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International Bus Driver Study Proposal

I. Introduction

Rationale – Bus drivers are well documented to have higher rates of bodily injury, psychological disorders and increased prevalence of hypertension. Yet, the specific causes of these health outcomes are still not well understood particularly with regard to obesity, and cardiovascular illnesses. Drivers are exposed to multiple risk factors on the job while driving that impact their health including noxious chemicals, demanding schedules, potentially dangerous environments including both driving and passengers, as well as a number of psychosocial work stressors such as job strain (work high in demands and low in control) inter alia. (See Special Issue of Studies of Urban Mass-Transit Operators of the Journal of Occupational Health Psychology Vol 3 Nº2, April 1998).

We are particularly interested in the role of work hours, scheduling, deadlines, constraints and organizational psychosocial stressors as they might contribute to fatigue, mental exhaustion, obesity, elevated blood pressure and safety issues. We believe the presence of many of these stressors negatively impacts on the drivers mental functioning and ability to carry out their jobs properly thus contributing to accidents.

I. Possible Goals of this proposed research project

1) To identify and compare the prevalence of accidents, cardio-metabolic risks factors and psychosocial work factors among the country participants
2) To examine the associations between work stressors, in particular psychosocial stressors and accidents, cardio-metabolic risks factors in bus drivers samples from Colombia, México, Switzerland, Poland and the USA.
3) To determine the statistical contribution of different aspects of work, individual factors, job stress (e.g. as explained by the job strain and effort-reward imbalance models) in accidents and cardio-metabolic indicators (e.g. obesity, blood pressure, heart rate) in bus drivers from different countries.

Question to discuss:

It is understood among us that the research goals in each country will reflect the specific problems and needs of each particular country. Nonetheless, the challenge for us is it possible to define a common goal (or goals) for all participant researchers that will allow valuable comparisons between countries. What exposures and outcomes as well as methods should be selected as common? This would be a central issue for discussion at our meeting Saturday am May 18th at 8am.

II. Possible Methods and Procedures

A common design for the International Study could be a cross-sectional study.

A, Outcomes of Interest:

1) Accidents. This variable could be measured by records of the organization or self-report of bus drivers
2) Fatigue and Emotional Exhaustion
3) Metabolic Syndrome: Includes Obesity, Blood Pressure, Glucose, Triglycerides and Cholesterol (depending of selected criteria). Self reported and objective measures of these variables should be discussed.
4) Hearth rate, HRV cardiovascular symptoms.
5) Self reported health and compensation and health insurance claims.

B. Exposures of interest:

1) Universal work place stressors: Job strain, ERI, Job insecurity
Specific work stressors: route, clerical requirements, type of passengers, etc.
2) Work hours
3) Scheduling
4) Shifts
5) Other

C. Methods of common interest

A. Qualitative methods including focus groups.
B. Ambulatory monitoring
One approach we wish to explore with transit drivers would involve ambulatory monitoring of bus drivers including measuring cortisol, blood pressure, heart rate, heart rate variability and activity with simple and inexpensive monitors that can be worn during working hours. 

For this procedure a feasibility study should be carried out or could be completed in sub-samples if it is not possible to do it in the complete sample.

Example of a Bus Driver Feasibility Pilot Study :

Goal: Demonstrate feasibility defined as safety and comfort of collecting ambulatory physiological data in a small group of firefighters.

Complete approvals

Ambulatory measures
1) Ambulatory bp (Spacelabs or Omron devices)
2) Cortisol (oral swab)
3) Activity monitor (worn on body)
4) Heart rate and heart rate variability (chest strap). This methodology is highly recojmmended due to ease of use and value of outcome data.

We would need 5-10 volunteers per project to wear equipment.

Key question. Can a Spacelabs ambulatory BP monitor be worn safely while driving?

1) Safety – automated monitor will grab and squeeze are for 45 seconds
2) Can Spacelab’s device obtain a reliable reading while driving?

Need 5-8 readings in a workday of blood pressure to get a reliable estimate of an individual’s bp.

An alternative a to Spacelab’s device would be an automated wrist device. This could be put on, triggered and bp collected in 60 seconds. Would need a repeated window during the day in which to obtain these readings. Drivers would need to be trained in its use. When do such opportunities present themselves during the day? Red lights, traffic jams, rest breaks (how many of these occur during the work day). If they occur every 2 hours this is not enough intervals to collect 5-8 readings.


UCI Firefighter Obesity Research Project: Workplace Assessment to Reduce Disease (FORWARD)

Visit the FORWARD Study Website at: http://www.coeh.uci.edu/forward/

Firefighter Obesity Research: Workplace Assessment to Reduce Disease (FORWARD) is a 2-year project of the UCI-COEH, funded by the Center for Disease Control and Prevention/National Institute for Occupational Safety and Health (Award #: 1 R21 OH009911-01). The study will consider the unique working conditions and health behaviors of firefighters who work on a 24 hour-shift system. This will allow in the end to develop a firefighter-relevant work and health questionnaire along with several recommendations to reduce the obesity risk of firefighters. We propose this as an exploratory study which meets the public safety sub-sector strategic goals 1.4 and 1.5 of the National Occupational Research Agenda (NORA) and the Research to Practice (r2P) initiatives at the National Institute for Occupational Safety and Health.

