Psychological Problems and Adverse Childhood Experiences among Sanitation Workers in India: An Ordinal Logistic Regression Analysis

Abstract

Sanitation workers in India are a marginalized workforce group exposed to adverse working environments, social stigma, and socioeconomic insecurity. Nevertheless, scarce empirical interest has been devoted to the role of pre-adolescent hardships in determining their mental and behavioural consequences at adulthood. The paper will discuss how the Adverse Childhood Experiences (ACE) could affect the development of substance-related psychological issues in sanitation workers in India. The data were collected using the quantitative and cross-sectional design, where 1,418 sanitation workers in ten states in India were sampled with the help of a structured and interviewer-administered questionnaire. The cumulative ACE score was used to measure ACE exposure and the degree of psychological problems using three ordinal outcomes, frequency of alcohol/drug/tobacco use, lack of ability to control substance use and the neglect of personal/family responsibilities owing to substance use. The PLUM procedure in SPSS was used to estimate the ordinal logistic regression models. Findings of the bivariate models revealed that the higher ACE scores, the more substance use, loss of control, and neglect of duties. Adjacent models, which incorporated the sociodemographic variables as well as occupational variables, affirmed that the relationships were statistically significant and verified all the six hypotheses of the study. The results revealed that cumulative childhood adversity has a long-lasting effect on the psychological functioning of adults and especially among employees whose jobs are characterized by stigmatization and instability like manual scavenging. Although there are certain breaches to the proportional odds assumption, the trends and effect consistency demonstrate the strength of the findings. This research paper brings to the literature the extension of ACE research to a less studied population of occupational health workers in India, and the importance of occupational health policies and early prevention measures on long-term psychosocial risks in sanitation workers.