From insecure to secure employment: changes in work, health, health related behaviours, and sickness absence

Transitioning into and out of precarious employment and life satisfaction: Evidence from asymmetric fixed effects models

Previous studies have found that those with precarious jobs report lower levels of life satisfaction than those with non-precarious jobs. However, it is unclear whether transitioning into and out of precarious jobs has differential effects on life satisfaction. This study examines the association between employment status transitions and life satisfaction, as well as gender differences in these associations. Data from the Korean Welfare Panel Study (N = 9,792) from 2006 to 2020 were used in this study. A novel asymmetric fixed effects model was employed to separately estimate the association for transitioning into and out of precarious employment. Gender heterogeneity was estimated by including an interaction term of gender and employment transition. Standard fixed effects estimates showed that precarious employment is negatively associated with life satisfaction (b = -0.048). Asymmetric fixed effects models revealed that transitioning out of precarious employment is associated with increased life satisfaction (b = 0.051), while transitioning into a precarious job is not significantly associated with life satisfaction. These asymmetric associations were more pronounced for men than women. This study provides evidence that, especially for men, the association for transitioning out of precarious employment is significantly larger than the association for transitioning into precarious employment. Policies that facilitate the transition into stable employment are likely to enhance the quality of life for employed individuals.

Risking one's life to save one's livelihood: Precarious work, presenteeism, and worry about disease exposure during the COVID-19 pandemic

The present study advances research on the negative consequences of precarious work experiences (PWE), which include perceptions of threats to one's job and financial security as well as a sense of powerlessness and inability to exercise rights in the workplace. Using the COVID-19 pandemic as a backdrop, we examine how PWE relate to sickness presenteeism and worry about work-related COVID-19 exposure. In a 12-week, four-wave study of workers working fully in-person, perceptions of powerlessness and job insecurity were associated with presenteeism (e.g., general presenteeism as well as attending work with known or possible COVID-19 infection) and concerns about disease exposure at work. Whereas powerlessness primarily operated at the between-person level of analysis, job insecurity's effects emerged at both levels of analysis. A sense of powerlessness at work also predicted sending children to school/daycare sick. In sum, the findings suggest that precarity related to being able to keep one's job and a sense of powerlessness at work contribute to concerns about the risk of COVID-19 exposure at work and, simultaneously, behaviors that may contribute to the health risks faced by others. This research provides added support to the argument that precarious work should be addressed in order to improve both worker well-being and public health. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Ex-ante moral hazard and health insurance: Evidence from China's urban residence basic medical insurance scheme

This study examines whether implementing Urban Residents Medical Insurance Scheme decreased an individual's risky lifestyle behavior before illness, termed ex-ante moral hazard. Ex-ante moral hazard is predicted by the classical economic theory suggesting that health insurance coverage reduces an individual's incentive to take preventive efforts to remain healthy. Studies have provided mixed evidence for this prediction. China's 2006 nationwide social experiment of implementing the Urban Residents Basic Medical Insurance Scheme offers an excellent opportunity for examining the effect of the transition from uninsured to insured on an individual's health behaviors. We exploit the longitudinal dimension of a representative survey data for 2007-2010 and employ the instrumental variable technique, thereby addressing the issue of self-selection into voluntary health insurance schemes. The results do not provide evidence for and contrast the prediction of the ex-ante moral hazard. Significant differences exist between insured and uninsured groups with respect to smoking, drinking habits, and being overweight. People with insurance care more about their health than people without insurance do. The main results still hold if we use alternative estimation methods and other robustness tests.

Unequal access? Use of sickness absence benefits by precariously employed workers with common mental disorders: a register-based cohort study in Sweden

OBJECTIVE

This study compares the use of sickness absence benefits (SABs) due to a common mental disorder (CMD) between precariously employed and non-precariously employed workers with CMDs.

DESIGN

Register-based cohort study.

PARTICIPANTS

The study included 78 215 Swedish workers aged 27-61 who experienced CMDs in 2017, indicated by a new treatment with selective serotonin reuptake inhibitors (SSRIs). Excluded were those who emigrated or immigrated, were self-employed, had an annual employment-based income <100 Swedish Krona, had >90 days of unemployment per year, had student status, had SABs due to CMDs during the exposure measurement (2016) and the two previous years, had an SSRI prescription 1 year or less before the start of the SSRI prescription in 2017, had packs of >100 pills of SSRI medication, had a disability pension before 2017, were not entitled to SABs due to CMDs in 2016, and had no information about the exposure.

OUTCOME

The first incidence of SABs due to CMDs in 2017.

RESULTS

The use of SABs due to a CMD was slightly lower among precariously employed workers compared with those in standard employment (adjusted OR [aOR] 0.92, 95% CI 0.81 to 1.05). Particularly, women with three consecutive years in precarious employment had reduced SABs use (aOR 0.48, 95% CI 0.26 to 0.89), while men in precarious employment showed weaker evidence of association. Those in standard employment with high income also showed a lower use of SABs (aOR 0.74, 95% CI 0.67 to 0.81). Low unionisation and both low and high-income levels were associated with lower use of SABs, particularly among women.

CONCLUSIONS

The study indicates that workers with CMDs in precarious employment may use SABs to a lower extent. Accordingly, there is a need for (1) guaranteeing access to SABs for people in precarious employment and/or (2) reducing involuntary forms of presenteeism.

How Much Does Presenteeism Change in Response to Interventions or Alterations in Health Status? A Systematic Review and Meta-Analysis Using the COSMIN Methodology

Purpose The purpose of this study was to estimate the extent to which measures of presenteeism among workers change in response to alterations in health status induced by treatment or natural history. Methods We searched eight databases in August 2020 for studies published since 2012 measuring presenteeism longitudinally. Two independent reviewers screened the titles, abstracts, and full-text articles and performed data extraction. Studies were stratified into longitudinal studies using presenteeism as an outcome and measurement studies designed to test the responsiveness of presenteeism measures. We appraised the methodological quality of the measurement studies using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) risk of bias checklist. Standardized response means (SRMs) for interventional studies where participants reported improvement on anchor measures were quantitatively pooled.Results Our searches returned 2882 results. Eleven measurement studies and 126 longitudinal studies were included. Of the measurement studies (n = 2625 participants), 7 had adequate study quality and 4 studies were deemed doubtful. Anchors and responsiveness methods varied considerably. Our estimate of responsiveness from 5 measurement studies and 4 presenteeism measures is an SRM of 0.85 (95% CI 0.77, 0.92) and Cohen's d of 0.54 (95% CI 0.49, 0.58), translating to an average important change of 17/100. For deterioration, the value is - 17/100. Conclusions We found considerable variation regarding how responsiveness data was reported in measurement studies. There is evidence that responsiveness is strong for four presenteeism measures: the Work Productivity Survey, the Work Functioning Impairment Scale, the Work Role Functioning Questionnaire, and the Nurses Work Functioning Questionnaire.

