United States Workers Research Articles

Longitudinal associations of effort and reward at work with changes in cognitive function: evidence from a national study of U.S. workers.

This study aimed to examine longitudinal associations of workplace effort and reward with changes in cognitive function among United States workers. Data from the national, population-based Midlife in the United States (MIDUS) study with a 9-year follow-up were used. Validated workplace effort and reward scales were measured at baseline, and cognitive outcomes (including composite cognition, episodic memory, and executive functioning) were measured with the Brief Test of Adult Cognition by Telephone (BTACT) at baseline and follow-up. Multivariable linear regression analyses based on generalized estimating equations (GEE) examined the longitudinal associations under study. Among this worker sample of 1,399, after accounting for demographics, socioeconomics, lifestyle behaviors, health conditions, and job control, high reward at baseline was associated with increased composite cognition (regression coefficient: 0.118 [95% CI: 0.049, 0.187]), episodic memory (0.106 [0.024, 0.188]), and executive functioning (0.123 [0.055, 0.191]) during follow-up. The joint exposure of 'high effort and high reward' was also associated with increased composite cognition (0.130 [0.030, 0.231]), episodic memory (0.131 [0.012, 0.250]), and executive functioning (0.117 [0.017, 0.216]), while the combination of 'low effort and high reward' was associated with increased composite cognition (0.106 [0.009, 0.204]) and executive functioning (0.139 [0.042, 0.235]). Findings suggest that workplace high reward is related to improved cognitive scores among United States workers. Future research should investigate larger cohorts over longer timespans and expand into disease outcomes such as dementia. If these findings emerge as causal, relevant workplace rewards to promote worker cognitive health should be considered.

Burden and social distribution of occupational psychosocial exposures in the United States workforce, 2022.

To characterize the burden and social distribution of occupational psychosocial exposures in the United States (US). We merged 2022 US employment and demographic data from the Current Population Survey (CPS) with occupational characteristic data from the Occupational Information Network (O*NET), wage data from the Occupational Employment and Wage Statistics Survey, and hours worked from the CPS, to estimate the number and proportion of US workers at risk of exposure to 19 psychosocial hazards. We additionally estimated the number and proportion of US workers over- or underrepresented in exposure burden. Of the exposures examined, US workers were most commonly employed in occupations with high time pressure (67.5 million US workers exposed; 43.2% US workers exposed), high emotional labor (57.1 million; 36.6%), and low wages (47.8 million; 30.6%). The burden of exposures was uneven across sociodemographic strata, attributable to occupational segregation. The full data set is available online at https://deohs.washington.edu/us-exposure-burden. Work-related psychosocial exposures are ubiquitous and should be considered in occupational and public health research, policy, and interventions to reduce the burden of disease and health inequities in the United States.

Precarious employment and mental health in the United States: Results from the Medical Expenditure Panel Survey (MEPS), 2008–2021

ObjectivesTo measure associations between employment precarity and mental health among United States (US) workers. MethodsThis 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. ResultsOur 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. ConclusionsIncreasing 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.

Association of Occupational and Leisure-Time Physical Activity With Allostatic Load

IntroductionLeisure-time physical activity (LTPA) decreases allostatic load (AL), a measure of burden of chronic stress. However, the role of occupational PA (OPA) is unknown. This study examined associations of OPA and LTPA with AL among workers in the United States (US). MethodsThis cross-sectional study included 6944 US workers aged 20–64 years from the National Health and Nutrition Examination Survey (2007–2018). PA was assessed using the Global Physical Activity Questionnaire. AL was calculated using biomarkers of cardiovascular health, metabolic function and immune response. Associations of OPA and LTPA were examined with AL using negative binomial regressions. Analyses were conducted between August 2022 and March 2023. ResultsVigorous LTPA inversely associated with AL among all workers (count ratio = 0.68, 95% CI: 0.62–0.76) and in each sex- and age- stratified group (i.e., females aged 20–44 years, females aged 45–64 years, males aged 20–44 years, and males aged 45–64 years), as well as in each race/ethnicity- stratified group (i.e., Whites, Blacks, Hispanics). Vigorous OPA positively associated with AL only among females aged 20–44 years [1.38 (1.10–1.73)]. Inverse associations of vigorous LTPA with AL were similar in young females with high [0.61 (0.50–0.75)] or low [0.66 (0.60–0.74)] vigorous OPA. ConclusionsIncreasing vigorous LTPA is associated with a lower AL for all workers, while increasing vigorous OPA is associated with a higher AL only in young females. Promoting vigorous LTPA reduces AL among young females with either low or high vigorous OPA.

