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Occupational, social, and relationship hazards and psychological distress among low-income workers: implications of the ‘inverse hazard law’
  1. Nancy Krieger1,
  2. Afamia Kaddour2,
  3. Karestan Koenen1,
  4. Anna Kosheleva1,
  5. Jarvis T Chen1,
  6. Pamela D Waterman1,
  7. Elizabeth M Barbeau3,4
  1. 1Department of Society, Human, Development and Health, Harvard School of Public Health, Boston, Massachusetts, USA
  2. 2Department of Global Health and Population, Harvard, School of Public Health, Boston, Massachusetts, USA
  3. 3Harvard School of Public Health and Center for Community-Based Research, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
  4. 4Health Dialog, Boston, Massachusetts, USA
  1. Correspondence to Nancy Krieger, Department of Society, Human Development, and Health, Harvard School of Public Health, 677 Huntington Avenue, Kresge 717, Boston, MA 02115, USA; nkrieger{at}


Background Few studies have simultaneously included exposure information on occupational hazards, relationship hazards (eg, intimate partner violence) and social hazards (eg, poverty and racial discrimination), especially among low-income multiracial/ethnic populations.

Methods A cross-sectional study (2003–2004) of 1202 workers employed at 14 worksites in the greater Boston area of Massachusetts investigated the independent and joint association of occupational, social and relationship hazards with psychological distress (K6 scale).

Results Among this low-income cohort (45% were below the US poverty line), exposure to occupational, social and relationship hazards, per the ‘inverse hazard law,’ was high: 82% exposed to at least one occupational hazard, 79% to at least one social hazard, and 32% of men and 34% of women, respectively, stated they had been the perpetrator or target of intimate partner violence (IPV). Fully 15.4% had clinically significant psychological distress scores (K6 score ≥13). All three types of hazards, and also poverty, were independently associated with increased risk of psychological distress. In models including all three hazards, however, significant associations with psychological distress occurred among men and women for workplace abuse and high exposure to racial discrimination only; among men, for IPV; and among women, for high exposure to occupational hazards, poverty and smoking.

Conclusions Reckoning with the joint and embodied reality of diverse types of hazards involving how people live and work is necessary for understanding determinants of health status.

  • Gender inequalities
  • psycholog distress
  • social epidemiology
  • social inequalities
  • violence RB

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  • Funding NIOSH, Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA 30333, USA, grants OHO7366-01 and OHO7366-018.

  • Competing interests None to declare.

  • Ethics approval This study was conducted with the approval of the Dana-Farber Cancer Institute's Office for the Protection of Research Subjects, the Human Subjects Committee of the Harvard School of Public Health, and the Institutional Review Board of the University of Massachusetts.

  • Provenance and peer review Not commissioned; externally peer reviewed.