Dissertations and Theses

Date of Degree


Document Type


Degree Name

Doctor of Philosophy (Ph.D.)


Community Health and Social Sciences


Sandra E. Echeverria

Terry Huang

Committee Members

Sandra E. Echeverria

Terry Huang

Margrethe F. Horlyck-Romanovsky

Subject Categories

Community Health and Preventive Medicine | Public Health


Latino health, women's health, working conditions, psychosocial work stressors, Type 2 Diabetes Mellitus, health behaviors


Background: Type 2 Diabetes Mellitus (T2DM or ‘diabetes’) poses a significant public health challenge to the healthcare system, economy, and well-being of communities in the United States (U.S.). There are also substantial racial/ethnic and social disparities in diabetes incidence and control that have persisted for decades. For Latinos and other minoritized groups in the U.S., diabetes disparities may be linked to working conditions. Globally, work is considered a major determinant of health and yet studies in the U.S. tend to focus on legacy hazards, such as chemical, biological, and environmental factors. In recent years, occupational health scholars have argued for the inclusion of other measures of working conditions that can illustrate how work influences health in populations. Therefore, the objectives of this study are to examine if structural working conditions, such as work hours, and psychosocial work factors are associated with the prevalence of T2DM, diabetes-specific health behaviors and diabetes control in a diverse sample of U.S. workers.

Methods: I utilized data from the National Health Interview Survey (NHIS) and the National Health and Nutrition Examination Survey (NHANES), two publicly available nationally representative surveys that are designed to represent the U.S. population. In Aim 1, I estimated prevalence ratios (PR) to examine the association between psychosocial work factors (job insecurity, hostile work environment, and work-life interference) and health damaging behaviors (physical inactivity, smoking, and binge drinking) among all U.S. workers (N=18,970). I additionally stratified by race/ethnicity and sex and reported statistical significance for the interaction terms. For Aim 2, I examined if work hours (≤20, 21-39, 40, 41-50, and >50 hours worked per week) are associated with diabetes prevalence among Latinos (N=2,970) and tested for effect measure modification by nativity status (foreign-born and U.S.-born). For Aim 3, I examined if work hours are associated with diabetes control (optimal vs. suboptimal) among U.S. workers (N=1,041) diagnosed with diabetes and tested for interaction effects by race/ethnicity and sex.

Results: In Aim 1, models testing for interaction between work hostility and race/ethnicity (p for interaction

Discussion: Study findings showed that non-Latino Black workers and women were more likely to experience bullying, harassment, and threats in work contexts. A substantial percentage of U.S. workers living with diabetes are not properly controlled. Future research should explore workers’ experiences of workplace harassment to develop effective interventions and workplace health promotion programs that prevent health damaging coping mechanisms associated with psychosocial work stressors. Additional research is also needed to examine other working conditions, such as overnight hours, which may have a greater effect on T2DM prevalence due to disruptions to metabolic processes via interrupted sleep patterns. Results also indicated that workplace policies and programs are urgently needed to support optimal diabetes control in the U.S. working population. This dissertation research presents much needed evidence to support the health of U.S. workers.



To view the content in your browser, please download Adobe Reader or, alternately,
you may Download the file to your hard drive.

NOTE: The latest versions of Adobe Reader do not support viewing PDF files within Firefox on Mac OS and if you are using a modern (Intel) Mac, there is no official plugin for viewing PDF files within the browser window.