Sex and Gender Role Differences in Occupational Exposures and Work Outcomes Among Registered Nurses in Correctional Settings

Source: Mazen El Ghaziri, Alicia G Dugan, Yuan Zhang, Rebecca Gore, Mary Ellen Castro, Annals of Work Exposures and Health, Advance Articles, March 30, 2019

From the abstract:
Background and context:
The correctional environment exposes registered nurses to unique occupational health hazards including, but not limited to, an increased risk for workplace violence. Gender role expectations regarding femininity and masculinity may influence occupational exposures and outcomes differently. Risk comparisons between male and female registered nurses working in correctional settings, have been minimally examined. With the proportion of male registered nurses working in corrections higher than that of nurses working in other healthcare sectors, and with the increasing number of males entering the nursing workforce in general, it is important to characterize and understand occupational exposures and outcomes of male and female registered nurses, especially those working in correctional settings.

Purpose/objectives:
This paper aims to describe and compare sex and gender role differences in occupational exposures and work outcomes among correctional registered nurses.

Methods:
A cross-sectional web-based survey using Qualtrics was administered to registered nurses working in a northeastern correctional healthcare system between June and October 2016. The survey was composed of 71 items from the CPH-NEW Healthy Workplace All Employee Survey, Assessing Risk of Exposure to Blood and Airborne Pathogens and General Health Survey, Bem Sex Role Inventory-Short Form (BSRI-SF), and the Negative Acts Questionnaire-Revised.

Results:
Of 95 registered nurse participants, 75% were female with the highest percentage identified as belonging to the feminine group (37%), while the highest percentage of male participants were identified as belonging to the androgynous group (33%). Females worked primarily on the first shift, while males tended to work the second and third shifts (P < 0.05). Over one third of all participants (37%) reported having experienced a sharps-related injury and having been exposed to blood-borne pathogens and body fluids within the previous 2–5 years. The majority of the participants (>95%) reported being at risk for workplace violence and having been victims of workplace violence perpetrated by an inmate. Significant gender differences (P < 0.0001) were noted in the bullying exposure with androgynous nurses having higher occasional bullying. There was a marginal difference in burnout for females (M = 6.8, SD = 2.1) and males (M = 5.8, SD = 1.9, P = 0.05). Implications: Effective interventions are needed to address the sex and gender role-based differences in bullying exposure and burnout in order to promote the overall health and well-being of correctional registered nurses.

Neglect Unchecked

Source: Kaiser Health News, 2018-2019

This Kaiser Health News series examines the reasons that long-term care facilities, their owners and the government fail to protect residents.

Though nursing homes are among the most heavily regulated types of medical providers, they remain dangerous places for frail residents. Four of 10 were cited for harming a patient or putting them in jeopardy over a three-year period.

Assisted living facilities have notably less oversight than nursing homes, even though they increasingly care for elderly people who are so frail that they might otherwise be in a nursing home.

This Kaiser Health News series examines the reasons that nursing homes, their owners and the government fail to protect residents.

Articles include:
Nursing Home Fines Drop As Trump Administration Heeds Industry Complaints
By Jordan Rau, Kaiser Health News, March 15, 2019
Inspectors are citing nursing facilities for violating health and safety more often than during the Obama administration. But the average fine is nearly a third lower than it was before President Donald Trump took office.

Assisted Living’s Breakneck Growth Leaves Safety Of Dementia Patients Behind
By Jordan Rau, Kaiser Health News, December 17, 2018
An analysis of inspection records in California, Florida and Texas shows significant numbers of violations related to assisted living residents with dementia.

1,400 Nursing Homes Get Lower Medicare Ratings Because Of Staffing Concerns
By Jordan Rau and Elizabeth Lucas, Kaiser Health News, July 30, 2018
Medicare said those homes either lacked a registered nurse for “a high number of days” over three months, provided data the government couldn’t verify or didn’t supply their payroll data at all.

‘Like A Ghost Town’: Erratic Nursing Home Staffing Revealed Through New Records
By Jordan Rau, Kaiser Health News, July 13, 2018
Daily nursing home payroll records just released by the federal government show the number of nurses and aides dips far below average on some days and consistently plummets on weekends.

The Decline of Cash Assistance and the Well-Being of Poor Households with Children

Source: H Luke Shaefer, Kathryn Edin Vincent, Fusaro Pinghui Wu, Social Forces, Advance Articles, March 19, 2019
(subscription required)

From the abstract:
Since the early 1990s, the social safety net for families with children in the United States has undergone an epochal transformation. Aid to poor working families has become more generous. In contrast, assistance to the deeply poor has become less generous, and what remains more often takes the form of in-kind aid. A historical view finds that this dramatic change parallels others. For centuries, the nature and form of poor relief has been driven in part by shifting cultural notions of which social groups are “deserving” and “undeserving.” This line was firmly redrawn in the 1990s. Did the re-institutionalization of these categorizations in policy have material consequences? This study examines the relationship between the decline of traditional cash welfare between 2001 and 2015 and two direct measures of wellbeing among households with children: household food insecurity and public school child homelessness. Using models that control for state and year trends, along with other factors, we find that the decline of cash assistance was associated with increases in both forms of hardship.

