Occupational factors associated with burnout among a sample of 9-1-1 public safety telecommunicators in Washington State.

INTRODUCTION: This study aimed to investigate occupational factors associated with burnout among a sample of 9-1-1 public safety telecommunicators (PSTs). METHODS: An online survey measuring organizational factors (i.e., perceived visibility and inclusion in the agency, respectful culture, leadership support, perceived gratitude, and co-worker conflict); job characteristics (i.e., work-life integration, overtime, salary satisfaction, and job meaningfulness); burnout, demographic and call center characteristics, was emailed to a sample of PSTs.AnalysisDescriptive, bivariate, and multiple linear regression analyses were used to characterize the sample and investigate relationships among variables. RESULTS: N = 324 PSTs completed the survey. Multi-variate analysis showed that poor work-life integration and coworker conflict were associated with greater PST burnout, while job meaningfulness and perceptions of greater visibility and inclusion were linked to decreased levels of burnout. CONCLUSION: Occupational factors were associated with burnout among PSTs.

Work-Related Factors Associated With Health and Well-Being of Early Care and Education Workers.

OBJECTIVE: We assessed and examined relationships between the health and working conditions of early care and education workers. METHODS: We surveyed early care and education workers ( n = 2242) about their socioeconomic characteristics; work organization; psychosocial, physical, and ergonomic exposures; coping behaviors; and health. RESULTS: Nearly half of respondents reported chronic health conditions. Most worked full time, half earned less than $30,000 a year, and many reported unpaid hours or inability to take breaks. One-quarter reported economic strain. Numerous exposures were prevalent. Workers' general health was poorer than normed averages, although their physical functioning was slightly better. Sixteen percent of workers reported work-related injuries, and 43% reported depressive symptoms. Factors associated with health included socioeconomic characteristics, having a chronic condition, job type, access to benefits, eight psychosocial stressors, four physical exposures, sleep, and alcohol consumption. CONCLUSIONS: Findings support the need for attention to this workforce's health.

Do Different Patterns of Employment Quality Contribute to Gender Health Inequities in the U.S.? A Cross-Sectional Mediation Analysis.

Compared to recent generations, workers today generally experience poorer quality employment across both contractual (e.g., wages, hours) and relational (e.g., participation in decision-making, power dynamics) dimensions within the worker-employer relationship. Recent research shows that women are more likely to experience poor-quality employment and that these conditions are associated with adverse health effects, suggesting employment relations may contribute to gender inequities in health. We analyzed data from the General Social Survey (2002-2018) to explore whether the multidimensional construct of employment quality (EQ) mediates the relationship between gender and health among a representative, cross-sectional sample of U.S. wage earners. Using a counterfactually-based causal mediation framework, we found that EQ plays a meaningful role in a gender-health relationship, and that if the distribution of EQ among women was equal to that observed in men, the probability of reporting poor self-reported health and frequent mental distress among women would be lower by 1.5% (95% Confidence Interval: 0.5-2.8%) and 2.6% (95% CI: 0.6-4.6%), respectively. Our use of a multidimensional, typological measure of EQ allowed our analysis to better account for substantial heterogeneity in the configuration of contemporary employment arrangements. Additionally, this study is one of the first mediation analyses with a nominal mediator within the epidemiologic literature. Our results highlight EQ as a potential target for intervention to reduce gender inequities in health.

Early Care and Education Workers' Experience and Stress during the COVID-19 Pandemic.

