Objective: This longitudinal study aimed to measure precarious employment in the US using a multidimensional indicator. Methods: We used data from the National Longitudinal Survey of Youth (1988–2016) and the Occupational Information Network database to create a longitudinal precarious employment score (PES) among 7568 employed individuals over 18 waves (N=101 290 observations). We identified 13 survey indicators to operationalize 7 dimensions of precarious employment, which we included in our PES (range: 0–7, with 7 indicating the most precarious): material rewards, working-time arrangements, stability, workers’ rights, collective organization, interpersonal relations, and training. Using generalized estimating equations, we estimated the mean PES and changes over time in the PES overall and by race/ethnicity, gender, education, income, and region. Results: On average, the PES was 3.17 [standard deviation (SD) 1.19], and was higher among women (3.34, SD 1.20), people of color (Hispanics: 3.24, SD 1.23; non-Hispanic Blacks: 3.31, SD 1.23), those with less education (primary: 3.99, SD 1.07; high school: 3.43, SD 1.19), and with lower-incomes (3.84, SD 1.08), and those residing in the South (3.23, SD 1.17). From 1988 to 2016, the PES increased by 9% on average [0.29 points; 95% confidence interval (CI) 0.26–0.31]. While precarious employment increased over time across all subgroups, the increase was largest among males (0.35 points; 95% CI 0.33–0.39), higher-income (0.39 points; 95% CI 0.36–0.42) and college-educated (0.37 points; 95% CI 0.33–0.41) individuals. Conclusions: Long-term decreases in employment quality are widespread in the US. Women and those from racialized and less-educated populations remain disproportionately precariously employed; however, we observed large increases among men, college graduates and higher-income individuals.

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The fringe banking industry, including payday lenders and check cashers, was nearly nonexistent three decades ago. Today it generates tens of billions of dollars in annual revenue. The industry's growth accelerated in the 1980s with financial deregulation and the working class's declining resources. With Current Population Survey data, we used propensity score matching to investigate the relationship between fringe loan use, unbanked status, and self-rated health, hypothesizing that the material and stress effects of exposure to these financial services would be harmful to health. We found that fringe loan use was associated with 38 percent higher prevalence of poor or fair health, while being unbanked (not having one's own bank account) was associated with 17 percent higher prevalence. Although a variety of policies could mitigate the health consequences of these exposures, expanding social welfare programs and labor protections would address the root causes of the use of fringe services and advance health equity.

Applying a relational class theory based on property ownership, authority, and credentials/skill, we analyzed the relationship between class, self-rated health (SRH), and mortality using the 1972–2016 General Social Survey. In a simple measure of class, we assigned respondents to worker, manager, petty bourgeois, or capitalist classes. In a complex measure, we subdivided workers (less-skilled/more-skilled), managers (low/high), and capitalists (small/large). Next, we estimated trends in class structure. Finally, after gender-stratification, we estimated the relationships between class, SRH, and mortality and, in sensitivity analyses, tested for class-by-race interaction. Class structure changed little over time, with workers constituting over half the population each decade. Concerning SRH, for the simple measure, managers, petty bourgeoisie, and capitalists reported better health than workers. For the complex measure, patterns were similar, although skilled workers reported better health than less-skilled workers, low managers, and petty bourgeoisie. Concerning mortality, for the simple measure, inequities were small among women; among men, only capitalists’ hazard was lower than workers’ hazard. For the complex measure, across genders, the hazards of less-skilled workers and petty bourgeoisie were highest, while skilled workers’ hazard resembled that of managers and capitalists. Finally, we found some evidence that the relationship between class and mortality varied by race, although the estimates were imprecise.

The working lives of Americans have become less stable over the past several decades and older adults may be particularly vulnerable to these changes in employment quality (EQ). We aimed to develop a multidimensional indicator of EQ among older adults and identify EQ and retirement trajectories in the United States. Using longitudinal data on employment stability, material rewards, workers’ rights, working-time arrangements, unionization, and interpersonal power relations from the Health and Retirement Study (HRS), we used principal component analysis to construct an EQ score. Then, we used sequence analysis to identify late-career EQ trajectories (age 50–70 years; N = 11,958 respondents), overall and by sociodemographics (race, gender, educational attainment, marital status). We subsequently examined the sociodemographic, employment, and health profiles of these trajectories. We identified 10 EQ trajectories; the most prevalent trajectories were Minimally Attached and Wealthy (13.9%) and Good EQ to Well-off Retirement (13.7%), however, 42% of respondents were classified into suboptimal trajectories. Those in suboptimal trajectories were disproportionately women, people of color, and less-educated. Individuals in the Poor EQ to Delayed and Poor Retirement and Unattached and Poor clusters self-reported the greatest prevalence of poor health and depression, while individuals in the Wealthy Business Owners and Great EQ to Well-off Retirement clusters self-reported the lowest prevalence of poor health and depression at baseline. Trajectories were substantially constrained for women of color. Although our study demonstrates EQ is inequitably distributed in later life, labor organizing and policy change may afford opportunities to improve EQ and retirement among marginalized populations.

