Previous research has documented a link between downturns in the economy and suicide among adults. But how do those downturns ripple throughout families and communities, and in particular, how do massive job losses affect the mental health of teens? A new study has found that, sadly, many teens are not immune to the stress of a struggling economy.
Published online last week in the American Journal of Public Health, researchers found that increases in statewide job losses are associated with heightened suicide-related behaviors among adolescent girls and black teens. Specifically, the study found that job losses among 1 percent of a state’s working-age population increased the probability of young girls and black teens reporting suicide-related behaviors by 2 to 3 percentage points. The same job losses did not have an impact on the suicide behaviors of boys, whites or Hispanics. To conduct the study, researchers examined Youth Risk Behavior Survey data as well as Bureau of Labor Statistics data between 1997 and 2009. The study noted that youth suicide is a “serious public health concern,” with suicide being the third leading cause of death for young people ages 10 to 24 years old.
Anna Gassman-Pines, a lead author on the study and an assistant professor public policy, psychology and neuroscience at the Center for Child and Family Policy at Duke University, said that on one hand, the results weren’t entirely unexpected, considering previous research on adults. On the other hand, Gassman-Pines told me that the results were somewhat surprising, as the uptick in teen suicide behavior was an indirect effect of job loss — in other words, it’s very unlikely that it was the affected teen who lost the job.
So, if the results tell a story of mostly indirect effects, how can researchers be sure of a link? Gassman-Pines responded that if the study only examined one period of time, researchers might be worried that the uptick in suicide behaviors was due to other variables. However, this study gathered more than a decade worth of data, and researchers consistently found the same unfortunate trends. Gassman-Pines also noted that the data covered periods of economic boom and recession, and so the findings are “not just a story about recession – it’s really a story about when these mass layoffs and closings occur, what are some of the consequences?”
Gassman-Pines and her colleagues found that job losses among 1 percent of the working-age population increased the probability of teen girls reporting suicidal ideation by 2 percentage points and suicide plans by 2.2 percentage points. Among black adolescents, the same job losses increased self-reported suicidal ideation by 2.3 percentage points, suicide plans by 3.1 percentage points and suicide attempts by 2 percentage points. The study noted that job losses seemed to exacerbate pre-existing gender gaps, as girls are more likely than boys to engage in suicide-related behavior and experience serious mood or anxiety disorders. Also, while black youth tend to experience lower levels of suicide-related behaviors and mental illness overall, the study results are consistent with previous research finding that local job losses are associated with a disproportionate use of emergency psychiatric care among black teens. Gassman-Pines and study co-authors Elizabeth Oltmans Ananat and Christina Gibson-Davis write:
Follow-up analyses increased our confidence that the association between statewide job loss and adolescent suicide-related behaviors was not attributable to other aspects of states’ economic circumstances, including the unemployment rate, poverty rate, gross domestic product, or home mortgage delinquency rate. These results suggest that our measure of job loss was not simply a proxy for other aspects of a state’s economic climate but instead represented a meaningful economic shock that led to changes in girls’ and black adolescents’ suicide-related behaviors.
“I think most importantly, we should all be thinking about the widespread effects of these kinds of layoffs and business closings,” Gassman-Pines told me. “We tend to think about the people who have been laid off as the only affected people who may need services and while certainly they’re the most affected, we’d benefit from thinking about the needs that go beyond the directly affected workers.”
She said the study findings may be particularly useful to schools, social service workers, after-school programs and other community stakeholders who regularly work with young people and at-risk youth.
“These are big enough job losses that people are generally aware of them, so just knowing about this link might help (stakeholders) intervene early and prevent suicides down the road,” she said.
To request a full copy of the study, visit the American Journal of Public Health.
Kim Krisberg is a freelance public health writer living in Austin, Texas, and has been writing about public health for more than a decade.
