What Extraordinary Times Tell Us About Ordinary Ones: A Multiple Case Study of Precariously Employed Food Retail and Service Workers in Two U.S. State Contexts during the COVID-19 Pandemic

Disease prevention relies on a complex interplay between social context and individual behaviors. Work and the employment conditions that shape it are key domains where this interplay occurs, a reality highlighted by the COVID-19 pandemic. To explore the links between employment quality and social context as drivers of disease prevention, we conducted a multiple case study of food retail and services workers during COVID-19 in two U.S. states - Indiana and Washington - with differing norms and policy landscapes. We drew on public health surveillance data, government/NGO documents, and media sources to contextualize in-depth interviews with 26 precariously employed food workers. Analysis consisted of a within-case and a cross-case phase, each drawing on state contextual and interview data. Precariously employed food workers in Indiana and Washington had contrasting expectations of employers, government, and public health that we interpret as parallels of policies and norms in their respective states. Workers in both states discussed preventive behaviors in an individualized way, but appeared motivated by different constraints on their choices. Our study points to the importance of explicitly considering employment and the social safety net in public health to better prepare us for the next crisis and ameliorate health inequities under ordinary circumstances.