Exploring the Health Effects of Precarious Employment by Sex/Gender Using Mixed Methods

Employment in the United States has changed dramatically since the mid-1970s. Labor market forces like globalization and diversification of the American workforce have led to a heavily segmented labor market where new types of flexible employment such as temporary, contingent, and nonstandard work arrangements are increasingly common. These newer types of work are often on the lower end of the precarious employment continuum, categorizing jobs by their degree of: 1) temporariness, 2) disempowerment, 3) vulnerability, 4) compensation (wages), 5) rights, and 6) ability to exercise worker rights. The increase in precarious employment likely disproportionately affects women when compared to men, in part because women are more likely to work in part-time occupations that already: 1) provide fewer work-related benefits, 2) have less opportunity for upward movement, and 3) pay less on average than full-time occupations. Further, dissimilarities in biology and in social context make it likely that the health effects of precarious employment differ substantially by sex/ gender category, but many of those differences have yet to be explored. Precarious employment also has the potential to amplify health disparities that already exist in a number of populations, particularly for low-wage and low-educated workers. Occupations are heavily segregated by race/ethnicity as well as by sex/gender, making it likely that the exposure to precarious employment and any resulting health effects of precarious employment vary meaningfully by race/ethnicity. This project employed a mixed methods framework to explore if a composite measure of precarious employment could be constructed using the Spanish validated 2010 Employment Precariousness Scale as a guide. Quantitative Phase I of the project utilized principal component analysis to develop an eight indicator, two component measure of precarious employment using the 2010 National Health Interview survey. In this phase of the project, women were more likely to be precarious workers across both the two component measures and the sum measure of employment precarity (i.e. economic precariousness, psychological precariousness, sum employment precarity), but the effect size for each measure varied, with economic precariousness having the largest odds ratio. Additionally, Non-Hispanic Black workers demonstrated significantly increased odds of employment precarity across all three measures as well. The relationship between precarious employment and five specified health outcomes (i.e. hypertension, carpal tunnel syndrome, work days missed due to illness, moderate mental distress, and self-rated health) was also assessed using the 2010 National Health Interview Survey as well. The odds of hypertension, moderate mental distress, and poorly rated self-health were significantly increased for precarious-workers in the full sample. Women precarious-workers had increased odds for hypertension, moderate mental distress and poorly rated self-health when compared to women non-precarious workers. Hispanic and Non-Hispanic Black precarious workers were found to have increased odds of poorly rated self-health and moderate mental distress. In the Qualitative Phase II of the project, a series of four gender-segmented focus groups were held with recruiting efforts focused on a likely low-income and precarious population of workers in Brooklyn, NY. Women and men who participated in these focus groups worked primarily in different jobs and within very dissimilar social contexts. Men participants worked exclusively in the formal labor market, while many of the women participants described working informally, outside of labor market rules and regulations, often caring for their family members and neighbors. The segregation of women and men into distinctive jobs led to their describing different earning levels, fringe benefit access, and work exposures (e.g. hours worked, days of the week worked, or job tasks). The dissimilar family structures of women and men contributed to variations in work earnings, benefits, and exposures that were exacerbated the different responsibilities women and men had within these structures. The public health implications of the project encompass: 1) possible changes to national and local labor policies regarding job and income security, 2) interventions at the organizational level that target worker control of different workplace conditions (e.g. schedule, task, or utilization of fringe benefits), and 3) education campaigns that inform individual workers about their workplace rights, their ability to exercise those rights, and about how to address workplace harassment or exploitation