An Assessment of MSW Social Work Curricula: Semester-Long Courses Specifically Related to Immigrants and Immigration

ABSTRACT Social workers are well positioned to meet the needs of the immigrant population in the United States (U.S.) and social workers across all fields and specializations should both feel competent and have the appropriate skills to work with immigrant clients. In this paper, we provide context around the immigrant population in the U.S. and discuss social work’s role in helping immigrants, and the role of the MSW degree in helping to prepare social workers to work with immigrants. Using publicly available data on MSW school websites, we analyze the prevalence of courses that specifically focus on immigrants or immigration. We found a lack of semester-long immigrant-specific courses in that only 12% of the programs offered these courses. We also noted the geographic clustering of some programs that offer these courses. We propose that schools do one of the following depending on their current course offerings, faculty expertise, and other resources: ensuring that basic content and case examples about immigrants are included in foundational social work courses, and when feasible or appropriate create elective courses, or create a concentration for those wishing to specialize in social work practice with immigrants.

Deradicalization of Islamists: Theory and Practices (International and Russian Experience)

The article is based on the materials of the international scientific conference held by the Center for Civilizational and Regional Studies of the Institute for African Studies of the Russian Academy of Sciences “Deradicalization of Islamists: Theory and Practices (International and Russian Experience)”. The conference was attended by both representatives of the academic circles from Russia, Kazakhstan and the United States, and practitioners, psychologists and social workers who are directly involved in the programs of deradicalization of Islamists in their countries. The conference discussed the main directions and theoretical approaches of deradicalization, as well as specific programs and practices of the deradicalization of Islamists. Special attention was paid to the possibilities of applying international experience in the Russian Federation. The conference was interdisciplinary. According to the participants of the conference, the programs adopted in different countries have their own regional specifics, but each program somehow includes work with convicts or those who are at risk: sessions with respected and authoritative religious figures and imams; work with psychologists; involvement in the process of deradicalization of the inner circle, parents, friends and family; vocational education and obtaining a profession, as well as integration into the process of peaceful life after the convicts were released after imprisonment. Deradicalization programs should be comprehensive in nature, including not only forceful methods, but also a set of measures for training, education and social rehabilitation. Despite different approaches to the main definitions of deradicalization, the participants of the discussion demonstrated unanimity in assessing the relevance of the topic and its prospects. The paper contains an introduction and the short theses of the conference participants. At the end of the work, a conclusion is given, which summarizes the main results of the conference.

Occupational Injuries and Illnesses among Paramedicine Clinicians: Analyses of US Department of Labor Data (2010 - 2020).

