Working Conditions and Racial and Ethnic Disparities in Self-rated Health.

OBJECTIVE: The aims of the study are to examine racial and ethnic differences in occupational physical demands, substantive complexity, time pressure, work hours, and establishment size and to assess whether working conditions contribute to racial and ethnic differences in self-rated health. METHODS: We used 2017 and 2019 Panel Study of Income Dynamics data for 8439 adults. Using path models, we examined working conditions among Black, Latino, and White workers and explored whether those conditions mediated racial and ethnic differences in incident poor self-rated health. RESULTS: Some working conditions disproportionately affected Black workers (high physical demands, low substantive complexity), Latino workers (low substantive complexity, small establishments), and White workers (time pressure). Time pressure predicted worse self-rated health; there was no evidence that the working conditions studied mediated racial/ethnic differences. CONCLUSIONS: Working conditions vary by racial and ethnic group; some predict worse health.

Personal and work-related factors associated with mental health among auto workers during the COVID-19 pandemic in the United States.

Little is known about the psychological impact of the COVID-19 pandemic on non-healthcare workers, especially among those who weathered unemployment related to shutdowns and supply-chain disruptions. We administered a cross-sectional survey (May - October 2021) to understand patterns between personal and work-related predictors and mental health symptoms among in-person auto workers in the United States (N = 1,165). The Generalized Anxiety Disorder-2 and the Patient Health Questionnaire-2 measured the presence of anxiety and depressive symptoms, respectively. Predictors included the presence of financial/family stressors, fear of SARS-CoV-2 exposure, perceptions of safety climate/culture, and clarity of workplace COVID-19 protocols. We used multinomial logistic regression to examine associations between the predictors and anxiety symptoms alone, depressive symptoms alone, and both anxiety and depressive symptoms compared to no symptoms, adjusting for socio-demographic characteristics, employee type, COVID-19 infection history, and preexisting psychological or psychiatric disorders. Experiencing financial/family stressors (adjusted odds ratio (AOR): 2.65, 95 % CI: 1.86-3.78) and feeling very concerned over SARS-CoV-2 exposure (AOR: 2.12, 95 % CI: 1.47-3.06) increased the odds of having both anxiety and depressive symptoms in comparison to experiencing no stressors, and feeling less than very concerned over exposure, respectively. Positive perceptions of safety climate/culture (AOR = 0.79, 95 % CI: 0.75-0.84) and strong clarity of COVID-19 protocols (AOR = 0.91, 95 %CI: 0.84-0.99) were associated with lower odds of both anxiety and depressive symptoms. These findings highlight the importance of job security and feeling safe at work in affecting the psychological impact of the pandemic on workers. Considerations for COVID-19 prevention in the workplace and mental health should go hand-in-hand.

Employment Pathways during Economic Recession and Recovery and Adult Health.

Our study bridges literatures on the health effects of job loss and life course employment trajectories to evaluate the selection into employment pathways and their associations with health in the short and medium terms. We apply sequence analysis to monthly employment calendars from a population-based sample of working-age women and men observed from 2009 to 2013 (N = 737). We identify six distinct employment status clusters: stable full-time employment, stable part-time employment, stably being out of the labor force, long-term unemployment, transition out of the labor force, and unstable full-time employment. After adjustment for sociodemographic characteristics and health at baseline, those who transitioned out of the labor force showed significantly poorer self-rated health at follow-up, whereas steadily part-time employed respondents still showed a greater risk of meeting criteria for major or minor depression. The findings have important implications for how social scientists conceptualize and model the relationship between employment status and health.

Occupational differences in advance care planning: Are medical professionals more likely to plan?

