Racial disparities in job strain among American and immigrant long‐term care workers

Abstract

Background Nursing homes are occupational settings, with an increasing minority and immigrant workforce where several psychosocial stressors intersect. Aim To examine racial/ethnic differences in job strain between Black (n=127) and White (n=110) immigrant and American direct-care workers at nursing homes (total n=237). Methods Cross-sectional study with data collected at four nursing homes in Massachusetts, during 2006-2007. We contrasted Black and White workers within higher-skilled occupations such as Registered Nurses (RNs) or Licensed Practical Nurses (LPNs, n=82) and lower-skilled staff such as Certified Nursing Assistants (CNAs, n=155). Results Almost all Black workers (96 percent) were immigrants. After adjusting for demographic and occupational characteristics, Black employees were more likely to report job strain, compared to Whites (Relative Risk [RR]: 2.9, 95% CI 1.3 to 6.6). Analyses stratified by occupation showed that Black CNAs were more likely to report job strain, compared to White CNAs (RR: 3.1, 95% CI: 1.0 to 9.4). Black workers were also more likely to report low control (RR: 2.1, 95% CI: 1.1 to 4.0). Additionally, Black workers earned $2.58 less per hour and worked 7.1 more hours per week on average, controlling for potential confounders. Conclusion Black immigrant workers were 2.9 times more likely to report job strain than Whites, with greater differences among CNAs. These differences may reflect organizational and job characteristics, individual characteristics, or potentially interpersonal or institutional racial or ethnic discrimination. Further research should consider the role of race/ethnicity in shaping patterns of occupational stress.

Race‐based job discrimination, disparities in job control, and their joint effects on health

“…Disparities in the workplace psychosocial environment, including low job control and high job strain, have previously been reported and are generally found to be greater in Black subjects when contrasted with Whites or Latinos [Quinn et al, 2007;Meyer et al, 2011;Hurtado et al, 2012;Meyer and Mutambudzi, 2012]. While the effects of low job control and high strain, including hypertension, cardiovascular disease, and adverse pregnancy outcomes are well described [Karasek, 1996;Landsbergis and Hatch, 1996;de Lange et al, 2003;Landsbergis et al, 2003;Meyer et al, 2007;Smith et al, 2008a,b], the underlying reasons for disproportionately high adverse work exposures in Blacks has received less attention.…”

“…A fivefold difference is apparent between Black and White participants. While the health effects of racial discrimination have been well-described [Curtis et al, 1997;Williams et al, 1997;DinDzietham et al, 2004;Hurtado et al, 2012], this pathway appears to obviate the effect of education on health entirely in Blacks, and thus may provide at least a partial explanation for decreasing returns in health from increased education that have been described in African-Americans for over two decades [McGrady et al, 1992;Collins and Butler, 1997;Collins et al, 2004;Farmer and Ferraro, 2005;Meyer et al, 2010].…”

“…Whether the effect is mediated though environmental exposures, psychosocial hazards, reduced incomes, or a combination of these with other factors is not clear, however. Focusing on work's psychosocial hazards, we have found, when worker race/ethnicity is considered in stratified analyses of job characteristics and health outcomes, a pattern emerges of both lower job control and a greater effect of low job control on health in Black subjects [Brett et al, 1997;Thomas et al, 2004;Quinn et al, 2007;Meyer et al, 2010;Hurtado et al, 2012]. In addition, within equivalent educational strata, there are differences in the proportions of Blacks and Whites working in low-control occupations.…”

Work–family conflict, cardiometabolic risk, and sleep duration in nursing employees.

“…Recent systematic reviews suggest that work stress-related cardiovascular risk is more consistently observed in male samples than in women (Backe, Seidler, Latza, Rossnagel, & Schumann, 2012) whereas marital stress is more important for women (Orth-Gomer, et al, 2000). For sleep, socioeconomic conditions related to neighborhood and other family factors as well as overall job insecurity could well shape patterns of risk of short sleep duration for many people in lower socioeconomic positions (Bartley, 2005; Bartley & Ferrie, 2001; Beatty et al, 2011; Ertel, Berkman, & Buxton, 2011; Hurtado, Sabbath, Ertel, Buxton, & Berkman, 2012; Okechukwu, El Ayadi, Tamers, Sabbath, & Berkman, 2012). …”

Psychosoziale Belastungen und Beanspruchungen in der Altenpflege: Vergleich zwischen Pflegekräften mit und ohne Migrationshintergrund

“…Beschäftigte mit Migrationshintergrund sind allgemein häufig, aufgrund mangelnder Deutschkenntnisse, geringer Qualifikation oder fehlender Anerkennung von ausländischen Abschlüssen, als An-und Ungelernte beschäftigt [6,17]. In der Studie von Hurtado et al [26] berichteten Pflegeassistenten mit Migrationshintergrund häufiger über arbeitsplatzbezogene Beanspruchung und geringere Einflussmöglichkeiten als die nichtmigrierten Beschäftigten. Giver et al [19] [39], das "DemandControl-Model" (DCM) [27] und das "Demand-Control-Resources-Model" (DCR) [36].…”