Research Projects- Occupational Health Nursing

NIOSH: R03

9/30/23-9/29/25

The 400,000 nail salon workers (NSW) in the U.S.—primarily immigrant women in their prime reproductive years—are part of a $10 billion small business industry that is understudied and hard-to-reach. NSWs are emblematic of low-wage, underinsured, immigrant women in the workforce who are invisible in the communities they serve. This overlooked worker population is continuously exposed to occupational hazards such as toxic chemicals, biological agents, poor ergonomics, and psychological stressors. The coronavirus pandemic (COVID-19) heightened not only the economic vulnerability of these workers but also exacerbated existing unaddressed occupational health and safety (OHS) issues. Pre- pandemic studies indicated NSWs expressed needs for training on product exposure and safety measures. Given COVID-19, workplace priorities have undoubtedly shifted as the focus may now be on job security, infection control, resource access, and mental health. In addition, NSWs are particularly at risk for COVID-19 infection given the close proximity needed to provide client services. Several recommendations have been published to guide employers’ methods to safeguard employees’ OHS during the pandemic. However, we do not know whether and to what extent nail salons owners are adopting and implementing those guidelines to protect their workers. Without a comprehensive understanding of established protective measures and whether and how NSW priorities have shifted in light of COVID-19, future interventions will be ill-equipped to meet their needs and effectively promote these workers’ health and wellbeing. This mixed-method sequential design study, guided by a community-engaged approach has the following Specific Aims: (1) Characterize the safety measures that nail salon owners have implemented during COVID-19 and changes in priorities; (2) Explore NSWs’ perceived OHS experiences and needs during COVID-19; and (3) Collaborate with NSWs and owners to develop, pilot, and validate a survey instrument informed by the literature and qualitative data from Aims 1 and 2. This proposal advances the missions of the NIOSH National Occupational Research Agenda (NORA) Services sector as well as the Healthy Work Design and Well-Being Cross-Sector as it will: 1) advance our assessment approach of OHS needs and changes, in light of the pandemic, among an understudied small business industry worker group; and 2) inform the design of a future evidence-based intervention. The main research-to-practice (r2p) contribution of this application is two-pronged: 1) the development of a targeted survey to improve understanding of the pandemic’s effects on NSWs OHS and other workers with similar types of characteristics (e.g., female, low-wage, underinsured, immigrant); and 2) establish and strengthen partnership and collaboration among the study team members and nail salon community. Intermediate outcomes include the potential for changes in NSW needs assessment methodology for occupational health researchers. In addition to the survey, outputs will include publications and conference proceedings.

NIOSH: R03

9/1/23-8/31/25

The health status of hotel housekeepers hired through Non-Standard Work Arrangement (NSWA) is understudied. Making up the majority of the 1.8 million workers in the hospitality industry, hotel housekeepers (HHs) are likely to face alternative work arrangements because of several factors, including seasonal demands as well as the overemphasis on cost and labor control. HHs already experience stress at work (e.g., high job strain) and outside of work, and poor health. Thus, HHs hired through NSWA are likely to encounter heightened suboptimal work experiences and poor economic and health-related outcomes. Yet there is a dearth of studies exploring the health and lived experiences of hotel housekeepers employed through NSWA. Through the Healthy Work Design and Well-Being program, the National Institute for Occupational Safety and Health (NIOSH) identified NSWA as a research priority. NIOSH noted the vulnerability of workers hired through NSWA given that it is characterized by “temporariness, instability, irregularity, and lack of legal protections and social benefits for workers” all of which may negatively affect workers’ health and wellbeing. To address this federally identified gap and in response to PAR-18-797-we propose to conduct a mixed-method sequential design study to quantitatively (N=140) explore the health status of HHs hired through NSWA compared to HHs hired through standard work (SW) and qualitatively (n=40) explore how the lived experiences and health status of the two groups (NSWA vs. SW) differ. This project will contribute to NIOSH’s mission in three ways. (1) The study responds to NIOSH’s Healthy Work Design and Well-Being program which identified NSWA as one of its priority areas and the call for an understanding of risks and conditions associated with occupational diseases and injuries. (2) This first descriptive exploratory study is necessary in laying the groundwork for future studies that will help further our scientific knowledge of the relationship between NSWA and the health of HHs and other worker groups. (3) The study findings will inform guidelines and policies on NSWA as well as future interventions that can facilitate organizational change and support the individual worker. This study has several innovative facets. First, it focuses on a vulnerable and understudied population, HHs. Second, this will be the first study to explore the health status and lived experience of HHs hired through NSWA. Third, this study incorporates the Identity, Research, and Health Dialogic Open-Ended (I-ReH-DO) interviewing approach which allows for narrative discourse for understanding dynamics of social constructs influencing health. The mixed- method approach brings scientific rigor making the study the first of its kind to include both quantitative and qualitative methods to understand the complexity of the phenomenon of NSWA in relation to workers’ health. Our educational experiences, research skills, previous studies, interdisciplinary team, and community-based connections with local organizations ensure the success of this project.

