An Online Training Module to Increase Knowledge and Awareness of Chemical Exposures and Safety Measures Among Nail Salon Workers.

OBJECTIVE: We developed an online training module targeting nail salon workers' knowledge of chemical exposure and safety, responding directly to the workers' expressed needs in a Midwest State. METHODS: Following a needs assessment, we designed and developed the module content. Implementation and evaluation approaches were rolled out into three phases. RESULTS: Seven workers completed the English version of the module and 24 workers completed the Vietnamese version. The average pre-test scores for those who completed the English and Vietnamese versions of the training were 81.43% and 58.33% respectively. The average post-test score was 98.57% for English and 91.67% for Vietnamese. CONCLUSION: Culturally appropriate educational resources are effective facets of enhancing nail salon workers' awareness, and their occupational health subsequently.

Service Workers' Experience and Perceptions of Workplace Protective Measures During the Onset of COVID-19.

OBJECTIVES: The Coronavirus-2019 (COVID-19) pandemic presents a unique burden specifically for workers in service industries. However, limited research on service worker's experience during the onset of COVID-19 exists. We aimed to describe the experiences and concerns of service industry workers during the pandemic's onset. METHODS: This is a mixed-method study. Participants were recruited through social media and completed either a survey or a phone interview during May and June 2020. The survey and transcribed interview data were analyzed using the SPSS software and content analysis, respectively. RESULTS: Twenty-seven individuals completed audio-recorded phone interviews and 28 completed the survey. Participants were mostly women between 19 and 65 years old. Participants worked in food retail (n = 23), restaurant (n = 25), and hospitality (n = 7) industries. There was discordance in perceived threat level of COVID-19. Most participants reported that their workplace complied with their state's mandates for protection measures, while others reported lacking basic supplies such as soap, hand sanitizer, and masks. Job insecurity, change of job tasks, and work hours were the most common ways that COVID-19 affected the workers. Worker's assertiveness to self-protect while at work was influenced by their perceived severity of the pandemic. CONCLUSION/APPLICATION TO PRACTICE: This study highlights the vulnerability of service workers relating to job security and job tasks during the pandemic. Organizational processes are needed to promote safe work environments and facilitate access to resources for these workers. In addition, occupational health practitioners need to be aware of and address the emerging health risks and worker needs.

Licensure and citations among nail salons in Michigan from 2017 to 2021: A cross-sectional study of an overlooked and vulnerable industry.

Background: Nail salon workers (NSW) in the United States (U.S.) are predominantly immigrant women who face a number of occupational hazards, such as biological, ergonomic, and chronic chemical exposures. Additionally, there are challenges to keeping up with the latest practices in this evolving small business industry. Licensure requirements are intended to keep not only consumers but also workers safe, however licensure requirements vary between states creating little skill, education, and occupational health and safety knowledge and practice consistency among the nail salon workforce. The current state of nail salons and licensure of workers in the State of Michigan-an overlooked state and region (Midwest) in NSW research-was determined to better characterize this workforce. Methods: A Freedom of Information Act request was submitted to the Michigan Department of Licensing and Regulatory Affairs regarding nail salon establishments and their workers, formally termed manicurists, and citation data for breaches. Data were provided on the number of licensed cosmetologists and cosmetology businesses from January 2017 to March 2021. From there, the total number of licensed manicurists was determined, and the cosmetology establishment list was analyzed to see if the businesses exclusively or predominantly provided nail services. Results: As of Mach 2021, there were 1372 nail salons that exclusively provided nail services and over 12,000 licensed manicurists. Over half of the disciplinary actions cited were for salons not officially licensed. Michigan has reduced licensure requirements compared to other states and no continuing education (CE) requirements for license renewals. Conclusion: There is a need for industry educational and training standardization, across the nation, as well as heightened licensure requirements for these vulnerable workers. CE not only keeps workers abreast of the latest practices in the industry, but also provides them the skills and knowledge to enhance their worker health, safety, and wellbeing.

Immigration-related stressors and health outcomes among low-wage immigrant hotel workers: A pilot study.

BACKGROUND: Immigrants comprise over 40% of the low-wage workforce. They are more likely to be employed in service industries, paid less, and experience more illness and injuries than their native counterparts. DESIGN/OBJECTIVE: The aim of this cross-sectional pilot study was to explore the relationship between immigrant workers' stressors and health. SAMPLE: Twenty-five female Mexican immigrant hotel workers. MEASUREMENTS: Surveys and blood samples were analyzed and compared to national data. Descriptive statistics and linear regression were used for analysis. RESULTS: Longer length of stay, older age at migration, and higher Demands of Immigration (DI) were significantly associated with more chronic conditions. Higher DI were significantly associated with more depressive symptoms. This is comparable to national data (n = 468) which shows a significant relationship between length of stay, Allostatic Load (AL), and chronic conditions (ß = 0.14, p = .043; ß = 0.13, p = .025). CONCLUSIONS: Immigrant-specific factors affect individuals' health. More studies are needed to further explore the relationship between DI and health among foreign-born workers.