Mental illness rates among employees with fixed-term versus permanent employment contracts: a Danish cohort study

PURPOSE

It has been hypothesized that employment in a fixed-term instead of permanent contract position is associated with an increased risk of development of mental health problems. The present study aimed at estimating rate ratios between fixed-term and permanent employees in the Danish labor force, for use of psychotropic drugs and psychiatric hospital treatment due to mood, anxiety or stress-related disorders, respectively.

METHODS

Employment data were drawn from the Danish Labor Force Survey of 2001-2013, which is a part of the European Labor Force Survey. Full-time employed survey participants without mental illness at the baseline interview (N = 106,501) were followed in national health registers for up to 5 years. Poisson regressions were used to estimate rate ratios for redeemed prescriptions of psychotropic drugs and psychiatric hospital treatments due to mood, anxiety or stress-related disease. The analyses were controlled for age, gender, industrial sector, nighttime work, level of education, calendar year, disposable family income and social transfer payments within 1 year prior to the baseline interview.

RESULTS

The rate ratio for hospital diagnosed mood, anxiety or stress-related disorders among employees with fixed-term vs. permanent employment contracts was estimated at 1.39 (99.5% CI 1.04-1.86), while the corresponding rate ratio for redeemed prescriptions of psychotropic drugs was estimated at 1.12 (99.5% CI 1.01-1.24).

CONCLUSION

The present study supports the hypothesis that employment in a fixed-term rather than permanent contract position is associated with an increased risk of developing mental health problems.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR2-10.2196/24392.

Informal Employment and Poor Mental Health in a Sample of 180,260 Workers from 13 Iberoamerican Countries

The aim of this study is to estimate the association between employment conditions and mental health status in the working population of Iberoamerica. In this cross-sectional study, we pooled individual-level data from nationally representative surveys across 13 countries. A sample of 180,260 workers was analyzed. Informality was assessed by social security, health affiliation, or contract holding. Mental health was assessed using several instruments. We used Poisson regression models to estimate the contribution of informality to poor mental health by sex and country, adjusted by sociodemographic and work-related characteristics. Then, we performed a meta-analysis pooling of aggregate data using a random-effects inverse-variance model. Workers in informal employments showed a higher adjusted prevalence ratio (aPR) of poor mental health than those in formal employment in Peru (aPR men 1.5 [95% confidence intervals 1.16; 1.93]), Spain (aPR men 2.2 [1.01; 4.78]) and Mexico (aPR men 1.24 [1.04; 1.47]; women 1.39 [1.18; 1.64]). Overall estimates showed that workers in informal employment have a higher prevalence of poor mental health than formal workers, with it being 1.19 times higher (aPR 1.19 [1.02; 1.39]) among men, and 1.11 times higher prevalence among women (aPR 1.11 [1.00; 1.23]). Addressing informal employment could contribute to improving workers’ mental health.

The Effect of Using Participatory Working Time Scheduling Software on Employee Well-Being and Workability: A Cohort Study Analysed as a Pseudo-Experiment

Shift workers are at increased risk of health problems. Effective preventive measures are needed to reduce the unfavourable effects of shift work. In this study we explored whether use of digital participatory working time scheduling software improves employee well-being and perceived workability by analysing an observational cohort study as a pseudo-experiment. Participants of the Finnish Public Sector cohort study with payroll records available between 2015 and 2019 were included (N = 2427). After estimating the propensity score of using the participatory working time scheduling software on the baseline characteristics using multilevel mixed-effects logistic regression and assigning inverse probability of treatment weights for each participant, we used generalised linear model to estimate the effect of using the participatory working time scheduling software on employees’ control over scheduling of shifts, perceived workability, self-rated health, work-life conflict, psychological distress and short sleep (≤ 6 h). During a 2-year follow-up, using the participatory working time scheduling software reduced the risk of employees’ low control over scheduling of shifts (risk ratio [RR] 0.34; 95% CI 0.25–0.46), short sleep (RR 0.70; 95% CI 0.52–0.95) and poor workability (RR 0.74; 95% CI 0.55–0.99). The use of the software was not associated with changes in psychological distress, self-rated health and work-life conflict. In this observational study, we analysed as a pseudo-experiment, the use of participatory working time scheduling software was associated with increased employees’ perceived control over scheduling of shifts and improved sleep and self-rated workability.

The changing nature of work - Job strain, job support and sickness absence among care workers and in other occupations in Sweden 1991-2013

This study examined exposure changes in three psychosocial dimensions - job demands, job control, and social support - and the associations between these dimensions and sickness absence throughout the period 1991-2013. The analyses covered periods of economic ups and downs in Sweden and periods involving major fluctuations in sickness absence. Data on care workers (n = 16,179) and a comparison group of employees in other occupations (n = 82,070) were derived from the biennial Swedish Work Environment Survey and linked to register data on sickness absence. Eight exposure profiles, based on combinations of demands, control, and support, were formed. The proportion of individuals with work profiles involving high demands doubled among care workers (14%-29%) while increasing modestly in the comparison group (17%-21%) 1991-2013. The work profile that isolated high-strain (iso-strain), i.e., high demands, low control, and low social support, was more prevalent among care workers, from 4% in 1991 to 11% in 2013. Individuals with work profiles involving high-demand jobs had the highest number of days on sickness absence during the study period and those with the iso-strain work profile had the highest increase in sickness absence, from 15 days per year during 1993-1994, to 42 days during 2000-2002. Employees with a passive work profile (low job demands and low job control) had the lowest rate and the lowest increase in sickness absence. Individuals with active work profiles, where high demands are supposed to be balanced by high job control, had a rather high increase in sickness days around 2000. A conclusion is that there is a long-term trend towards jobs with high demands. This trend is stronger among care workers than among other occupations. These levels of job demands seem to be at such a level that it is difficult to compensate for with higher job control and social support.

Cardiovascular age of workers with different employment categories

INTRODUCTION

We compared the cardiovascular age (an indicator of cardiovascular disease risk) in workers with different employment status after adjustment for demographic and socioeconomic factors.