NIOSH Exploratory and/or Developmental Grant Program (R21) 


PI: Choi, BongKyoo

Co-investigators: Schnall Peter MD, Leslie Israel MD, Marnie Dobson PhD, Pietro Galassetti MD, Dean Baker MD, Paul Landsbergis PhD (consultant).

Project Summary/Abstract

Among 41 male-dominated occupations, firefighters have the third highest prevalence rate of obesity. Few studies have examined the roles of working conditions and health behaviors of firefighters in obesity. In addition, few validated instruments — a methodological prerequisite for obesity studies in firefighters — are available that specifically assess the unique working conditions and health behaviors of firefighters who work on a 24 hour-shift system. Our long-term goals are to elucidate the roles of working conditions and health behaviors in the development of obesity among firefighters and to use this information to design and conduct intervention studies that lower CVD risk factors among firefighters by changing working conditions and health behaviors. The main aims of this proposal are a) to develop and validate a firefighter-relevant work and health questionnaire using qualitative and quantitative methods in firefighters enrolled in the Orange County Fire Authority (OCFA) Wellness Fitness (WEFIT) Program, b) to use this questionnaire in an epidemiological study to explore whether adverse working conditions and health behaviors are risk factors for obesity in firefighters, and c) to explore the interrelations between working conditions and health behaviors as they relate to obesity. A supplementary objective is to evaluate the strengths and weaknesses of Body Mass Index (BMI) as a measurement (commonly used as a surveillance measure of obesity in many WEFIT programs for firefighters) in comparison with skinfold-based body fat percent. For the purposes of this study, we will use a participatory action research (PAR) approach to build a work group of firefighters and researchers to develop and validate a questionnaire for assessing working conditions and health behaviors of firefighters. The developed questionnaire will be completed by about 350 OCFA firefighters over 15 months. A subsample of the firefighters (n=80) will be recruited to complete a 3-day food record and to wear an accelerometer during the same 3 days, and to fill in a short-form of the questionnaire for a one-week test and retest reliability. In addition, for analyses, the records of the WEFIT medical and fitness exams (Body Mass Indexes, body fat %, VO2 max, blood pressures, and blood lipid profiles) of the participants and archival records of 2004-2011 annual calls by each local OCFA fire station will be linked to the exposure profiles. At the end of this project a firefighter-relevant work and health questionnaire will have been developed, along with several recommendations to reduce the obesity risk of OCFA firefighters. We propose this as an exploratory study which meets the public safety sub-sector strategic goals 1.4 and 1.5 of the National Occupational Research Agenda (NORA) and the Research to Practice (r2P) initiatives at the National Institute for Occupational Safety and Health.

CSE Research Activities for 2010

The CSE’s research efforts are supported entirely by funds raised by contributions to the CSE or through contracts to evaluate worker health. The Center has developed and conducted occupational health projects with the support of 5 different unions and associated management groups over the last decade: HERE; UAW; CWA; IAFF; Orange County Fire Authority (Management).

CSE is finishing up a study conducted in November 2009 with Communications Workers of America (CWA) members employed as line-workers/technicians by Verizon in Southern California. Marnie Dobson (CSE Associate Director) prepared and presented a report to Verizon management and CWA representatives during a collective bargaining session in Southern Californiain March 2010. She also prepared a proposal outlining a study to be conducted in collaboration with Verizon Southern California and CWA to further study Verizon line workers and call-center workers. There has been no response from Verizon on this proposal. Marnie Dobson and Peter Schnall have published 2 abstracts presented at the November 2009 NIOSH Work and Health Conference in Puerto Rico describing the findings of work factors and health outcomes among CWA line workers.

The Center is currently involved in investigating work factors and their roles in obesity and hypertension among Orange County Firefighters (FF’s) in collaboration with the UCI Center for Occupational and Environmental Health.  Center staff at the UCI COEH recently wrote a successful two-year grant proposal to the CDC/NIOSH to study work characteristics, health behaviors and obesity risk in firefighters. The two-year study is currently underway at the UCI COEH as of November 2010 with collaboration from other CSE staff and is called the FORWARD project (Firefighter Obesity Research: Workplace Assessment to Reduce Disease)

FORWARD Project: Phase One of the project concluded with a last focus group (held on February 15th). The focus groups were conducted in order to revise/develop a firefighter work and health questionnaire. Phase Two to begin in May 2011 marks the beginning of recruitment and data collection. Our goal is to get 357 fire fighter respondents. Data collection is expected to take us into April of 2012. Phase Three is a sub-study, which begins sometime in June/July and takes us into December. It will include approximately 80 fire fighter participants who, for three days, will wear an accelerometer for physical activity monitoring and write what they eat in a food diary. Phase Four is ongoing and involves linking the WEFIT Clinical Data and the collection of BMI, body fat %, and CVD biological risk factors. OCFA archival data on call volume, etc., will also be collected. Phase Five, which will run between June and August of 2012 will involve holding new focus groups (to get feedback on the project and information collected therein), the submission of a final report to OCFA, along with an evaluation of the study and recommendations for prevention of obesity in OCFA fire fighters.

We have created a website for FF’s and the public to follow the progress of the project located at www.coeh.uci.edu/forward/index.htm. Please visit for more information and updates on our activities.

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