Investigating food retail workers' experiences during the COVID-19 pandemic: A case of effort-reward imbalance.

Food retail businesses experienced a pronounced increase in sales when food hospitality outlets closed in the early stages of the COVID-19 pandemic in Canada. This study investigates how pandemic-related modifications to food retail businesses in Ontario, Canada affected the well-being of workers. Semi-structured interviews were conducted with 17 food retail employees between June 2020 and May 2021 as part of the Food Retail Environment Study for Health and Economic Resiliency (FRESHER). Transcripts were analyzed inductively, and themes were refined using the Effort Reward Imbalance Model. Themes were connected to the main components of this model: extrinsic effort, intrinsic effort, money, esteem, status control, and burnout. Results indicate that, for food retail employees, the presence of an imbalance between efforts and rewards threatens well-being via symptoms of burnout. Further study is needed to examine how this inequality and burnout among this population might be measured and addressed.

Grief and Loss During Care Transitions: Experiences of Direct Care Workers.

Direct Care Workers (DCW) provide both personal care to patients and emotional support to patients and caregivers in hospice and palliative care. DCWs often develop close ties and are then expected to work with new clients immediately following a care transition, with little or no time to grieve. A qualitative pilot study (n = 24) was conducted to explore the experience of DCWs during care transitions. Data was collected via focus groups and individual interviews. Thematic analysis was used. Results suggest DCWs managed their experiences (n = 19), by anticipating and accepting grief and loss (n = 21), employing personal coping strategies (n = 19), and saying good-bye (n = 15). Relational factors impacted the experience of care transitions (n = 22), including building and maintaining the relationship (n = 14), and the strength of perceived connections (n = 15). Increased organizational support and training to help address grief and loss will better support DCWs and the direct care workforce.

Association of Low Hourly Wages in Middle Age With Faster Memory Decline in Older Age: Evidence From the Health and Retirement Study.

Little research has investigated the long-term relationship between low wages and memory decline, despite the growing share of low-wage workers in the US labor market. Here, we examined whether cumulative exposure to low wages over 12 years in midlife is associated with memory decline in later life. Using 1992-2016 data from the Health and Retirement Study, we analyzed data from 2,879 individuals born in 1936-1941 using confounder-adjusted linear mixed-effects models. Low-wage work was defined as an hourly wage lower than two-thirds of the federal median wage for the corresponding year and was categorized into "never," "intermittent," and "sustained" based on wages earned from 1992 to 2004. Memory function was measured at each study visit from 2004 to 2016 via a memory composite score. The confounder-adjusted annual rate of memory decline among "never" low-wage earners was -0.12 standard units (95% confidence interval: -0.13, -0.10). Compared with this, memory decline among workers with sustained earning of low midlife wages was significantly faster (ßtime×sustained = -0.014, 95% confidence interval: -0.02, -0.01), corresponding to an annual rate of -0.13 standard units for this group. Sustained low-wage earning in midlife was significantly associated with a downward trajectory of memory performance in older age. Enhancing social policies to protect low-wage workers may be especially beneficial for their cognitive health.

Occupational health within the bounds of primary care: Factors shaping the health of Latina/o immigrant workers in federally qualified health centers.

BACKGROUND: Many workers seek care for work-related medical conditions in primary care settings. Additionally, occupational medicine training is not consistently addressed in primary care professional training. These patterns raise concerns about the health outcomes of low-wage Latina/o immigrant workers who make use of primary care settings to obtain care for work-related injuries and illnesses. The objective of this qualitative study was to investigate how primary care clinicians assessed and addressed the role of occupational exposures on the health and well-being of Latina/o immigrant workers. METHODS: We conducted semistructured in-depth interviews with 17 primary care clinicians (physicians, resident physicians, and nurse practitioners) employed in an urban federally qualified health center (FQHC) with two sites located in Orange County, CA. RESULTS: Using a constructivist grounded theory approach, we determined that primary care clinicians had a general understanding that employment influenced the health and well-being of their Latina/o immigrant patients. Clinicians delivered care to Latina/o immigrant workers who feared reporting their injury to their employer and to Latina/o immigrants whose workers' compensation claim was terminated before making a full recovery. Clinicians were responsive to patients' work-related concerns and leveraged the resources available within the FQHC. Although some clinicians offered suggestions to improve occupational health in the FQHC, a few clinicians raised concerns about the feasibility of additional health screenings and clinic-based interventions, and pointed to the importance of interventions outside of the healthcare system. CONCLUSION: This study underscores the complexities of addressing occupational health concerns in urban FQHCs.