METHODS

This cross-sectional study used data collected from 2007 to 2017 for the Korea National Health and Nutrition Examination Survey (KNHANES). Study participants were placed into different employment categories based on employment status and work schedule: regular full-time, regular part-time, temporary full-time, temporary part-time, daily full-time, and daily part-time.

RESULTS

Analysis of women indicated that regular part-time, temporary full-time, temporary part-time, daily full-time, and daily part-time workers were more likely to have an older cardiovascular age (OR = 1.180, 1.238, 1.297, 1.493, and 1.408, respectively) after adjustment for age, marriage, education, income, residence, region, and drinking status. Analysis of men indicated employment status was unrelated to cardiovascular age.

CONCLUSION

Female nonstandard Korean workers were more likely to have an increased cardiovascular age. However, most of these workers, especially daily workers, are not currently protected by the Occupational Safety and Health Act (OSHA) of Korea. Collaboration or networking with community-based health care services in Korea is essential to better manage the health of these vulnerable female workers.

Treating tobacco dependence to aid re-employment among job-seekers: A randomized controlled trial

INTRODUCTION

U.S. reductions in smoking have not been experienced equally. Smoking prevalence is greater among persons of lower education, lower income, and unemployed. We evaluated whether a cessation intervention for job-seekers would result in significantly fewer cigarettes smoked per day and a greater likelihood of tobacco abstinence and re-employment, compared to the control condition at 6-months follow-up.

METHODS

Unemployed, job-seekers who smoked daily were recruited from five employment development departments in the San Francisco Bay Area, October 2015 to February 2018. Intention to quit smoking was not required. Participants were randomized to a brief motivationally-tailored, computer-assisted counseling intervention or referred to a toll-free quitline. Midstudy, 8-weeks of combination nicotine replacement was added to the intervention. Expired carbon monoxide and cotinine testing verified abstinence. Data were analyzed fall 2019.

RESULTS

Participants (N = 360; 70% men; 43% African American, 27% non-Hispanic Caucasian; 19% unhoused) averaged 12 cigarettes/day (SD = 6), 67% smoked within 30 min of wakening; 27% were in preparation stage to quit. During the 6-month study period, intervention participants were more likely to make a quit attempt (71% vs. 58%, p = .021) and reported significantly greater reduction in cigarettes/day than control participants (median reduction: 6.9 vs. 5.0, p = .038); however, bioconfirmed abstinence (3%) and re-employment (36%) did not differ by treatment group.

CONCLUSIONS

In a diverse sample with economic hardships, quit attempts and smoking reduction were greater in the intervention group; however, few achieved abstinence, and neither abstinence nor re-employment differed by condition. A priority group, further research is needed on smoking and re-employment.

Non-Standard Workers Have Poorer Physical and Mental Health Than Standard Workers

OBJECTIVES

To compare the health status of workers who had non-standard and standard employment in Korea.

METHODS

Data from the Korean National Health and Nutrition Examination Survey (KNHANES, 2007 to 2017) were used to compare the health of workers with standard and non-standard employment.

RESULTS

Workers with non-standard employment (rather than standard employment) were more likely to be women, older, have less education, have lower monthly income, perform manual work, and work fewer hours per week. Men with non-standard employment were more likely to have physician-diagnosed cardiovascular disease, arthritis, and to report depressive and suicidal ideation. Women with non-standard employment were more likely to have physician-diagnosed cardiovascular disease and to report depressive feelings.

CONCLUSION

Workers with daily employment were most vulnerable to physical and mental health problems. Health problems differed among individuals who had different types of non-standard employment.

Workers With Different Employment Status Have Different Exposures to Work Stressors and Different Responses to Identical Work Stressors

INTRODUCTION

This study evaluated the relationship between exposure to diverse work-related stressors and psychological well-being in workers with precarious employment.

METHODS

This was a secondary analysis of data from the fifth Korean Working Conditions Survey, conducted in 2017.

RESULTS

Daily workers were more likely to report poor psychological well-being than regular or temporary workers. Furthermore, higher proportions of daily workers reported exposure to the nine analyzed work stressors. However, only three of nine workplace stressors (lack of decision latitude, lack of reward, and lack of support from workplace managers) affected male and female daily workers.

CONCLUSION

A strategy designed to improve the psychological well-being of workers with precarious employment that is based on typical job stressor evaluation tools, may have limited effects.

Nurses' Job Insecurity and Emotional Exhaustion: The Mediating Effect of Presenteeism and the Moderating Effect of Supervisor Support

Presenteeism refers to attending work when one is ill, which not only leads to a decline in the physical and mental health of employees but also negatively impacts organizational productivity and increases an organization's extra costs. Therefore, to explore the antecedents and outcomes of nurses' presenteeism behavior and the acting mechanism among the variables, a sample of 330 nurses from China were investigated with the Sickness Presenteeism Questionnaire, Job Insecurity Scale, Perceived Supervisor Support Scale, and Emotional Exhaustion Scale. The results indicated that (1) job insecurity had a significantly predictive effect on nurses' presenteeism behavior; (2) nurses' presenteeism partially mediated the relationship between job insecurity and emotional exhaustion; and (3) supervisor support moderated the relationship between nurses' presenteeism behavior and emotional exhaustion; i.e., the higher the level of supervisor support, the weaker the positive relationship between nurses' presenteeism behavior and emotional exhaustion. The findings provide theoretical guidance and an empirical basis for prevention and intervention strategies concerning nurses' presenteeism behavior.

Sickness absence trajectories following labour market participation patterns: a cohort study in Catalonia (Spain), 2012-2014

BACKGROUND

Previous studies have focused on the relationship between employment pathways and health-related outcomes based on cross-sectional or longitudinal approaches. However, little is known about the cumulative effects of employment status mobility on sickness absence (SA) over time. The aim of the present study was to examine the association between prior labour market participation (LMP) patterns and SA trajectories from a life-course perspective.

METHODS

This cohort study was based on a sample of 11,968 salaried workers living in Catalonia and affiliated with the Spanish Social Security system, who accumulated more than 15 days on SA in at least one quarter during 2012-2014. Individuals were grouped into three different working life stages: early (18-25 years), middle (26-35 years), and late (36-45 years). To identify LMP patterns, we applied sequence analysis and cluster analysis (2002-2011), and we used latent class growth modelling to identify SA trajectories (2012-2014). Finally, we applied multinomial logistic regression models to assess the relationship between LMP patterns and SA trajectories.