End Date: 3/30/24

NIH-NIMHD: R01

9/1/23-8/31/25

A growing literature documents Black-White inequalities in sleep deficiencies with Black adults experiencing less sleep and lower sleep quality compared to White adults. Because sleep hygiene is tightly linked to health, racial inequalities in sleep deficiencies may be a key determinant of racial inequalities in health. Racial inequalities in work-related stress may be a key, but understudied driver of sleep inequalities and ultimately, health inequalities. As with all racial groups, the majority of Black men and women are in the labor force; however, compared to White adults, Black adults spend more time in the workplace, are more likely to hold multiple jobs – and twice as likely to hold two full-time jobs. Further compared to White adults, Black adults tend to be in occupations that are objectively more stressful, where they have less control and greater physical and emotional demands, and to report greater levels of stress at work. While work-related stress has been linked to sleep deficiencies, there is a need to examine more racially-salient forms of stress such as vigilance, or the thoughts and behaviors in which Black Americans may engage in order to navigate everyday spaces such as the workplace. A substantial qualitative literature indicates that Black adults regularly anticipate and worry about potential encounters in everyday life such as being followed in stores or having assumptions made about their intellect or character. Vigilance may be particularly important for sleep inequalities because it captures a racially-salient and prevalent for of stress with characteristics that interfere with sleep quality and duration, including: (a) anticipatory stress, which predicts increased biological stress even in the absence of a stressful event; and (b) ruminative stress, which can transform acute situations into chronic sources of stress. Using both real-world and laboratory settings, we propose to collect data from 500 Black men and women to capture both momentary work-related stressful experiences and chronic work-related stress. We propose to examine the linkages between racially-salient, work-related stress, captured through ecological momentary assessments (EMA), and sleep deficiencies, captured through self-report and actigraphy. The workplace is particularly relevant for racial inequalities in health due to focus on economic upward mobility among Black Americans and the growth of diversity, equity, and inclusion initiatives that may widen inequalities due to the need for vigilance as Black workers join predominantly White workplaces.

NIH-NIDA: Administrative Supplement

Background: Home care workers are integral actors in the support of aging in place for persons living with Alzheimer’s disease and Alzheimer’s disease-related dementias (ADRD). Over 3.2 million home care workers across the U.S. provide crucial supportive care, meeting such activities of daily living as bathing and dressing, that allows older Americans with memory care issues to continue to age in place. Despite their critical importance in promoting healthy aging, evidence-based knowledge on the home care workforce remains a gap in the literature. More importantly, there is a dearth of scientifically validated sampling strategies in this high- risk, historically excluded population of direct care workers. The overall goal of the Home Safe study is to conduct pilot interviews, and assess and develop respondent-driven sampling methods (RDS) specifically for home care workers. Our team is uniquely prepared to conduct the proposed study, given our expertise in the study of aging, home-based care and use of RDS methods.

Specific Aims: In Aim 1, we will conduct interviews with dementia home care workers to determine the barriers, facilitators and adaptations to protecting their safety and well-being during the pandemic. In Aim 2, we will determine the feasibility of using respondent- driven sampling methods to establish a longitudinal study of dementia home care workers. Project Methods: This study will conduct semi-structured video interviews with dementia home care workers in Michigan, using an inferential process to determine characteristics of their social network and the barriers and facilitators in acceptability of RDS sampling strategy in order to guide the design of longitudinal survey (Aim 2), and establish a pilot interview to identify 1) barriers home-based care workers faced that impacted their ability to provide safe care, 2) facilitators that allowed them to feel safe at work, and 3) adaptations made to core employment and personal tasks due to COVID-19 risk (Aim 1).

Unique Features and Innovation: This study has several innovations: Home care workers are an understudied group, where our proposed research will contribute to addressing the economic and workforce policy challenges of this group of direct care workers in order to better support individuals with ADRD and their family caregivers. Our study of the feasibility of an RDS sampling strategy will allow us to develop operational knowledge about RDS in the healthcare setting, in particular among direct care workers.

Anticipated Impact: This study will contribute to methodological innovations in the study of hard to sample groups but will more importantly provide needed research data on the home care workforce, and lead to a larger longitudinal study of home care workers. The need for this study is critically important given the key role of home care workers play to support individuals with ADRD to stay in their homes—and out of hospitals or long-term care facilities.