Paramedicine clinicians (PCs) in the United States (US) respond to 40 million calls for assistance every year. Their fatality rates are high and their rates of nonfatal injuries are higher than other emergency services personnel, and much higher than the average rate for all US workers. The objectives of this paper are to: describe current occupational injuries among PCs; determine changes in risks over time; and calculate differences in risks compared to other occupational groups. This retrospective open cohort study of nonfatal injuries among PCs used 2010 through 2020 data from the US Department of Labor (DOL), Bureau of Labor Statistics; some data were unavailable for some years. The rates and relative risks (RRs) of injuries were calculated and compared against those of registered nurses (RNs), fire fighters (FFs), and all US workers. The annual average number of injuries was: 4,234 over-exertion and bodily reaction (eg, motion-related injuries); 3,935 sprains, strains, and tears; 2,000 back injuries; 580 transportation-related injuries; and over 400 violence-related injuries. In this cohort, women had an injury rate that was 50% higher than for men. In 2020, the overall rate of injuries among PCs was more than four-times higher, and the rate of back injuries more than seven-times higher than the national average for all US workers. The rate of violence-related injury was approximately six-times higher for PCs compared to all US workers, seven-times higher than the rate for FFs, and 60% higher than for RNs. The clinicians had a rate of transportation injuries that was 3.6-times higher than the national average for all workers and 2.3-times higher than for FFs. Their overall rate of cases varied between 290 per 10,000 workers in 2018 and 546 per 10,000 workers in 2022. Paramedicine clinicians are a critical component of the health, disaster, emergency services, and public health infrastructures, but they have risks that are different than other professionals.This analysis provides greater insight into the injuries and risks for these clinicians. The findings reveal the critical need for support for Emergency Medical Services (EMS)-specific research to develop evidence-based risk-reduction interventions. These risk-reduction efforts will require an enhanced data system that accurately and reliably tracks and identifies injuries and illnesses among PCs.

Associations of Workplace Violence With Cardiovascular Disease Among United States Workers: Findings From a National Survey.

Recent research indicates a potential association between workplace violence and an increased risk of cardiovascular disease (CVD) in the working-age population. However, the relevant evidence in the United States is sparse. Thus, this study was conducted to explore the possible relationship between workplace violence and CVD among United States workers. We utilized cross-sectional data from the 2015 National Health Interview Survey, which included a representative sample of 18 380 workers, to investigate the associations between workplace violence and the prevalence of CVD using logistic regression. Workplace violence was determined based on self-reported threats, bullying, or harassment at work over the past 12 months, supplemented with additional information regarding frequency. CVD included all forms of heart disease and stroke. A total of 1334 workers reported experiences of workplace violence, and 1336 workers were diagnosed with CVD. After adjustment for covariates, participants who reported any instance of workplace violence had significantly higher odds of having CVD (odds ratio [OR], 1.76; 95% confidence interval [CI], 1.35 to 2.30) than those who reported no such violence. Furthermore, the highest odds of CVD (OR, 1.80; 95% CI, 1.23 to 2.63) were observed among those frequently exposed to workplace violence. Even occasional exposure to workplace violence was associated with 74% excess odds of CVD. Our study indicates an association between workplace violence and CVD in United States workers, exhibiting a dose-response pattern.

A Cohort Study of Occupational Fatalities among Paramedicine Clinicians: 2003 through 2020.

Emergency medical technicians (EMTs) and paramedics respond to 40 million calls for assistance every year in the United States; these paramedicine clinicians are a critical component of the nation's health care, disaster response, public safety, and public health systems. The study objective is to identify the risks of occupational fatalities among paramedicine clinicians working in the United States. To determine fatality rates and relative risks, this cohort study focused on 2003 through 2020 data of individuals classified as EMTs and paramedics by the United States Department of Labor (DOL). Data provided by the DOL and accessed through its website were used for the analyses. The DOL classifies EMTs and paramedics who have the job title of fire fighter as fire fighters and so they were not included in this analysis. It is unknown how many paramedicine clinicians employed by hospitals, police departments, or other agencies are classified as health workers, police officers, or other and were not included in this analysis. An average of 206,000 paramedicine clinicians per year were employed in the United States during the study period; approximately one-third were women. Thirty percent (30%) were employed by local governments. Of the 204 total fatalities, 153 (75%) were transportation-related incidents. Over one-half of the 204 cases were classified as "multiple traumatic injuries and disorders." The fatality rate for men was three-times higher than for women (95% confidence interval [CI], 1.4 to 6.3). The fatality rate for paramedicine clinicians was eight-times higher than the rate for other health care practitioners (95% CI, 5.8 to 10.1) and 60% higher than the rate for all United States workers (95% CI, 1.24 to 2.04). Approximately 11 paramedicine clinicians are documented as dying every year. The highest risk is from transportation-related events. However, the methods used by the DOL for tracking occupational fatalities means that many cases among paramedicine clinicians are not included. A better data system, and paramedicine clinician-specific research, are needed to inform the development and implementation of evidence-based interventions to prevent occupational fatalities. Research, and the resulting evidence-based interventions, are needed to meet what should be the ultimate goal of zero occupational fatalities for paramedicine clinicians in the United States and internationally.