RESULTS

The analyses yielded six LMP patterns: stable employment (value range: 63-81%), increasing employment (5-22%), without long-term coverage (7-8%), decreasing employment (4-10%), fluctuant employment (13-14%), and steeply decreasing employment (7-9%). We also identified four SA trajectories: low stable (83-88%), decreasing (5-9%), increasing (5-11%), and high stable (7-16%). However, the only significant association we identified for LMP patterns and SA trajectories was among young men, for whom an increasing employment pattern was significantly associated with a lower risk for increased days on SA (adjusted odds ratio: 0.21; 95% confidence interval: 0.05-0.96).

CONCLUSIONS

SA trajectories are generally not related to prior 10-year LMP patterns at any stage of working life. To disentangle this relationship, future research might benefit from considering working life transitions with a quality-of-work approach framed with contextual factors closer to the SA course.

Job Insecurity, Sickness Presenteeism and the Moderating Effect of Workplace Health Promotion

OBJECTIVE

This study examined the relationship between job insecurity and presenteeism, and the role of workplace health promotion as moderator in this association.

METHODS

We used data from 9525 employees from the sixth BIBB/BAuA Employment Survey 2012 for the working population in Germany. Data analysis was performed with logistic regressions.

RESULTS

Job insecurity was associated with a higher risk of presenteeism, even after adjustment for control factors (OR = 1.25, CI: 1.01-1.53, P < 0.05). Workplace health promotion moderated this relationship: It no longer existed in companies with health promotion.

CONCLUSIONS

The results suggest that employees with job insecurity are more likely to work despite feeling ill with the aim of securing their jobs. By establishing workplace health promotion, companies can protect their employees from that behavior in order to avoid negative long-term consequences.

Inequalities and the Impact of Job Insecurity on Health Indicators in the Spanish Workforce

In a context of high job insecurity resulting from social deregulation policies, this research aims to study health and substance abuse inequalities in the workplace from a gender perspective. To this end, a transversal study was carried out based on microdata from the National Health Survey in Spain—2017, selecting the active population and calculating the prevalence of the state of health and consumption, according to socio-occupational factors (work relationship, social occupational class, time and type of working day). Odds ratios adjusted by socio-demographic variables and their 90% confidence intervals were estimated by means of binary logistic regressions stratified by sex. The results obtained showed two differentiated patterns of health and consumption. On the one hand, unemployed people and those from more vulnerable social classes showed a higher prevalence of both chronic depression and anxiety and of hypnosedative and tobacco use. On the other hand, the better positioned social classes reported greater work stress and alcohol consumption. In addition, while unemployment affected men’s health more intensely, women were more affected by the type of working day. The study can be used to design sustainable preventive occupational health policies, which should at least aim at improving the quantity and quality of employment.

Association between employment status and sickness presenteeism among Korean employees: a cross-sectional study

Background

Sickness presenteeism (SP) indicates “going to work while being ill.” The importance of SP has only recently been investigated, and the association between SP and employment status has been inconsistent across studies. Therefore, we conducted this study to explore the association between SP and employment status by using presenteeism propensity (PP), which can reflect the individual decision-making process.

Methods

The study population included employees participating in the 5th Korean Working Condition Survey. We analyzed data of only employees with at least one health event, which was calculated as the sum of SP and sickness absenteeism days. Employment status was grouped into 3 categories: stable employment, unstable employment (contract period ≥ 1 year), and unstable employment (contract period < 1 year). Survey-weighted logistic regression analysis was conducted to assess the association between employment status and PP (dichotomized as “≤ 0.5” and “> 0.5”).

Results

Unstable employees (contract period ≥ 1 year) had higher odds of PP than stable employees (odds ratio [OR]: 1.23, 95% confidence interval [CI]: 1.03–1.47), whereas unstable employees (contract period < 1 year) had lower odds of PP than stable employees (OR: 0.82, 95% CI: 0.71–0.96).

Conclusions

Employment status was associated with SP. Given the negative health impact of SP, social efforts, such as paid sick leave, are required to reduce SP and enhance the health status of unstable workers.

Comparative analyses of workers' compensation claims of injury among temporary and permanent employed workers in Ohio

BACKGROUND

A small but increasing number of studies have examined the risk of injury among temporary workers compared to that among workers in permanent employer arrangements. The purpose of this study was to conduct a comparative analysis of injury risk among temporary and permanent employer workers using a large dataset of workers' compensation (WC) claims of injury.

METHODS

Over 1.3 million accepted WC claims in Ohio during the years 2001 to 2013 were analyzed, including 45 046 claims from workers employed by temporary services agencies. General descriptive statistics, injury rates and rate ratios (temporary to permanent workers) were calculated by injury type and event, industry group, and industry manual classes.

RESULTS

Injured temporary workers were younger and had less tenure compared to injured permanent workers. Temporary workers had higher injury rates, and lower lost-time and medical costs. Differences in injury rates between temporary and permanent workers varied by injury event, industry, and manual class.

CONCLUSION

Temporary workers had higher overall injury rates than permanent workers, controlling for industry manual class. These differences were pronounced for certain industries and injury events. We were not able to control for age and tenure of the worker, so it is not clear how these factors affected observed results. These findings were mostly similar to those from other studies using WC data from the states of Washington and Illinois. Together, these studies provide insights to improve injury prevention among temporary workers, however, additional research is still needed to improve safety and health programming for this group of workers.

Refusal to Take Sick Leave after Being Diagnosed with a Communicable Disease as an Estimate of the Phenomenon of Presenteeism in Poland

OBJECTIVE

The purpose of this study was to estimate the prevalence of presenteeism in patients with communicable diseases in Poland.

SUBJECT AND METHODS

This study was based on data from the medical records of 2,529 patients aged 19-64 years. All of the patients were diagnosed with communicable diseases. The inclusion criteria were based on implementing decision concerning communicable diseases made by the Commission of the European Union. Associations between refusal to take sick leave and patients' age, gender, and diagnosis in terms of the International Statistical Classification of Diseases and Related Health Problems (ICD-10) were tested. Linear regression analysis of the data acquired from the patients who agreed to take sick leave was further used to estimate the possible length of sick leave in patients who refused to take it.

RESULTS

The number of patients who refused to take sick leave was 18.1%. The presenteeism rate was related to the age of patients (periods of sick leave were longer in older patients) and the ICD-10 diagnosis (largely in bacterial intestinal infections and measles). The estimated number of days spent on sick leave in patients who refused to take it, assuming that they made a different decision and complied with it, was in the range of 4-6 days.

CONCLUSION

The prevalence of presenteeism in the case of communicable diseases in Poland is lower than in the general population. However, as the refusals to take sick leave took place in the case of potentially contagious diseases, the negative impact on productivity may be significant.