Material Hardships, Perceived Stress, and Health among Low-Wage Hospital Workers.

Many service, clerical, and technical hospital workers deemed essential during the pandemic have wages that do not reflect the essential nature of their work and do not earn enough income to cover basic expenses. Thus, many experience material hardships related to food, housing, and medical care. Previous studies have shown strong relationships between material hardships and health; however, they do not fully explain the role of stress as an intervening mechanism. This cross-sectional study analyzes an online survey with 257 lower-wage hospital workers to examine the relationships between hardships and health, and how perceived stress mediates these relationships. Path analysis revealed that financial and food hardships were related to mental health through perceived stress, while medical hardship was directly associated with physical health. These findings add to the evidence that workers' hardships either directly or indirectly contribute to negative mental and physical health outcomes through perceived stress. Future investigations should further examine relationships among material hardships, stress, and health, and advocacy efforts should focus on raising wages for essential hospital workers.

Implementation of an organizational intervention to improve low-wage food service workers' safety, health and wellbeing: findings from the Workplace Organizational Health Study.

BACKGROUND: Many organizational interventions aim to improve working conditions to promote and protect worker safety, health, and well-being. The Workplace Organizational Health Study used process evaluation to examine factors influencing implementation of an organizational intervention. This paper examines the extent to which the intervention was implemented as planned, the dose of intervention implemented, and ways the organizational context hindered or facilitated the implementation of the intervention. METHODS: This proof-of-concept trial was conducted with a large, multinational company that provides food service through contractual arrangements with corporate clients. The 13-month intervention was launched in five intervention sites in October 2018. We report findings on intervention implementation based on process tracking and qualitative data. Qualitative data from 25 post-intervention interviews and 89 process tracking documents were coded and thematically analyzed. RESULTS: Over the 13-month intervention, research team representatives met with site managers monthly to provide consultation and technical assistance on safety and ergonomics, work intensity, and job enrichment. Approximately two-thirds of the planned in-person or phone contacts occurred. We tailored the intervention to each site as we learned more about context, work demands, and relationships. The research team additionally met regularly with senior leadership and district managers, who provided corporate resources and guidance. By assessing the context of the food service setting in which the intervention was situated, we explored factors hindering and facilitating the implementation of the intervention. The financial pressures, competing priorities and the fast-paced work environment placed constraints on site managers' availability and limited the full implementation of the intervention. CONCLUSIONS: Despite strong support from corporate senior leadership, we encountered barriers in the implementation of the planned intervention at the worksite and district levels. These included financial demands that drove work intensity; turnover of site and district managers disrupting continuity in the implementation of the intervention; and staffing constraints that further increased the work load and pace. Findings underscore the need for ongoing commitment and support from both the parent employer and the host client. TRIAL REGISTRATION: This study was retrospectively registered with the Clinical Trials. Gov Protocol and Results System on June 2, 2021 with assigned registration number NCT04913168 .

Occupational health research beyond the work setting: inclusive inquiry with ethnic minority and immigrant workers.

Ethnic minority and immigrant workers comprise a sizable proportion of the low-wage workforce. They are surprisingly understudied despite their workplace prominence. Factors such as workplace policies, structures, worker-related characteristics, and research designs preclude their comprehensive research participation when studies are conducted in work settings. Consequently, ethnic minority and immigrant workers continue to be under-represented in inquiry and simultaneously over-represented with compromising occupational health risks. The purpose of this paper is to provide strategies to promote the inclusion of ethnic minority and immigrant workers in occupational health research. Using three different research-based examples, we illustrate the benefit of conducting occupational health research in non-workplace settings as a way to ensure research representation of ethnic minority and immigrant workers.

