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Threat Avoidant Vigilance


“Research studies have examined “threat-avoidant” vigilant work, i.e., work that involves continuously maintaining a high level of vigilance in order to avoid disaster, such as loss of human life [56]. This is a feature of a number of occupations at high risk for CVD, e.g., truck drivers, air traffic controllers, and sea pilots. More recently, researchers have been investigating the health effects of employment insecurity and “downsizing” [60].” (Taken from: Schnall PL, Dobson M, Rosskam E, Editors Unhealthy Work: Causes, Consequences, Cures. Baywood Publishing, 2009.)

A cross-sectional study of San Francisco MUNI bus drivers conducted to evaluate the prevalence of hypertension in 1500 black and white male bus drivers (as compared to employed individuals in general) found that, after adjusting for age and race, hypertension rates for bus drivers were significantly greater than rates for each of the three comparison groups (individuals from a national survey, a local health survey and individuals undergoing baseline health examinations prior to employment as bus drivers).

Karen Belkic developed a Professional-Driver specific Occupational Stress Index in an effort to capture some of the effects of the work environment on drivers. She emphasizes that, “when the potential consequences of one’s actions can include disaster, work can become a threat-avoidant vigilant activity…. There is epidemiologic, human laboratory and experimental animal data that directly and indirectly links prolonged exposure to threat-avoidant vigilant activity with adverse cardiovascular outcomes, including cardiac electrical instability and even sudden cardiac death (Corley 1977, Lown 1990, Menotti 1985, Murphy 1991, Suurnakki 1987, Theorell 1993).” 

The OSI Questionnaire for professional drivers is about half the length of the General OSI, and the questions are very concrete and germane to this occupational group.

Below are a few select items from the OSI for professional drivers:

 16. Do you always have at least one break during your work day?   Yes   No

If yes, how many breaks do you usually have?_______
How long is your usual break?___________

17. The times at which you drive / your work schedule: 
*Do you have a regular work schedule?   Yes   No 
*If yes, when do you begin work? _____________ End work:________________

* Do you drive the split shift (early morning and afternoon rush hours)
   a. Yes, I constantly work the split shift
   b. Sometimes
   c. Rarely or never

*Do you drive in the dark/at night ?
   a. No, I work (drive) only during the daylight hours.
   b. Yes, I drive in the city at night, and/or when it’s dark.
   c. Yes, I drive inter-city (long routes) at night, and/or when it’s dark.
(If no, continue with question 18)

*If you drive on the job at night, 
Are the roads well lit?   Yes   No
Are the roads divided according to the direction of traffic?   Yes   No

*Do you drive after midnight (third/night shift)?   Yes   No
If yes, do you drive the night shift:
   a. Constantly
   b. On a rotating basis (describe please how this rotates:______________)

 19. Do you perform heavy lifting at work?

   a. Yes, often times during the day lift 50 kg ( 110 lbs), or more. 
   b. Yes, I lift from 20 to 50 kg loads (44 – 110 lbs) during my usual work day.
   c. Yes, I lift up to 20 kg (44 lbs) during my usual work day.
   d. No, I rarely or never lift anything heavy during work.

 20. What are the physical conditions like in your vehicle cabin?

   a. I have good shock absorbers and isolation. I don’t usually feel much vibration nor gases/fumes.
   b. I have poor shock absorbers, but good isolation. I feel vibration but not much gases/fumes
   c. I have good shock absorbers but poor isolation. I don’t usually feel much vibration but I do feel gases/fumes because the isolation is poor.
   d. I have poor shock absorbers and poor isolation. I feel vibration and also gases/fumes.

 22. Do you drive under specially hazardous conditions (check all answers that apply)

   a. Yes, I carry flammable/explosive material in my vehicle.
   b. Yes, I drive along winding, narrow roads
   c. Yes, I face threat of violence from passengers
   d. Yes, for another reason(s): ______________________________________________
   e. No, I face ordinary traffic conditions, but no special hazards.

 23. Have you even had an accident or been injured (including assault) at work?

   a. No
   b. Yes, only of a minor nature
   c. Yes, I have had one or more serious accidents or have suffered serious physical harm at work:

Please briefly describe all serious accidents or injuries 


56. Belkic, K., P. A. Landsbergis, P. Schnall, et al., Psychosocial Factors: Review of the Empirical Data among Men, in The Workplace and Cardiovascular Disease Occu- pational Medicine: State of the Art Reviews, Schnall, P., K. Belkic, P. A. Landsbergis, and D. Baker (eds.), Hanley and Belfus, Philadelphia, PA, pp. 24-46, 2000.

60. Vahtera, J., M. Kivimaki, J. Pentti, et al., Organisational Downsizing, Sickness Absence, and Mortality: 10-Town Prospective Cohort Study, British Medical Journal, 328:7439, p. 555, 2004.

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