Organizational change and the risk of sickness absence: a longitudinal multilevel analysis of organizational unit-level change in hospitals

Background

Organizational change is often associated with reduced employee health and increased sickness absence. However, most studies in the field accentuate major organizational change and often do not distinguish between and compare types of change. The aim of this study was to examine the different relationships between six unit-level changes (upsizing, downsizing, merger, spin-off, outsourcing and insourcing) and sickness absence among hospital employees.

Methods

The study population included employees working in a large Norwegian hospital (n = 26,252). Data on unit-level changes and employee sickness absence were retrieved from objective hospital registers for the period January 2011 to December 2016. The odds of entering short- (< = 8 days) and long-term (> = 9 days) sickness absence for each individual employee were estimated in a longitudinal multilevel random effects logistic regression model.

Results

Unit-level organizational change was associated with both increasing and decreasing odds of short-term sickness absence compared to stability, but the direction depended on the type and stages of change. The odds of long-term sickness absence significantly decreased in relation to unit-level upsizing and unit-level outsourcing.

Conclusions

The results from this study suggested that certain types of change, such as unit-level downsizing, may produce greater strain and concerns among employees, possibly contributing to an increased risk of sickness absence at certain stages of the change. By contrast, changes such as unit-level insourcing and unit-level upsizing were related to decreased odds of sickness absence, possibly due to positive change characteristics.

The Effect of Presenteeism on Productivity Loss in Nurses: The Mediation of Health and the Moderation of General Self-Efficacy

Background: Seventy-four percent of Chinese employees have experienced working with illness, but limited number of researchers have paid attention on this phenomenon. Most of the previous research on presenteeism has almost exclusively focused on North America and Europe and have gone to the financial emphasis. The current researches have two shortages, which are laying in the consensus on the definition and measurement of presenteeism, as well as the mechanism of presenteeism and its outcomes have set barriers for scholars to generate deeper understanding of the behavior. The aim of the present study was to explore the current situation of presenteeism among Chinese nurses and the mediating effect of health and the moderating effect of general self-efficacy between presenteeism and productivity loss. Methods: Data were collected from a sample of 340 female nurses from a 3A-graded general hospital in Henan Province, China by using the Sickness Presenteeism Questionnaire (SPQ), the Stanford Presenteeism Scale (SPS-6), the 12-item General Health Questionnaire (GHQ-12), and the General Self-Efficacy Scale (GSES). Results: The results indicated that the mean of SPQ was 3.2 ± 0.7 in this sample, and there were significant differences in age and marital status in SPQ scores. Presenteeism was significantly associated with health and productivity loss, and health was significantly associated with productivity loss, and general self-efficacy was negatively associated with productivity loss. A bootstrap test showed that health fully mediated the relationship between presenteeism and productivity loss in nurses. Hierarchical regression analysis confirmed the moderating role of general self-efficacy between presenteeism and productivity loss. Conclusions: Presenteeism can significantly predict productivity loss in nurses, and hospital management can improve the physical and mental health of nurses and enhance their self-efficacy level to reduce the negative impact of presenteeism on productivity loss.

The impact of employment protection on health: Evidence from fixed-term contract workers in South Korea

In this paper, we examine the impact of increased employment protection on the self-rated health of workers. We utilize the recent labor reform in South Korea which sharply increased the employment protection level of fixed-term contract workers meeting certain criteria. By applying a difference-in-differences framework to longitudinal data, we explore the causal impact of employment protection. We find that subjective health and perceived job security improved with increased statutory employment protection. Further analysis suggests that the improvement in subjective health is less likely to be driven by improvement in working conditions or health related behaviors.

Do Temporary Workers More Often Decide to Work While Sick? Evidence for the Link between Employment Contract and Presenteeism in Europe

European employees are increasingly likely to work in cases of illness (sickness presenteeism, SP). Past studies found inconsistent evidence for the assumption that temporary workers decide to avoid taking sick leave due to job insecurity. A new measure to identify decision-based determinants of SP is presenteeism propensity (PP), which is the number of days worked while ill in relation to the sum of days worked while ill and days taken sickness absence. We investigated the link between employment contract and PP using cross-sectional data from 20,240 employees participating in the 2015 European Working Conditions Survey. Workers were grouped by type and duration of employment contract. The link between contract and PP was estimated using a multilevel Poisson model adjusted for socio-demographical, occupational and health-related covariates. We found that European employees worked 39% of the days they were ill. In contrast to previous studies, temporary workers were significantly more likely to decide for presenteeism than permanent workers were, especially when the contract was limited to less than 1 year. Controlling for perceived job insecurity did just marginally attenuate this association. Presenteeism was also more common among young and middle-aged workers; however, we did not find a significant interaction between contract and age affecting presenteeism. In conclusion, the employment contract is an important determinant of presenteeism. Our results give reason to believe that temporary workers show increased attendance behavior independent of job insecurity, because they are less likely to have access to social protection in case of illness.

Work absenteeism due to voice disorders in Brazilian schoolteachers

The study aimed to investigate the prevalence and duration of work absenteeism due to voice disorders in Brazilian schoolteachers and the association with work-related factors and health status. This was a cross-sectional study with a representative sample of 6,510 female and male schoolteachers in basic education, from October 2015 to March 2016. The dependent variable was the teacher's report of some work absence due to a voice problem in the previous 12 months. The independent variables related to work conditions and health status. A descriptive analysis was performed of the prevalence and duration of work absences due to voice problems. The association between the target event and the other variables was measured as the prevalence ratio with 95% confidence intervals, using Poisson regression. The main reason for teachers missing classroom work was voice disorders (17.7%), and most absences (78%) were short (seven days or less). In the final multivariate model adjusted by gender, higher prevalence of absence due to voice disorders was associated with schoolteachers in the North and Northeast of Brazil, longer time commuting to and from work, self-report of occupational disease, visit to health services, and report of psychological and respiratory problems during the same 12-month period. There was a high prevalence of short work absences due to voice problems, associated with comorbidities. Macrostructural factors suggest the social nature of the illness process and work absenteeism in Brazilian schoolteachers.

Sickness presenteeism at work: prevalence, costs and management

INTRODUCTION

Presenteeism is defined as continuing to attend work during illness. As a growing health concern, awareness of the factors that encourage presenteeism and the risks of this behaviour is needed.

SOURCES OF DATA

A narrative review of research obtained via several databases, including Medline and Psycinfo, was conducted.

AREAS OF AGREEMENT

A range of contextual and individual factors is associated with presenteeism. Workers in some sectors, such as healthcare, appear to be at greater risk. Presenteeism may facilitate rehabilitation and recovery but it can exacerbate existing health problems and increase the risk of subsequent illness and absence as well as impair workability.