Exploring the Link Between the Hazards and Value of Work, and Overcoming Risk for Community-Based Health Interventions for Immigrant Latinx Low-Wage Workers.

Few studies integrate work and immigration as intersecting social determinants of health. We synthesize data from 12 focus groups (N = 97) originating from two separate community-engaged studies that originally centered on exploring barriers to health and hazards of work among immigrant Latinx women and men to explore the role of work in their overall health and well-being. The three major interrelated themes we drew from this research-hazards of work, value of work, and building agency to overcome risk-provide insights that can help to reframe and begin to operationalize how community-based health promotion practice might better incorporate workplace issues for Latinx low-wage workers. The value of work, and its subtheme, pride in performing well specifically, could be engaged by workers to actively change conditions for themselves and others. We discuss findings in light of previous occupational health research and implications for community-based intervention design and practice.

COVID-19 and mental health of food retail, food service, and hospitality workers.

The coronavirus pandemic has taken a detrimental toll on the lives of individuals globally. In addition to the direct effect (e.g., being infected with the virus), this pandemic has negatively ravaged many industries, particularly food retail, food services, and hospitality. Given the novelty of the disease, the true impact of COVID-19 remains to be determined. Because of the nature of their work, and the characteristics of the workers, individuals in the food retail, food service, and hospitality industries are a group whose vulnerability is at its most fragile state during this pandemic. Through this qualitative study, we explored workers' perspectives on the impact of COVID-19 on their mental health and coping, including screening for post-traumatic stress disorder (PTSD) and alcohol use disorder symptoms. Twenty-seven individual interviews were conducted, audio-recorded, transcribed, and analyzed using qualitative content analysis. Four key themes emerged: being infected and infecting others, the unknown, isolation, and work and customer demands. Considering the many uncertainties of COVID-19, workers in these three industries were experiencing heightened levels of mental distress because of where they worked and the already existing disparities they faced on a daily basis before the pandemic started. Yet they remained hopeful for a better future. More studies are needed to fully understand the magnitude, short-term, and long-term effects of COVID-19. Based on this study's findings, programs are critically needed to promote positive coping behaviors among at-risk and distressed workers. Recommendations for employers, occupational health and safety professionals, and policy stakeholders to further support these service workers are discussed.

Direct Caregiving in Older Adults: How Systems of Care Perpetuate the Grand Challenges and What Social Workers Can Do about It.

Direct care workers (DCWs) provide personal care, emotional support, and companionship, helping older adults maintain quality lives. DCWs earn low wages, have little training, and experience high turnover rates. While the demand for DCWs grows, real wages continue to fall. Undervaluing DCWs threatens the continuity and quality of care that older adults receive. Through the social work grand challenges lens, this article discusses two qualitative studies, in home care (n = 24) and nursing homes (n = 23), that demonstrate that while DCWs help advance long and productive lives, they experience extreme economic inequality and lack equal opportunity and justice. The article concludes with a discussion of social work's role in advancing opportunity and justice.

Interventions to promote hotel workers' health: A scoping review.

BACKGROUND: The hospitality industry employs millions of workers and is a key contributor to the US economy. Despite being essential drivers in the industry's success, hotel workers, particularly hotel housekeepers, are exposed to occupational hazards and experience disproportionate rates of injuries and chronic health conditions. Thus there is a significant need for health promotion efforts directed toward these workers. However, little is known about existing interventions targeting their health. METHODS: We conducted a scoping review to identify and appraise workplace health promotion interventions targeting hotel employees. We performed a scoping review following the framework outlined by Arksey and O'Malley (2005). Our literature search process was recorded using the preferred reporting items for systematic reviews and meta-analyses. Basic study information was compiled into a matrix table. Study quality was assessed using the template for intervention description and replication. RESULTS: Eight unique interventions were identified, occurring at over 30 hotels with participants ranging between 16 and 1207 employees. Though many of the reported health outcomes were not statistically significant, studies reported results with clinical implications, including decreased numbers of injury claims, reduced anxiety, improvements in cardiovascular disease risk indicators, such as body mass index, and increased knowledge among participants. CONCLUSIONS: This is the first review to interrogate the literature on existing workplace interventions targeting the health of hotel workers. While some studies found significant improvements in health outcomes, few conducted rigorous program evaluation. The results highlight the need for more and effective interventions targeting these at-risk workers.