On NPR’s Morning Edition earlier today, Laura Starecheski reported on efforts to use peer groups to prevent young men from becoming rapists. She set the stage by talking with psychologist David Lisack about a study he (and colleague Paul M. Miller of Brown University School of Medicine) conducted among male University of Massachusetts Boston students and published in Violence and Victims in 2002. Knowing that the majority of rapes are never reported to authorities, and wanting to know whether serial rapists were responsible for many of them, Lisack and Brown took a direct approach: They asked men to tell them about any rapes they had committed. Starecheski summarizes their findings:
He surveyed about 1,800 men, asking them a wide range of questions about their sexual experiences. To learn about sexual assault, he asked things like, “Have you ever had sex with an adult when they didn’t want to because you used physical force?” When the results came back, he was stunned.
All told, 120 men in the sample, or about 6 percent of the total, had raped women they knew. Two-thirds of those men were serial rapists, who had done this, on average, six times. Many of the serial rapists began offending before college, back in high school. … Together, the 120 men in Lisak’s study were responsible for 439 rapes. None was ever reported.
The questions didn’t ask “have you committed rape”; instead, rapists were identified by their “yes” answers to questions like “Have you ever had sexual intercourse with someone, even though they did no want to, because they were too intoxicated (on alcohol or drugs) to resist your sexual advances (e.g., removing their clothes)? Of the 120 men whose responses identified them as rapists, 81% reported raping women who were incapacitated by drugs or alcohol, while smaller percentages admitted to using force.
Lisack interviewed men who’d committed rapes, and they described tactics such as preparing punch with sweet juice and a potent mix of alcohol, so young women would become drunk quickly. (The current online text version of the story doesn’t contain all the chilling quotes; listen to the audio version for more on how rapists scope out their victims and get them into situations where they’ll be vulnerable.) Starecheski summarizes the rapists’ thinking:
Alcohol was the weapon of choice for these men, who typically saw themselves as college guys hooking up. They didn’t think what they had done was a crime.
“Most of these men have an image or a myth about rape, that it’s some guy in a ski mask wielding a knife,” says Lisak. “They don’t wear ski masks, they don’t wield knives, so they don’t see themselves as rapists.”
In fact, they’d brag about what they had done afterwards to their friends. That implied endorsement from male friends — or at the very least, a lack of vocal objection — is a powerful force, perpetuating the idea that what these guys are doing is normal rather than criminal.
If such tacit acceptance from male peers is preventing rapists from understanding that they are criminals, perhaps explicit condemnation could prevent men from becoming rapists. That’s the thinking behind the intervention Starecheski profiles: Mentors in Violence Prevention, or MVP. At a few Sioux City, Iowa high schools, older students are matched with incoming students, and the older students facilitate discussions about relationships, alcohol, and sexual assualt. Younger students have a chance to think about what they’d do in situations where a rape might occur, and discuss responses. Starecheski talked to one former MVP mentor, Tucker Carrell, who’s now a junior at Iowa State University:
Tucker says that he’s not afraid to confront his Delta Tau Delta fraternity brothers when they talk about women in a way that makes him uncomfortable. He’ll sit down with them, sometimes even bringing a woman they’ve hit on into the conversation.
The day we talked, Tucker said he’d used his MVP training to intervene in a situation just the night before.
This was at a going-away party at a bar in Ames, Iowa. Tucker noticed that a friend’s female cousin was pretty drunk. She was over by the jukebox with two guys who weren’t part of the party. They were strangers. Tucker says he was paying attention to her body language, and something didn’t look right. She looked almost cornered.
Carrell and a friend went over to the jukebox, picked out a song, and then casually asked the young woman if she’d like to head back over to the table to see her cousin. She did, and that was the end of the situation.
What struck me in listening to Tucker Carrell’s description of the jukebox situation is that his ability to pick up on non-verbal cues from across the room is impressive and, I’m guessing, not something every male college student possesses. (In the recorded version of the story, Carrell gives more examples of the young woman’s body language and also notes that his friend didn’t pick up on those cues the way he did.) Such an ability can be useful not only in bars and at parties, but in personal relationships and the workplace.
In young adulthood, it can be especially hard for young men to stand up to their peers and tell them that their approach to sexual conquests is wrong. I admire the young men like Tucker Carrell, and I’d like to see more young men doing the kinds of things he is. When our society is such that 6 – 10% of men think it’s okay to rape, we have to ask both men and women to take measures that might be difficult or uncomfortable at times. (See the Daily Show’s Jessica Williams for a funny-but-not-really rundown on some of the measures women take to protect themselves.) The burden shouldn’t fall entirely on women.
