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Objectives The lack of a common definition for precarious employment (PE) severely hampers the comparison of studies within and between countries, consequently reducing the applicability of research findings. We carried out a systematic review to summarize how PE has been conceptualized and implemented in research and identify the construct's dimensions in order to facilitate guidance on its operationalization. Methods According to PRISMA guidelines, we searched Web of Science and Scopus for publications with variations of PE in the title or abstract. The search returned 1225 unique entries, which were screened for eligibility. Exclusion criteria were (i) language other than English, (ii) lack of a definition for PE, and (iii) non-original research. A total of 63 full-text articles were included and qualitative thematic-analysis was performed in order to identify dimensions of PE. Results We identified several theory-based definitions of PE developed by previous researchers. Most definitions and operationalizations were either an accommodation to available data or the direct result of qualitative studies identifying themes of PE. The thematic-analysis of the selected articles resulted in a multidimensional construct including the following three dimensions: employment insecurity, income inadequacy, and lack of rights and protection. Conclusions Despite a growing number of studies on PE, most fail to clearly define the concept, severely restricting the advancement of the research of PE as a social determinant of health. Our combined theoretical and empirical review suggests that a common multidimensional definition could be developed and deployed in different labor market contexts using a variety of methodological approaches.

High-quality longitudinal evidence exploring the mental health risk associated with low-quality employment trajectories is scarce. We therefore aimed to investigate the risk of being diagnosed with common mental disorders, substance use disorders, or suicide attempt according to low-quality employment trajectories. A longitudinal register-study based on the working population of Sweden (N=2 743 764). Employment trajectories (2005-2009) characterized by employment quality and pattern (constancy, fluctuation, mobility) were created. Hazard ratios (HR) were estimated using Cox proportional hazards regression models for first incidence (2010-2017) diagnosis of common mental disorders, substance use disorders and suicide attempt as dependent on employment trajectories. We identified 21 employment trajectories, 10 of which were low quality (21%). With the exception of constant solo self-employment, there was an increased risk of common mental disorders (HR 1.07-1.62) and substance use disorders (HR 1.05-2.19) for all low-quality trajectories. Constant solo self-employment increased the risk for substance use disorders among women, while it reduced the risk of both disorders for men. Half of the low-quality trajectories were associated with a risk increase of suicide attempt (HR 1.08-1.76). Low-quality employment trajectories represent risk factors for mental disorders and suicide attempt in Sweden, and there might be differential effects according to sex - especially in terms of self-employment. Policies ensuring and maintaining high-quality employment characteristics over time are imperative. Similar prospective studies are needed, also in other contexts, which cover the effects of the Covid-19 pandemic as well as the mechanisms linking employment trajectories with mental health.

The world of work is facing an ongoing pandemic and an economic downturn with severe effects worldwide. Workers trapped in precarious employment (PE), both formal and informal, are among those most affected by the COVID-19 pandemic. Here we call attention to at least 5 critical ways that the consequences of the crisis among workers in PE will be felt globally: (a) PE will increase, (b) workers in PE will become more precarious, (c) workers in PE will face unemployment without being officially laid off, (d) workers in PE will be exposed to serious stressors and dramatic life changes that may lead to a rise in diseases of despair, and (e) PE might be a factor in deterring the control of or in generating new COVID-19 outbreaks. We conclude that what we really need is a new social contract, where the work of all workers is recognized and protected with adequate job contracts, employment security, and social protection in a new economy, both during and after the COVID-19 crisis.