Occupational Credentials and Job Qualities of Direct Care Workers: Implications for Labor Shortages.

Occupational training and credentialing requirements for direct care workers were in place for consumers' health and safety, but their effects on job qualities and labor shortages in the direct care industry have been controversial. Using a nationally representative sample of psychiatric, nursing, and home health aides, a series of Average Treatment Effect models were analyzed to examine the effects of occupational credentials on various measures of job qualities. The findings revealed that credential-holding was related to higher annual earnings and increased probability of working full-time, year-round, and having access to employer-provided health insurance and retirement savings plans. The positive effects, however, were modest in size and suggested that, given the current wage and benefit levels for direct care workers, training and credential requirements cannot be the key to resolving job quality and labor shortage issues in the direct care industry. Implications of these findings and alternative ways to address the issues were discussed.

Stressors, allostatic load, and health outcomes among women hotel housekeepers: A pilot study.

Hotel housekeepers are exposed to stressors at work and outside of work. A minimal amount is known about these workers' pathophysiological responses to those stressors. Allostatic load is a concept increasingly used to understand pathophysiologic manifestations of individuals' bodily response to stress. The purpose of this study was to examine the associations between work and nonwork stressors, allostatic load, and health outcomes among hotel housekeepers. Work and nonwork stressors (e.g., the number of traumatic events, everyday discrimination, and job strain) and health outcomes (e.g., general health status, physical and mental health, and chronic diseases) were measured. Biometric and anthropometric measures and fasting blood specimens were collected. Blood biomarkers included CRP, HbA1c, HDL, and cortisol. Descriptive analyses, correlations, regressions, and t-tests were conducted. Forty-nine women hotel housekeepers participated, with a mean age of 40 years. One-fifth reported high job strain and more than 40% had at least one traumatic event. Chronic conditions were commonly reported, with about 78%, 55%, and 35% reporting one, two, and three chronic conditions, respectively. Correlation analyses showed that reports of high job strain and everyday discrimination were significantly associated with high ALI quartile score (r = 0.39, p = 0.011; r = 0.41, p = 0.004). Job strain and everyday discrimination had medium to large effect sizes on ALI quartile scores. High ALI quartile score was significantly associated with having at least one chronic disease (r = 0.40, p = 0.005), and it had a large effect size on chronic diseases. To our knowledge, this is the first study to explore allostatic load among hotel housekeepers. Hotel housekeepers have high exposure to stressors within and outside of their work and experience poor chronic conditions. Allostatic load had strong associations with both stressors and health outcomes. Despite this worker group being a hard-to-reach worker group to participate in research studies, this study demonstrates the feasibility of accessing, recruiting and collecting survey data and blood samples among them to determine health risks and guide future targeted interventions.

Health insurance tax credits, the earned income tax credit, and health insurance coverage of single mothers.

The Omnibus Budget Reconciliation Act of 1990 enacted a refundable tax credit for low-income working families who purchased health insurance coverage for their children. This health insurance tax credit (HITC) existed during tax years 1991, 1992, and 1993, and was then rescinded. A difference-in-differences estimator applied to Current Population Survey data suggests that adoption of the HITC, along with accompanying increases in the Earned Income Tax Credit (EITC), was associated with a relative increase of about 4.7 percentage points in the private health insurance coverage of working single mothers with high school or less education. Also, a difference-in-difference-in-differences estimator, which attempts to net out the possible influence of the EITC increases but which requires strong assumptions, suggests that the HITC was responsible for about three-quarters (3.6 percentage points) of the total increase. The latter estimate implies a price elasticity of health insurance take-up of -0.42.