Background: Recently, United States life expectancy has stagnated or declined for the poor and working class and risen for the middle and upper classes. Declining labor-union density-the percent of workers who are unionized-has precipitated burgeoning income inequity. We examined whether it has also exacerbated racial and educational mortality inequities.Methods: From CDC, we obtained state-level all-cause and overdose/suicide mortality overall and by gender, gender-race, and gender-education from 1986-2016. State-level union density and demographic and economic confounders came from the Current Population Survey. State-level policy confounders included the minimum wage, the generosity of Aid to Families with Dependent Children or Temporary Assistance for Needy Families, and the generosity of unemployment insurance. To model the exposure-outcome relationship, we used marginal structural modeling. Using state-level inverse-probability-of-treatment-weighted Poisson models with state and year fixed effects, we estimated 3-year moving average union density's effects on the following year's mortality rates. Then, we tested for gender, gender-race, and gender-education effect-modification. Finally, we estimated how racial and educational all-cause mortality inequities would change if union density increased to 1985 or 1988 levels, respectively.Results: Overall, a 10% increase in union density was associated with a 17% relative decrease in overdose/suicide mortality (95% confidence interval [CI]: 0.70, 0.98), or 5.7 lives saved per 100 000 person-years (95% CI: −10.7, −0.7). Union density's absolute (lives-saved) effects on overdose/suicide mortality were stronger for men than women, but its relative effects were similar across genders. Union density had little effect on all-cause mortality overall or across subgroups, and modeling suggested union-density increases would not affect mortality inequities.Conclusions: Declining union density (as operationalized in this study) may not explain all-cause mortality inequities, although increases in union density may reduce overdose/suicide mortality. K E Y W O R D S fatal overdose epidemic, health disparities, health inequities, labor movement, labor unions, marginal structural models, mortality inequities, social determinants of health

BackgroundWe used a relational social-class measure based on property ownership and managerial authority to analyse the longitudinal relationships between class, self-rated health (SRH) and mental illness. To our knowledge, this is the first study using a relational social-class measure to evaluate these relationships longitudinally.MethodsUsing Panel Study of Income Dynamics data from 1984 to 2017, we first assigned respondents aged 25–64 to the not in the labour force (NILF), worker, manager, petit bourgeois (PB) or capitalist classes based on business ownership, managerial authority and employment status. Next, using Cox models, we estimated the confounder-adjusted associations between 2-year-lagged class and incidence of poor/fair SRH and serious mental illness. We also tested whether the associations varied by gender, whether they persisted after more-fully adjusting for traditional socioeconomic-status measures (education and income) and how they changed temporally.ResultsWe identified large inequities in poor/fair SRH. NILFs had the greatest hazard, followed by workers, PBs, managers and capitalists. We also identified large inequities in serious mental illness; NILFs and workers had the greatest hazard, while capitalists had the lowest. Class inequities in both outcomes lessened but remained considerable after confounder and socioeconomic-status adjustment, and we found some evidence that the class–SRH relationship varied by gender, as being NILF was more harmful among men than women. Additionally, class inequities in the outcomes decreased somewhat over time.ConclusionWe identified substantial class inequities in SRH and mental illness. Our findings demonstrate the importance of using relational social-class measures to deepen understanding of health inequities’ root causes.

Union members enjoy better wages, benefits, and power than non-members, which can improve health. However, the longitudinal union-health relationship remains uncertain, partially because of healthy-worker bias, which cannot be addressed without high-quality data and methods that account for exposure-confounder feedback and structural non-positivity. Applying one such method, the parametric g-formula, to United-States-based Panel Study of Income Dynamics (PSID) data, we analyzed the longitudinal relationships between union membership, poor/fair self-rated health (SRH), and moderate mental illness (Kessler-K6>5). The SRH analyses included 16,719 respondents followed from 1985-2017, while the mental-illness analyses included 5,813 respondents followed from 2001-2017. Using the parametric g-formula, we contrasted cumulative incidence of the outcomes under two scenarios, one in which we set all employed-person-years to union-member employed-person-years (union scenario), and one in which we set no employed-person-years to union-member employed-person-years (non-union scenario). We also examined whether the contrast varied by gender, gender-race, and gender-education. Overall, the union scenario did not reduce incidence of poor/fair SRH (RR: 1.01, 95% CI: 0.95, 1.09; RD: 0.01, 95% CI: -0.03, 0.04) or moderate mental illness (RR: 1.02, 95% CI: 0.92, 1.12; RD: 0.01, 95% CI: -0.04, 0.06) relative to the non-union scenario. These associations largely did not vary by subgroup.