Abstract P274: Associations of Occupational Physical Activity With Allostatic Load Among Workers in the United States

Introduction: Occupational physical activity (OPA) has been linked to adverse cardiovascular outcomes and mortality among workers, but underlying mechanisms are not clear. Allostatic load (AL) presents a measure of the accumulative burden of chronic stress and may play a role in the association of OPA with cardiovascular outcomes. We hypothesized that OPA was positively associated with AL in workers. Methods: Analyses were conducted in 6487 United States (U.S.) workers (i.e., working at a job or business) aged 20-60 years who were not pregnant, had data on moderate-to-vigorous OPA and biomarkers for AL calculation using a national representative sample, the National Health and Nutrition Examination Survey (2007-2018). OPA was dichotomized primarily by time spent on moderate-to-vigorous OPA (i.e., high: ≥ 150 vs. low: < 150; min/week) and secondarily by energy spent on it (i.e., high: ≥ median vs. low: < median; kcal/week). AL score was calculated using a common method from 9 biomarkers with a range of 0-9. Associations of OPA with AL were assessed using multivariable linear regression models with sampling weights applied to represent U.S. workers. Results: AL score was significantly higher among workers who spent higher time on moderate-to-vigorous OPA (β = 0.11, P = 0.02) or had higher energy on it (β = 0.10, P = 0.05) than their counterparts. When stratified by gender and age, the positive associations of OPA with AL remained significant only among females aged 20-40 years (β = 0.16, P = 0.02 for higher time on moderate-to-vigorous OPA; β = 0.35, P < 0.001 for higher energy on moderate-to-vigorous OPA), but such associations were not observed in other groups (females aged 41-60 years, males aged 20-40 years, and males aged 41-60 years). Conclusions: We found that OPA was positively associated with AL among U.S. workers, particularly in young female workers. Our findings are novel and worthy of further studies to confirm the role of OPA in explaining cardiometabolic disorders.

Thriving from Work Questionnaire: Dimensionality, reliability, and validity of the longand short form questionnaires.

Thriving from Work is defined as the state of positive mental, physical, and social functioning in which workers' experiences of their work and working conditions enable them to thrive in their overall lives, contributing to their ability to achieve their full potential at work, at home, and in the community. The purpose of this study was to develop a psychometrically-sound questionnaire measuring the positive contribution that work can have on one's well-being both at, and outside of, their work. We used both a qualitative and quantitative approach of item reduction, domain mapping dimensionality testing, development of "long-"and "short-"versions of the questionnaire, reliability, and construct and criterion validity testing. This was established in two independent online samples of USbased workers (n = 1550, n = 500). We developed a bi-factor model 30-item long-form and a uni-factorial 8-item short-version. The long-form measures both the latent construct of Thriving from Work and six domains (psychological/emotional; work-life integration; social; experience of work; basic needs; health). Both long- and short- forms were found to have high empirical reliability (0.93 and 0.87 respectively). The short-form captures 94% of variance of the long-form. Construct and criterion validity were supported. Test-retest reliability was high. The Thriving from Work Questionnaire appears to be a valid and reliable measure of work-related well-being in United Statesworkers. Further testing is needed to refine and test the instrument in specific industries, unique worker populations, and across geographic regions.

The associations of job strain and leisure-time physical activity with the risk of hypertension: the population-based Midlife in the United States cohort study.

