Local health department engagement with workplaces during the COVID-19 pandemic-Examining barriers of and facilitators to outbreak investigation and mitigation.

Objectives: To document local health department (LHD) COVID-19 prevention or mitigation activities at workplaces in the United States and identify facilitators for and barriers to these efforts. Methods: We conducted a web-based, cross-sectional national probability survey of United States LHDs (n = 181 unweighted; n = 2,284 weighted) from January to March 2022, collecting information about worker complaints, surveillance, investigations, relationships and interactions with employers/businesses, and LHD capacity. Results: Overall, 94% LHD respondents reported investigating workplace-linked COVID-19 cases; however, 47% reported insufficient capacity to effectively receive, investigate and respond to COVID-19-related workplace safety complaints. Prior relationships with jurisdiction employers and LHD personnel with formal occupational health and safety (OHS) training were predictors of proactive outreach to prevent COVID-19 spread in workplaces (p < 0.01 and p < 0.001). LHD size predicted OHS personnel and sufficient financial resources to support workplace investigation and mitigation activities (p < 0.001). Conclusions: Differences in LHD capacity to effectively respond to communicable disease spread in workplaces may exacerbate health disparities, especially between rural and urban settings. Improving LHD OHS capacity, especially in smaller jurisdictions, could facilitate effective prevention and mitigation of workplace communicable disease spread.

Employment Precarity and Increased Risk of Hazardous Occupational Exposures Among Residents of High Socioeconomic Hardship Neighborhoods.

BACKGROUND: While there is evidence that workers in nonstandard employment arrangements are disproportionately exposed to recognized occupational hazards, existing studies have not comprehensively examined associations between employment precarity and exposure to occupational hazards for these workers in the USA. The aim of this study was to examine relationships between employment precarity and occupational hazards in two contiguous high socio-economic hardship neighborhoods in Chicago. METHODS: Using a community-based participatory research approach, community researchers administered a community-developed survey to 489 residents of Greater Lawndale who reported current or recent employment in a job that met at least one characteristic of precarious employment (e.g. unpredictable schedule, insecure work, no living wage/benefits). Employment precarity was calculated using a modified version of the Employment Precarity Index (EPI) developed by the Poverty and Employment Precarity in Southern Ontario group. We modeled the association between employment precarity and occupational exposures using logistic regression models. RESULTS: We identified a high prevalence of precarious employment in this sample, as well as a high prevalence of self-reported exposure to recognized occupational hazards. Increases in relative employment precarity were significantly associated with self-reported exposure to chemical and biological hazards, physical hazards, and slip, trip, strike, fall, trap or crush hazards at work. CONCLUSIONS: Results highlight the importance of using community research approaches and robust measures of employment characteristics, such as the EPI, to evaluate associations between employment precarity and hazardous exposures. These results suggest that variability in employment situations and resultant relative employment precarity are important predictors of exposure to recognized occupational hazards. Findings also suggest that health inequities observed among precariously employed workers may be partly explained by increased risk for exposure to occupational hazards, which has implications for community health and should be investigated in future longitudinal research.

Health Equity and Worker Justice in Temporary Staffing: The Illinois Case.

Temporary staffing has an increasing role in world economies, contracting workers and dispatching them to work for leasing employers within countries and across borders. Using Illinois as a case study, co-authors have undertaken investigations to understand the occupational health, safety, and well-being challenges for workers hired through temporary staffing companies; to determine knowledge and attitudes of temp workers and temp staffing employers; and to assess temporary staffing at a community level. Temporary staffing workers in Illinois tend to be people of color who are employed in the most hazardous sectors of the economy. They have a higher rate of injury, are compensated less, and often lose their jobs when injured. Laws allow for ambiguity of responsibility for training, reporting, and compensation between the staffing agency and host employers. Our findings illustrate the ways in which principles of fairness and equity are violated in temporary staffing. Shared responsibility for reporting injuries, providing workers' compensation insurance, and training workers should be mandated in law and required in contractual language between temporary staffing and host/contracting employers. Monitoring, enforcement, and adjustment of the law based on experience are required to "promote inclusive and sustainable economic growth, employment and decent work for all.

Evaluation Results From the Healthy Work Collaborative: A Cross-Sectoral Capacity Building Partnership to Address Precarious Employment.

