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.

Background/objectives: Older homeless-experienced adults have low rates of advance care planning (ACP) engagement despite high rates of morbidity and mortality. To inform intervention development, we examined potential barriers and solutions to ACP engagement. Design: Cross-sectional qualitative study. Setting: We recruited adults who were homeless in the prior three years, ≥50 years of age in the San Francisco Bay Area and recruited clinical stakeholders from a national meeting of homeless providers. We analyzed qualitative data using thematic analysis. Measurements: We conducted semi-structured interviews with homeless-experienced older adults (n=20) and focus groups with clinical stakeholders (n=24) about perceived barriers and solutions to ACP engagement.

Older homeless-experienced adults have low engagement in advance care planning (ACP) despite high morbidity and mortality. We conducted a cross-sectional analysis of a cohort of 350 homeless-experienced adults aged 50 and older in Oakland, California. We assessed the prevalence of potential surrogate decision-makers, ACP contemplation, discussions, and ACP documentation (surrogate designation, advance directives). We used multivariable logistic regression to examine factors associated with ACP discussions and documentation. The median age of the cohort was 59 (range 52-82), 75.2% were male, and 82.1% were black. Sixty-one percent reported a potential surrogate, 21.5% had discussed ACP, and 19.0% reported ACP documentation. In multivariable models, having 1 to 5 confidants versus none (adjusted odds ratio (aOR)55.8, 95% confidence interval (CI)51.7-20.0), 3 or more chronic conditions versus none (aOR52.3, 95% CI50.9-5.6), and a recent primary care visit (aOR52.1, 95% CI51.0-4.4) were associated with higher odds of ACP discussions and each additional 5 years of homelessness (aOR50.7, 95% CI50.5-0.9) with lower odds. Having 1 to 5 confidants (aOR55.0, 95% CI51.4-17.5), being black (aOR55.5, 95% CI51.5-19.5), and having adequate versus limited literacy (aOR57.0, 95% CI51.5-32.4) were associated with higher odds of ACP documentation and illicit drug use (aOR50.3, 95% CI50.1-0.9) with lower odds. Although the majority of older homelessexperienced adults have a potential surrogate, few have discussed or documented their ACP wishes; the odds of both were greater with larger social networks. Future interventions must be customized for individuals with limited social networks and address the instability of homelessness, health literacy, and the constraints of safety-net healthcare settings.

As community residents and recovery workers, Latino immigrants play important roles after disasters, yet are rarely included in preparedness planning. A community-university-labor union partnership created a demonstration project after Hurricane Sandy to strengthen connections to disaster preparedness systems to increase community resilience among Latino immigrant communities in New York and New Jersey. Building ongoing ties that connect workers and community-based organizations with local disaster preparedness systems provided mutual benefits to disaster planners and local immigrant communities, and also had an impact on national disaster-related initiatives.

Few studies integrate work and immigration as intersecting social determinants of health. We synthesize data from 12 focus groups ( N = 97) originating from two separate community-engaged studies that originally centered on exploring barriers to health and hazards of work among immigrant Latinx women and men to explore the role of work in their overall health and well-being. The three major interrelated themes we drew from this research—hazards of work, value of work, and building agency to overcome risk—provide insights that can help to reframe and begin to operationalize how community-based health promotion practice might better incorporate workplace issues for Latinx low-wage workers. The value of work, and its subtheme, pride in performing well specifically, could be engaged by workers to actively change conditions for themselves and others. We discuss findings in light of previous occupational health research and implications for community-based intervention design and practice.