Job strain is positively associated with incident hypertension, while increasing leisure-time physical activity (LTPA) can reduce incident hypertension. However, the joint associations of job strain and LTPA with incident hypertension among United States workers have yet to be investigated. This study examined the independent and joint associations of job strain and LTPA with incident hypertension. This prospective cohort study (n=1,160) utilized data from the population-based Midlife in the United States study. The associations of job strain and LTPA at baseline with incident hypertension during follow-up were examined using Cox proportional hazards models. High job strain was derived from a combination of high job demands and low job control, and high LTPA was defined as engagement in moderate or vigorous LTPA at least once per week. During 9,218 person-years of follow-up, the hypertension incidence rate was 30.6 (95% confidence interval [CI], 27.3 to 34.3) per 1,000 person-years. High job strain was associated with a higher risk for hypertension than low job strain (adjusted hazard ratio [aHR], 1.29; 95% CI, 1.00 to 1.67). High LTPA was associated with lower hypertension risk than low LTPA (aHR, 0.77; 95% CI, 0.60 to 0.98). Hypertension risk was higher among workers with high job strain and low LTPA than among those with low job strain and high LTPA (aHR, 1.70; 95% CI, 1.18 to 2.43). Job strain and LTPA showed positive and inverse associations, respectively, with incident hypertension. The combination of high job strain and low LTPA was associated with the highest risk for hypertension.

Triangulating the New Frontier of Health Geo-Data: Assessing Tick-Borne Disease Risk as an Occupational Hazard among Vulnerable Populations.

Determining interventions to combat disease often requires complex analyses of spatial-temporal data to improve health outcomes. For some vulnerable populations, obtaining sufficient data for related analyses is especially difficult, thus exacerbating related healthcare, research, and public health efforts. In the United States (U.S.), migrant and seasonal workers are especially affected in this regard, with data on health interventions and outcomes largely absent from official sources. In response, this study offers a multi-modal approach that involves triangulating geographically specified health data that incorporate reports on canine tick species, Lyme disease (LD) incidence, and patient symptom severity indicating potential subsequent disease burden. Spatial alignment of data at the U.S. county level was used to reveal and better understand tick-borne disease (TBD) incidence and risk among the identified populations. Survey data from migrant and seasonal workers in Texas were employed to determine TBD risk based on symptoms, occupations, and locations. Respondents who were found to have a higher likelihood of a TBD were also considerably more likely to report the most common symptoms of LD and other TBDs on the Horowitz Multiple Systemic Infectious Disease Syndrome Questionnaire. Those in the highly likely scoring group also reported more poor health and mental health days. Overall, a notable number of respondents (22%) were likely or highly likely to have a TBD, with particular relevance attributed to county of residence and living conditions. Also of note, almost a third of those reporting severe symptoms had received a previous Lyme disease diagnosis. These findings underscore the need for further surveillance among vulnerable populations at risk for TBDs.

Workplace violence during the COVID-19 pandemic: March–October, 2020, United States

Problem: COVID-19 has impacted United States workers and workplaces in multiple ways including workplace violence events (WVEs). This analysis scanned online media sources to identify and describe the characteristics of WVEs related to COVID-19 occurring in the United States during the early phases of the pandemic. Method: Publicly available online media reports were searched for COVID-19-related WVEs during March 1–October 31, 2020. A list of 41 keywords was used to scan four search engines using Natural Language Processing (NLP). Authors manually reviewed media reports for inclusion using the study definition and to code variables of interest. Descriptive statistics were calculated across three types of violence: non-physical, physical, and events with both physical and non-physical violence. Results: The search of media reports found 400 WVEs related to COVID-19 during March 1–October 31, 2020. Of the WVEs, 27% (n = 108) involved non-physical violence, 27% (n = 109) physical violence, and 41% (n = 164) both physical and non-physical violence. Nineteen WVEs could not be assigned to a specific type of violence (5%). Most occurred in retail and dining establishments (n = 192, 48%; n = 74, 19%, respectively). Most WVEs related to COVID-19 were perpetrated by a customer or client (n = 298, 75%), but some were perpetrated by a worker (n = 61, 15%). Most perpetrators were males (n = 234, 59%) and acted alone (n = 313, 79%). The majority of WVEs were related to mask disputes (n = 286, 72%). In 22% of the WVEs, the perpetrator coughed or spit on a worker while threatening infection from SARS-CoV-2, the virus that causes COVID-19. Discussion: This analysis demonstrated that media scraping may be useful for workplace violence surveillance. The pandemic resulted in unique violent events, including those perpetrated by workers. Typical workplace violence prevention strategies may not be effective in reducing COVID-19-related violence. More research on workplace training for workers during public health crises is needed.

