title: Racial disparities in job strain among American and immigrant long-term care workers.
abstract: BACKGROUND
  Nursing homes are occupational settings, with an increasing minority and immigrant workforce where several psychosocial stressors intersect.
  
  
  OBJECTIVE
  This study aimed to examine racial/ethnic differences in job strain between Black (n = 127) and White (n = 110) immigrant and American direct-care workers at nursing homes (total n = 237).
  
  
  METHODS
  Cross-sectional study with data collected at four nursing homes in Massachusetts during 2006-2007. We contrasted Black and White workers within higher-skilled occupations such as registered nurses or licensed practical nurses (n = 82) and lower-skilled staff such as certified nursing assistants (CNAs, n = 155).
  
  
  RESULTS
  Almost all Black workers (96%) were immigrants. After adjusting for demographic and occupational characteristics, Black employees were more likely to report job strain, compared with Whites [relative risk (RR): 2.9, 95% confidence interval (CI) 1.3 to 6.6]. Analyses stratified by occupation showed that Black CNAs were more likely to report job strain, compared with White CNAs (RR: 3.1, 95% CI: 1.0 to 9.4). Black workers were also more likely to report low control (RR: 2.1, 95% CI: 1.1 to 4.0). Additionally, Black workers earned $2.58 less per hour and worked 7.1 more hours per week on average, controlling for potential confounders.
  
  
  CONCLUSIONS
  Black immigrant workers were 2.9 times more likely to report job strain than White workers, with greater differences among CNAs. These findings may reflect differential organizational or individual characteristics but also interpersonal or institutional racial/ethnic discrimination. Further research should consider the role of race/ethnicity in shaping patterns of occupational stress.
authors.affiliation: Department of Society, Human Development and Health, Harvard School of Public Health, Boston, MA 02115, USA. dhurtado@hsph.harvard.edu
authors.forename: D A
authors.initials: DA
authors.lastname: Hurtado
authors.forename: E L
authors.initials: EL
authors.lastname: Sabbath
authors.forename: K A
authors.initials: KA
authors.lastname: Ertel
authors.forename: O M
authors.initials: OM
authors.lastname: Buxton
authors.forename: L F
authors.initials: LF
authors.lastname: Berkman
mesh_terms: D000328:Adult; D000349:Africa / Q000208:ethnology; D001741:Black or African American / Q000523:psychology*; D003430:Cross-Sectional Studies; D054242:Emigrants and Immigrants / Q000523:psychology*; D005260:Female; D054624:Health Status Disparities; D006801:Humans; D008134:Long-Term Care; D008297:Male; D008404:Massachusetts / Q000453:epidemiology; D009728:Nursing Assistants / Q000523:psychology; D009735:Nursing Homes; D009740:Nursing Staff / Q000523:psychology*; D009743:Nursing, Practical; D009784:Occupational Diseases / Q000453:epidemiology*; D012044:Regression Analysis; D013315:Stress, Psychological / Q000453:epidemiology*; D014900:West Indies / Q000208:ethnology; D044465:White People / Q000523:psychology; D000078329:Workforce