ObjectivesIn countries with ageing populations, home care (HC) aides are among the fastest growing jobs. There are few quantitative studies of HC occupational safety and health (OSH) conditions. The objectives of this study were to: (1) assess quantitatively the OSH hazards and benefits for a wide range of HC working conditions, and (2) compare OSH experiences of HC aides who are employed via different medical and social services systems in Massachusetts, USA.MethodsHC aides were recruited for a survey via agencies that employ aides and schedule their visits with clients, and through a labour union of aides employed directly by clients or their families. The questionnaire included detailed questions about the most recent HC visits, as well as about individual aides’ OSH experiences.ResultsThe study population included 1249 HC aides (634 agency-employed, 615 client-employed) contributing information on 3484 HC visits. Hazards occurring most frequently related to musculoskeletal strain, exposure to potentially infectious agents and cleaning chemicals for infection prevention and experience of violence. Client-hired and agency-hired aides had similar OSH experiences with a few exceptions, including use of sharps and experience of verbal violence.ConclusionsThe OSH experience of HC aides is similar to that of aides in institutional healthcare settings. Despite OSH challenges, HC aides enjoy caring for others and the benefits of HC work should be enhanced. Quantification of HC hazards and benefits is useful to prioritise resources for the development of preventive interventions and to provide an evidence base for policy-setting.

Background Although there is a growing dependence on the immigrant workforce in many countries, recent trend analyses on the work-related health of immigrants are scarce. Thus, this study aims to fill this gap by comparing reported occupational injuries due to accidents (OIA) trends among native-born Swedes with first-generation immigrants arriving from different global regions now working in Sweden from 2003 to 2020. Methods A repeated cross-sectional registered-based study was conducted including the total working population (18 years or older) (approximately 3.5-4 million individuals annually). Information on OIA and migrant status was obtained from nationwide registers. The incidence rate (IR) of an OIA per 1000 workers with 95% confidence intervals (CI) was calculated for region of birth, the reason for immigration, and time since immigration for each year. Joinpoint analyses were employed to detect significant shifts in the trends. Results The IR of OIA among native-born workers demonstrated a relatively stable trend between 2003 and 2020. Immigrant workers had in general a higher IR of OIA compared to native-born workers across the study period. Among immigrant workers, a steeper downward trend in OIA was observed until 2008/2010. After 2010, the trends were relatively stable or slightly increasing, depending on the region of birth, reason for immigration, and time since immigration. The stratified analysis demonstrated varying patterns depending on sociodemographic and occupational factors. Conclusions Immigrant workers in Sweden have a higher incidence of occupational injuries than native Swedes. Despite a general downward trend since 2003, young immigrants from Africa and the Middle East show an upward trend, highlighting a concerning increase for an already vulnerable group and potentially worsening health inequalities.

Background Immigrants continue to face challenges after entering the labor market and remain overrepresented in ‘3-D jobs’ (dirty, difficult, degrading). This study aims to investigate the differences in occupational injury due to accidents (OIA) among immigrants compared to native-born workers in Sweden, and to examine the role of migrant-specific and work factors in these differences. Methods This repeated cross-sectional study used nationwide registers including all gainfully employed individuals in 2004–2020 (average annual sample 4.5 million individuals). OIA was treated as a binary outcome and migrant status was categorized based on region of birth and reason for immigration. OIA odds were estimated using pooled logistic regression analyses, where the crude model was adjusted for sociodemographic factors, time since immigration, and work factors. Results First-generation immigrants (odds ratios [OR] 1.41; 95% confidence interval [CI] 1.40, 1.42) and second-generation immigrants (OR 1.10; 95% CI 1.09, 1.11) had higher odds of OIA than native-born workers. Among the first-generation immigrants, the strength of the association varied depending on region of birth and reason for immigration. Immigrating to Sweden for work reasons was associated with lower odds of OIA among first-generation immigrants (OR 0.62; 95% CI 0.61, 0.64). The elevated odds of OIA among immigrants relative to native-born workers remained after adjusting for important covariates. Conclusions The differences in OIA underscore the disparities among native-born and immigrant workers in Sweden. The current findings highlight the importance of addressing these issues to ensure a safe work environment for all.

