Community and Global Health Works

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Ahonen et al. Respond
(American Public Health Association, 2018-06-06) Ahonen, Emily Q.; Fujishiro, Kaori; Flynn, Michael; Cunningham, Thomas; Social and Behavioral Sciences, School of Public Health
COVID-19 and Precarious Employment: Consequences of the Evolving Crisis
(Sage, 2021) Matilla-Santander, Nuria; Ahonen, Emily Q.; Albin, Maria; Baron, Sherry; Bolíbar, Mireia; Bosmans, Kim; Burström, Bo; Cuervo, Isabel; Davis, Letitia; Gunn, Virginia; Håkansta, Carin; Hemmingsson, Tomas; Hogstedt, Christer; Jonsson, Johanna; Julià, Mireia; Kjellberg, Katarina; Kreshpaj, Bertina; Lewchuk, Wayne; Muntaner, Carles; O'Campo, Patricia; Orellana, Cecilia; Östergren, Per-Olof; Padrosa, Eva; Ruiz, Marisol E.; Vanroelen, Christophe; Vignola, Emilia; Vives, Alejandra; Wegman, David H.; Bodin, Theo; Social and Behavioral Sciences, School of Public Health
The world of work is facing an ongoing pandemic and an economic downturn with severe effects worldwide. Workers trapped in precarious employment (PE), both formal and informal, are among those most affected by the COVID-19 pandemic. Here we call attention to at least 5 critical ways that the consequences of the crisis among workers in PE will be felt globally: (a) PE will increase, (b) workers in PE will become more precarious, (c) workers in PE will face unemployment without being officially laid off, (d) workers in PE will be exposed to serious stressors and dramatic life changes that may lead to a rise in diseases of despair, and (e) PE might be a factor in deterring the control of or in generating new COVID-19 outbreaks. We conclude that what we really need is a new social contract, where the work of all workers is recognized and protected with adequate job contracts, employment security, and social protection in a new economy, both during and after the COVID-19 crisis.
Evaluating goals in worker health protection using a participatory design and an evaluation checklist
(Sage, 2013) Ahonen, Emily Q.; Zanoni, Joseph; Forst, Linda; Ochsner, Michele; Kimmel, Louis; Martino, Carmen; Ringholm, Elisa; Rodríguez, Eric; Kader, Adam; Sokas, Rosemary; Social and Behavioral Sciences, School of Public Health
Spanish-speaking immigrant workers in construction are considered hard to reach and at high risk for work-related injury and fatality. This evaluation study describes the use of participatory methods and an evaluation checklist to consider a health and safety (H&S) training program for these workers. A previously developed training manual and model were disseminated to eight worker centers (WCs) through participatory research collaboration. It incorporated H&S training for workers while strengthening the role of WCs as sources for leadership development and worker empowerment. Design, delivery, reaction, application, and extension were assessed through individual interviews with participants, trained trainers, and center staff and through observation of training sessions and partner debriefs; pre- and post-training tests assessed participant learning. Results indicate moderate learning and application by participants and strong evidence for structural gains in and among WCs. We conclude that such partnerships and models are valuable tools for collaborating with hard-to-reach workers.
Flynn et al. Respond
(American Public Health Association, 2018-09) Flynn, Michael A.; Cunningham, Thomas R.; Ahonen, Emily Q.; Fujishiro, Kaori; Environmental Health Science, School of Public Health
Comment on Work as an Inclusive Part of Population Health Inequities Research and Prevention. [Am J Public Health. 2018] New Horizons for Occupational Health Surveillance. [Am J Public Health. 2018]
Gendered exposures: exploring the role of paid and unpaid work throughout life in U.S. women’s cardiovascular health
(Taylor & Francis, 2020) Ahonen, Emily Q.; Fujishiro, K.; Brown, S.; Wang, Y.; Palumbo, A. J.; Michael, Y. L.; Social and Behavioral Sciences, School of Public Health
The paper explores how paid and unpaid labor history over the life course influence women’s cardiovascular disease. U.S. women comprise about 50% of the paid workforce and perform the majority of unpaid labor. However, the influence of women’s work on their health is under-researched. Our sample was drawn from the Women’s Health Initiative Observational Study, a cohort of post-menopausal women in the U.S. aged 50–79 at recruitment. Women were categorized into five groups according to paid labor history: worked in paid jobs consistently throughout adult life; left the workforce early; entered the workforce later; discontinuous work history; never worked outside the home. Live birth history (none, at least one, missing) served as a proxy for unpaid labor in prime age. Cox proportional hazard models were used to estimate the hazard ratio of CVD associated with different paid work histories. We then assessed the effect of unpaid labor on the relation between paid labor and CVD. Paid labor participation was not associated with CVD risk among women without unpaid labor after adjusting for age, education, and birth cohort. Among those with unpaid demands, leaving the workforce early or having discontinuous work history was protective. In this U.S. sample, the association between paid work participation history and CVD risk depends on the presence of unpaid labor. Our results demonstrate the necessity of including work – paid and unpaid – in consideration of women’s health.
