Tessa Bonney, PhD, University of Illinois at Chicago School of Public Health, Division of Environmental and Occupational Health Sciences; Emily Morales-Reyes, BA, Boone County Health Department and University of Illinois at Chicago School of Public Health, Division of Environmental and Occupational Health Sciences

The primary objective of this study is to explore the relationships between employment precarity, mental health, and substance use and abuse in a rural context.

Nonstandard, increasingly precarious employment is on the rise in the United States, resulting in a growing population of workers who are exposed to risks and vulnerabilities that can lead to adverse health outcomes, particularly in rural areas. In addition to disproportionate risks of job insecurity and unemployment, rural communities across the U.S. already experience significant health disparities, including higher rates of suicide and drug overdoses than in rural communities. There is evidence of an association between job insecurity or job loss and poor mental health, as well as evidence of associations between common mental health disorders and substance use and abuse. Stressors related to precarious employment are likely to have a cascading effect, leading to other stressors, such as the inability to meet basic individual and family needs, which may increase the risk for both distress and self-medication of distress through substance use. While prior research has examined relationships between employment status and mental health and substance use, respectively, the contribution of comprehensive features of work, such as the availability, conditions, and arrangements of work, to a worker’s mental health and substance use and abuse is not well understood and thus warrants further investigation.

Data collection efforts are ongoing at the time of abstract submission. At submission, 100 individuals had completed this survey and an additional 69 eligible individuals had consented and were scheduled to complete the survey. We anticipate collecting data from up to 200 subjects in total by end of August 2021. Eligible study participants are adult (18+) English- and/or Spanish-speaking residents of a rural Illinois county who are either currently employed or had been employed within 24 months of initial recruitment contact. Subjects are recruited via active and passive recruitment methods (random-digit-dial telephone sampling and flier distribution, both electronic and physical) to participate in a 45-minute interviewer-administered telephone survey. The survey inquires about the participant’s employment situation, work- and life-related psychosocial stressors, alcohol consumption patterns and drug use, depression and anxiety, changes in the aforementioned work and health constructs as a result of the COVID-19 pandemic, and sociodemographic characteristics. For analyses, precarity of employment is assessed using the 10-item Employment Precarity Index (EPI), developed by the Poverty and Employment Precarity in Southern Ontario group. Depression and anxiety are measured using the abbreviated Mental Health Inventory (MHI-5) and alcohol use is measured via the Alcohol Use Disorders Identification Test (AUDIT). Drug use is measured using select measures from the Alcohol Use Disorder and Associated Disabilities Interview Schedule 5 (AUDADIS 5). Preliminary analyses were conducted using SPSS.

In our preliminary analyses (n=100), 40% of respondents were currently or recently employed in stable/secure jobs, 34% in vulnerable jobs, and 26% in precarious jobs; 37% were classified as having poor mental health (using 70 as the MHI-5 scaled-score cutoff point); 4% were classified as having potentially hazardous or harmful alcohol consumption and 2% were classified as likely alcohol dependent (using WHO AUDIT scoring classifications); 6% reported taking painkillers without a prescription in the previous year. Precariously employed individuals were significantly more likely to be classified as having poor mental health as compared to non-precariously employed individuals (p<0.05). Significant differences were not detected between precarity groups for alcohol consumption or drug use at time of submission.

In this sample, employment precarity is associated with poorer mental health and may be associated with increased substance use, though small sample size may limit our ability to detect meaningful differences between sample groups. The COVID-19 may contribute to respondents’ employment precarity and behavioral health.

Findings from our study suggest that employment precarity may be an important determinant of behavioral health, and trends towards employment precarity in the United States, especially in rural areas, may result in increased mental health problems and coping behaviors, such as increased alcohol consumption and drug use.

Tags: Applicable to all occupations/industries, Basic research, COVID-19, Emerging Issues, Non-Standard Employment Arrangements, Organization- and Job-Level Environments and Practices, Psychological and Biological Effects of Job Stress, Work Scheduling and Flexibility, Workplace Stress; Outcomes; and Recovery