Early care and education (ECE) workers experience many job-related stressors. During the COVID-19 pandemic, ECE programs either closed or remained open while workers faced additional demands. We deployed a survey of the center-based ECE workforce in Washington State (United States) one year into the COVID-19 pandemic to assess impacts and workers' perceived stress levels. We describe the prevalence of reported impacts, including workplace closures; job changes; COVID-19 transmission; risk factors for severe COVID-19; the use of social distancing practices; satisfaction with workplace responses; perceptions of worker roles, respect, and influence; and food and financial insecurity. Themes from open-ended responses illustrate how workers' jobs changed and the stressors that workers experienced as a result. Fifty-seven percent of ECE workers reported moderate or high levels of stress. In a regression model assessing unique contributions to stress, work changes that negatively impacted home life contributed most to stress. Feeling respected for one's work and feeling positive about one's role as an "essential worker" contributed to lower levels of stress. Experiencing financial insecurity, caring for school-aged children or children of multiple ages, being younger, and being born in the United States also contributed to higher stress. Findings can inform policies designed to support the workforce.

What does non-standard employment look like in the United States? An empirical typology of employment quality.

Despite significant interest in the changing nature of employment as a critical social and economic challenge facing society-especially the decline in the so-called Standard Employment Relationship (SER) and rise in more insecure, precarious forms of employment-scholars have struggled to operationalize the multifaceted and heterogeneous nature of contemporary worker-employer relationships within empirical analyses. Here we investigate the character and distribution of employment relationships in the U.S., drawing on a representative sample of wage-earners and self-employed from the General Social Survey (2002 - 2018). We use the multidimensional construct of employment quality (EQ), which includes both contractual (e.g., wages, contract type) and relational (e.g., employee representation and participation) aspects of employment. We further employ a typological measurement approach, using latent class analysis, to explicitly examine how the multiple aspects of employment cluster together in modern labor markets. We present eight distinct employment types in the U.S., including one resembling the historical conception of the SER model (24% of the total workforce), and others representing various constellations of favorable and adverse employment features. These employment types are unevenly distributed across society, in terms of who works these jobs and where they are found in the labor market. Importantly, women, those with lower education, and younger workers are more likely to be in precarious forms of employment. More generally, our typology reveals limitations associated with binary conceptions of standard vs. non-standard employment, or insider-outsider dichotomies envisioned within dual labor market theories.

Climate Change Impacts and Workforce Development Needs in Federal Region X: A Qualitative Study of Occupational Health and Safety Professionals' Perceptions.

Climate change is considered one of the top health threats in the United States. This research sought to (1) to understand the perceptions of occupational health and safety (OHS) professionals regarding the impacts of climate-related hazards on OHS in Region X, and (2) to explore the ideas of these OHS professionals regarding the content of future training programs that would better prepare OHS professionals to identify and mitigate climate-related hazards in Region X. Key informant (KI) interviews with 17 OHS professionals familiar with the climate-related hazards and impacts to OHS in Region X were coded and thematically analyzed. Climate hazards, social and economic impacts from climate-related hazards, and sector-specific worker and workplace impacts from climate-related hazards were described as having interacting relationships that influenced worker health and safety impacts. KIs further described how workplace controls could be used to mitigate OHS impacts of climate-related hazards, and how training of the OHS workforce could influence the ability to successfully implement such controls. Our findings suggest that OHS impacts are sector-specific, influenced by social and economic factors, and can be mitigated through workplace controls designed and implemented by a trained OHS workforce. The findings from this work should inform future educational and training programming and additional research and translation activities in the region, while our approach can inform other regions as they develop regionally specific OHS climate change training and programming.

Working Safely in the Trades as Women: A Qualitative Exploration and Call for Women-Supportive Interventions.

BACKGROUND: Construction work offers women economic advancement and self-fulfillment opportunities, but multiple barriers prevent their increased representation in the industry. This study used qualitative methods to identity key physical and psychosocial safety hazards affecting tradeswomen. METHODS: Three focus groups were held in 2015 with 19 tradeswomen in Washington State. Groups discussed workplace hazards and solutions to make the trades safer for women. Discussions were recorded, transcribed, and two independent reviewers analyzed themes. RESULTS: Participants identified myriad physical and psychosocial hazards including a dangerous work environment, inadequate personal protective equipment, gender discrimination, and fear of layoff for reporting concerns. Participants identified mentorship as a potential intervention to overcome some of these barriers. CONCLUSION: Findings suggest that the industry's work environment can be hostile and unsupportive for women, contributing to tradeswomen's injury risk and psychological distress. Future research and interventions should focus on understanding the relationships between and mediating the negative impact of women's physical and psychosocial workplace hazards. Results from these focus groups inspired a randomized control trial to study the impact mentorship has on decreasing physical and psychosocial hazards for women in construction, and improving retention.