AREAS OF CONTROVERSY

The incidence of sickness presenteeism is rising, alongside reductions in absenteeism. The growing awareness of the costs of presenteeism, especially in safety-critical environments, suggests that it should be considered a risk-taking behaviour and carefully measured and managed.

GROWING POINTS AND AREAS FOR DEVELOPING RESEARCH

Measuring presenteeism as well as absenteeism will provide more accurate information about employee health. Raising awareness of the risks of working while sick and the economic, moral, cultural and social pressures on employees to do so appears crucial. Systemic interventions to manage presenteeism based on research evidence are required.

Refusal to take a sick leave as an estimate of the phenomenon of presenteeism in Poland

Introduction

Absenteeism and presenteeism are two main phenomena related to health problems and professional activity. Presenteeism is the involvement in a professional activity despite being ill. The purpose of the current study is to estimate the prevalence of presenteeism in Poland on the basis of medical records and to explore associations between presenteeism and patients’ age, gender and type of medical problem. Another purpose is to provide estimates of the length of sick leave if it was accepted.

Results

The amount of patients who refused to take a sick leave was 27.4%. There was a minor relationship between the refusals and gender (slightly higher in men) as well as strong effects of the age of patients (periods of sick leave were longer in older patients) and ICD-10 diagnosis (largely in acute diseases of the upper respiratory tract). The estimated number of days spent on sick leave in the group of patients that refused to take it, assuming that they made a different decision and complied to it, was in the range between 5 and 10 days.

Discussion

The prevalence of presenteeism in Poland is relatively high. Since the largest proportion of refusals took place in the case of potentially contagious diseases, the negative impact on productivity may be even higher. Even though the relationship between presenteeism and wages remains unclear, the remarkable increase of wages in Poland within the last 20 years may explain the propensity to work despite being ill. Further research needs to consider the simultaneous use of medical records and self-measured productivity loss.

Materials and Methods

The current study is based on data from medical records concerning 550,360 patients aged 19–64. Associations between refusals to take a sick leave and patients’ age, gender, as well as diagnosis in terms of ICD-10 (International Statistical Classification of Diseases and Related Health Problems), were tested. Linear regression analysis on the data acquired from the patients who accepted to take a sick leave were further used to estimate the possible length of sick leave in the group of patients that refused to take it.

Prevalence and correlates of burnout in health professionals in Ecuador

BACKGROUND

Although burnout is a widespread phenomenon among healthcare professionals, there are no studies about its prevalence in Ecuador. This study assesses the prevalence of burnout syndrome among Ecuadorian healthcare professionals and examine the relationship with their personal and organizational characteristics.

METHODS

A total of 2404 healthcare professionals (average age 40.0years; 68.4% women) from the capitals of all 24 provinces in Ecuador participated in this study. Trained psychologists assessed the presence of burnout by applying the Maslach Burnout Inventory. Sociodemographic variables, emotional distress, social support and coping styles as well as organizational variables were also collected.

RESULTS

Of all healthcare professionals surveyed, 2.6% presented burnout syndrome. By dimensions, 17.2% of the participants presented a high level of emotional exhaustion, 13.5% of depersonalization, and 18.2% had reduced personal accomplishment. Being non-mestizo, being classified as a probable case of mental disorder and using more passive coping were associated with a greater probability of presenting burnout; having >10years of experience was associated with a lower probability of burnout.

CONCLUSIONS

A significant number of active health professionals suffer from burnout. It is necessary to develop effective psychotherapeutic interventions for those who have the syndrome and to evaluate potential prevention strategies in those who have not yet developed it.

Factors underlying observed injury rate differences between temporary workers and permanent peers

BACKGROUND

Temporary workers face increased risk of injury as compared to permanent workers in similar occupations. This study explores the role played by several potential risk factors.

METHODS

Injured temporary and permanent workers, matched by industry, tenure and demographic characteristics, were interviewed to isolate the association of temporary employment with several injury risk factors.

RESULTS

Temporary workers had higher workers' compensation claims rates than their permanent worker-peers. In interviews temporary workers a reported a lower frequency of exposure to hazards. However, they also reported being less likely to be equipped to cope with hazards by such countermeasures as experience screening, safety training and task control.

CONCLUSION

Policies are needed to improve screening and training of temporary workers to assigned tasks, to discourage job-switching, to improve temporary workers' hazard awareness, to protect their right to report unsafe conditions. The responsibilities of agencies and host employers for ensuring the safety of their temporary workers need clarification in regulatory policy.

Changes in the Employment Status and Risk of Stroke and Stroke Types

Background and Purpose—

Because of limited evidence, we investigated a long-term impact of changes in employment status on risk of stroke.

Methods—

This was a prospective study of 21 902 Japanese men and 19 826 women aged 40 to 59 years from 9 public health centers across Japan. Participants were followed up from 1990 to 1993 to the end of 2009 to 2014. Cox proportional hazard ratio of stroke (incidence and mortality) and its types (hemorrhagic and ischemic) was calculated according to changes in the employment status within 5 years interval between 1990 to 1993 and 1995 to 1998 (continuously employed, job loss, reemployed, and continuously unemployed).

Results—

During the follow-up period, 973 incident cases and 275 deaths from stroke in men and 460 cases and 131 deaths in women were documented. Experiencing 1 spell of unemployment was associated with higher risks of morbidity and mortality from total, hemorrhagic, and ischemic stroke in both men and women, even after propensity score matching. Compared with continuously employed subjects, the multivariable hazard ratio (95% confidence interval) for total stroke incidence in job lost men was 1.58 (1.18–2.13) and in job lost women was 1.51 (1.08–2.29), and those for total stroke mortality were 2.22 (1.34–3.68) in men and 2.48 (1.26–4.77) in women. The respective hazard ratio (95% confidence interval) in reemployed men was 2.96 (1.89–4.62) for total stroke incidence and 4.21 (1.97–8.97) for mortality, whereas those in reemployed women were 1.30 (0.98–1.69) for incidence and 1.28 (0.76–2.17) for mortality.

Conclusions—

Job lost men and women and reemployed men had increased risks for both hemorrhagic and ischemic stroke incidence and mortality.

Regulatory mechanisms for absenteeism in the health sector: a systematic review of strategies and their implementation

BACKGROUND

A systematic review was undertaken to identify regulatory mechanisms aimed at mitigating health care worker absenteeism, to describe where and how they have been implemented as well as their possible effects. The goal was to propose potential policy options for managing the problem of absenteeism among human resources for health in low- and middle-income countries. Mechanisms described in this review are at the local workplace and broader national policy level.