The housing first technical assistance and training (HFTAT) implementation strategy: outcomes from a mixed methods study of three programs
(Biomed Central, 2018-09-21) Watson, Dennis P.; Ahonen, Emily Q.; Shuman, Valery; Brown, Molly; Tsemberis, Sam; Huynh, Philip; Ouyang, Fangqian; Xu, Huiping; Social and Behavioral Sciences, School of Public Health
BACKGROUND: This paper discusses the initial testing of the Housing First Training and Technical Assistance (HFTAT) Program, a multifaceted, distance-based strategy for the implementation of the Housing First (HF) supportive housing model. HF is a complex housing intervention for serving people living with serious mental illness and a substance use disorder that requires significant individual- and structural-level changes to implement. As such, the HFTAT employs a combined training and consultation approach to target different levels of the organization. Training delivered to all organizational staff focuses on building individual knowledge and uses narrative storytelling to overcome attitudinal implementation barriers. Consultation seeks to build skills through technical assistance and fidelity audit and feedback. METHOD: We employed a mixed method design to understand both individual-level (e.g., satisfaction with the HFTAT, HF knowledge acquisition and retention, and HF acceptability and appropriateness) and structural-level (e.g., fidelity) outcomes. Quantitative data were collected at various time points, and qualitative data were collected at the end of HFTAT activities. Staff and administrators (n = 113) from three programs across three states participated in the study. RESULTS: Satisfaction with both training and consultation was high, and discussions demonstrated both activities were necessary. Flexibility of training modality and narrative storytelling were particular strengths, while digital badging and the community of practice were perceived as less valuable because of incompatibilities with the work context. HF knowledge was high post training and retained after 3-month follow-up. Participants reported training helped them better understand the model. Attitudes toward evidence-based interventions improved over 6 months, with qualitative data supporting this but demonstrating some minor concerns related to acceptability and appropriateness. Fidelity scores for all programs improved over 9 months. CONCLUSION: The HFTAT was a well-liked and generally useful implementation strategy. Results support prior research pointing to the value of both (a) multifaceted strategies and (b) combined training and consultation approaches. The study also provides evidence for narrative storytelling as an approach for changing attitudinal implementation barriers. The need for compatibility between specific elements of an implementation strategy and the work environment was also observed.
Human Factors Affecting Logging Injury Incidents in Idaho and the Potential for Real-Time Location-Sharing Technology to Improve Safety
(MDPI, 2018-10) Newman, Soren M.; Keefe, Robert F.; Brooks, Randall H.; Ahonen, Emily Q.; Wempe, Ann M.; Social and Behavioral Sciences, School of Public Health
Human factors, including inadequate situational awareness, can contribute to fatal and near-fatal traumatic injuries in logging, which is among the most dangerous occupations in the United States. Real-time location-sharing technology may help improve situational awareness for loggers. We surveyed and interviewed professional logging contractors in Idaho to (1) characterize current perceptions of in-woods hazards and the human factors that lead to injuries; (2) understand their perspectives on using technology-based location-sharing solutions to improve safety in remote work environments; and (3) identify logging hazard scenarios that could be mitigated using location-sharing technology. We found production pressure, fatigue, and inexperience among the most-common factors contributing to logging injuries from the perspective of participants. Potential limitations of location-sharing technology identified included potential for distraction and cost. Contractors identified several situations where the technology may help improve safety, including (1) alerting workers of potential hand-faller injuries due to lack of movement; (2) helping rigging crews to maintain safe distances from yarded trees and logs during cable logging; and (3) providing a means for equipment operators to see approaching ground workers, especially in low-visibility situations.