Epidemiologic risk factors and occupation analysis of COVID-19 cases, hospitalizations, and deaths–southern California, 2020

Background: COVID-19 occupational exposures have been examined using death certificates and employment data from the Bureau of Labor Statistics and the O*Net database in the United States. However, no studies have examined cases, hospitalizations, and deaths by occupation using hospital records.1 We analyzed COVID-19 cases using hospitalization data from a large, rural community hospital to fill this gap in the evidence base. Methods: A retrospective cross-sectional study design was used to examine patients with COVID-19 from March 1 through July 31, 2020. We examined demographic characteristics, such as age, sex, race or ethnicity, and length of stay (LOS), among those who tested positive for SARS-CoV-2. Epidemiological risk factors were also analyzed, including smoking status, body mass index (BMI), alcohol use, and occupation. Occupational data were processed using the National Institute for Occupational Safety and Health Industry and Occupation Computerized Coding System. Homemakers, disabled persons or retirees, students or minors, and listed occupations with insufficient information were excluded from the analysis. Occupations were categorized into 23 major occupation groups based on the 2018 Standard Occupational Classification System. To examine whether certain occupations are at a higher risk due to COVID-19, we stratified the analysis by overall cases, hospitalizations, and deaths. Microsoft Power BI Desktop and IBM SPSS version 28.0.0.0 software were used to analyze the data. This study was reviewed and approved by the local institutional review board. Results: In total, 2,132 COVID-19 diagnoses with 1,049 total hospitalizations were identified during the study period. Most cases were in the group aged 50–64 years, white race, and/or Hispanic ethnicity (Table 1). Most cases never or rarely drank alcohol, were nonsmokers, and had a BMI ≥30 (Table 2). The average LOS among those hospitalized for COVID-19 was 6.46 days. The occupational analysis revealed a higher frequency of cases among those in management (n = 95, 14%) and healthcare (n = 83, 12%), with those in management (n = 40, 14%) and sales (n = 29, 10%) having the highest frequency of being hospitalized. However, the highest frequency of deaths occurred among those in building and grounds cleaning and maintenance occupations (13%) (Table 3). Conclusions: This study describes the burden of COVID-19 in a rural area with a large aging population and highlights potential health disparities among severe cases and deaths in different occupational groups.1. Baker MG, Peckham TK, Seixas NS. Estimating the burden of United States workers exposed to infection or disease: a key factor in containing risk of COVID-19 infection. PLoS One 2020;15:e0232452.Funding: NoneDisclosures: None

Employment conditions as barriers to the adoption of COVID-19 mitigation measures: how the COVID-19 pandemic may be deepening health disparities among low-income earners and essential workers in the United States

BackgroundThe COVID-19 pandemic has disproportionately impacted economically-disadvantaged populations in the United States (US). Precarious employment conditions may contribute to these disparities by impeding workers in such conditions from adopting COVID-19 mitigation measures to reduce infection risk. This study investigated the relationship between employment and economic conditions and the adoption of COVID-19 protective behaviors among US workers during the initial phase of the COVID-19 pandemic.MethodsEmploying a social media advertisement campaign, an online, self-administered survey was used to collect data from 2,845 working adults in April 2020. Hierarchical generalized linear models were performed to assess the differences in engagement with recommended protective behaviors based on employment and economic conditions, while controlling for knowledge and perceived threat of COVID-19, as would be predicted by the Health Belief Model (HBM).ResultsEssential workers had more precarious employment and economic conditions than non-essential workers: 67% had variable income; 30% did not have paid sick leave; 42% had lost income due to COVID-19, and 15% were food insecure. The adoption of protective behaviors was high in the sample: 77% of participants avoided leaving home, and 93% increased hand hygiene. Consistent with the HBM, COVID-19 knowledge scores and perceived threat were positively associated with engaging in all protective behaviors. However, after controlling for these, essential workers were 60% and 70% less likely than non-essential workers, who by the nature of their jobs cannot stay at home, to stay at home and increase hand hygiene, respectively. Similarly, participants who could not afford to quarantine were 50% less likely to avoid leaving home (AOR: 0.5; 95% CI: 0.4, 0.6) than those who could, whereas there were no significant differences concerning hand hygiene.ConclusionsOur findings are consistent with the accumulating evidence that the employment conditions of essential workers and other low-income earners are precarious, that they have experienced disproportionately higher rates of income loss during the initial phase of the COVID-19 pandemic and face significant barriers to adopting protective measures. Our findings underscore the importance and need of policy responses focusing on expanding social protection and benefits to prevent the further deepening of existing health disparities in the US.