BACKGROUND: The COVID-19 pandemic has illuminated the profound health and safety risks of precariously employed workers, many of whom are disproportionately Latinx and Black. Precarious employment (PE) is a social determinant of health (SDOH) characterized by low wages, hazardous conditions, unstable work schedules, no termination protection, and few benefits. Even before COVID-19, calls for more effective health promotion efforts to address SDOH like PE existed. PURPOSE: The University of Illinois at Chicago Center for Healthy Work, Healthy Communities Through Healthy Work developed the Healthy Work Collaborative (HWC) as an evidence-informed capacity building policy, systems, and environmental change (PSE) initiative. The HWC aimed to facilitate cross-sectoral partnerships between health and labor sector partners. The labor sector provided technical assistance (TA) to participants to improve their ability to address PE through PSE. METHODS: This article reports findings from a mixed-methods evaluation using the Kirkpatrick training model including participants' reactions, learning, behavior, and outcomes. A pre-post survey was administered to participants (N = 21) and analyzed descriptively; 3-month post HWC interviews were conducted (N = 13) and thematically analyzed. CONCLUSION: Findings included positive results at all Kirkpatrick levels. Participants' reported that the HWC curriculum and delivery was valuable and well received; they demonstrated gains toward addressing PE through PSE knowledge and skills and increased or strengthened health/labor partnerships. In addition, HWC influenced participants' application of HWC concepts, and in a few cases, participants' made changes in policies and plans in their organizational settings. The HWC may serve as a model to address other SDOH through cross-sectoral PSE change.

Results From a National Mixed-Methods Study Exploring Community Health Improvement Implementation: An Opportunity to Strengthen Public Health Systems Through Collective Action.

CONTEXT: There are multiple calls for public health agency role and workforce transformation to increase capacity to orchestrate cross-sectoral partnerships that set and implement strategies addressing the structural and social determinants of health. Mobilizing for Action through Planning and Partnerships (MAPP) may be one tool for collective action to improve population health and equity. However, little is known about the Action Cycle in MAPP and implementation of resulting community health improvement plans. OBJECTIVE: To explore the characteristics of MAPP users who completed the MAPP Action Cycle and factors that facilitated or inhibited implementation activities during this phase. METHODS: We used a sequential participatory mixed-methods design involving 2 phases of data collection. The first data collection phase included a Web-based survey using Qualtrics. The second data collection phase included qualitative key-informant interviews and focus groups. A national public health and health care advisory group informed the evaluation throughout the entire process to ground the process in practice and experience. RESULTS: This study showed that some MAPP participants do not conduct implementation activities as defined by the MAPP Action Cycle and of those who do, implementation activity varies by participant experiences conducting MAPP and accreditation status. The MAPP users who completed 3 or more rounds of MAPP were more likely to align and integrate MAPP within their agencies as well as organize a collaborative implementation process with partners. More resources and skills in planning that facilitate long-range partnerships were noted as key to implementation. CONCLUSIONS: Opportunity remains to improve implementation in MAPP. National leaders should explore and build capacity and infrastructure within public health agencies and with their partners to create a system of readiness and an infrastructure that support implementation over time.

Reemployment Needs and Barriers of Users of Workforce Development Programs: A Mixed-Methods Study.

BACKGROUND: Employment is an important social determinant of health, and supporting individuals' return to the workforce is likely to have robust impacts on their health and well-being. The aim of this study was to identify (a) the self-perceived employment needs and expectations of users of community employment services; (b) the assets, needs, and barriers to reemployment among users of community employment services; and (c) areas of priority for programmatic development, including implications for patient-worker needs assessment and care coordination in clinical settings. METHODS: We conducted structured interviews with 71 adults recruited from three workforce development programs located in the Chicago metropolitan area serving vulnerable workers. Topics of discussion included job histories, financial and social assets, and the respondents' motivation and expectations for their return to the workforce. We used descriptive statistics to analyze quantitative responses and performed content analysis for qualitative data. FINDINGS: Users reported discrimination, legal barriers, family responsibilities, physical or mental health concerns, and needs related to transportation and housing as common challenges to reemployment. Concerns regarding navigating complex social support programs to meet individual and family needs, as well as uncertainty regarding what would qualify as sufficient employment in order to not be reliant on these programs in the future, were expressed. CONCLUSION/APPLICATION TO PRACTICE: Health care providers have opportunities to identify those that may benefit from comprehensive referrals to reemployment programs and social services. Occupational health providers are also in a unique position to enhance workforce development programs through collaborations to better educate and support workers.

Role of technical assistance in U.S. labor and health sector collaboration to address precarious work.