It’s encouraging that researchers like those behind the MVP program are exploring ways to engage in primary prevention, in addition to the secondary-prevention efforts that many of us have seen. Anyone who’s attended college over the past couple of decades has probably heard tips about looking out for one’s friends at parties — but that’s only preventing individuals from falling victim to the rapist risk that’s already widespread. Primary prevention, in this case, means preventing men from getting to the point where they think getting partygoers extremely drunk is an acceptable way to assure a successful sexual conquest. That’s the goal, and I hope in the coming years we’ll see more work to develop, evaluate, and disseminate successful primary-prevention interventions to stop men from becoming rapists.
Twenty-three years and millions served: CDC’s National Breast and Cervical Cancer Early Detection Program
Next time someone asks you what exactly public health does, repeat this number: 4.3 million. That’s the number of women — mothers, sisters, wives, aunts, grandmothers, daughters and friends — who might have otherwise gone without timely breast and cervical cancer screenings if it weren’t for public health and its commitment to prevention.
This year marks the 23rd anniversary of the National Breast and Cervical Cancer Early Detection Program, which the Centers for Disease Control and Prevention launched in 1991 to ensure that low-income women would have the same opportunity to detect cancers in their earliest stages and when treatment is often easier and more effective. The program and its success are the subject of the most recent supplement of Cancer, a journal of the American Cancer Society, and represents the first time such detailed information about the program’s success and strategies has been published. According to the published research, more than 4.3 million women with limited access to health care received breast and cervical cancer screening and diagnostic services in the first 20 years of the CDC program, which provided more than 10.7 million screening examinations. The number of women screened has grown from 82,000 in the early years to more than 500,000 every year.
Also in the program’s first two decades, program providers detected 56,662 breast cancers, 3,206 cervical cancers and 152,470 precancerous cervical lesions. More than 90 percent of women in whom cancer or lesions were detected received appropriate and timely follow-up care. In 2012 alone, the CDC program screened more than 340,000 women for breast cancer, diagnosing nearly 6,000 cancer cases, and more than 251,600 women for cervical cancer, diagnosing 261 cancer cases and about 12,400 premalignant cervical lesions. And providing these screening and diagnostic services to those who might not otherwise have had access cost just $145 per person.(Unfortunately, funding cuts at both state and federal levels do threaten the program’s reach — learn more about that at the Cancer Action Network.)
In addition to opening access to screening and diagnostic services, the CDC program, which funds health agencies in all 50 states, Washington, D.C., five territories and 11 tribal organizations to implement the program on the ground, also connects women to timely follow-up testing, treatment and case management. The CDC program was designed to address a critical service gap: While research had shown that regular cancer screenings could reduce the risk of dying from cancer, poor and uninsured women were less likely to receive the potentially life-saving services and were often diagnosed with cancer at a later stage in the disease cycle. As such, the CDC program is well positioned to positively impact disparities in cancer. For example, in one of the Cancer journal studies, the authors noted that Hispanic women experience the highest rate of developing cervical cancer, and black women experience a disproportionate rate of breast and cervical cancer mortality.
The National Breast and Cervical Cancer Early Detection Program takes a decisively public health approach to providing this traditionally clinical service, designing localized programs that reach low-income women where they are and reducing social and economic barriers that often impede access. In one of the journal studies, authors Jacqueline Miller, Vivien Hanson, Gale Johnson, Janet Royalty and Lisa Richardson write about the Wisconsin Well Woman Program (WWWP), which launched in 1992 with funding from CDC. The Wisconsin program zeroes in on reaching women ages 45 to 64 years old who are underinsured or don’t have any insurance and who are living at or below 250 percent of the poverty level. It also aims to reach Hispanic, black and Native American women as well as women in rural communities. The decentralized state program engages local agencies to tailor education, outreach and enrollment activities that resonate with their residents. The authors write:
The WWWP has developed a network of more than 1,060 provider sites statewide for breast and cervical cancer screening in order to maintain screening services within a 50-mile radius of a woman’s residence. The WWWP provider network includes ambulatory surgery centers, family planning clinics, federally qualified health centers, hospitals, independent laboratories, mammography facilities, pathologists, radiologists, nurse practitioners, rural health clinics, and tribal health clinics. Covered services are available from participating providers at no cost to WWWP clients.