Advance care planning (ACP) helps ensure that treatment preferences are met at the end of life. Medical professionals typically are responsible for facilitating patients' ACP, and may be especially effective in doing so if they have first-hand insights from their own planning. However, no large-scale U.S. studies examine whether persons working on the front lines of health care are more likely than other workers to have done ACP. We contrast the use of three ACP components (living wills, durable power of attorney for health care, and informal discussions) among persons working in medical, legal, social/health support services, other professional, and other non-professional occupations. Data are from the Health and Retirement Study (n = 7668) and Wisconsin Longitudinal Study (n = 5464). Multivariable logistic regression analyses are adjusted for socioeconomic, demographic, health, and psychosocial factors that may confound associations between occupational group and ACP. Medical professionals in both samples are more likely than other professional workers to discuss their own treatment preferences, net of all controls. Medical professionals in the WLS are more likely to execute living wills and DPAHC designations, whereas legal professionals in the HRS are more likely to name a DPAHC. Non-professional workers are significantly less likely to do all three types of planning, although these differences are accounted for by socioeconomic factors. Social and health services professionals are no more likely than other professionals to do ACP. The on-the-job experiences and expertise of medical professionals may motivate them to discuss their own end-of-life preferences, which may render them more trustworthy sources of information for patients and clients. The Affordable Care Act provides reimbursement for medical professionals' end-of-life consultations with Medicare beneficiary patients, yet practitioners uncomfortable with such conversations may fail to initiate them. Programs to increase medical professionals' own ACP may have the secondary benefit of increasing ACP among their patients.

Cumulative employment intensity and complexity across the life course and cognitive function in later life among European women and men.

PURPOSE: Relatively little is known about how working-age life course cumulative exposure to employment intensity and job complexity informs older-age cognitive function. We investigate these associations, separately for men and women, and net of known confounders. METHODS: Using retrospective lifetime employment histories of Europeans born 1923-1959 (2004-2009, N = 22 266), we calculate cumulative working-age exposure to nonemployment, full-time and part-time employment, and a professional occupation. In gender-stratified linear regression models, these indicators predict cognitive function score based on the DemTect scale and Mini Mental State Exam. RESULTS: Nonemployment ≥25% of the working life course was associated with poorer cognitive function for men by -0.43 points (95% CI = -0.79, -0.06) on a 19-point scale. Women's full-time employment, even if <25% of the working lifetime, was associated with a cognitive advantage over never-employment by 0.60 points (95% CI = 0.17, 1.02). Compared to predominantly nonprofessionally employed men, those working professionally for ≥75% of the life course had better cognition by 0.38 points (95% CI = 0.16, 0.60). CONCLUSIONS: This paper provides novel evidence that older-age cognitive functioning is associated with cumulative exposure to both employment intensity and complexity, but that these relationships vary by sex.

Invited Commentary: Linking Job Security and Mental Health-Challenges and Future Directions.

Research in the social and health sciences has linked job insecurity to poorer mental health but relies on observational data and faces challenges of causal inference. LaMontagne et al. (Am J Epidemiol. 2021;190(2):207-215) innovate by using both within-person fixed-effects and random-effects regression to analyze data from 14 annual waves of an Australian survey spanning 2002-2015. Using this more rigorous design, they find that improvements in perceived job insecurity were associated with improvements in Mental Health Inventory-5 scores in a large, nationally representative panel study. By using each respondent as their own control, fixed-effects models remove the influence of time-invariant confounders. Innovative new approaches are still needed to address the causal directionality of the association and to capture both those whose exposure changes as well as those for whom it persists. Future work should also consider potential modifying factors including societal conditions, macroeconomic and other period effects, and characteristics of individuals, as well as drawing on multidisciplinary approaches that consider jobs as a combination of multiple health-relevant exposures and embed individual workers in families and communities to assess the full reach and consequences of perceived job insecurity.

Corrigendum to "Occupational Differences in BMI, BMI Trajectories, and Implications for Employment Status among Older U.S. Workers"Sarah A. Burgard and Amanda Sonnega.

[This corrects the article DOI: 10.1093/workar/waw038.][This corrects the article DOI: 10.1093/workar/waw038.].

Women's Work-Family Histories and Cognitive Performance in Later Life.