Precarious work has recognized adverse impacts on the health of workers; however, there are few policy, systems and environmental (PSE) change public health interventions that target the causes and consequences of precarious work. To build the capacity of health organizations to develop and implement such interventions, researchers engaged representatives from health organizations in a six-session learning process, entitled the healthy work collaborative. Representatives of labor organizations were engaged as technical assistance (TA) providers, which involved sharing content and skill knowledge with health participants. Semi-structured interviews were conducted with providers and participants to examine perceptions of the role of TA; providers' motivations for providing TA; and providers' and participants' perceptions of the impact of TA on learning and preparing for subsequent intervention. Results suggest that the provider-participant engagement evolved from one-way knowledge translation to a robust, two-way knowledge exchange with potential for collaborative intervention development and implementation. These results highlight the ways in which this provider-participant model facilitated engagement between representatives from sectors that had not previously worked together and suggests that such a model may be effective in catalyzing multi-level, multi-sectoral PSE change to address precarious work.

Development of the Healthy Work Collaborative: Findings From an Action Research Study to Inform a Policy, Systems, and Environmental Change Capacity-Building Initiative Addressing Precarious Employment.

Precarious employment (PE) is a complex problem that affects an increasing number of workers across all economic sectors who experience low wages, hazardous conditions, and few benefits, and results in adverse health outcomes. PE is characterized by nontraditional work arrangements, precluding workplace-based interventions. Policy, systems, and environmental initiatives that engage cross-sectoral stakeholders may be an applicable health promotion approach to address PE. The University of of Illinois at Chicago Center for Healthy Work's Healthy Communities through Healthy Work (HCHW) is an outreach project of the Centers for Disease Control and Prevention/National Institute for Occupational Safety and Health-funded Center of Excellence for Total Worker Health that conducted a multiphased qualitative action research (AR) study. AR designs may be a novel approach to develop initiatives to address problems like PE. This article reports on HCHW's first AR phase to answer four research questions: (1) What are participants' perceptions of PE? (2) What are participants' perceptions of their roles in addressing PE? (3) What initiatives are under way that address PE? and (4) How can the findings be used to facilitate opportunities for healthy work? Key informant interviews with health (public health and health care; N = 23) and labor sector organizations (worker centers, worker advocacy organizations, and unions; N = 21) were conducted. Data were thematically analyzed alongside a chart-based content analysis, and shared in 11 key stakeholder meetings. Findings revealed an opportunity for the labor sector to improve health sector readiness to address PE in the context of health, and were used to develop the Healthy Work Collaborative, a cross-sectoral health promotion capacity building policy, systems, and environmenta change initiative to address PE.

Understanding the Role of Academic Partners as Technical Assistance Providers: Results from an Exploratory Study to Address Precarious Work.

Universities may be well poised to support knowledge, skill, and capacity-building efforts to foster the development of multi-level interventions to address complex problems. Researchers at the University of Illinois at Chicago (UIC) engaged organizations interested in developing policy- and systems-level initiatives to address the drivers of precarious work in a six-meeting Action Learning (AL) process, in which the researchers served as technical assistance (TA) providers focused on facilitating learning and promoting critical thinking among participants. This exploratory qualitative study examined the role, facilitators, challenges, and impacts of university facilitation in this context. A total of 22 individuals participated in this study, including UIC TA providers, content expert TA providers from labor-focused organizations, and TA recipients from health-focused organizations. Results from interviews and a focus group highlight the utility of a university connecting organizations from different disciplines that do not traditionally work together, and suggest that the TA provided by UIC helped participants think concretely about precarious work and ways in which their organizations might work collaboratively to bring about sustainable change. Findings from this study suggest that university facilitation using an AL approach may be effective in increasing knowledge to action.

Occupational Safety and Health in the Temporary Services Industry: A Model for a Community-University Partnership.

Workers in the temporary staffing industry face hazardous working conditions and have a high risk of occupational injury. This project brought together local workers' centers and university investigators to build a corps of Occupational Health Promoters (OHPs) and to test a survey tool and recruitment methods to identify hazards and raise awareness among workers employed by temporary staffing companies. OHPs interviewed ninety-eight workers employed by thirty-three temporary agencies and forty-nine client companies, working mainly in shipping and packing, manufacturing, and warehousing sectors. Surveys identified workplace hazards. OHPs reported two companies to OSHA, resulting in several citations. Partners reported greater understanding of occupational safety and health challenges for temporary workers and continue to engage in training, peer education, and coalition building.