The WWWP has provided more than 490,000 examinations to more than 70,000 Wisconsin women since the program began providing screening services on June 1, 1994. Program data indicate that over the last 18 years, 74% of the women receiving program mammograms were white, 12% were black, and almost 3% were Native American. Hispanic women accounted for 11% of program mammograms. Over this period, the WWWP has diagnosed 1,023 invasive breast cancers and 94 invasive cervical cancers.
However, the same study notes that many more women need to be reached. The authors write that the CDC program only reaches about 13 percent of women who are eligible for the program’s breast cancer screening and 9 percent of women eligible for cervical cancer screening. Of course, with the implementation of the Affordable Care Act (ACA), access to such screenings is likely to change. Still, in one of the journal studies examining the impact of health reform, authors estimated that even with full implementation of ACA — which assumes all 50 states expand their Medicaid programs — 4.5 million women would still be eligible for cervical cancer screening via the CDC program and 1.7 million would be eligible for breast cancer screening. In reality, only about half of states decided to expand Medicaid eligibility.
That Medicaid gap is just one of the many reasons why there’s still a significant need for a public health approach to cancer screening. As one of the journal studies noted: “Limited health literacy or self-efficacy, language barriers, lack of knowledge about screening, fear of cancer, and geographic isolation are common patient barriers that will not be addressed by improved health insurance coverage alone. …These factors (and others) call for partnerships between public health, communities and the health care system to leverage each other’s expertise, connections, and resources to implement more organized and coordinated efforts to increase use of clinical preventive services, which include cancer screening.”
Kim Krisberg is a freelance public health writer living in Austin, Texas, and has been writing about public health for more than a decade.
Erik Deighton’s work-related death could have been prevented. That’s how I see the findings of Michigan OSHA (MIOSHA) in the agency’s citations against his employer, Colonial Plastics (here, here). The 23-year-old was working at the firm’s Shelby Township, Michigan location in March 2014 when he suffered fatal traumatic injuries involving a stamping press. I wrote about the incident shortly after it was reported by local press.
MIOSHA conducted an inspection of the worksite following Deighton’s death. The agency recently issued citations to Colonial Plastics for seven serious violations and proposed a $20,850 penalty. Those violations include failing to comply with several of MIOSHA’s safety regulations which specifically address plastic molding operations, such as:
R 408.16211: An employer shall provide training to an employee regarding the operating procedures, hazards, and safeguards of any assigned job.
R 408.16226(5) When used, interlocks shall be installed to minimize the possibility of accidental operation or tampering.
R 408.16227(2) …each employee doing the work shall lock out the power source of the machine or equipment to be repaired or serviced if unexpected motion would cause injury. Any residual pressure which would be hazardous shall be relieved before and remain relieved during work by an employee doing the work.
R 408.16234(6) When purging an injection molding machine, an employee shall be protected from the purging splatter by a shield that is fixed, portable, or worn on the employee. The same guarding shall be used when servicing a heated runner manifold nozzle.
When the incident was initially reported, Shelby Township Police Captain Stephen Stanbury told the press,
“This is totally an accident.”
“I don’t think it’s a sloppy operation from what our guys found at Colonial Plastics.”
MIOSHA’s findings tell a different story. Call it sloppy, call it poor management, call it breaking the law. Whatever you want to call it, Erik Deighton’s work-related death could have been prevented.
Failing to get the time to acclimate to a hot work environment can be deadly. That’s the message I took away from an item in last week’s Morbidity and Mortality Weekly Report (MMWR).
“Heat illness and deaths among workers — U.S. 2012-2013” reports on 13 occupational heat-related fatalities investigated by federal OSHA. Nine of the 13 incidents (69 percent) involved an individual who was working in their hot job for three or fewer days. Among the cases examined by the authors, none of the employers had acclimation programs, and only five of the 13 had provided access to a cool or shaded area for rest breaks. In nearly all the cases, the deceased workers’ opportunity for a rest break came only during scheduled breaks—not necessarily at frequent enough time periods to assist with acclimation.