Objectives. We quantified risks of sharp medical device (sharps) injuries and other blood and body fluid exposures among home health care nurses and aides, identified risk factors, assessed the use of sharps with safety features, and evaluated underreporting in workplace-based surveillance. Methods. We conducted a questionnaire survey and workplace-based surveillance, collaborating with 9 home health care agencies and 2 labor unions from 2006 to 2007. Results. Approximately 35% of nurses and 6.4% of aides had experienced at least 1 sharps injury during their home health care career; corresponding figures for other blood and body fluid exposures were 15.1% and 6.7%, respectively. Annual sharps injuries incidence rates were 5.1 per 100 full-time equivalent (FTE) nurses and 1.0 per 100 FTE aides. Medical procedures contributing to sharps injuries were injecting medications, administering fingersticks and heelsticks, and drawing blood. Other contributing factors were sharps disposal, contact with waste, and patient handling. Sharps with safety features frequently were not used. Underreporting of sharps injuries to the workplace-based surveillance system was estimated to be about 50%. Conclusions. Sharps injuries and other blood and body fluid exposures are serious hazards for home health care nurses and aides. Improvements in hazard intervention are needed.

ObjectiveTo determine differences in mortality rates and trends according to the occupation of workers who died from the ‘deaths of despair’ (DoD).MethodsDeath certificates for deaths due to poisonings (including opioid-related overdoses), suicides, and alcoholic liver disease occurring in Massachusetts from 2000 to 2015 were collected and coded according to the occupation of the decedent. Mortality rates and trends in mortality were calculated for each occupation. We also examined possible underlying causes of differences by occupation in rates of DoD by investigating the relationship between occupational injuries and DoD using data from the U.S. Bureau of Labor Statistics.ResultsDoDs increased by more than 50% from 32.5 deaths per 100,000 workers in 2000–2004 to 49.6 in 2011–2015. Deaths increased in all three cause categories, but opioid-related deaths increased most rapidly. There were substantial differences in mortality rates and trends according to occupation. There were particularly elevated risks for blue collar, notably: construction; farming, fishing, and forestry; installation, maintenance, and repair; transportation and material moving; building and grounds cleaning and maintenance; production; and healthcare support workers. Most of these occupations not only had higher than average rates of death, but these rates also increased more rapidly over the 16 year period. As hypothesized, occupations with high injury rates also suffered from high DoD mortality rates. Compared to occupations in the lowest quartile of injuries (< 40 per 10,000 full-time workers), those in the high quartile (> 199 per 10,000 full-time workers) had nearly 4 times higher rates of DoD.ConclusionsThese findings suggest that work may be a factor contributing to DoD. Interventions should be targeted to the needs of workers with elevated mortality rates and trends for the deaths of despair. Further work is needed to identify preventable risk factors for these outcomes that may be contributing to these.

The United States (US) has been among those nations most severely affected by the first—and subsequent—phases of the pandemic of COVID-19, the disease caused by SARS-CoV-2. With only 4% of the worldwide population, the US has seen about 22% of COVID-19 deaths. Despite formidable advantages in resources and expertise, presently the per capita mortality rate is over 585/million, respectively 2.4 and 5 times higher compared to Canada and Germany. As we enter Fall 2020, the US is enduring ongoing outbreaks across large regions of the country. Moreover, within the US, an early and persistent feature of the pandemic has been the disproportionate impact on populations already made vulnerable by racism and dangerous jobs, inadequate wages, and unaffordable housing, and this is true for both the headline public health threat and the additional disastrous economic impacts. In this article we assess the impact of missteps by the Federal Government in three specific areas: the introduction of the virus to the US and the establishment of community transmission; the lack of national COVID-19 workplace standards and enforcement, and lack of personal protective equipment (PPE) for workplaces as represented by complaints to the Occupational Safety and Health Administration (OSHA) which we find are correlated with deaths 16 days later (ρ = 0.83); and the total excess deaths in 2020 to date already total more than 230,000, while COVID-19 mortality rates exhibit severe—and rising—inequities in race/ethnicity, including among working age adults.