Race and the Accumulation of Wealth: Racial Differences in Net Worth over the Life Course, 1989-2009

Source: Melvin Thomas, Cedric Herring, Hayward Derrick Horton, Moshe Semyonov, Loren Henderson, Patrick L Mason, Social Problems, Advance Articles, March 21, 2019

From the abstract:
Using data from the 1989–2009 Panel Study of Income Dynamics, this research examines racial differences in wealth accumulation over the life course. We ask: (1) How have racial differences in wealth changed over time? (2) Do racial wealth gaps change over the life course? (3) Are racial gaps in net worth expanding, contracting, or staying the same over time and over the life course? and (4) Do these patterns differ by cohort? The analysis is informed by (1) the declining significance of race and post-racial perspectives; (2) the cumulative effects of discrimination explanation; and (3) the vintage hypothesis. Results show that African Americans’ wealth as a percentage of whites’ wealth fell in 2009. Results do not support the declining significance of race and post-racial perspectives. Partially consistent with the vintage hypothesis, post-1960s African Americans are relatively better off than are pre-1960s African Americans (compared with whites of the same cohort). Consistent with the cumulative effects of discrimination model, the African American-white wealth gap increases over the life course for each historical period. If current patterns persist, presumed gains made by young African Americans relative to young whites may turn out to be illusory as they progress through the life course.

Sun Protection Behaviors of State Park Workers in the Southeastern USA

Source: Vinayak K Nahar, Amanda H Wilkerson, Brian Martin, Javier F Boyas, Mary A Ford, John P Bentley, Paul Johnson, Kim R Beason, William H Black, Robert T Brodell, Annals of Work Exposures and Health, Advance Articles, March 27, 2019
(subscription required)

From the abstract:
Background:
Due to the nature of their work, state park workers receive substantial exposure to sunlight, putting them at an increased risk of developing skin cancer. Increased use of sun protection behaviors can reduce this risk.

Objectives:
Using the health belief model (HBM) as a theoretical framework, the purpose of this study was to assess factors associated with sun protection behaviors among state-park workers.

Methods:
In this cross-sectional study, a convenience sample of participants were recruited from 23 state parks in the Southeastern USA to complete a self-administered questionnaire based on the constructs of the HBM.

Results:
The sample comprised 310 state park workers. The majority of participants were non-Hispanic White (61.6%), male (63.5%), and were aged 39.56 (±13.97) years on average. The average duration of sun exposure during the workday was reported as 3.51 h (±1.88). Nearly 12% of the participants reported that their workplace had a sun-safety policy and ~10% reported receiving sun-safety training at their workplace. The majority of participants reported that they did not sufficiently use sun protection methods. Factors associated with sun protection behaviors included the HBM constructs of perceived benefits outweighing perceived barriers (standardized coefficient = 0.210, P = 0.001), self-efficacy (standardized coefficient = 0.333, P < 0.001), and cues to action (standardized coefficient = 0.179, P = 0.004). Conclusion: Future research should explore the barriers to adopting and enforcing sun-safety policies in the workplace. HBM appears to be efficacious in explaining sun protection behaviors among state park workers. HBM constructs should be considered in future interventions aimed at increasing sun protection behaviors in this population.

Pervasive Penality: How the Criminalization of Poverty Perpetuates Homelessness

Source: Chris Herring, Dilara Yarbrough, Lisa Marie Alatorre, Social Problems, Advance Article, March 29, 2019(subscription required)

From the abstract:
A growing literature examines the extent to which the criminal justice system perpetuates poverty and inequality. This research examines how anti-homeless laws produce various forms of police interactions that fall short of arrest, yet have wide-ranging impacts on the urban poor. Our analysis draws on a citywide survey of currently and recently homeless people, along with 43 in-depth interviews, to examine and reveal the mechanisms through which consistent punitive interactions, including move-along orders, citations, and destruction of property, systematically limit homeless people’s access to services, housing, and jobs, while damaging their health, safety, and well-being. Our findings also suggest that anti-homeless laws and enforcement fail to reduce urban disorder, but create instead a spatial churn in which homeless people circulate between neighborhoods and police jurisdictions rather than leaving public space. We argue that these laws and their enforcement, which affected the majority of study participants, constitute a larger process of pervasive penality—consistent punitive interactions with state officials that rarely result in arrest, but that do material and psychological harm. This process not only reproduces homelessness, but also deepens racial, gender, and health inequalities among the urban poor.