Commute distance and jobs-housing fit.

Anecdotal evidence suggests that the affordable housing crisis is forcing households to seek lower cost housing in the outer reaches of major metropolitan areas, helping to explain recent increases in commute distance. To test this relationship, we use spatial regression to examine the relationship between the availability of affordable housing in close proximity to jobs (jobs-housing fit) and commute distance in the Los Angeles metropolitan area. The analysis draws on 2015 Longitudinal Employer-Household Dynamics (LEHD) Origin-Destination Employment Statistics (LODES) by workplace supplemented with data from the 2013-2017 5-Year American Community Survey on affordable housing units. We find substantial variation in jobs-housing fit across Los Angeles neighborhoods. The imbalance is greatest in higher-income neighborhoods located along the coast and in Orange County, south of Los Angeles. Controlling for other determinants of commute distance, a higher ratio of jobs to affordable housing is associated with longer distance commutes. To address growing commute distances, policymakers must greatly expand and protect the supply of long-term rental housing particularly in job-rich neighborhoods.

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.

Worksite Health Promotion for Low-Wage Workers: A Scoping Literature Review.

OBJECTIVE: To determine: (1) What research has been done on health promotion interventions for low-wage workers and (2) what factors are associated with effective low-wage workers' health promotion programs. DATA SOURCE: This review includes articles from PubMed and PsychINFO published in or before July 2016. Study Inclusion/Exclusion Criteria: The search yielded 130 unique articles, 35 met the inclusion criteria: (1) being conducted in the United States, (2) including an intervention or empirical data around health promotion among adult low-wage workers, and (3) measuring changes in low-wage worker health. DATA EXTRACTION: Central features of the selected studies were extracted, including the theoretical foundation; study design; health promotion intervention content and delivery format; intervention-targeted outcomes; sample characteristics; and work, occupational, and industry characteristics. DATA ANALYSIS: Consistent with a scoping review, we used a descriptive, content analysis approach to analyze extracted data. All authors agreed upon emergent themes and 2 authors independently coded data extracted from each article. RESULTS: The results suggest that the research on low-wage workers' health promotion is limited, but increasing, and that low-wage workers have limited access to and utilization of worksite health promotion programs. CONCLUSION: Workplace health promotion programs could have a positive effect on low-wage workers, but more work is needed to understand how to expand access, what drives participation, and which delivery mechanisms are most effective.

Effort-Reward Imbalance and Work Productivity Among Hotel Housekeeping Employees: A Pilot Study.

This study explored the relationship between effort-reward imbalance (ERI) at work and work productivity among hotel housekeepers. A community-based approach was used to recruit 23 hotel housekeepers who completed the ERI and Work Performance Questionnaires. Work productivity was determined by combining self-report absenteeism and presenteeism. More than 40% of the participants reported high ERI (ERI >1). Also, 59.1% reported low work productivity. Interestingly, despite the individualized high reports of ERI and low work productivity, correlation analysis showed that high ERI was correlated with high presenteeism and work productivity as a whole. This is the first study to explore work productivity among this worker group. Despite the small sample size and the cross-sectional nature of the study, this study points to the need for organization-based interventions to not only improve employee health but also their work productivity.

High-ACE Low Wage Workers: Occupational Health Nursing Research and Praxis Through a Trauma-Informed Lens.

Individuals with a history of adverse childhood experiences (ACEs) disproportionately have poor mental and physical health outcomes. These experiences affect individuals across the life span extending beyond health with deleterious impact on work-related outcomes. Low-wage workers are particularly at risk. Social service and health organizations are becoming aware of the extent to which the populations they serve have been affected by these experiences. Employment support programs may serve high-ACE individuals but likely are unaware of their histories and the developmental or health deficits that result and can impinge on successful employment. Occupational health nurses may be well-positioned not only to implement trauma-informed care in workplaces but also to influence the ways in which employment services for this vulnerable group are delivered. The purpose of this article is to consider how ACEs could affect vulnerable workers. The need for trauma-informed research and praxis to advance occupational health nursing is discussed.