The “dirty work” of last responders: Occupational stigma risk and protective factors

Abstract

Last responders constitute an occupational category that includes all those who are involved in the postmortem care of deceased persons and their families. The work of last responders is often considered “dirty work” and, as a result, stigmatized. Last responders are aware of this stigma, and stigma consciousness has been associated with negative health outcomes. Despite the wide acknowledgment of stigma among last responders, specific risk, or protective factors for experiencing stigma have not been investigated. This paper aims to identify determinants of stigma among last responders in the United States. The data for this study were obtained from a national cross-sectional survey of last responders. The survey included a measure of stigma and multiple sociodemographic characteristics. A hurdle model was used to assess the association between the characteristics of last responders and their perceived stigma. Respondents were predominantly male (55.1%), White non-Hispanic (90.2%), and employed full-time (96%). Seventy-seven percent reported having experienced at least one form of occupation-related stigma. There was no significant association between the experience of stigma and any socio-demographic variables. The experience of stigma is nearly ubiquitous among last responders—>75% of last responders in the sample experienced at least one form of stigma. Another aspect of its ubiquitous nature is the lack of evidence that stigma was experienced differentially across sex, race/ethnicity, employment type, and length of years as a last responder. Interventions are needed to decrease stigma among last responders and to support last responders in managing the consequences of the stigma they experience.

Keywords:

• Stigma
• last responder
• risk factor

Acknowledgments

The authors would like to thank the nine last responder organizations/associations who agreed to share the survey with their members. These include (in alphabetical order): American Board of Medicolegal Death Investigators, Council of Funeral Association Executives (CFAE), International Order of Golden Rule, Iowa Funeral Directors Association, Johnson Consulting, National Association of Medical Examiners (NAME), National Funeral Directors Association (NFDA), Selected Independent Funeral Homes, Worsham College of Mortuary Science.

The authors would also like to thank the project advisory board which consists of last responders and other experts in emergency management. Without their guidance, our research would be less robust, and its implications less understood.

The authors would also like to thank the reviewers for their critical comments that strengthened this manuscript.

Finally, the authors would like to acknowledge and uplift the incredible work of last responders. Thank you for ensuring our loved ones who pass are put to rest with dignity and compassion, and for caring for our families. We see you. We appreciate you.

Data availability statement

The data that support the findings of this study are available on request from the corresponding author.

Disclaimer

The findings and conclusions in this article are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by CDC/HHS, or the U.S. Government.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This publication was funded through grants from: The University of Iowa Prevention Research Center for Rural Health through Cooperative Agreement Number U48DP006389 from the Centers for Disease Control and Prevention of the U.S. Department of Health and Human Services (HHS). The Funeral Service Foundation. The University of Iowa, College of Public Health.