CNAs described policies and practices that result from management priorities being diverted away from worker safety. These difficulties are compounded by several aspects of CNAs' socio-economic vulnerability. This study demonstrates the utility of a structural perspective for OSH disparities research and points to the need for occupational health intervention on a structural level.

Missed Work Due to Occupational Illness among Hispanic Horse Workers.

Occupational illnesses are inadequately reported for agriculture, an industry dominated by a vulnerable Hispanic population and high fatal and nonfatal injury rates. Work-related illnesses can contribute to missed work, caused by a combination of personal and work factors, with costs to the individual, employer, and society. To better understand agricultural occupational illnesses, 225 Hispanic horse workers were interviewed via community-based convenience sampling. Descriptive statistics, bivariate analyses, and log binomial regression modeling were used to: (1) describe the prevalence of missed work due to work-related illnesses among Hispanic horse workers, (2) examine work-related and personal factors associated with missed work, and (3) identify health symptoms and work-related characteristics potentially associated with missed work. Key findings reveal that having at least one child (PR = 1.71, 95% CI = 1.03, 2.84), having poor self-reported general health (PR = 0.72, 95% CI = 0.48, 1.08), experiencing stress during a typical workday (PR = 2.58, 95% CI = 1.25, 5.32), or spending less time with horses (PR = 1.87, 95% CI = 1.15, 3.05) are significant predictors of missing work. Interventions can be designed to identify workers most susceptible to missing work and provide resources to reduce absenteeism. Future research should examine work-related illness in agricultural horse production, including personal and work-related factors, in order to diminish occupational health disparities among these workers, who are more likely to be employed in hazardous agricultural work.

Subjective well-being among Latino day laborers: Examining the role of religiosity, social networks, and cigarette use.

Background: Latino day laborers (LDLs) experience chronic stressors, that adversely affects their subjective well-being (SWB). The purpose of the study was to determine whether LDLs’ sociodemographic characteristics, religiosity, social networks, and cigarette use were significantly associated with SWB.Methods: AApproximately 150 LDLs from 4 informal day laborer sites in Dallas and Arlington, Texas, participated in the cross-sectional survey. Informed consent was obtained from all participants and data on SWB were collected face-to-face from April 2013 through July 2013.Results: Most respondents were of Mexican ancestry, (n = 112; 75%), were foreign-born (n = 140; 93%), and undocumented (n = 108; 72%). LDLs reported a mean satisfaction with life score of 19.07 (SD=8.52). Thirty percent of LDLs reported not smoking any cigarettes in the past 30 days. However, 20% reported smoking 20–39 cigarettes, while another 20% reported smoking 40 or more cigarettes in the past 30 days. Hierarchical multiple regression results indicated that marital status (β = 0.13, P ≤ 0.05), connectedness to friends (β = 0.21, P ≤ 0.001), the influence of religion on life (β = 0.57, P ≤ 0.01), frequency of attendance to religious institution (β = 0.11, P ≤ 0.005), and cigarette use (β = -0.15, P ≤ 0.05) were significantly associated with the SWB appraisals of LDLs.Conclusion: These findings show that LDLs are resilient and rely on noneconomic factors to enhance their perceived quality of life. The results underscore the need to identify pathways to improve SWB among LDLs. Doing so may address the broader mental health and occupational health disparities gaps that affect LDLs.

Risks that are “Worthy” to take: Temporary Workers’ Risk-Benefit Perceptions

In order to deepen and broaden understanding on the occupational safety and health disparities between temporary and non-temporary workers, psychological and perceptual gaps between the two groups need to be carefully investigated, particularly in relation to risk taking behaviors. To this end, the present study showed the precarious nature of temporary employment in terms of perceived job security and perceived job control. Although the present study showed that risk perception is not significantly different across the temporary and non-temporary worker groups, temporary workers tended to perceive higher monetary benefits from potentially hazardous working opportunities and reported greater willingness to undertake the working opportunities than non-temporary workers. Temporary workers may be more likely to view the working opportunities in hazardous occupational settings as risks that are worthy to take. These findings need to be incorporated in the safety management of temporary workers to promote self-regulatory engagement in safer and healthier behaviors.