The MMWR report, prepared by OSHA and NIOSH staff, notes:
“New workers and all workers returning from an absence of more than a week should begin with 20 percent of the usual duration of work in the hot environment on the first day, increasing incrementally by no more than 20 percent each subsequent day.”
The report shows the diversity of jobs and situations in which workers are at risk of suffering a heat-related illness or death. Three of the 13 fatalities involved waste collection/recycling workers, two were postal workers, and others included a roofer, a turf grass installer, and a person working in a commercial laundry.
The authors’ data, as they acknowledge, is only a subset of all work-related fatal heat-illnesses cases. It does not include, for example, incidents from California, North Carolina and the 19 other states that operate their own OSHA program. Moreover, it only includes cases for which the employer received a citation from federal OSHA for not addressing the fatal heat hazard. Because OSHA doesn’t have a regulation on heat stress, such citations were written as “general duty clause” violations (i.e., failing to provide a workplace that is free from recognized hazards that are likely to cause serious physical harm.) The above quote from the report is only a recommendation, not a requirement.
In 2011, Public Citizen and Farmworker Justice submitted a petition to OSHA urging the agency to issue a standard on heat stress. The petition reminded us that NIOSH recommended in 1972 a comprehensive worker safety standard on heat exposure, and repeated the call in 1986. The organizations also noted that the states of California, Minnesota and Washington have, to varying degrees, standards to address hot work environments. (Minnesota’s regulation covers indoor environments only and Washington’s regulations cover outdoor environments only, with Washington’s applicable from May through September.) All three standards recognize the importance of acclimation, most notably the California standard which requires:
“ Close supervision of a new employee by a supervisor or designee for the first 14 days of the employee’s employment by the employer, unless the employee indicates at the time of hire that he or she has been doing similar outdoor work for at least 10 of the past 30 days for 4 or more hours per day.”
Earlier this year, NIOSH solicited public comments on (yet again) a draft recommended standard on occupational exposure to heat and hot environments. The “Criteria for a Recommended Standard: Occupational Exposure to Heat and Hot Environments” notes the advantages of acclimation:
- Increased sweating efficiency (earlier onset of sweating, greater sweat production, and reduced electrolyte loss in sweat)
- Work is performed with lower core temperature and heart rate
- Increased skin blood flow at a given core temperature
And offers this draft acclimization plan:
- Gradually increase exposure time in hot environmental conditions over a 7-14 day period.
- For new workers, the schedule should be no more than 20 percent exposure on day 1 and a no more than 20 percent increase on each additional day.
- For workers who have had previous experience with the job, the acclimization regime should be no more than a 50 percent exposure on day 1, 60 percent on day 2, 80 percent on day 3, and 100 percent on day 4.
As they’ve done in the last few years, federal OSHA has teamed up with the National Weather Service to raise awareness about heat-related illness. The slogan “Water. Rest. Shade.” has become the hot-weather mantra in some worker safety circles. The report on these 13 heat-related worker fatalities, however, makes me wonder whether the slogan needs an update. Water, shade and rest may not be enough if newly assigned workers haven’t had a chance to adjust to the heat.
It didn’t make a lot of headlines, but a new presidential executive order could be a big deal for workers’ rights and safety. On July 31, President Obama signed the Fair Pay and Safe Workplaces executive order, which requires federal contractors to disclose prior labor violations and prohibits contractors from forcing workers into arbitration to settle workplace discrimination cases.
The National Law Review explains the order in detail. According to writers Dwight Armstrong and Nisha Verma, the order applies to federal contracts valued at more than $500,000 and could affect a substantial number of workers. Under the disclosure requirements, employers seeking federal contracts must make public any “administrative merits determination, arbitral award or decision, or civil judgment” associated with a violation of state or national labor law. Based on those disclosures, an awarding agency must consider whether the employer “is a responsible source that has a satisfactory record of integrity and business ethics.” Employers who do receive federal contracts must then update their disclosures every six months and ensure any subcontractors do the same.