Long-term exposures to the stress and stimulation of different work, parenting, and partnership combinations might influence later life cognition. We investigated the relationship between women's work-family life histories and cognitive functioning in later life. Analyses were based on data from women born between 1930 and 1957 in 14 European countries, from the Survey of Health, Ageing and Retirement in Europe (2004-2009) (n = 11,908). Multichannel sequence analysis identified 5 distinct work-family typologies based on women's work, partnership, and childrearing statuses between ages 12 and 50 years. Multilevel regressions were used to test the association between work-family histories and later-life cognition. Partnered mothers who mainly worked part-time had the best cognitive function in later life, scoring approximately 0.63 (95% confidence interval (CI): 0.18, 1.07) points higher than mothers who worked full-time on a 19-point scale. Partnered mothers who were mainly unpaid caregivers or who did other unpaid activities had cognitive scores that were 1.19 (95% CI: 0.49, 1.89) and 0.93 (95% CI: 0.20, 1.66) points lower than full-time working mothers. The findings are robust to adjustment for childhood advantage and educational credentials. This study provides new evidence that long-term exposures to certain social role combinations after childhood and schooling are linked to later-life cognition.

Stability and Change in Health Behavior Profiles of U.S. Adults.

OBJECTIVES: While understanding of complex within-person clustering of health behaviors into meaningful profiles of risk is growing, we still know little about whether and how U.S. adults transition from one profile to another as they age. This study assesses patterns of stability and change in profiles of tobacco and alcohol use and body mass index (BMI). METHOD: A nationally representative cohort of U.S. adults 25 years and older was interviewed up to 5 times between 1986 and 2011. Latent transition analysis (LTA) models characterized the most common profiles, patterning of transitions across profiles over follow-up, and assessed whether some were associated with higher mortality risk. RESULTS: We identified 5 profiles: "health promoting" with normal BMI and moderate alcohol consumption; "overweight"; "current smokers"; "obese"; and "nondrinkers". Profile membership was largely stable, with the most common transitions to death or weight gain. "Obese" was the most stable profile, while "smokers" were most likely to transition to another profile. Mortality was most frequent in the "obese" and "nondrinker" profiles. DISCUSSION: Stability was more common than transition, suggesting that adults sort into health behavior profiles relatively early. Women and men were differently distributed across profiles at baseline, but showed broad similarity in transitions.

Informal and Formal Social Integration Shape Eating and Drinking of Older Black and White Americans.

Objective: Health behaviors are seen as one possible pathway linking race to health outcomes. Social integration has also been consistently linked to important health outcomes but has not been examined as a mechanism accounting for racial differences in health behaviors among older U.S. adults. Method: We use data from the American's Changing Lives (ACL) Study to explore racial differences in measures of social integration and whether they help account for racial differences in several dietary behaviors and alcohol use. Results: We find differences by race and social integration measures in dietary behaviors and alcohol use. Net of socioeconomic status, health status, and reported discrimination, variation in social integration helps to account for racial differences in some health behaviors. Discussion: Our results highlight the nuanced role of social integration in understanding group differences in health behaviors. Interventions should consider such complexities when including aspects of social integration in their design.

Marital status and cognitive impairment in the United States: evidence from the National Health and Aging Trends Study.

PURPOSE: We provide population-based longitudinal evidence of marital status differences in the risk of cognitive impairment and dementia in the United States. METHODS: Data were from the longitudinal National Health and Aging Trends Study, 2011-2018. The sample included 7508 respondents aged 65 years and older who contributed 25,897 person-year records. We estimated discrete-time hazard models to predict the risk of dementia and cognitive impairment, not dementia (CIND), as well as impairment in three major cognitive domains: memory, orientation, and executive function. RESULTS: Relative to their married counterparts, divorced and widowed elders had higher odds of dementia and CIND, as well as higher odds of impairment in each of the cognitive domains. Never-married elders had higher odds of impairment in memory and orientation than their married counterparts but did not differ significantly in the odds of impaired executive function, dementia, or CIND. Cohabiting elders did not differ significantly from married respondents on any measure of cognitive impairment. We found no gender differences in the associations between marital status and the measures of cognitive impairment. CONCLUSIONS: Marital status is a potentially important but overlooked social risk/protective factor for cognitive impairment. Divorced and widowed older adults are particularly vulnerable to cognitive impairment.

