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Exploring Occupational and Behavioral Risk Factors for Obesity in Urban Bus Drivers

Abstract:

About 4 million motor vehicle operators, including 0.7 million bus drivers are among the heaviest occupational groups in the United States. Little is known about occupational and behavioral risk factors for obesity among bus drivers, particularly minority (African-American and Hispanic) urban bus drivers. Also, few validated instruments are available for research on work and obesity among bus drivers. The ultimate goal of this study is to design and conduct effective and sustainable worksite obesity intervention studies that lower the risk for obesity and cardiovascular disease in urban bus drivers. The specific aims of this study, based on a participatory action research approach and with multiple research methods, are to a) continue to expand the ongoing collaboration between a multidisciplinary research team at the UC Irvine Center for Occupational and Environmental Health (UCI COEH), the Los Angeles County Metropolitan Transit Authority (LACMTA), the local union of the United Transportation Union (UTU), and the United Transportation Union – Metropolitan Transportation Authority Trust Fund (UTU-MTA Trust Fund) Wellness Program to form a Research Advisory Committee, b) to conduct six interviews, walk-throughs, and six focus groups (in total, up to 60 bus drivers) at LACMTA division offices or the LACMTA headquarters with bus drivers and other key informants in management, union, and the wellness program to identify and prioritize the specific working conditions and health-related behaviors associated with obesity among LACMTA bus drivers, and c) develop a bus driver work and health questionnaire based on existing surveys and an extensive literature review that will be culturally sensitive to the diversity of LACMTA bus drivers and will be further tested and used in future epidemiological observational and intervention studies. This study meets several research strategic goals of the National Occupational Research Agenda (NORA).

Specific Aims:

There are about 4 million motor vehicle operators, including 0.7 million bus drivers in the United States [1-2]. Obesity, an excessive accumulation of body fat, is a key health issue among bus drivers who have a high risk for cardiovascular disease (CVD) [3-4]. Bus drivers along with other motor vehicle operators were the first and second rank in prevalence of obesity among 41 male and female occupational groups in the United States [1]. Bus drivers (n=4,772) in the Los Angeles County Metropolitan Transit Authority (LACMTA) also have a very high percentage (86%) of African American and Hispanic drivers, whose risk of obesity and cardiovascular mortality is high compared to other ethnic groups. Little is known about occupational and behavioral risk factors for obesity and CVD among bus drivers, especially minorities. In addition, few validated instruments are available for research on work and obesity among bus drivers. The ultimate goals of this pilot study are to improve the cardiovascular health of bus drivers at the LACMTA and to reduce health disparity among working populations with diverse ethnic backgrounds by designing and conducting effective worksite obesity intervention studies. The specific aims of our study, based on a participatory action research (PAR) approach and with multiple research methods, are to a) continue to expand the ongoing collaboration between UC Irvine researchers, the LACMTA and the local union of the United Transportation Union (UTU) to form a Research Advisory Committee, b) to conduct interviews, walk-throughs, and focus groups with bus drivers and other key informants in management, the union, and the wellness program to identify and prioritize the specific working conditions and health-related behaviors associated with obesity among LACMTA bus drivers, and c) develop a bus driver work and health questionnaire that will be used in future epidemiological and intervention studies and will be culturally sensitive to the diversity of LACMTA bus drivers.

Background and Significance:

Why We Need To Learn More About Occupational and Behavioral Risk Factors For Obesity In Urban Bus Drivers. Obesity is a serious public health issue in the general population and among workers in the United States (US) [1, 5, 6]. Obesity has been well documented as a key risk factor for a wide range of chronic diseases such as hypertension, coronary heart disease, osteoarthritis, dyslipidemia, Type II diabetes, some cancers as well as increased mortality [7, 8]. Despite the high obesity prevalence rate among bus drivers, there have been few observational or intervention studies on bus drivers and obesity. To the best of our knowledge, only one cross-sectional epidemiological study [9] specifically examined significant differences in some health-related behaviors between normal weight and obese bus drivers in the Metro Transit Council of Minneapolis, Minnesota. While the study identified some behavioral risk factors for obesity among the bus drivers (e.g., less moderate or vigorous level of physical activity, more time sitting, more time watching television, and more frequent intake of soft drinks), the study was very limited in identifying the occupational risk factors which can affect adiposity of bus drivers directly or indirectly via or in combination with health-related behaviors among bus drivers. Ignoring structural barriers to healthy behaviors likely results in, at best a moderate success of obesity prevention among working populations in the short term, and in the long term the success cannot be maintained [10, 11]. In addition, worksite interventions targeting physical activity and dietary behaviors with a work environment component, albeit still scarce, have been found to be more effective in reducing weight than those without a work environment component [12].

There is emerging evidence that several adverse psychosocial working conditions can increase the risk for obesity among working populations (for review, see [13-15]). This was the case in our recently completed NIOSH funded project (called hereafter the FORWARD study) on work and obesity with firefighters who worked for Orange County Fire Authority (OCFA). Bus drivers have similar adverse psychosocial working conditions to firefighters: e.g., shift work [split-shift, a work shift is divided into two time zones (morning and afternoon) with an in-between non-work time], long work hours (up to 15 hours per day in the LAC-MTA workers); prolonged sedentary work, time pressure, low decision authority, and poor social relationships with coworkers supervisors, and customers) [3-4]. Additional stressful working conditions of bus drivers (e.g., violence from passengers; threat-avoidance vigilance; traffic and road conditions; work and family conflict; mechanical problems with the buses; poor safety climate; and labor-management relationship) [3-4] may contribute to increasing the risk for obesity among bus drivers.

A few articles of interest:

Exploring Occupational and Behavioral Risk Factors for Obesity in Firefighters: A Theoretical Framework and Study Design
Exploring Occupational and Health Behavioral Causes of Firefighter Obesity: A Qualitative Study

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