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Assessing the impact of unionization on the relationship between workload and health among California janitors Kevin Ru* Kevin Ru Melissa Afterman Max Blumberg Dominic Pina Javier Freire Carisa Harris Ellen Eisen

Background: The COVID-19 pandemic placed substantial strain upon janitorial workers seeking to meet increased cleaning demands. Prior studies among California (CA) janitors found high workload groups had greater odds of adverse physical and mental health outcomes. Yet, there is limited insight on the impact of unionization on these relationships which our study sought to quantify.

Methods: We conducted a cross-sectional survey in 2022 of CA janitors from the Service Employees International Union (SEIU) and a non-union organization, the Maintenance Cooperation Trust Fund (MCTF). Workload exposure was assessed across 16 common tasks, accounting for intensity, frequency, and duration of each to calculate an overall workload index score. These were then categorized into low, medium, and high workload groups. Severe pain was measured using a 10-point numeric scale across 4 body regions while prevalence of anxiety and depression was determined using the PHQ-9 and GAD-7 surveys respectively. Logistic regression was used to assess for associations, adjusting for age and sex.

Results: For severe pain, union workers (N=240) saw 4.19-fold increased odds [95% CI: 1.51-11.64] compared to the reference group in contrast to the 13.35-fold odds in non-union workers (N=120) [95% CI: 4.37-40.77]. For anxiety and depression, high workload groups for both union (N=221) and non-union (N=123) had 2.25-fold [95% CI: 0.9-5.62] and 2.23-fold [95% CI: 0.59-8.45] increased odds respectively compared to the low workload group.

Conclusion: Non-union janitors had increased odds of severe pain prevalence compared to union. In contrast, for depression/anxiety, there was a high prevalence across all janitors, reflecting the mental burden they often face. This study has shown that these associations are worth further exploration and understanding in addressing and reducing occupational health disparities among janitors in California.