Gender differences in the association of living and working conditions and the mental health of trafficking survivors.

OBJECTIVES: To assess the association of living and working conditions experienced during trafficking with mental health of female and male survivors. METHODS: We analyzed a cross-sectional study of 1015 survivors who received post-trafficking services in Cambodia, Thailand, and Vietnam. Modified Poisson regression models were conducted by gender to estimate prevalence ratios. RESULTS: For females, the elevated prevalence of anxiety, depression, and post-traumatic stress disorder (PTSD) symptoms was associated with adverse living conditions, while for males the prevalence of anxiety (PR = 2.21; 95% CI 1.24-3.96) and depression (PR = 2.63; 95% CI 1.62-4.26) more than doubled and almost tripled for PTSD (PR = 2.93; 95% CI 1.65-5.19) after adjustment. For males in particular, excessive and extreme working hours per day were associated with more than a four- and threefold greater prevalence of PTSD. Being in a detention center or jail was associated with all three mental health outcomes in males. CONCLUSIONS: Providers and stakeholders need to consider the complex mental health trauma of the differential effects of living and working conditions for female and male survivors during trafficking to support treatment and recovery.

Material hardship and sleep: results from the Michigan Recession and Recovery Study.

OBJECTIVE: Sleep is unequally distributed in the US population. People with low socioeconomic status report worse quality and shorter sleep than people with high socioeconomic status. Past research hypothesized that a potential reason for this link could be exposure to material hardship. This study examines the associations between several material hardships and sleep outcomes. METHODS: We use population-representative cross-sectional data (n = 730) from the Michigan Recession and Recovery Study collected in 2013 and examine the associations between 6 indicators of material hardship (employment instability, financial problems, housing instability, food insecurity, forgone medical care, and the total number of material hardships reported) and 3 sleep outcomes (short sleep, sleep problems, and nonrestorative sleep). We build multivariable logistic regression models controlling for respondents' characteristics and light pollution near their residence. RESULTS: In unadjusted models, all material hardships were associated with negative sleep outcomes. In adjusted models, forgone medical care was a statistically significant predictor of nonrestorative sleep (average marginal effect 0.16), as was employment instability (average marginal effect 0.12). The probability of sleep problems and nonrestorative sleep increased with a greater number of hardships overall (average marginal effects of .02 and .05, respectively). We found marginally statistically significant positive associations between food insecurity and short sleep and sleep problems. CONCLUSIONS: This study finds that, except when considering foregone medical care, employment instability, and total count of material hardships, associations between material hardship and negative sleep outcomes are not statistically significant after adjusting for a robust set of sociodemographic and health characteristics.

Interdependence in Health and Functioning Among Older Spousal Caregivers and Care Recipients.

Older spousal caregiving relationships involve support that may be affected by the health of either the caregiver or care recipient. We conducted a longitudinal analysis using pooled data from 4,632 community-dwelling spousal care recipients and caregivers aged ⩾50 from the 2002 to 2014 waves of the Health and Retirement Study. We specified logistic and negative binomial regression models using lagged predictor variables to assess the role of partner health status on spousal caregiver and care recipient health care utilization and physical functioning outcomes. Care recipients' odds of hospitalization, odds ratio (OR): 0.83, p<.001, decreased when caregivers had more ADL difficulties. When spouses were in poorer versus better health, care recipients' bed days decreased (4.69 vs. 2.54) while caregivers' bed days increased (0.20 vs. 0.96). Providers should consider the dual needs of caregivers caring for care recipients and their own health care needs, in adopting a family-centered approach to management of older adult long-term care needs.

