Elsevier

Social Science & Medicine

Volume 67, Issue 12, December 2008, Pages 1970-1981
Social Science & Medicine

The inverse hazard law: Blood pressure, sexual harassment, racial discrimination, workplace abuse and occupational exposures in US low-income black, white and Latino workers

https://doi.org/10.1016/j.socscimed.2008.09.039Get rights and content

Abstract

Research on societal determinants of health suggests the existence of an “inverse hazard law,” which we define as: “The accumulation of health hazards tends to vary inversely with the power and resources of the populations affected.” Yet, little empirical research has systematically investigated this topic, including in relation to workplace exposures. We accordingly designed the United for Health study (Greater Boston Area, Massachusetts, 2003–2004) to investigate the joint distribution and health implications of workplace occupational hazards (dust, fumes, chemical, noise, ergonomic strain) and social hazards (racial discrimination, sexual harassment, workplace abuse). Focusing on blood pressure as our health outcome, we found that among the 1202 low-income multi-racial/ethnic working class participants in our cohort – of whom 40% lived below the US poverty line – 79% reported exposure to at least one social hazard and 82% to at least one high-exposure occupational hazard. Only sexual harassment, the least common social hazard, was associated with elevated systolic blood pressure (SBP) among the women workers. By contrast, no statistically significant associations were detectable between the other additional highly prevalent social and occupational hazards and SBP; we did, however, find suggestive evidence of an association between SBP and response to unfair treatment, implying that in a context of high exposure, differential susceptibility to the exposure matters. These results interestingly contrast to our prior findings for this same cohort, in which we found associations between self-reported experiences of racial discrimination and two other health outcomes: psychological distress and cigarette smoking. Likely explanations for these contrasting findings include: (a) the differential etiologic periods and pathways involving somatic health, mental health, and health behaviors, and (b) the high prevalence of adverse exposures, limiting the ability to detect significant associations. As clarified by the “inverse hazard law,” to understand health inequities, research is needed that contrasts exposures and health status population-wide, not just among those most inequitably exposed.

Section snippets

Study population and protocol: the United for Health cohort

As described in detail in our prior publications (Barbeau et al., 2007, Krieger et al., 2005, Krieger et al., 2006, Quinn et al., 2007), we recruited participants in the United for Health study from the rosters of union members employed in 14 worksites located in the greater Boston area in Massachusetts and variously engaged in meat processing, electrical light manufacturing, retail grocery stores, and school bus driving. The unions and management had no access to the study data and no role in

Results

Table 1 shows the distribution of the outcome and selected exposures and key covariates among the 1202 members of the United for Health cohort, overall and by race/ethnicity, prior to imputing missing values. As presented in more detail in Supplemental Table 1 and in our previous papers (Barbeau et al., 2007, Krieger et al., 2005, Krieger et al., 2006), the findings reveal high levels of economic deprivation and of exposure to social and occupational hazards (79% to at least 1 social hazard,

Discussion

Among the 1202 low-income multi-racial/ethnic working class participants in our cohort – of whom 40% lived below the US poverty line, 79% reported exposure to at least one social hazard and 82% at least one high-exposure occupational hazard – only sexual harassment, the least common social hazard, was associated with elevated SBP among the women workers. By contrast, no statistically significant associations were detectable between the other additional highly prevalent social and occupational

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  • Cited by (0)

    This study was supported by NIOSH grants R01 OHO7366-01 and R01 OHO7366-01S. The authors wish to thank: (a) other contributing members of the study team (in alphabetical order): Louiza Bloomstein, Vanessa Costa, Ruth Lederman, Maribel Melendez, Deepa Naishadham, Michael Ostler, Elizabeth Pratt, Roona Ray, Grace Sembajwe, David Wilson, and Richard Youngstrom; (b) our union and worksite collaborators; and (c) the workers who shared their experiences with us by participating in this study.

    1

    At time of study: Center for Community-Based Research, Dana-Farber Cancer Institute, 44 Binney Street, Boston, MA 02115, USA.

    2

    At time of study: Harvard School of Public Health and Center for Community-Based Research, Dana-Farber Cancer Institute, 44 Binney Street, Boston, MA 02115, USA.

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