Employment Quality and Mental and Self-Reported Health Inequities among Latinx Housecleaners: The Safe and Just Cleaners Study

A Qualitative Analysis of Immigrant Latinx Housecleaners' Experiences of How Power Relations With "Employers" Influence Working Conditions in New York City: The Safe and Just Cleaners Study

BACKGROUND

Housecleaning work has been characterized as precarious employment with unstable work hours, arbitrary and low pay and benefits, and exposures to chemical, physical, and psychosocial stressors. Understanding how interpersonal power dynamics between workers and clients, a component of precarious work, contributes to work exposures can inform and improve prevention programs.

METHODS

We used reflexive thematic analysis of data from seven focus groups with Latinx immigrant housecleaners in New York City to explore workers' experience of interpersonal power dynamics with their clients-whom they referred to as their "employers"-and its influences on working conditions.

RESULTS

Employer direction and monitoring varied and mostly reduced workers' autonomy to choose products, sometimes leading workers to complete tasks in more hazardous ways. Housecleaners reported using larger quantities of products, products with stronger scents, and more physical exertion to increase the efficiency of their cleaning, to complete tasks quickly, and to please their clients. Allotted time, tasks, and pay were interconnected, often resulting in negative reports about health and well-being. As immigrants, they also experienced discrimination and intimidation, which compounded their anxiety due to their employment insecurity. Nevertheless, participants learned and navigated high variance in employers' cleaning preferences and attempted to take control over the conduct of their work, when possible, and sometimes expressed self-advocacy.

CONCLUSIONS

Housecleaners' precarious employment arrangements affect how they navigate interpersonal relationships with employers, which impairs their working conditions and occupational exposures. Improvements in labor and social protections, such as designing supportive policies and training for workers and employers, are needed to improve working conditions.

Respiratory quaternary ammonium and volatile organic compound exposures experienced by home care aides during residential bathroom cleaning using conventional and green products

INTRODUCTION

US home care (HC) aide visits to clients' homes typically involve cleaning and disinfecting (C&D) environmental surfaces, particularly in bathrooms. Some ingredients in C&D products are associated with respiratory illness: sodium hypochlorite (bleach), quaternary ammonium compounds (QACs), and volatile organic compounds (VOCs). This study assessed and compared aides' respiratory exposures to specific VOCs and QACs while using 2 conventional and 1 "green" household C&D spray products during bathroom cleaning. Measured exposures were compared to ingredients listed on publicly available sources.

METHODS

Three C&D products were selected with principal active disinfecting ingredients: 1% to 5% sodium hypochlorite by weight ("bleach-based"); 0.1% to 1% QACs ("QACs-based"); and 0.05% thymol ("green"). Twenty-two aides were recruited to perform C&D tasks in a simulated residential bathroom constructed in an environmental monitoring laboratory. A balanced experimental study design involved each aide visiting the lab 4 times to perform typical cleaning tasks with the 3 products and distilled water (as a control), randomly assigned across the 4 visits. Aides wore air sampling equipment for breathing zone samples: canisters to collect whole air for VOC analyses and filter cassettes for QACs analyses.

RESULTS

Aides performed 84 cleaning visits contributing approximately 20 air samples each for VOCs and QACs, for each of the 3 products and distilled water. In total, 38 unique VOCs were identified in the canister whole air samples: 20 in the QACs-based product samples, 15 in the bleach-based, and 10 in the green. Most VOCs were not listed in publicly available sources of cleaning product ingredients. Toxicity information was limited. Few VOCs had occupational exposure limits. The QACs-based product generated QACs aerosol: benzalkonium chloride (BAC)12 (geometric mean (GM) = 6.98 µg/m3), BAC14 (GM=2.97 µg/m3), BAC16 (GM=0.78 µg/m3); and the 3 QACs summed (GM=10.86 µg/m3).

DISCUSSION

The use of C&D spray products for residential cleaning can generate respiratory exposures to complex mixtures of volatile and nonvolatile compounds. Notably, we measured aerosols containing QACs during the use of the QACs-based product. Dermal is usually considered the main route of exposure because QACs are nonvolatile salts. This study provides evidence that QACs inhalation exposure should be recognized and minimized in addition to the well-accepted dermal exposure routes. The green product generated the fewest VOCs. However, more toxicity information is needed on the health impacts of green C&D products. Spraying of C&D products, conventional and green, should be avoided.