Mental health, violence and psychological coercion among female and male trafficking survivors in the greater Mekong sub-region: a cross-sectional study.

BACKGROUND: Human trafficking is a pervasive global crime with important public health implications that entail fundamental human rights violations in the form of severe exploitation, violence and coercion. Sex-specific associations between types of violence or coercion and mental illness in survivors of trafficking have not been established. METHODS: We conducted a cross-sectional study with 1015 female and male survivors of trafficking (adults, adolescents and children) who received post-trafficking assistance services in Cambodia, Thailand or Vietnam and had been exploited in various labor sectors. We assessed anxiety and depression with the Hopkins Symptoms Checklist (HSCL-25) and post-traumatic stress disorder (PTSD) symptoms with the Harvard Trauma Questionnaire (HTQ), and used validated questions from the World Health Organization International Study on Women's Health and Domestic Violence to measure physical and sexual violence. Sex-specific modified Poisson regression models were estimated to obtain prevalence ratios (PRs) and their 95% confidence intervals (CI) for the association between violence (sexual, physical or both), coercion, and mental health conditions (anxiety, depression and PTSD). RESULTS: Adjusted models indicated that for females, experiencing both physical and sexual violence, compared to not being exposed to violence, was a strong predictor of symptoms of anxiety (PR = 2.08; 95% CI: 1.64-2.64), PTSD (PR = 1.55; 95% CI: 1.37-1.74), and depression (PR = 1.57; 95% CI: 1.33-1.85). Among males, experiencing physical violence with additional threats made with weapons, compared to not being exposed to violence, was associated with PTSD (PR = 1.59; 95% CI: 1.05-2.42) after adjustment. Coercion during the trafficking experience was strongly associated with anxiety, depression, and PTSD in both females and males. For females in particular, exposure to both personal and family threats was associated with a 96% elevated prevalence of PTSD (PR = 1.96; 95% CI: 1.32-2.91) and more than doubling of the prevalence of anxiety (PR = 2.11; 95% CI: 1.57-2.83). CONCLUSIONS: The experiences of violence and coercion in female and male trafficking survivors differed and were associated with an elevated prevalence of anxiety, depression, and PTSD in both females and males. Mental health services must be an integral part of service provision, recovery and re-integration for trafficked females and males.

Working, Parenting and Work-Home Spillover: Gender Differences in the Work-Home Interface across the Life Course.

In this study, we bring a life course approach to work-family research and ask how work-home spillover changes as men and women move through different parenting stages. We use two waves of the Mid-Life in the United States Study (MIDUS I and II, 1996-2004, N=1,319) and estimate change-score models to document the association between five parenting transitions (becoming a parent, starting to parent a school-aged child, an adolescent, young adult, or adult child) and changes in both positive and negative work-to-home (WHS) and home-to-work (HWS) spillover, testing for gender differences in these associations. We find that moving through parenting stages is related to within-person changes in reports of work-home spillover, and that mothers and fathers encounter changes in spillover at different points in the life course. Our findings detail how transitions through parenthood produce a gendered life course, and speaks to the need for policies to support working parents throughout the life course.

Association of a Negative Wealth Shock With All-Cause Mortality in Middle-aged and Older Adults in the United States.