Life-course trajectories of employment quality and health in the U.S.: A multichannel sequence analysis.

The organization of employment in the U.S. has changed dramatically since the 1970s, causing decreased power and security for workers across many dimensions of the employment relationship. Multidimensional employment-quality (EQ) measures can be used to capture these changes and test their association with health. However, most public-health EQ studies have used cross-sectional, unidimensional data. We addressed these limitations using a longitudinal, multidimensional EQ measure and data on 2779 1985-2017 Panel Study of Income Dynamics respondents. First, using a multichannel sequence-analysis approach, we identified gender-specific clusters of mid-career (ages 29-50) EQ trajectories based on respondents' employment stability, material rewards, working-time arrangements, collective organization, and power relations. Next, we examined cross-cluster variation in respondent characteristics. Finally, we estimated the gender-specific associations between cluster-membership and post-sequence-analysis-period prevalence of poor/fair self-rated health (SRH) and moderate mental illness (Kessler-K6≥5). We identified five clusters among women and seven among men. Respondents in poor-EQ clusters were disproportionately people of color and less-educated; they also tended to report worse health. For example, among women, the prevalence of poor/fair SRH and moderate mental illness was lowest among standard-employment-relationship-like-non-union workers and the becoming self-employed, and greatest among minimally-attached, returning-to-the-labor-force, and precariously-employed workers. Meanwhile, among men, the prevalence of the outcomes was lowest among stably-high-wage workers and the wealthy self-employed, and greatest among exiting-the-labor-force and precariously-employed workers. Given the potential role of EQ in health inequities, researchers and practitioners should consider EQ in their work.

Considering Work Arrangement as an "Exposure" in Occupational Health Research and Practice.

Most occupational health research is conducted with the so-called "standard employment relationship" in mind, which entails ongoing, full-time employment for a single employer. Yet mounting evidence suggests the way work is organized is increasingly deviating from this standard model, and that work arrangements themselves-the terms and conditions of employment such as contract type and the extent of directive control over tasks-are important determinants of worker health and safety. However, a lack of clear conceptual definitions or taxonomic system defining the wide variety of economic work arrangements in the contemporary workplace hampers rigorous investigation of their relationship to health. The various forms of "non-standard" employment arrangements-also called non-traditional, alternative, flexible, fissured, precarious, contingent, temporary, atypical, or gig work-may have overlapping attributes, yet ambiguity regarding the character of these arrangements obscures mechanisms that lead to increased health and safety risks. Here, we attempt to clarify work arrangements as a workplace exposure, deserving of specific attention within occupational health and safety research, practice, and policy. We argue that, at minimum, three key features of work arrangements need to be considered: (1) whether an arrangement is permanent or temporary; (2) whether a worker is a contractor or an employee; and (3) whether an arrangement involves more than one firm. We further propose mechanisms linking work arrangements to increased work-related health risks to better inform strategies aimed at protecting the growing non-standard workforce.

Assessing the Impact of Housing Features and Environmental Factors on Home Indoor Radon Concentration Levels on the Navajo Nation.

