Workplace hazards and health among informally employed domestic workers in 14 cities, United States, 2011-2012: Using four approaches to characterize workers' patterns of exposures.

BACKGROUND: We characterized informally employed US domestic workers' (DWers) exposure to patterns of workplace hazards, as well as to single hazards, and examined associations with DWers' work-related and general health. METHODS: We analyzed cross-sectional data from the sole nationwide survey of informally employed US DWers with work-related hazards data, conducted in 14 cities (2011-2012; N = 2086). We characterized DWers' exposures using four approaches: single exposures (n = 19 hazards), composite exposure to hazards selected a priori, classification trees, and latent class analysis. We used city fixed effects regression to estimate the risk ratio (RR) of work-related back injury, work-related illness, and fair-to-poor self-rated health associated with exposure as defined by each approach. RESULTS: Across all four approaches-net of individual, household, and occupational characteristics, and city fixed effects-exposure to workplace hazards was associated with increased risk of the three health outcomes. For work-related back injury, the estimated RR associated with heavy lifting (the single hazard with the largest RR), exposure to all three hazards selected a priori (worker did heavy lifting, climbed to clean, and worked long hours) versus none, exposure to the two hazards identified by classification trees (heavy lifting, verbally abused) versus "no heavy lifting," and membership in the most- versus least-exposed latent class were, respectively, 3.4 (95% confidence interval [CI] 2.7-4.1); 6.5 (95% CI 4.8-8.7); 4.4 (95% CI 3.6-5.3), and 6.6 (95% CI 4.6-9.4). CONCLUSIONS: Measures of joint work-related exposures were more strongly associated than single exposures with informally employed US DWers' health profiles.

A Novel Use of Latent Class Analysis to Identify Patterns of Workplace Hazards among Informally Employed Domestic Workers in 14 Cities, United States, 2011-2012.

INTRODUCTION: Few studies, mostly descriptive, have quantitatively analyzed the working conditions of domestic workers (DWers) informally employed by private households in the USA. These workers are explicitly or effectively excluded from numerous workplace protections, and scant data exist on their exposures or how best to categorize them. METHODS: We analyzed data from the sole nationwide survey of informally employed US DWers with work-related hazards data, conducted by the National Domestic Workers Alliance, the University of Illinois Chicago Center for Urban Economic Development, and the DataCenter in 14 US cities (2011-2012; N = 2086). We used exploratory latent class analysis to identify groups of DWers with distinct patterns of exposure to 21 self-reported economic, social, and occupational workplace hazards (e.g. pay violations, verbal abuse, heavy lifting). We then used multinomial logistic latent class regression to examine associations between workers' individual, household, and occupational characteristics and latent class membership. RESULTS: Among the 2086 DWers, mean age was 42.6 years, 97.3% were women, 56.0% Latina/o, 26.5% White, 33.2% undocumented immigrants, and 11.7% live-in. 53.5%, 32.0%, and 14.5% primarily worked doing housecleaning, child care, and adult care, respectively. 49.9% of workers reported ≥3 hazards. Latent class analysis identified four groups of DWers doing: 'Low hazard domestic work' (lowest exposure to all hazards), 'Demanding care work' (moderate exposure to pay violations [item response probability (IRP) = 0.42] and contagious illness care [IRP = 0.39]), 'Strenuous cleaning work' (high exposure to cleaning-related occupational hazards, such as climbing to clean [IRP = 0.87]), and 'Hazardous domestic work' (highest exposure to all but one hazard). Covariates were strongly associated, in many cases, with latent class membership. For example, compared to other DWers, DWers doing 'hazardous domestic work' had the largest predicted probability of being economically insecure (0.53) and living-in with their employers (0.17). CONCLUSIONS: Results indicate that informally employed US DWers experience distinct patterns of workplace hazards, and that it is informative to characterize DWers' exposures to different sets of multiple hazards using latent class analysis.

Beyond Occupational Hazards: Abuse of Day Laborers and Health.

With the increase in labor market flexibility and worksite immigration enforcement, day labor is a common type of informal employment arrangement among immigrants. Our study contextualized day laborers' physical and mental health within work- and community-level factors. We use a nationally representative sample of 2015 day laborers from the National Day Labor Survey. Multivariable logistic regression models estimated the association of occupational and socioenvironmental abuses with self-rated health (SRH), a positive PHQ-2 screening, morbidities, and workplace injuries. Employer abuse was associated with fair/poor SRH, workplace injuries, morbidity, and PHQ-2; business owner abuse was associated with PHQ-2 and workplace injuries; and crime and having a dangerous job are both associated with workplace injuries. Health disadvantages stem from unsafe occupational conditions and an overlapping array of adverse social experiences. These findings highlight the need to develop and evaluate policies that protect all workers regardless of socioeconomic position and immigration status.

Workplace Health and Safety Hazards Faced by Informally Employed Domestic Workers in the United States.

Informally employed domestic workers encounter a range of workplace hazards, though these have been poorly documented and are typically left unacknowledged. Safety concerns include exposure to toxic cleaning products, a high prevalence of ergonomic injuries, and inadequate access to medical care. Presenting the results of an in-person survey of 2,086 informally employed nannies, housecleaners, and caregivers in 14 U.S. cities, this article documents the range of common health and safety hazards faced by domestic workers and suggests some interventions that could improve their working conditions. The survey was conducted in nine languages and data were collected from workers from 71 countries, including a substantial proportion with irregular immigration status. We observed that substandard workplace health and safety conditions are shaped by three aspects of domestic work: long-standing exclusions from federal employment protections, the common disregard of the home as a workplace, and the complexity of care work and the bonds of intimacy that often form through caregiving. Together these factors have served to perpetuate substandard working conditions. Regulatory reforms, as well as worker and employer education, are necessary to improve health outcomes for domestic workers.