Importance: A sudden loss of wealth-a negative wealth shock-may lead to a significant mental health toll and also leave fewer monetary resources for health-related expenses. With limited years remaining to regain lost wealth in older age, the health consequences of these negative wealth shocks may be long-lasting. Objective: To determine whether a negative wealth shock was associated with all-cause mortality during 20 years of follow-up. Design, Setting, and Participants: The Health and Retirement Study, a nationally representative prospective cohort study of US adults aged 51 through 61 years at study entry. The study population included 8714 adults, first assessed for a negative wealth shock in 1994 and followed biennially through 2014 (the most recent year of available data). Exposures: Experiencing a negative wealth shock, defined as a loss of 75% or more of total net worth over a 2-year period, or asset poverty, defined as 0 or negative total net worth at study entry. Main Outcomes and Measures: Mortality data were collected from the National Death Index and postmortem interviews with family members. Marginal structural survival methods were used to account for the potential bias due to changes in health status that may both trigger negative wealth shocks and act as the mechanism through which negative wealth shocks lead to increased mortality. Results: There were 8714 participants in the study sample (mean [SD] age at study entry, 55 [3.2] years; 53% women), 2430 experienced a negative wealth shock during follow-up, 749 had asset poverty at baseline, and 5535 had continuously positive wealth without shock. A total of 2823 deaths occurred during 80 683 person-years of follow-up. There were 30.6 vs 64.9 deaths per 1000 person-years for those with continuously positive wealth vs negative wealth shock (adjusted hazard ratio [HR], 1.50; 95% CI, 1.36-1.67). There were 73.4 deaths per 1000 person-years for those with asset poverty at baseline (adjusted HR, 1.67; 95% CI, 1.44-1.94; compared with continuously positive wealth). Conclusions and Relevance: Among US adults aged 51 years and older, loss of wealth over 2 years was associated with an increased risk of all-cause mortality. Further research is needed to better understand the possible mechanisms for this association and determine whether there is potential value for targeted interventions.

Occupational Differences in BMI, BMI Trajectories, and Implications for Employment Status among Older U.S. Workers.

We examined associations between employment and obesity, arguing that risk for unhealthy weight may vary across occupational groups because they shape workplace exposures, social class standing, material resources, and norms and expectations about healthy behaviors and weight. We used a large sample of 51-61-year-old workers from the Health and Retirement study, tracking their body mass index (BMI) over time while accounting for potentially confounding influences of socioeconomic status and gender and exploring whether gender modified associations between occupational group, BMI, and retirement timing. Compared with women in professional occupations, women managers were less likely to be obese at baseline and were less likely to be in the obese upward trajectory class, while female professionals and operators and laborers were less likely than women in farm and precision production to be in the normal stable trajectory. Male professionals were less likely than men in sales, service, and operator and laborer positions to be obese at baseline and more often followed the normal upward trajectory than most other groups, though they and farm and precision production men were more likely to be in the overweight to obese trajectory than men in service occupations. Adjustment for sociodemographic and lifestyle characteristics reduced associations more for men than for women. While retirement risk differed across occupational groups, most of these differences were explained by socioeconomic, demographic, and lifestyle characteristics, especially for men. Obesity at baseline was an independent predictor of retirement but did not further explain differences in the timing of retirement by occupational group.

The Effect of Sleep Disturbance on the Association between Chronic Medical Conditions and Depressive Symptoms Over Time.

Chronic medical conditions (CMC) and sleep disturbances are common among adults and associated with depression. We tested sleep disturbance as a moderator of the effect of CMC on depressive symptoms. The sample includes 3597 adults surveyed up to five times over 25 years (1986-2012) from the nationally representative American's Changing Lives Study (ACL). A multi-level model was estimated to examine sleep disturbance as a moderator of the CMC and depressive symptom association, with a second interaction tested for age as a moderator of the within-person level variability in CMC and depressive symptom association. Sleep disturbance and CMC were associated with depressive symptoms at the between-person level, while only sleep disturbance was associated with depressive symptoms at the within-person level. Sleep disturbance significantly interacted with CMC such that more CMCs were associated with more depressive symptoms among individuals sleeping well, but poor sleep was associated with worse depression regardless of CMC. A second interaction between age and within-person variability in CMC was found significant, suggesting that younger adults had higher symptoms of depression at times of below average CMC relative to older adults. The effect of CMC on depressive symptoms may depend on sleep as well as age. Sleeping restfully may allow individuals with CMC the rejuvenation needed to cope with illness adaptively.