A multi-sector assessment of community organizational capacity for promotion of Chinese immigrant worker health.

Community-based collaborative approaches have received increased attention as a means for addressing occupational health disparities. Organizational capacity, highly relevant to engaging and sustaining community partnerships, however, is rarely considered in occupational health research. To characterize community organizational capacity specifically relevant to Chinese immigrant worker health, we used a cross-sectional, descriptive design with 36 agencies from six community sectors in King County, Washington. Joint interviews, conducted with two representatives from each agency, addressed three dimensions of organizational capacity: organizational commitment, resources, and flexibility. Descriptive statistics were used to capture the patterning of these dimensions by community sector. Organizational capacity varied widely across and within sectors. Chinese and Pan-Asian service sectors indicated higher capacity for Chinese immigrant worker health than did Chinese faith-based, labor union, public, and Pan-ethnic nonprofit sectors. Variation in organizational capacity in community sectors can inform selection of collaborators for community-based, immigrant worker health interventions.

Data linkage between the National Birth Defects Prevention Study and the Occupational Information Network (O*NET) to assess workplace physical activity, sedentary behaviors, and emotional stressors during pregnancy.

Knowledge of the prevalence of work-related physical activities, sedentary behaviors, and emotional stressors among pregnant women is limited, and the extent to which these exposures vary by maternal characteristics remains unclear. Data on mothers of 6,817 infants without major birth defects, with estimated delivery during 1997 through 2009 who worked during pregnancy were obtained from the National Birth Defects Prevention Study. Information on multiple domains of occupational exposures was gathered by linking mother's primary job to the Occupational Information Network Version 9.0. The most frequent estimated physical activity associated with jobs during pregnancy was standing. Of 6,337 mothers, 31.0% reported jobs associated with standing for ≥75% of their time. There was significant variability in estimated occupational exposures by maternal age, race/ethnicity, and educational level. Our findings augment existing literature on occupational physical activities, sedentary behaviors, emotional stressors, and occupational health disparities during pregnancy.

Health disparities of Latino immigrant workers in the United States

Purpose – The purpose of this paper is to provide an overview of the literature pertaining to occupational health disparities experienced by Latino immigrant workers in the USA and to advance a general framework based on systems science to inform epidemiological and intervention research. Design/methodology/approach – Using papers and other sources from 2000 to the present, the authors examined the employment conditions and health outcomes of Latino immigrant workers and critically analyzed the pervasive evidence of health disparities, including causal mechanisms and associated intervention programs. Findings – The occupations, including the work environment and resultant living conditions, frequently performed by Latino immigrants in the USA represent a distinct trigger of increased injury risk and poor health outcomes. Extant intervention programs have had modest results at best and are in need of more comprehensive approaches to address the complex nature of health disparities. Practical implications – An integrated, systems-based framework concerning occupational health disparities among Latino immigrant workers allows for a holistic approach encompassing innovative methods and can inform high-leverage interventions including public policy. Originality/value – Reductionist approaches to health disparities have had significant limitations and miss the complete picture of the many influences. The framework the authors have provided elucidates a valuable method for reducing occupational health disparities among Latino immigrant workers as well as other populations.

Effects of Social Determinants on Chinese Immigrant Food Service Workers' Work Performance and Injuries

The effects of social discrimination, job concerns, and social support on worker mental health and the influence of mental health on occupational health outcomes have been documented intermittently. We propose an integrated, theory-driven model to distinguish the impact of social determinants on work performance and injuries and the mediating effects of mental health problems. The US Chinese immigrant food service workers (N = 194) completed a multimeasure interview; we tested the integrated model using structural equation modeling. Mental health problems, which were associated with decreased work performance and increased injuries, also mediated relationships between job/employment concerns and both work performance and injuries but did not mediate the influences of discrimination and social support. This research reveals mechanisms by which social determinants influence immigrant worker health, pointing to complementary strategies for reducing occupational health disparities.