The arbitration provision applies to contracts worth more than $1 million and bans employers from requiring workers to sign pre-dispute agreements that would send any discrimination claims automatically to arbitration. Emily Bazelon at Slate quoted Paul Bland, executive director at Public Justice, describing the executive order as “one of the most important positive steps for civil rights in the last 20 years.” Bland especially praised the arbitration provision. Bazelon writes:
The second part of the order is what Bland is so excited about. This provision says that companies with federal contracts worth more than $1 million can no longer force their employees out of court, and into arbitration, to settle accusations of workplace discrimination. “Here’s why this is so important,” Bland said when I asked him to explain. “For the last 20 years, the Supreme Court has been encouraging employers to force their workers into a system of arbitration that has been badly rigged against the workers. And so this order will result in millions of employees having their rights restored to them.”
Arbitration is a private mechanism for dispute resolution. If both parties freely choose to use it rather than going to court, then it can be perfectly legitimate as well as cheaper and faster. The problem is that companies increasingly sneak mandatory arbitration clauses into the fine print of contracts with employees and consumers. Deep into the deal you sign when you take a job, or get a loan, or buy a product, is language in which you agree that you’ll settle any related dispute through a private arbitrator rather than before a judge.
Bazelon notes that the “new executive order says that if you’re a federal contractor with a workplace complaint rooted in your sex, race, ethnicity, or religion, you get to go to court — unless you agree to arbitration voluntarily and after the dispute arises.”
Obama’s executive order is attracting praise from worker advocates. International Union, United Automobile, Aerospace and Agricultural Implement Workers of America (UAW) said the order “will create a level playing field for businesses that do the right thing.” The National Employment Law Project said the order “incentivizing federal contractors to obey the law protects taxpayers’ interest in ensuring that their tax dollars do not underwrite illegal conduct.” And the NAACP applauded the order, saying that “promoting competition and protecting civil rights in federal contacting is a measure of both our business ethics and democratic values.”
For a White House fact sheet on the executive order, click here.
In other news:
ESPN: Student athletes may see some of the billions that universities make from collegiate sports. In a recent decision, a federal judge has struck down National Collegiate Athletic Association (NCAA) rules that prohibit athletes from receiving anything other than scholarships and other costs associated with going to college. However, the ruling also states that the NCAA can cap such payments. In an editorial about the ruling, the Los Angeles Times noted that “considering how much money they make, major-college football and basketball programs carry more than a whiff of exploitation.”
EHS Today: Brooklyn’s Brookdale University Hospital and Medical Center faces $78,000 in OSHA fines after the agency found that the medical center failed to protect employees from violent patients. Reporter Josh Cable wrote that the most serious incident involved an assault on a nurse, who sustained serious brain injuries after being attacked by a patient. In its investigation, OSHA uncovered 40 incidents of workplace violence between February and April. More on this story is at New York Daily News.
Reuters: In a somewhat ironic twist, LinkedIn Corp, whose mission is to “connect the world’s professionals to make them more productive and successful,” was found to have violated wage law to the tune of millions of dollars. In a settlement with the U.S. Department of Labor, the company has agreed to pay more than $3.3 million in overtime wages and more than $2.5 million in damages to workers in California, Illinois, Nebraska and New York.
The Nation: Reporter Michelle Chen chronicles the state of low-wage work at Baltimore’s Thurgood Marshall International Airport, a major airport just outside of Washington, D.C. In particular, the article explores the significant concentration of black workers in the airport’s lowest-paying job positions. A local worker advocate told Chen: “It’s not fair that we work on publicly owned property, paid for by tax dollars, our tax dollars, but we are paid barely above minimum wage…. Some of us are paid so low that the only time we get a decent meal is when we are at work.”
Huffington Post: Last week, two workers filed a lawsuit in federal court accusing the sandwich chain Jimmy John’s of systematic wage theft. Reporter Dave Jamieson writes that the workers “claim that they were forced to regularly work off the clock because of unreasonably low payroll budgets provided to individual Jimmy John’s stores, leading to minimum wage and overtime violations.” (Last year, the Pump Handle interviewed Jimmy John’s workers in St. Louis who were taking part in a local campaign to bring living wages to fast food workers.)
Kim Krisberg is a freelance public health writer living in Austin, Texas, and has been writing about public health for more than a decade.