Intervention needs among hotel employees and managers.

BACKGROUND: Hotel room cleaners are disproportionately exposed to hazards that increase risk for poor health outcomes. Interventions are needed to improve the health of these workers. Yet we know little about the expressed needs of hotel room cleaners nor do we know about managers' perspectives on how to best optimize employee health. OBJECTIVE: We aimed to develop an understanding of perceived intervention needs among hotel room cleaners and to assess managers' views on the acceptability of the proposed interventions. METHODS: We used a community-based approach to recruit study participants. We conducted five focus groups among hotel room cleaners and individual interviews with hotel managers. Interviews were audio-recorded, transcribed, and analyzed using content analysis. RESULTS: The workers expressed needs centered on pay, workload, appreciation, ergonomics, chemical and biological hazards, nutrition, smoking cessation, exercise, mental health and stress management. In addition to echoing the workers' expressed needs, managers emphasized employee retention and financial literacy. CONCLUSIONS: To our knowledge, this is the first paper to include both workers' and managers' accounts on intervention approaches that will optimize health and wellbeing. This paper offers a guide for future program development among hospitality workers. Effective interventions need to be integrated, encompassing the individual, intrapersonal, organizational, and policy levels.

Emancipatory Photovoice Research: A Primer.

Photovoice can be more than a research method for communities to identify and mitigate social oppressions. Photovoice has the potential for emancipatory outcomes and the transformation of power relations. This article serves as a primer for beginning researchers who are new to the emancipatory power of the photovoice method or for advanced researchers who would like to re-imagine their current use of the photovoice method to an emancipatory approach that elevates and empowers. Our purpose is to provide a framework for deciding structures, processes, and outcomes of emancipatory photovoice. We specifically prescribe steps with respect to power relations among partners, design prompts or heuristics, and the anticipated and unanticipated outcomes. We base our perspectives on over a decade of photovoice research experiences. Emancipatory photovoice research, if implemented thoughtfully, can facilitate power sharing, collective learning, healing, and growth.

I Am a Nurse, Not a Martyr: Qualitative Investigation of Nurses' Experiences During Onset of the Coronavirus Pandemic.

Nurses have always played an essential role during epidemics, risking their lives caring for sick and dying patients. However, the unprecedented nature of the novel coronavirus disease 2019 (COVID-19) has left organizations and healthcare professionals ill-prepared and under-equipped to manage the severity, manifestations, and acute and long-term implications. While COVID-19 has presented profound physical and mental health implications for nurses, we know little about nurses' professional experiences within their organizational context. Thus, this qualitative descriptive study fills that gap through in-depth exploration of nurses' shared professional experiences working in hospitals during the first surge of COVID-19 in the United States. Twenty-two nurses were interviewed via telephone during April and May 2020. Through thematic analysis four main themes emerged: (1) fear, (2) collective resilience through shared trauma, (3) uncharted territory, and (4) perceived disposability. Nurses felt ill-praepared for the rapid changes wrought by COVID-19; yet they also felt proud with a renewed sense of meaning in their work. While unit colleagues were a great source of strength, nurses still reported disappointment, even feeling abandoned by their organizations. Our study indicates that nurses relied on one another to cope and find meaning. These findings are invaluable for policy development and the establishment of preventive and early intervention strategies. Done right, such efforts could better support nurses by encouraging team building, protection, and rewards to maintain nurses' wellbeing during such outbreaks and in their aftermath. Organizations also ought to make nurses' health and wellbeing a priority by streamlining communication, transparency, and leadership visibility.

Perceived work exposures and expressed intervention needs among Michigan nail salon workers.

BACKGROUND: Nail salon workers are an underserved population exposed to various occupational hazards. Comprised primarily of women and immigrants, these workers face challenges that further increase their workplace exposures and adverse health outcomes. Though previous studies have noted nail salon workers' exposures, these studies have yet to explore the workers' insights on intervention needs. This study among Michigan nail salon workers addresses this gap. METHODS: This qualitative study was informed by the phenomenology methodological framework anchored within critical social theory. Participants were recruited from nail salons in Southeast Michigan to partake in focus groups. Interviews were recorded, transcribed, and analyzed using content analysis. RESULTS: Three focus groups were conducted with 13 participants. Three major categories emerged. The first category, workers' perceived work-related stressors, included six themes: lack of standardized policies, regulations, education/training; disconnect between education/training and real-world practice; inadequate knowledge on exposures and safety protocols; unsafe nail products; customer pressure; and immigrant-related pressures. The second category, health issues perceived to be directly related to workplace exposures, included two themes: symptoms experienced due to contact with nail products and symptoms due to poor ergonomics. The third category, participants' perceived intervention needs, included four themes: continuing education; updates with new products; communication with key stakeholders; and partnership building and resource access. CONCLUSIONS: To our knowledge, this is the first qualitative study among U.S. nail salon workers focused in Midwest. In addition to the noted individual and organizational-level interventions, policy level implications are discussed given discrepancies in training and practices across states.

