Precarious Employment as a Determinant of Overweight and Cardiometabolic Risk

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PROJECT SUMMARY Reducing obesity disparities could greatly reduce health disparities by race/ethnicity for the leading cause of death in the U.S., cardiovascular disease (CVD). Therefore, it is critical to understand the systemic causes of disparities in obesity prevalence between racial/ethnic minority adults and children, compared to their white counterparts. “Precarious employment,” which is often characterized by low wages, limited fringe benefits, shorter tenure, and irregular hours, making employment risky and stressful for the worker, is disproportionately represented among racial/ethnic minorities. Precarious employment may increase body mass index through multiple mechanisms including, a biological stress response. Determining the extent to which precarious employment is a determinate of overweight and cardiometabolic risk is vitally important for mitigating disparities in chronic disease risk and informing structural approaches for improving population health in the U.S. The proposed work in this Pathway to Independence Award builds upon my current program of research investigating the role of employment status and conditions in overweight risk and enhances it by adding training in areas that are critical to accomplishing my career goal: establishing an independent research program that rigorously investigates the role of employment status and conditions as a determinate of racial and ethnic disparities in chronic disease risk. The training portion of this project includes coursework, guided readings, and career- building activities to gain skills in three areas: 1) causal inference methodologies; 2) the study of stress and CVD, and 3) racial/ethnic health disparities. The newly acquired skills and knowledge obtained during the training phase of this award will be applied in the research phase of the study. The research phase of the study aims to provide novel insights into the impacts of precarious employment on overweight and cardiometabolic risk, and to investigate the pathways of these relationships. We will leverage three unique datasets, two racially/ethnically diverse longitudinal cohorts with complementary employment and biological data (National Longitudinal Survey of Youth and National Longitudinal Study of Adolescent to Adult Health), and objective data on work activities and organization (Occupational Information Network Database), to accomplish the following specific aims: 1) determine the extent to which precarious employment affects overweight/obesity risk among adults and children in the U.S. and examine whether any association varies by race/ethnicity; 2) determine whether biological stress mediates the association between precarious employment and BMI and overweight/obesity risk among adults; 3) determine whether precarious employment is associated with cardiometabolic risk biomarkers among adults and examine whether any association varies by race/ethnicity; and 3a) determine whether overweight/obesity and biological stress mediate the association between precarious employment and cardiometabolic risk. Employment precariousness is modifiable through policy-level changes, making this a critical topic for study.