Uranium is naturally found in the environment as a radioactive metal element with high concentrations in the Southwestern US. In this region is the Navajo Nation, which spans approximately 69,930 square kilometers. A decay product of uranium is radon gas, a lung carcinogen that has no color, odor, or taste. Radon gas may pass from soil into homes; and, indoor accumulation has been associated with geographical location, seasonality, home construction materials, and home ventilation. A home and indoor radon survey was conducted from November 2014 through May 2015, with volunteers who reported residence on the Navajo Nation. Home geolocation, structural characteristics, temperature (°C) during radon testing, and elevation (meters) were recorded. Short-term indoor radon kits were used to measure indoor radon levels. 51 homes were measured for indoor radon levels, with an arithmetic mean concentration of 60.5 Becquerels per cubic meter (Bq/m3) (SD = 42.7). The mean indoor radon concentrations (Bq/m3) by house type were: mobile, 29.0 (SD = 22.9); wood, 58.6 (SD = 36.0); hogan, 74.0 (SD = 0.0); homes constructed of cement and wood, 82.6 (SD = 3.5); and homes constructed of concrete and cement, 105.7 (SD = 55.8). A key observation is that house construction type appears to be associated with the mean home indoor radon concentration. This observation has been published in that the basic structural make-up of the home may affect home ventilation and therefore indoor radon concentration levels.

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

INTRODUCTION: With 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. METHODS: To 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. RESULTS: Based 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). CONCLUSIONS: The 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.

Retrospective cohort study of the association between maternal employment precarity and infant low birth weight in women in the USA.

OBJECTIVES: To investigate the association between maternal employment precarity and infant low birth weight (LBW), and to assess if this association differs by race/ethnicity. METHODS: Data were collected from 2871 women enrolled in the National Longitudinal Survey of Youth 1979 and the National Longitudinal Survey of Youth 1979 Children and Young Adult Cohort. Employment precarity was evaluated using a summary variable that combined several employment attributes: availability of employer-sponsored insurance, income, long shifts, non-daytime shifts, availability of employer sponsored training or educational benefits and membership in a union or collective bargaining unit. Employment precarity scores (a sum of the number of negative employment attributes) were categorised into low (0-2), medium (3) and high (4-6). LBW was defined as weight less than 2500 g at birth. Modified Poisson models were fit to calculate risk ratios and 95% CIs and adjusted for maternal age, race/ethnicity, educational attainment, nativity, prepregnancy body mass index, alcohol consumption, smoking during pregnancy and infant year of birth. We assessed effect modification by maternal race/ethnicity using a composite exposure-race variable. RESULTS: Women with high employment precarity had higher risk of a LBW delivery compared with women with low employment precarity (RR: 1.48, 95% CI: 1.11 to 1.98). Compared to non-Hispanic/non-black women with low employment precarity, non-Hispanic black women (RR: 2.68; 95% CI: 1.72 to 4.15), Hispanic women (RR: 2.53; 95% CI: 1.54 to 4.16) and non-Hispanic/non-black women (RR: 1.46; 95% CI: 0.98 to 2.16) with high employment precarity had higher risk of LBW. CONCLUSIONS: We observed higher risk of LBW in pregnancies of women with high employment precarity; this association was stronger among black and Hispanic mothers compared to non-Hispanic/non-black women. Findings of this study can be used to inform antenatal care and identify workplace policies to better support women who work during pregnancy.

Precarious employment in occupational health - an OMEGA-NET working group position paper.

Objectives The aims of this position paper are to (i) summarize research on precarious employment (PE) in the context of occupational health; (ii) develop a theoretical framework that distinguishes PE from related concepts and delineates important contextual factors; and (iii) identify key methodological challenges and directions for future research on PE and health. Methods This position paper is the result of a working group consisting of researchers from the EU, Turkey and the USA, who have discussed the issue over the course of six months (October 2018-April 2019), meeting both online and face-to-face on several occasions. Results The lack of a common theoretical framework of PE hinders it from becoming an established part of occupational and public health research. There are also issues regarding operationalization in surveys and registers. Further, previous research on PE and health suffers from methodological limitations including inadequate study designs and biased assessments of exposure and outcomes. PE is highly dependent on contextual factors and cross-country comparison has proven very difficult. We also point to the uneven social distribution of PE, ie, higher prevalence among women, immigrants, young and low educated. We propose a theoretical framework for understanding precarious employment as a multidimensional construct. Conclusions A generally accepted multidimensional definition of PE should be the highest priority. Future studies would benefit from improved exposure assessment, temporal resolution, and accounting for confounders, as well as testing possible mechanisms, eg, by adopting multi-level and intersectional analytical approaches in order to understand the complexity of PE and its relation to health.

