This post is based on a presentation given by Constancia Dominguez. It is the eighth in the “Essentials of Pandemic Response” series based on AIHA's 2021 ebook. 

Constancia Dominguez is a graduate student and research assistant in the Environmental Health Sciences Program at the University of California, Berkeley. Her area of concentration is in industrial hygiene. After hearing personal accounts about how the pandemic had affected essential workers, especially grocery store workers, Dominguez joined a research project to gather information about their experiences. This research would help meet an important need, as at the beginning of the pandemic, COVID-19 workplace prevention strategies focused mainly on healthcare workers while strategies for other essential workers failed to keep up with the pace of the pandemic. Dominguez presented the findings of this project in an educational session at AIHce EXP 2021, titled “COVID-19 Prevention Measures and Organizational Policies in the California Grocery Store Industry.”

This project took the form of a survey conducted among California grocery workers by Dominguez and other researchers with the University of California’s Berkeley and San Francisco campuses. Data was collected on the effects of heightened demand and pandemic working conditions, communication of COVID-19 policies by employers to grocery workers, the implementation of COVID-19 policies across grocery employers, and the pandemic’s effects on grocery workers’ mental health. The findings have practical applications for public health policy as well as within the occupational and environmental health and safety field.

Dominguez and her colleagues worked toward four research goals:

• Who is represented in the grocery industry?
• What are the COVID-19 prevention measures implemented across the different levels of the organization?
• What are the health impacts on grocery workers during the COVID-19 pandemic?
• How could they, as researchers, disseminate information to protect grocery workers and create safer work environments?

“This project aimed to answer these questions in order to understand how we, as researchers, can provide evidence to stakeholders who want to promote protection of grocery workers during the COVID-19 pandemic,” said Dominguez.

Background to the Survey

Dominguez cited the UC Berkeley Labor Center’s findings that in 2018, 55 percent of Latinx workers and 48 percent of Black workers in California were employed in front-line essential jobs, meaning that these groups would likely face greater risk of workplace exposure to SARS-CoV-2 compared to other groups in the state. The Labor Center also found that Latinx workers were overrepresented as front-line essential workers in many of California’s largest occupations, including occupations related to the food or grocery industries.

As essential workers, grocery workers were not included in California’s shelter-in-place order issued on March 19, 2020. Moreover, at this time, grocery stores struggled to meet increased demand as California residents stocked up in preparation for lockdown. Long lines and crowded stores created conditions more likely to expose grocery workers to SARS-CoV-2 and impacted them in other ways.

“When the pandemic hit, not only were [these workers] carrying the burden of working in low-wage occupations,” Dominguez said, “but they were also trying to meet these new high demands for food access.”

On April 17, 2020, the California Division of Occupational Safety and Health (Cal/OSHA) issued COVID-19 guidelines specific to the grocery industry, which recommended limitations on store customers, social distancing, daily wellness screenings, the use of physical barriers, the wearing of face masks and gloves, and sanitizing all frequently touched surfaces. Grocery workers were still required to interact with the public on a daily basis, putting them at greater risk compared to occupations that could work remotely.

The combination of low wages, limited health benefits, and heightened health risks has been found to affect grocery workers’ health. A separate study, conducted in May 2020 by Fan-Yun Lan and other researchers with the Harvard T.H. Chan School of Public Health’s Environmental Health Department, assessed 104 workers at a single Massachusetts grocery store for SARS-CoV-2 positivity, personal perceptions of COVID-19, symptoms of generalized anxiety disorder, and other health effects. Twenty percent of the workers were found to be positive for SARS-CoV-2 via reverse transcription qualitative PCR testing, although most were asymptomatic. Employees directly exposed to customers were five times more likely to test positive. Effective implementation of preventive measures and workers’ ability to practice social distancing inversely correlated to anxiety and depression symptoms.

Survey of California Grocery Workers

Dominguez and her colleagues collaborated with the United Food and Commercial Workers Union to develop and distribute a survey that was sent to 25,000 Californian grocery workers affiliated with UFCW in June and July 2020. The survey was voluntary and anonymous, took 10–15 minutes to complete, and was sent to recipients as links in text messages from UFCW representatives, with one reminder also sent by text. The study received no funding. It was only made available in English.

Respondents had the options to skip whichever questions they wanted and to end the survey at any time. However, respondents were excluded from the final analysis if more than 25 percent of their responses were missing. They were asked questions on whether their employer had any plan to protect workers from SARS-CoV-2 exposure; whether they had been provided COVID-19 prevention training and, if so, what kind of training and whether it was helpful; specific prevention measures in place; interactions with customers; their employers’ involvement in protecting their safety; and their mental health.

According to Dominguez, “The main goal of this survey was to gather information about the worker experiences, including the prevention measures and related policies in the workplace during the pandemic.”

Survey Results

More than 1,100 recipients completed the survey and were stratified by employer type: employees of independent grocery stores versus employees of chain grocery stores. Responses fell into five domains: work demands, communication of policies related to COVID-19, working conditions, psychosocial stress, and mental health.

The findings of Dominguez and her colleagues and collaborators are too extensive to be covered completely in this blog post, and the most significant takeaways have been summarized. Critically, 42 percent of survey respondents were aged 50 or over: age is a risk factor for COVID-19. Furthermore, 45 percent of respondents reported having a comorbidity or underlying health condition that would put them at greater risk of severe illness or death from COVID-19.

Work demands. Seventy-eight percent of respondents said that their workload had increased after the onset of the pandemic, and 55 percent said that their management had pressured them to work faster.