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.

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.

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.

A scoping review of interventions targeting allostatic load.

Allostatic load (AL) is the manifestation of cumulative responses to chronic stress exposure. Numerous studies have shown the importance of AL in understanding disease risks. Yet little is known about existing interventions that target AL specifically. We aimed to address this gap by identifying interventions targeting AL and determining the success of these interventions in improving biological functioning. We searched five electronic databases using variations of two concepts: AL and programs or interventions. We included original research reports that focused on AL as an outcome. We excluded work that focused on a single indicator, not written in English or did not implement an intervention. The Template for Intervention Description and Replication checklist guided our intervention critique and synthesis. Six articles were included, with sample size across the interventions ranging between 2 and 733. Despite inconsistencies in the selection of AL indicators and scoring of AL, all four body systems were represented in all the studies. Four interventions showed significant improvement in Al (as indicated by a decrease in AL score) as early as 7 weeks. More interventions targeting Al are needed. The reduction in AL scores among four of the six interventions suggests that Al could be a biological outcome measure that is sensitive to change in response to interventions. This has significant clinical and research implications. Future studies are needed to examine whether AL serves as a mediator in the effects of the intervention on improving clinical manifestations of diseases.

Exploring the validity of allostatic load in pregnant women.

BACKGROUND: The theory of allostatic load has gained momentum in perinatal research to understand the biological pathways of the impact of maternal chronic stress on adverse perinatal outcomes. However, due to physiological changes of pregnancy, including large variations across gestation, the extent to which allostatic load measured in pregnancy is valid has not been queried in depth. OBJECTIVES: This study aimed to assess the gestational patterns of selected individual allostatic load indicators and to explore whether a pregnancy allostatic load index score had face validity in relation to chronic sociodemographic stress. DESIGN: This is a secondary analysis using data from the 1999-2006 National Health and Nutrition Examination Survey. METHODS: A total of 1056 pregnant women were included for analyses. Using ten physiological indicators commonly included in an index of allostatic load, we described individual indicator and index score patterns across gestation and assessed differences in allostatic load index scores between women with and without sociodemographic stress. FINDINGS: The average allostatic load index score at any gestational month was not statistically significantly different from the average allostatic load index score in the non-pregnant sample. We also found the allostatic load index score remained steady across gestational month, despite very different gestational patterns of individual allostatic load indicators, as long as gestation-specific risk quartiles were used to calculate the allostatic load index score. Face validity was affirmed via higher allostatic load index scores in women with sociodemographic stress compared to those without such stress. CONCLUSION: Our study suggests that measuring allostatic load in pregnancy is valid for reflecting women's true physiological functions and chronic stress, but gestational age should be considered when scoring the allostatic load index for women at different gestational age. IMPLICATIONS FOR PRACTICE: As a valid measure of chronic stress, a pregnancy allostatic load index may contribute to research on health inequities and perinatal outcomes.

Employee Health and Blood Pressure Outcomes by Job Family.

OBJECTIVE: The purpose of the study was to explore the relationship between job families and blood pressure (BP). METHODS: Subjective (self-report questionnaire) and objective (on-site health screening including blood pressure) data were collected at a large academic institution from employees, which were categorized into 10 job families based on Human Resources career paths. Analysis included descriptive statistics and multivariate logistic regression. RESULTS: A total of 20,198 employees participated. Some specific job families were significantly associated with having high BP (P < 0.01). Being 58 years old and older (odds ratio [OR] 2.33, P < 0.01) and being man (OR 2.52, P < 0.01) were the strongest predictors for elevated BP. CONCLUSIONS: Certain job families may need interventions that target and mitigate particular circumstances in order to reduce and maintain lower BP levels.

Exploring the optimal allostatic load scoring method in women of reproductive age.

AIMS: The aim of this study was to determine the optimal allostatic load scoring method. DESIGN: This is a secondary analysis of data on women of reproductive age from the 2001-2006 National Health and Nutrition Examination Survey. METHODS: We created allostatic load summary scores using five scoring methods including the count-based, Z-Score, logistic regression, factor analysis and grade of membership methods. Then, we examined the predictive performance of each allostatic load summary measure in relation to three outcomes: general health status, diabetes and hypertension. RESULTS: We found that the allostatic load summary measure by the logistic regression method had the highest predictive validity with respect to the three outcomes. The logistic regression method performed significantly better than the count-based and grade of membership methods for predicting diabetes as well as performed significantly better for predicting hypertension than all of the other methods. But the five scoring methods performed similarly for predicting poor health status. CONCLUSION: We recommended the logistic regression method when the outcome information is available, otherwise the frequently used simpler count-based method may be a good alternative. IMPACT: The study compared different scoring methods and made recommendations for the optimal scoring approach. We found that allostatic load summary measure by the logistic regression method had the strongest predictive validity with respect to general health status, diabetes and hypertension. The study may provide empirical evidence for future research to use the recommended scoring approach to score allostatic load. The allostatic load index may serve as an 'early warning' indicator for health risk.

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.