Occupational, social, and relationship hazards and psychological distress among low-income workers: implications of the 'inverse hazard law'.
BACKGROUND
Few studies have simultaneously included exposure information on occupational hazards, relationship hazards (eg, intimate partner violence) and social hazards (eg, poverty and racial discrimination), especially among low-income multiracial/ethnic populations.


METHODS
A cross-sectional study (2003-2004) of 1202 workers employed at 14 worksites in the greater Boston area of Massachusetts investigated the independent and joint association of occupational, social and relationship hazards with psychological distress (K6 scale).


RESULTS
Among this low-income cohort (45% were below the US poverty line), exposure to occupational, social and relationship hazards, per the 'inverse hazard law,' was high: 82% exposed to at least one occupational hazard, 79% to at least one social hazard, and 32% of men and 34% of women, respectively, stated they had been the perpetrator or target of intimate partner violence (IPV). Fully 15.4% had clinically significant psychological distress scores (K6 score ≥ 13). All three types of hazards, and also poverty, were independently associated with increased risk of psychological distress. In models including all three hazards, however, significant associations with psychological distress occurred among men and women for workplace abuse and high exposure to racial discrimination only; among men, for IPV; and among women, for high exposure to occupational hazards, poverty and smoking.


CONCLUSIONS
Reckoning with the joint and embodied reality of diverse types of hazards involving how people live and work is necessary for understanding determinants of health status.
Krieger
Nancy
N
Department of Society, Human Development, and Health, Harvard School of Public Health, 677 Huntington Avenue, Kresge 717, Boston, MA 02115, USA. nkrieger@hsph.harvard.edu
Kaddour
Afamia
A
Koenen
Karestan
K
Kosheleva
Anna
A
Chen
Jarvis T
JT
Waterman
Pamela D
PD
Barbeau
Elizabeth M
EM
D000328:Adult; D001900:Boston / Q000453:epidemiology; D015331:Cohort Studies; D017280:Condoms / Q000706:statistics & numerical data; D003430:Cross-Sectional Studies; D004651:Employment / Q000145:classification* / Q000592:standards / Q000706:statistics & numerical data; D005006:Ethnicity / Q000523:psychology / Q000706:statistics & numerical data; D005260:Female; D006304:Health Status; D006801:Humans; D007750:Labor Unions; D008297:Male; D017533:Marital Status / Q000208:ethnology / Q000706:statistics & numerical data; D008875:Middle Aged; D015999:Multivariate Analysis; D016273:Occupational Exposure / Q000009:adverse effects* / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data; D011203:Poverty / Q000208:ethnology / Q000523:psychology / Q000706:statistics & numerical data; D011287:Prejudice; D011594:Psychometrics; D021841:Safe Sex / Q000208:ethnology / Q000523:psychology / Q000706:statistics & numerical data; D012725:Sexual Behavior / Q000145:classification / Q000208:ethnology / Q000706:statistics & numerical data; D017406:Sexual Harassment / Q000208:ethnology / Q000523:psychology / Q000706:statistics & numerical data; D012747:Sexual Partners / Q000145:classification / Q000523:psychology; D012907:Smoking / Q000009:adverse effects / Q000208:ethnology; D012923:Social Class; D012928:Social Desirability; D012935:Social Justice / Q000523:psychology; D018454:Spouses / Q000208:ethnology / Q000523:psychology; D013315:Stress, Psychological / Q000453:epidemiology / Q000208:ethnology / Q000523:psychology*; D017132:Workplace / Q000145:classification / Q000523:psychology* / Q000592:standards