METHODS

A comprehensive online search was conducted on EMBASE, CINAHL, PubMed, Google Scholar, Google, and Social Science Citation Index using MEDLINE search terms. Retrieved studies were uploaded onto reference manager and screened by two independent reviewers. Only publications in English were included. Data were extracted and synthesized according to the objectives of the review.

RESULTS

Twenty six of the 4,975 published articles retrieved were included. All were from high-income countries and covered all cadres of health workers. The regulatory mechanisms and possible effects include 1) organizational-level mechanisms being reported as effective in curbing absenteeism in low- and middle-income countries (LMICs); 2) prohibition of private sector activities in LMICs offering benefits but presenting a challenge for the government to monitor the health workforce; 3) contractual changes from temporary to fixed posts having been associated with no reduction in absenteeism and not being appropriate for LMICs; 4) multifaceted work interventions being implemented in most settings; 5) the possibility of using financial and incentive regulatory mechanisms in LMICs; 6) health intervention mechanisms reducing absenteeism when integrated with exercise programs; and 7) attendance by legislation during emergencies being criticized for violating human rights in the United States and not being effective in curbing absenteeism.

CONCLUSION

Most countries have applied multiple strategies to mitigate health care worker absenteeism. The success of these interventions is heavily influenced by the context within which they are applied.

Incidence of sickness absence by type of employment contract: one year follow-up study in Spanish salaried workers

Background

To examine the differences in the incidence of registered sickness absence by type of employment contract in a large representative sample of salaried workers in Spain in 2009.

Method

A study of 653,264 salaried workers covered by the Social Security system who had 133,724 sickness absence episodes in 2009. Crude and adjusted rate ratios and their corresponding 95 % confidence intervals (CIs) were calculated with Poisson regression models.

Results

The incidence rate per 100 workers-year of sickness absence for temporary workers (IR = 32.2) was slightly higher than that of permanent workers (IR = 28.9). This pattern was observed in both men (RR = 1.12; 95 % CI 1.10–1.14) and women (RR 1.11; 95 % CI 1.09–1.12). However, after adjusting for age, company size, and occupational category, the differences disappeared in men (_aRR = 1.01; 95 % CI 0.99–1.02) and decreased in women (_aRR = 1.06; 95 % CI 1.04–1.07).

Conclusion

Our findings provide evidence on the independence of sickness absence benefits from the type of employment contract as well as on the nonexistence of incentives for taking sickness absence in workers with a permanent employment contract. In the context of increasing market flexibility, these results show a positive functioning of the Social Security system.

Electronic supplementary material

The online version of this article (doi:10.1186/s13690-016-0152-x) contains supplementary material, which is available to authorized users.

A 'Balanced' Life: Work-Life Balance and Sickness Absence in Four Nordic Countries

Background:

Little attention has been given to the relationship between work-life balance and sickness absence.

Objective:

To investigate the association between poor work-life balance and sickness absence in 4 Nordic welfare states.

Methods:

Multivariable logistic regression analysis was performed on pooled cross-sectional data of workers aged 15–65 years from Denmark, Finland, Sweden, and Norway (n=4186) obtained from the 2010 European Working Conditions Survey (EWCS). Poor work-life balance was defined based on the fit between working hours and family or social commitments outside work. Self-reported sickness absence was measured as absence for ≥7 days from work for health reasons.

Results:

Poor work-life balance was associated with elevated odds (OR 1.38, 95% CI 1.06 to 1.80) of self-reported sickness absence and more health problems in the 4 Nordic countries, even after adjusting for several important confounding factors. Work-related characteristics, no determination over schedule (OR 1.26, 95% CI 1.04 to 1.53), and job insecurity (OR 1.56, 95% CI 1.21 to 2.02) increased the likelihood of sickness absence, and household characteristics-cohabitation status (OR 0.75, 95% CI 0.58 to 0.96) reduced this likelihood. The associations were non-significant when performed separately for women and men.

Conclusion:

Sickness absence is predicted by poor work-life balance. Implementation of measures that prevent employee difficulties in combining work and family life seems necessary

The Relocation of a Health Care Department's Impact on Staff: A Cross-Sectional Survey

OBJECTIVE

This survey compares certain quality of work-life factors between a relocated work group and a control group.

METHODS

A self-administered, cross-sectional survey was conducted 12 months after five departments (304 workers) had been relocated between two public health sites. The survey explored the workers' psychosocial job characteristics, their perceived health, and psycho-organizational constraints. The results compared both the relocated and control groups by using univariate and then multivariate statistical analyzes.

RESULTS

When compared with the control group (n = 272), the relocated group (n = 180) showed a higher prevalence of psychosocial job characteristic "isostrain." The relocated group showed greater psycho-organizational constraints regarding the organizations favoring communication and team relationships.

CONCLUSIONS

It seems that staff relocation can provoke a sense of uncertainty and isolation. Perhaps better communication might have reduced this and deter possible negative health outcomes.

Work organization, exposure to workplace hazards and sickness presenteeism in the European employed population

BACKGROUND

Aim of the study was to identify work organization features and workplace hazards associated with sickness presenteeism (SP) among European workers.

METHODS

The study was conducted on data from the European Working Conditions Survey 2010 and included a study population of 30,279 employees. The relationship between work-related factors and SP was assessed through Poisson multivariate robust regression models, adjusting for significant (P < 0.05) individual and work-related characteristics.

RESULTS

SP for at least 2 days in the previous year was reported by 35% of the workers. In fully adjusted model, several psychosocial (decision authority, skill discretion, reward, abuse; psychological, cognitive, and emotional demand), and organizational factors (shift work, working with clients, long work hours) were positively associated with SP, whereas job insecurity and exposure to physical factors (lifting or moving people, vibration) decreased SP risk.

CONCLUSIONS

Our results support the importance of work-related factors, especially psychosocial exposures and organizational features, in determining workers' SP.