Socioeconomic predictors of COVID-19-related health disparities among United States workers: A structural equation modeling study.

The COVID-19 pandemic has disproportionately impacted the physical and mental health, and the economic stability, of specific population subgroups in different ways, deepening existing disparities. Essential workers have faced the greatest risk of exposure to COVID-19; women have been burdened by caretaking responsibilities; and rural residents have experienced healthcare access barriers. Each of these factors did not occur on their own. While most research has so far focused on individual factors related to COVID-19 disparities, few have explored the complex relationships between the multiple components of COVID-19 vulnerabilities. Using structural equation modeling on a sample of United States (U.S.) workers (N = 2800), we aimed to 1) identify factor clusters that make up specific COVID-19 vulnerabilities, and 2) explore how these vulnerabilities affected specific subgroups, specifically essential workers, women and rural residents. We identified 3 COVID-19 vulnerabilities: financial, mental health, and healthcare access; 9 out of 10 respondents experienced one; 15% reported all three. Essential workers [standardized coefficient (β) = 0.23; unstandardized coefficient (B) = 0.21, 95% CI = 0.17, 0.24] and rural residents (β = 0.13; B = 0.12, 95% CI = 0.09, 0.16) experienced more financial vulnerability than non-essential workers and non-rural residents, respectively. Women (β = 0.22; B = 0.65, 95% CI = 0.65, 0.74) experienced worse mental health than men; whereas essential workers reported better mental health (β = -0.08; B = -0.25, 95% CI = -0.38, -0.13) than other workers. Rural residents (β = 0.09; B = 0.15, 95% CI = 0.07, 0.24) experienced more healthcare access barriers than non-rural residents. Findings highlight how interrelated financial, mental health, and healthcare access vulnerabilities contribute to the disproportionate COVID-19-related burden among U.S. workers. Policies to secure employment conditions, including fixed income and paid sick leave, are urgently needed to mitigate pandemic-associated disparities.

Associations of job strain and family strain with risk of major depressive episode: A prospective cohort study in U.S. working men and women

BackgroundStudies assessing sex differences in the associations of psychosocial strain with depression have shown mixed and inconsistent results. Our objective was to examine prospective associations of job strain and family strain with risk of major depressive episode (MDE) among United States workers, as well as assess potential effect modification by sex. MethodsUsing data from the nationally representative and population-based Mid-life in the United States (MIDUS) study with a prospective cohort design and a 9-year follow-up period, the effects of job strain and family strain at baseline on risk of MDE within the 12 months prior to the follow-up assessment were examined in 1581 workers (805 men, 776 women) who were free from MDE within the 12 months prior to the baseline survey, by multivariate Poisson regression analysis. ResultsAfter adjustment for relevant covariates, there was evidence for effect modification by sex for the association between job strain and MDE but not for the association between family strain and MDE. Indeed, high job strain was prospectively associated with the risk of MDE (RR and 95% CI = 2.14 [1.14, 4.03]) in men but not in women. Moreover, high family strain was prospectively associated with a higher risk of MDE (RR and 95% CI = 1.57 [1.05, 2.37]) in the whole sample. ConclusionFamily strain was associated with risk of MDE regardless of the sex of a person. In contrast, high job strain may involve an increased risk of developing MDE only in men but not in women.