CONCLUSIONS

Aides' respiratory health should be protected from chemical exposures while performing C&D in home care.

A Systematic Review of Evaluated Labor Market Initiatives Addressing Precarious Employment: Findings and Public Health Implications

Precarious employment (PE) is a major determinant of population health and contributor to health and social inequities. The purpose of this article is to synthesize and critically appraise available evidence on labor market initiatives addressing PE identified through a systematic review. Of the 21 initiatives reviewed, grouped into four categories-labor market policies, legislation, and reforms; union strategies; apprenticeships and other youth programs; social protection programs-10 showed consistently positive outcomes and 11 a combination of negative, mixed, or inconclusive outcomes. In addition to reviewing the key findings, we discuss public health implications and recommendations related to PE and the implementation and evaluation of initiatives. Given the wide diversity of initiatives, implementation approaches, evaluation methods, and socioeconomic and historical contexts characterizing the labor markets of the countries studied, we refrain from making recommendations regarding the most effective initiatives to address PE. Instead, we discuss several implications concerning the four types of initiatives to further support those searching for solutions to address PE. We strongly recommend tailoring adopted initiatives to local contexts to match a country's specific PE problems and unique labor market and socioeconomic context.

Precarious employment and mental health in the Belgian service voucher system: the role of working conditions and perceived financial strain

INTRODUCTION

Jobs in domestic cleaning are often conceived as 'precarious employment' (PE)-i.e. a multidimensional concept referring to accumulated adverse characteristics of employment due to workers' weak bargaining position. Against this background, the Belgian service voucher system (SVS) was implemented aimed at creating formal and stable, subsidized domestic services jobs.

PURPOSE

The current study assesses the relationship between PE and mental health (WHO5) in the Belgian SVS, accounting for the potential mediating role of working conditions and perceived financial strain at the household level.

METHODS

We analysed a cross-sectional sample of 1,115 Belgian SVS domestic cleaners, collected in 2019 through an online survey. A mediation model was estimated.

RESULTS

The crude effect of PE on adverse mental health was strong (ß 0.545-S.E. 0.063). However, 50% of the association between PE and mental well-being was mediated by work task characteristics (quantitative demands, physical demands, task variation and autonomy) and 25% by household-level perceived financial strain. The remaining direct effect of PE on adverse mental well-being is ß 0.066 (S.E. 0.032-25% of the total effect).

CONCLUSION

These findings are the first based on the Belgian Employment Precariousness Scale (EPRES-BE) and are consistent with earlier-made-but seldom simultaneously tested-assumptions on the mechanisms relating PE to adverse mental health-i.e. involving direct associations and indirect associations via adverse working conditions and material deprivation. Based on the results, we recommend more democratic and higher-quality management practices in the SVS, in addition to higher wages and working time reduction.

COVID-19 Infections, Pandemic-Related Social and Economic Impacts, and Changes to Mental and Self-Rated Health Among Latinx Immigrant Housecleaners in New York City: The Safe and Just Cleaners Study

Objectives. To estimate impacts of COVID-19 infections and social and economic sequelae on mental and self-rated health among Latinx immigrant housecleaners in New York City. Methods. From March to June 2021, we conducted a follow-up study with 74% retention of 402 housecleaners initially surveyed before the pandemic between August 2019 and February 2020. We measured rates of self-reported COVID-19 infections, COVID-19 antibodies, and pandemic-related social and economic sequelae and examined predictors of mental and self-rated health changes using logistic regression models. Results. Fifty-three percent reported COVID-19 infections, consistent with the rate demonstrating COVID-19 antibodies. During shutdown of nonessential services, from March 22 to June 8, 2020, 29% worked as housecleaners, although this was not associated with higher COVID-19 infection rates. COVID-19-related stigma at work, lost earnings owing to COVID-19 infections, housing insecurity, food insecurity, and unsafe homes, including experiencing intimate partner verbal abuse, were statistically associated with changes in mental or self-rated health compared with prepandemic measures. Conclusions. The disproportionate impact and virtually nonexistent safety net housecleaners experienced during the first year of the pandemic highlight the importance of inclusive stopgap measures to mitigate economic insecurity and its sequelae. (Am J Public Health. 2023;113(8):893-903. https://doi.org/10.2105/AJPH.2023.307324).