Endotoxin and Hydrogen Sulphide Exposure and Effects on the Airways Among Waste Water Workers in Sewage Treatment Plants and Sewer Net System

Source: Kari K Heldal, Åse D Austigard, Kristin H Svendsen, Elin Einarsdottir, Lars Ole Goffeng, Liv Ingun Sikkeland, Karl-Christian Nordby, Annals of Work Exposures and Health, Volume 63, Issue 4, May 2019
(subscription required)

From the abstract:
Background:
The purpose of this study is to investigate whether airborne exposure to endotoxins, hydrogen sulphide (H2S), and inhalable particles negatively impacts the respiratory system and inflammatory blood proteins in sewage plant and sewer net system workers and, further, to determine dose-response associations between exposure and health outcomes.

Methods:
In total, 148 waste water workers (WWWs) from urban and rural sewage plants and the sewer net system participated. One hundred and twenty-one workers were exposed to sewage, 46 from sewage plants and 75 from the sewer net system. Twenty-seven workers were characterized as little or not exposed and served as an internal reference group. Personal inhalable samples were analysed for endotoxins (Limulus assay), particle dust (gravimetrically) and Salmonella and Yersinia spp. (polymerase chain reaction method, PCR). Levels of H2S were measured using personal electro chemical sensors. Intercellular adhesion molecule 1 (ICAM-1), interleukin 8 (IL-8), surfactant protein D (SP-D), club cell protein 16 (CC16), and macrophage inflammatory protein (MIP) were determined by enzyme-linked immunosorbent assay and C-reactive protein (CRP) by an HS-MicroCRP assay in blood samples.

Results:
Workers in sewage plants were exposed to significantly higher levels of endotoxins compared to workers in the sewer net system [median 55 EU m−3 (4–262 EU m−3) and median 27 EU m−3 (1–304 EU m−3), respectively]. The estimated H2S index showed higher values when working in the sewer net system [median 3.1 (0.5–78.1)] compared to workers at the sewage plants [median 1.3 (0.5–9.3)], and the most excessive exposure was collecting sewage from cesspools (273 p.p.m.). No viable airborne Salmonella and Yersinia spp. were detected. The exposed workers had significantly higher CRP compared to the referents [1.2 µg ml−1 (0.1–19.0 µg ml−1) and 0.8 µg ml−1 (0.1–5.0 µg ml−1), respectively] and lower forced expiratory volume in 1 s (FEV1)% [92.6%, standard deviation (SD) 14.6 and 102.0%, SD 10.1, respectively], with numbers given as mean and SD. The serum concentration of CRP was significantly and negatively associated with FEV1% (β = −7.7, R2 = 0.05) and forced vital capacity % (β = −8.5, R2 = 0.08), and the serum concentration of ICAM-1 with the estimated exposure to H2S (β = −19.9, R2 = 0.07).

Conclusion:
Despite moderate levels of endotoxin and H2S exposure, the results indicate an impact of these agents on lung function and the adhesion molecule ICAM-1, and a low-grade systemic inflammation was indicated in increased levels of CRP.

The Effect of Public Insurance Expansions on Substance Use Disorder Treatment: Evidence from the Affordable Care Act

Source: Johanna Catherine Maclean, Brendan Saloner, Journal of Policy Analysis and Management, Volume 38, Issue 2, Spring 2019
(subscription required)

From the abstract:
We examine the effect of Medicaid expansion under the Affordable Care Act (ACA) on substance use disorder (SUD) treatment utilization and financing. We combine data on admissions to specialty facilities and Medicaid‐reimbursed prescriptions for medications commonly used to treat SUDs in nonspecialty outpatient settings with an event‐study design. Several findings emerge from our study. First, among patients receiving specialty care, Medicaid coverage and payments increased. Second, the share of patients who were uninsured and who had treatment paid for by state and local government payments declined. Third, private insurance coverage and payments increased. Fourth, expansion also increased prescriptions for SUD medications reimbursed by Medicaid. Fifth, we find suggestive evidence that admissions to specialty treatment may have increased one or more years post‐expansion. However, this finding is sensitive to specification and we observe differential pretrends between the treatment and comparison groups. Thus, our finding for admissions should be interpreted with caution.

Patrolling Public Schools: The Impact of Funding for School Police on Student Discipline and Long‐term Education Outcomes

Source: Emily K. Weisburst, Journal of Policy Analysis and Management, Volume 38, Issue 2, Spring 2019
(subscription required)

From the abstract:
As police officers have become increasingly common in U.S. public schools, their role in school discipline has often expanded. While there is growing public debate about the consequences of police presence in schools, there is scant evidence of the impact of police on student discipline and academic outcomes. This paper provides the first quasi‐experimental estimate of funding for school police on student outcomes, leveraging variation in federal Community Oriented Policing Services (COPS) grants. Exploiting detailed data on over 2.5 million students in Texas, I find that federal grants for police in schools increase middle school discipline rates by 6 percent. The rise in discipline is driven by sanctions for low‐level offenses or school code of conduct violations. Further, I find that Black students experience the largest increases in discipline. I also find that exposure to a three‐year federal grant for school police is associated with a 2.5 percent decrease in high school graduation rates and a 4 percent decrease in college enrollment rates.