The New Peonage: Liberty and Precarity for Workers in the Gig Economy

According to a 2016 Time Magazine article, over 14 million people currently work in the “gig,” “on demand,” or “sharing” economy. In the past 10 years, 94% of net new jobs have appeared outside of traditional employment. The gig economy presents a paradox for workers in the United States. On its face, the “gig” economy represents the height of liberty. Part-time, temporary and platform workers are not tied to any single employer, and can theoretically choose when to work, and whom they want to work for. However, while workers in the gig economy enjoy nominal autonomy, they also lack many protections to which employees are legally entitled. Gig economy workers lack job security and must constantly search for new work. Most gig economy workers do not receive health insurance, pensions, or other benefits from their employers. The reality of the gig economy is greater economic inequality, insecurity, and precarity. The recent COVID crisis has exposed this reality and heightened the vulnerability of gig economy workers. Despite the promise of liberty in the gig economy, workers are increasingly subject to a new form of peonage, exploitative practices reminiscent of slavery and involuntary servitude.This article starts from first-hand accounts and empirical research and applies an inter-disciplinary approach to understanding what liberty of contract means, and can mean, to workers in the gig economy. It explores the ideology of liberty of contract and presents an alternative approach, the freedom from undue coercion promised by the Thirteenth Amendment. This is the first to article to consider what the Thirteenth Amendment could mean for gig economy workers. It draws on the work of labor scholars who have largely focused on the question of whether gig economy workers should be classified as employees, and constitutional scholars exploring what the promise of liberty in the Thirteenth Amendment means for United States workers. The Thirteenth Amendment offers a promise to these workers, a promise of freedom from undue coercion. However, that promise has yet to be enforced.

Estimating the burden of United States workers exposed to infection or disease: A key factor in containing risk of COVID-19 infection.

IntroductionWith the global spread of COVID-19, there is a compelling public health interest in quantifying who is at increased risk of contracting disease. Occupational characteristics, such as interfacing with the public and being in close quarters with other workers, not only put workers at high risk for disease, but also make them a nexus of disease transmission to the community. This can further be exacerbated through presenteeism, the term used to describe the act of coming to work despite being symptomatic for disease. Quantifying the number of workers who are frequently exposed to infection and disease in the workplace, and understanding which occupational groups they represent, can help to prompt public health risk response and management for COVID-19 in the workplace, and subsequent infectious disease outbreaks.MethodsTo estimate the number of United States workers frequently exposed to infection and disease in the workplace, national employment data (by Standard Occupational Classification) maintained by the Bureau of Labor Statistics (BLS) was merged with a BLS O*NET survey measure reporting how frequently workers in each occupation are exposed to infection or disease at work. This allowed us to estimate the number of United States workers, across all occupations, exposed to disease or infection at work more than once a month.ResultsBased on our analyses, approximately 10% (14.4 M) of United States workers are employed in occupations where exposure to disease or infection occurs at least once per week. Approximately 18.4% (26.7 M) of all United States workers are employed in occupations where exposure to disease or infection occurs at least once per month. While the majority of exposed workers are employed in healthcare sectors, other occupational sectors also have high proportions of exposed workers. These include protective service occupations (e.g. police officers, correctional officers, firefighters), office and administrative support occupations (e.g. couriers and messengers, patient service representatives), education occupations (e.g. preschool and daycare teachers), community and social services occupations (community health workers, social workers, counselors), and even construction and extraction occupations (e.g. plumbers, septic tank installers, elevator repair).ConclusionsThe large number of persons employed in occupations with frequent exposure to infection and disease underscore the importance of all workplaces developing risk response plans for COVID-19. Given the proportion of the United States workforce exposed to disease or infection at work, this analysis also serves as an important reminder that the workplace is a key locus for public health interventions, which could protect both workers and the communities they serve.