The role of precarious work in the production of health disparities in older ages

Abstract: The COVID-19 pandemic has highlighted - and exacerbated - the pervasive race/ethnic and social class based health inequities in the US today. Our essential but precarious food provision, service, and delivery workers areat increased risk of exposure to SARS-COV-2 and related health consequences. At present, the robust guidelines prepared by the Occupational Safety and Health Administration are not enforceable and COVID-19 related paid leave provisions are largely inaccessible by this segment of the workforce. Our objective is to show how workplace and other contexts shape individual behavior and define the role of employment quality in the hindrance or expansion of access to resources and opportunities necessary for engagement in individual-level COVID-19 prevention behaviors. Through individual structured and semi-structured interviews with older low wage food provision, service, and delivery workers in the states of Indiana and Washington, we aim toanswer three research questions: 1) What do older workers know about COVID-19 prevention and where do they get their information? 2) What are the personal and social factors that drive adherence or non-adherenceto prevention practices while at work and compliance with the broad preventive guideline of staying homewhen feeling sick? 3) How does place (including local policies, political culture, industry, and demography) influence the adherence to COVID-19 prevention practices for older workers? We will conduct 40 interviews per site (n = 80 total) with low income workers over 50 years old employed in the food provision, service and delivery industries, recruiting participants through social media and other venues. A stratified purposeful sample will allow identification of major variation across subgroups of interest, and facilitates comparisons across the two sites. Subgroups of interest will be defined by high versus low contact with others at work,race/ethnicity, sex/gender and education. In addition we will compile and review documents and prepare descriptive statistics from publicly available sources to understand the influence of place-based factors in hindering or improving adherence to COVID-19 prevention practices. In conducting this qualitative inquiry, we leverage our multidimensional conceptualization of employment quality as a framework for probing and contextualizing the experiences of these precarious essential workers. Knowledge gained through rich qualitative interviews will shed light on workplace interventions and policies that may improve prevention practices and reduce likelihood of infection with the virus while also improving public health messaging for this vulnerable population.