Effects of Co-Worker and Supervisor Support on Job Stress and Presenteeism in an Aging Workforce: A Structural Equation Modelling Approach

We examined the effects of co-worker and supervisor support on job stress and presenteeism in an aging workforce. Structural equation modelling was used to evaluate data from the 2010 wave of the Health and Retirement Survey in the United States (n = 1649). The level of presenteeism was low and the level of job stress was moderate among aging US workers. SEM revealed that co-worker support and supervisor support were strongly correlated (β = 0.67; p < 0.001). Job stress had a significant direct positive effect on presenteeism (β = 0.30; p < 0.001). Co-worker support had a significant direct negative effect on job stress (β = -0.10; p < 0.001) and presenteeism (β = -0.11; p < 0.001). Supervisor support had a significant direct negative effect on job stress (β = -0.40; p < 0.001) but not presenteeism. The findings suggest that presenteeism is reduced by increased respect and concern for employee stress at the workplace, by necessary support at work from colleagues and employers, and by the presence of comfortable interpersonal relationships among colleagues and between employers and employees.

The mental health consequences of the economic crisis in Europe among the employed, the unemployed, and the non-employed

Applying a multi-level framework to the data from the European Social Survey's Round 3 (2006) and Round 6 (2012), we assessed the crisis by increases in rates of unemployment, while also controlling for countries' pre-crisis economic conditions. We found a positive relationship between depression and an increase in national unemployment rates. This relationship can be only partly ascribed to an increase in the number of unemployed and those employed in nonstandard job conditions-with the exception of the self-employed and women working part-time. The crisis effect is more pronounced among men and those between 35 and 49years of age. Moreover, in strongly effected countries, the crisis has changed the relationship between part-time work and depression, between depression and certain subcategories of the unemployed (looking for a job or not looking), and between depression and the non-employed.

Socio-economic and cultural factors associated with smoking prevalence among workers in the National Health System in Belo Horizonte

OBJECTIVE

To identify factors related to smoking among health workers of the National Health System in Belo Horizonte, Minas Gerais, Brazil.

METHODS

A cross-sectional study based on a survey conducted between September 2008 and January 2009 with a stratified sample. Data on sociodemographic, health, employment, and work characteristics were analyzed. Poisson regression models with robust variance and estimation of unadjusted and adjusted prevalence ratios were used to establish associations at a 5% significance level for inclusion in the final model.

RESULTS

In 1,759 questionnaires analyzed, in which the question related to smoking was answered, the overall prevalence of smoking was 15.7%. Reasonable relationship between requirements and available resources remained negatively correlated to smoking in the final model (PR = 0.75; 95%CI 0.58 - 0.96). The variables that remained positively associated with smoking were being male (PR = 1.75; 95%CI 1.36 - 2.25) and the following positions: community health workers (PR = 2.98; 95%CI 1.76 - 5.05), professionals involved in monitoring (PR = 3.86; 95%CI 1.63 - 5.01), administrative and other general services workers (PR = 2.47; 95%CI 1.51 - 4.05); technical mid-level workers (PR = 2.23; 95%CI 1.31 - 3.78), including nurses and practical nurses (PR = 2.07; 95%CI 1.18 - 3.64).

CONCLUSION

Specific occupational subgroups were identified and should be prioritized in smoking cessation and prevention programs.

Is temporary employment a cause or consequence of poor mental health? A panel data analysis

Mental health status has an association with labour market outcomes. If people in temporary employment have poorer mental health than those in permanent employment then it is consistent with two mutually inclusive possibilities: temporary employment generates adverse mental health effects and/or individuals with poorer mental health select into temporary from permanent employment. We apply regression analyses to longitudinal data corresponding to about 50,000 observations across 8000 individuals between 1991 and 2008 drawn from the British Household Panel Survey. We find that permanent employees who will be in temporary employment in the future have poorer mental health than those who never become temporarily employed. We also reveal that this relationship is mediated by greater job dissatisfaction. Overall, these results suggest that permanent workers with poor mental health appear to select into temporary employment thus signalling that prior cross section studies may overestimate the influence of employment type on mental health.

The relationship between employment status and self-rated health among wage workers in South Korea: the moderating role of household income

The purpose of the study reported in this article was to investigate the relationship between employment status and self-rated health (SRH) and the moderating effect of household income among wage workers in South Korea. This research analyzed the Korean Labor and Income Panel Study, 2005 to 2008. Of the 10,494 respondents participating in the survey during the period, a total of 1,548 people whose employment status had remained either precarious or nonprecarious were selected. A moderated multiple regression model was used to examine the main effect of employment status on SRH and the moderating effect of total household income on the relationship between employment status and SRH. Among 343 precarious workers and 1,205 nonprecarious workers, after controlling for gender, age, education, smoking, and drinking, employment status was associated with SRH of wage workers, and household income was found to have a moderating effect on SRH in that higher income buffers the link between unstable employment status and low SRH. Unstable employment, combined with low income, was significantly related to precarious wage workers' perceived health. To promote public health, efforts may be needed to secure not only people's employment, but also their income.

Differences in self-rated health by employment contract and household structure among Japanese employees: a nationwide cross-sectional study

OBJECTIVES

The aim of this study was to examine whether the association between employment contract and self-rated health differs by household structure in a representative sample of employees in Japan.

METHODS

The participants were 81,441 male and 64,471 female employees aged 18-59 years who had participated in the 2010 Comprehensive Survey of Living Conditions. We assessed the interactive effect of employment contract (permanent or precarious) and household structure (couple only, couple with children, single parent, single person, or other multi-person) on fair/poor health, adjusting for covariates by using logistic regression. We then calculated the relative poverty rate by employment contract and household structure.

RESULTS

The interaction effect was significant for women (p<0.001) but not for men (p=0.413). A higher percentage of female precarious workers who lived in single-parent households (20.2%) reported fair/poor health compared with those in other types of households (10.4-13.2%), although the prevalence of fair/poor health did not differ substantially by household structure among female permanent workers. The relative poverty rates of female precarious workers who lived in single-parent households were higher compared with those of other female workers.

CONCLUSIONS

Our results suggest that female precarious workers are not a homogeneous group and that those living in single-parent households suffer from poor health due to low income and insufficient coverage by insurance firms and family-based safety nets.

Contingent workers: Workers' compensation data analysis strategies and limitations

The growth of the contingent workforce presents many challenges in the occupational safety and health arena. State and federal laws impose obligations and rights on employees and employers, but contingent work raises issues regarding responsibilities to maintain a safe workplace and difficulties in collecting and reporting data on injuries and illnesses. Contingent work may involve uncertainty about the length of employment, control over the labor process, degree of regulatory, or statutory protections, and access to benefits under workers' compensation. The paper highlights differences in regulatory protections and benefits among various types of contingent workers and how these different arrangements affect safety incentives. It discusses challenges caused by contingent work for accurate data reporting in existing injury and illness surveillance and benefit programs, differences between categories of contingent work in their coverage in various data sources, and opportunities for overcoming obstacles to effectively using workers' compensation data.