Abstract P344: Tipped-wage Work is Associated With Greater Perceived Stress in US Women

Background: Low income and income volatility are risk factors for stress and stress-induced illnesses such as hypertension. Subminimum wage, ranging from $2.13 to $7.82 in 43 states, applies to certain service occupations such as wait staff. The implicit assumption behind this law is that, combined with tips, subminimum wage ensures earnings equal to or greater than the minimum wage. However, tips are unpredictable and vary based on shift, day of week, season, and fluctuations in the economy. Women make up 67% of the tipped-wage workforce. We tested the hypothesis that women in tipped-wage occupations experience greater perceived stress and hypertension relative to women in non-tipped service occupations and non-tipped non-service occupations. Methods: We used data from the National Longitudinal Study of Adolescent to Adult Health (Wave IV, 2007-2008; age 24-33 years; n=3,562). In multivariable ordinal logistic regression, perceived stress tertiles (Cohen’s Perceived Stress Scale score: 0-3, 4-6, and 7-16) and hypertension (Normotensive, Stage 1, and Stage 2 relative to 7 th Report of the Joint National Committee standards) were modeled as a function of self-reported occupation type (US Bureau of Labor Statistics categories, classified as tipped-wage, non-tipped service, and non-tipped non-service). Models were adjusted for early life and adolescent confounders, such as parental socioeconomic status (SES) and experiences of maltreatment. Results: On average, women in non-service non-tipped occupations were from higher SES families and were themselves more educated than tipped and non-tipped service workers. Women in tipped and non-tipped service occupations were similar, with non-tipped workers coming from slightly lower SES families. For women in tipped-wage occupations, the odds of being in a higher perceived stress score tertile were 54% greater than women in non-tipped service occupations (OR: 1.54; 95%CI: 1.08,2.19) and 65% greater when compared to women in non-tipped non-service occupations (OR: 1.65; 1.21,2.26). The odds of having a higher hypertensive stage among tipped-wage workers were 45% lower than women in non-tipped service occupations (OR: 0.55; 95%CI: 0.32,0.94) but were similar to women in non-tipped non-service occupations (OR: 0.72; 95%CI: 0.43,1.21). Conclusions: In a nationally representative sample of women, working in a tipped-wage service occupation was associated with greater perceived stress, even when compared to other service occupations that similarly offer low wages with limited job control and employ women from relatively similar backgrounds. The negative association between tipped-wage occupations and hypertension may reflect selectivity related to the physical demands of tipped-wage work. Our findings suggest that reliance on tips to supplement wages may exacerbate stress relative to similar work afforded a reliable minimum wage.