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. 2022 May 2;22(1):870.
doi: 10.1186/s12889-022-13259-w.

Employment conditions as barriers to the adoption of COVID-19 mitigation measures: how the COVID-19 pandemic may be deepening health disparities among low-income earners and essential workers in the United States

Ariadna Capasso  1 , Sooyoung Kim  2 , Shahmir H Ali  1 , Abbey M Jones  3 , Ralph J DiClemente  1 , Yesim Tozan  4
Affiliations

Employment conditions as barriers to the adoption of COVID-19 mitigation measures: how the COVID-19 pandemic may be deepening health disparities among low-income earners and essential workers in the United States

Ariadna Capasso et al. BMC Public Health. .

Abstract

Background: The COVID-19 pandemic has disproportionately impacted economically-disadvantaged populations in the United States (US). Precarious employment conditions may contribute to these disparities by impeding workers in such conditions from adopting COVID-19 mitigation measures to reduce infection risk. This study investigated the relationship between employment and economic conditions and the adoption of COVID-19 protective behaviors among US workers during the initial phase of the COVID-19 pandemic.

Methods: Employing a social media advertisement campaign, an online, self-administered survey was used to collect data from 2,845 working adults in April 2020. Hierarchical generalized linear models were performed to assess the differences in engagement with recommended protective behaviors based on employment and economic conditions, while controlling for knowledge and perceived threat of COVID-19, as would be predicted by the Health Belief Model (HBM).

Results: Essential workers had more precarious employment and economic conditions than non-essential workers: 67% had variable income; 30% did not have paid sick leave; 42% had lost income due to COVID-19, and 15% were food insecure. The adoption of protective behaviors was high in the sample: 77% of participants avoided leaving home, and 93% increased hand hygiene. Consistent with the HBM, COVID-19 knowledge scores and perceived threat were positively associated with engaging in all protective behaviors. However, after controlling for these, essential workers were 60% and 70% less likely than non-essential workers, who by the nature of their jobs cannot stay at home, to stay at home and increase hand hygiene, respectively. Similarly, participants who could not afford to quarantine were 50% less likely to avoid leaving home (AOR: 0.5; 95% CI: 0.4, 0.6) than those who could, whereas there were no significant differences concerning hand hygiene.

Conclusions: Our findings are consistent with the accumulating evidence that the employment conditions of essential workers and other low-income earners are precarious, that they have experienced disproportionately higher rates of income loss during the initial phase of the COVID-19 pandemic and face significant barriers to adopting protective measures. Our findings underscore the importance and need of policy responses focusing on expanding social protection and benefits to prevent the further deepening of existing health disparities in the US.

Keywords: COVID-19; Economic precarity; Employment conditions; Essential workers; Health Belief Model; Health disparities; Precarious employment; Risk of infection; Social determinants of health.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Conceptual model depicting how certain employment conditions may be barriers to COVID-19 preventive behaviors
Fig. 2
Fig. 2
Distribution of economic precarity factors by essential worker status
Fig. 3
Fig. 3
Odds of engaging in a COVID-19 preventive behavior by HBM construct and economic precarity
See this image and copyright information in PMC

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References

    1. Adler NE, Newman K. Socioeconomic disparities in health: pathways and policies. Health Aff (Millwood). 2002;21(2):60–76. doi: 10.1377/hlthaff.21.2.60. - DOI - PubMed
    1. Phelan JC, Link BG, Tehranifar P. Social conditions as fundamental causes of health inequalities: theory, evidence, and policy implications. J Health Soc Behav. 2010;51(Suppl):S28–40. doi: 10.1177/0022146510383498. - DOI - PubMed
    1. Wadhera RK, Wadhera P, Gaba P, Figueroa JF, Joynt Maddox KE, Yeh RW, et al. Variation in COVID-19 hospitalizations and deaths across new york city boroughs. JAMA. 2020;323(21):2192–2195. doi: 10.1001/jama.2020.7197. - DOI - PMC - PubMed
    1. Centers for Disease Control and Prevention. COVID Data Tracker. Atlanta: US Department of Health and Human Services, CDC; 2022. https://covid.cdc.gov/covid-data-tracker.
    1. Koma W, Artiga S, Neuman T, Claxton G, Rae M, Kates K, et al. Low-income and communities of color at higher risk of serious illness if infected with coronavirus. San Francisco: Kaiser Family Foundation; 2020. Available from https://www.kff.org/disparities-policy/issue-brief/low-income-and-commun....