Communication of COVID-19 policies. While 66 percent of respondents said that their workplace made available training or information on COVID-19 symptoms and prevention measures, and 78 percent said their employer had a written plan to protect workers, a significant portion still did not know where to find information related to COVID-19 or protecting themselves from exposure. As a result of this communication gap, respondents had relied on outside sources to understand the virus and protect their health.

Findings indicated that employer policies related to sick leave may not be consistently explained across workplaces: 76 percent responded “Yes, definitely,” or “I think so,” when asked if they would be paid if they could not work due to being sick. Sixty percent said they would, or thought they would, be paid for work missed if they or a family member had a medical condition that put them at higher risk of serious COVID-19 illness.

Results were mixed on whether respondents thought their employer would inform them of actions taken in the wake of COVID-19 appearing in their workplace. For example, 33 percent and 21 percent said they “strongly agree” or “somewhat agree” with the statement “My employer will notify me if one of my coworkers becomes sick with COVID-19.” Employees of independent grocery stores were more likely than employees of chain grocery stores to agree with that statement.

Working conditions. The percentages of respondents who said that there were signs and floor markings in place to encourage social distancing were 96 and 97, respectively. Employees of independent grocery stores were more likely than employees of chain grocery stores to say that the number of customers permitted inside the store was limited to enable social distancing. Seventy-five percent said they could perform their job duties successfully, 61 percent said they had the resources they needed to perform their duties successfully, and 65 percent said they had time to implement protective practices—indicating sizeable minorities who reported they were not able to do so.

Psychosocial stress. Fifty-two percent of the respondents strongly or somewhat agreed that interactions with customers had become more negative. Eighty-one percent agreed that they were more concerned about their safety when interacting with customers. Fifty-eight percent said they strongly or somewhat agreed with the statement “It is up to me to enforce COVID-19 prevention measures with customers, even if I am fearful of their response.”

Mental health. Respondents were asked to self-report their feelings of anxiety or being on edge, depression, and anger, with more than half reporting having experienced those emotions at least once within the week they completed the survey (71 percent, 55 percent, and 66 percent, respectively). Over half of respondents (62 percent) disagreed with the statement “My employer has done something to support our mental health.”

“Our survey was limited in the ability to directly measure mental health, since a standardized scale was not used,” said Dominguez, “but these responses still do provide evidence that there is a definite need for interventions to be developed and resources to be made available to support grocery store workers during this public health crisis.”

Outcomes, Conclusions, and Next Steps

UFCW and other advocacy groups have used the findings of Dominguez and her colleagues as evidence in the development of California laws addressing the toll of the pandemic on grocery workers, including California Assembly Bill 685, which went into effect on January 1, 2021. AB 685 requires employers to notify employees of potential COVID-19 workplace exposures, COVID-19 benefits and protections, and disinfection and safety measures that will be taken at the work site in response to potential exposures. Employers must notify the California Department of Public Health and Cal/OSHA of COVID-19 outbreaks, defined as three or more confirmed cases occurring within two weeks.

The findings speak to the need for OEHS professionals to disseminate information to workers about their COVID-19 protections under their state’s laws and for COVID-19 resources to be made available at work sites in multiple languages. If employers cannot provide protective measures to employees, they may be able to provide information about how to access resources such as vaccination clinics and personal protective equipment. Dominguez referred to free resources produced in English and Spanish by UC Berkeley’s Labor Occupational Health Program, which inform workers of their rights in California.

Dominguez asked OEHS professionals to consider that COVID-19 protections may be implemented unevenly across different employers, particularly within small or independent business entities compared to larger corporations. This study’s findings about the differences in COVID-19 enforcement in independent versus chain grocery stores “should encourage everyone to question entities about their enforcement policies and to develop a mechanism that holds them accountable when they fail to do so,” she said.

Industrial and occupational health professionals “need to have an innovative mindset,” added Dominguez, “as we’re not always going to know all the potential exposures and hazards that arise and need to know how we’re going to create these resources in a timely manner for unprecedented events like the COVID-19 pandemic.”

Dominguez also requested for her audience to show gratitude and empathy for essential workers and to encourage employers to do the same, in ways that relieve the burden on essential workers and create opportunities for them to share their concerns.

The study conducted by Dominguez and her colleagues demonstrated the need to further evaluate COVID-19 protections for workers in the food industry, the potential for OEHS research to influence the development of COVID-19 legislation, and the value of collaboration between OEHS professionals and stakeholders such as those in organized labor. Outside of the COVID-19 pandemic, these findings shed light on work conditions and culture in the food industry, including the need for mental health support, and adds to the body of knowledge that will allow wider society to prepare for future public health crises.

Dominguez expressed the need for future studies further investigating and better analyzing the relationship between grocery workers’ self-reported mental health with workload, customer interactions, work culture, prevention measures, and organizational policies. Surveys available in more languages and including additional questions on psychosocial stressors, work culture, and mental health, constructed using established diagnostic tools for more measurable results, could be significant for these efforts.

Dominguez would like to recognize Dr. Anthony Pacini, MD, MPH; Suzanne Teran, MPH; Diane Bush, MPH; Laura Stock, MPH; Sadie Costello, PhD, MPH; and Carisa Harris-Adamson, PhD, CPE, for their research efforts, as well as UFCW Locals 5 and 324 for their support and partnership. Constancia Dominguez and Dr. Pacini's effort was supported by the Training Grant, T42OH008429, funded by NIOSH/CDC.

Resource:

Dominguez, Constancia: “COVID-19 Prevention Measures and Organizational Policies in the California Grocery Store Industry,” AIHce EXP Virtual Conference Presentation (May 25, 2021).