Evaluating Employment Quality as a Determinant of Health in a Changing Labor Market.

The shifting nature of employment in recent decades has not been adequately examined from a public health perspective. To that end, traditional models of work and health research need to be expanded to include the relational and contractual aspects of employment that also affect health. We examine the association of three health outcomes with different types of employment in the contemporary U.S. labor market, as measured by a multidimensional construct of employment quality (EQ) derived from latent class analysis. We find that EQ is associated with self-rated health, mental health, and occupational injury. Further, we explore three proposed mediating mechanisms of the EQ-health relationship (material deprivation, employment-related stressors, and occupational risk factors), and find each to be supported by these data.

Heat Exposure and Occupational Injuries: Review of the Literature and Implications.

PURPOSE OF REVIEW: The burden of heat-related adverse occupational health effects, as well as traumatic injuries, is already substantial. Projected increases in mean temperatures and extreme events may increase the risk of adverse heat health effects and enhance disparities among exposed workers. This article reviews the emerging literature on the relationship between heat exposure and occupational traumatic injuries and discusses implications of this work. RECENT FINDINGS: A recent meta-analysis of three case-crossover and five time series studies in industrialized settings reported an association of increasing occupational injuries with increasing heat exposure, with increased effect estimates for male gender and age less than 25 years, although heterogeneity in exposure metrics and sources of bias were demonstrated to varying degrees across studies. A subsequent case-crossover study in outdoor construction workers reported a 0.5% increase in the odds of traumatic injuries per 1 °C increase in maximum daily humidex (odds ratio 1.005 [95% CI 1.003-1.007]). While some studies have demonstrated reversed U-shaped associations between heat exposure and occupational injuries, different risk profiles have been reported in different industries and settings. Studies conducted primarily in industrialized settings suggest an increased risk of traumatic injury with increasing heat exposure, though the exact mechanisms of heat exposure's effects on traumatic injuries are still under investigation. The effectiveness of heat-related injury prevention approaches has not yet been established. To enhance the effectiveness of prevention efforts, prioritization of approaches should take into account not only the hierarchy of controls, social-ecological models, community and stakeholder participation, and tailoring of approaches to specific local work settings, but also methods that reduce local and global disparities and better address the source of heat exposure, including conservation-informed land-use planning, built environment, and prevention through design approaches. Participation of occupational health experts in transdisciplinary development and integration of these approaches is needed.

The Culture Of Health In Early Care And Education: Workers' Wages, Health, And Job Characteristics.

Little is known about the health of the 2.2 million early care and education (ECE) workers responsible for the care, well-being, and success of the approximately ten million children younger than age six enrolled in ECE, or the extent to which ECE environments and employers play a role in workers' health. The purpose of this analysis was to describe the health of an ECE worker sample by wage and by job and center characteristics and to begin to explore the relationships between these factors and workers' health. Our data indicate that ECE workers earn low wages and experience poor mental well-being and high rates of food insecurity. Lower-wage workers worked at centers with more children enrolled in subsidy programs and were more likely to work at centers that did not offer health insurance, paid sick leave, or parental or family leave. Policies and programs that raised workers' wages or mandated the provision of meals to both children and workers could better support teacher health and the quality of ECE for children. Our results suggest that the culture of health in ECE settings and equity-related outcomes could be improved by helping centers provide support and flexibility to teachers (for example, offsetting workers' benefit costs or reducing teacher-to-child ratios to reduce stress) who are managing their own health in the context of demanding work.