Immigrant populations, work and health—a systematic literature review
(2007-04) Ahonen, Emily Q.; Benavides, Fernando G.; Benach, Joan; ;
Objectives This paper summarizes the information on immigrant occupational health available from recent studies, incorporating varied study designs. Methods A systematic search was carried out in PubMed employing terms of interest to the study and related terms supplied by the same search engine. Articles were selected through the following process: (i) reading the title and abstract, in English or Spanish, for the period 1990–2005, (ii) reading of the entire text of selected articles; (iii) making a manual search of the relevant citations in the selected articles; (iv) eliminating articles without a focus on the themes of central interest (immigration, work, and health), and (v) reading and analyzing the definitive article set. No quality criteria were used in the article selection. Results The location of studies was not straightforward and required careful thought about the search terms. The included 48 papers were often multifaceted and difficult to categorize. They generally came from countries historically associated with immigration and described occupational risk factors, health consequences, and the social, economic, and cultural influences on worker health. They were also based on data, surveillance, training, and preventive measures that were inadequate. Conclusions Increased migration is a reality in industrialized countries all over the world, and it has social, political, and economic consequences for migrating groups, as well as for their sending and host societies. More reliable data, targeted appropriate interventions, and enforcement of existing regulations are necessary to improve the health of immigrant workers. Furthermore, studies in sending and developing countries should be encouraged to form a more complete understanding of this complex situation.
Initiatives addressing precarious employment and its effects on workers’ health and well-being: a protocol for a systematic review
(Springer, 2021-01-30) Gunn, Virginia; Håkansta, Carin; Vignola, Emilia; Matilla-Santander, Nuria; Kreshpaj, Bertina; Wegman, David H.; Hogstedt, Christer; Ahonen, Emily Q.; Muntaner, Carles; Baron, Sherry; Bodin, Theo; The Precarious Work Research (PWR) Group; Social and Behavioral Sciences, School of Public Health
Precarious employment is a significant determinant of population health and health inequities and has complex public health consequences both for a given nation and internationally. Precarious employment is conceptualized as a multi-dimensional construct including but not limited to employment insecurity, income inadequacy, and lack of rights and protection in the employment relation, which could affect both informal and formal workers. The purpose of this review is to identify, appraise, and synthesize existing research on the effectiveness of initiatives aiming to or having the potential to eliminate, reduce, or mitigate workers’ exposure to precarious employment conditions and its effects on the health and well-being of workers and their families.
Invisible work, unseen hazards: the health of women immigrant household service workers in Spain
(2010-04) Ahonen, Emily Q.; López-Jacob, María José; Vázquez, María Luisa; Porthé, Victoria; Gil‐González, Diana; García, Ana María; Ruiz-Frutos, Carlos; Benach, Joan; Benavides, Fernando G.
Household service work has been largely absent from occupational health studies. We examine the occupational hazards and health effects identified by immigrant women household service workers. Methods Exploratory, descriptive study of 46 documented and undocumented immigrant women in household services in Spain, using a phenomenological approach. Data were collected between September 2006 and May 2007 through focus groups and semi-structured individual interviews. Data were separated for analysis by documentation status and sorted using a mixed-generation process. In a second phase of analysis, data on psychosocial hazards were organized using the Copenhagen Psychosocial Questionnaire as a guide. Results Informants reported a number of environmental, ergonomic and psychosocial hazards and corresponding health effects. Psychosocial hazards were especially strongly present in data. Data on reported hazards were similar by documentation status and varied by several emerging categories: whether participants were primarily cleaners or carers and whether they lived in or outside of the homes of their employers. Documentation status was relevant in terms of empowerment and bargaining, but did not appear to influence work tasks or exposure to hazards directly. Conclusions Female immigrant household service workers are exposed to a variety of health hazards that could be acted upon by improved legislation, enforcement, and preventive workplace measures, which are discussed.

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