Hypertension and years of driving in transit vehicle operators

Challenges in Conducting Empirical Epidemiological Research with Truck and Bus Drivers in Diverse Settings in North America

Over 6.5 million commercial vehicle drivers were operating a large truck or bus in the United States in 2020. This career often has high stress and long working hours, with few opportunities for physical activity. Previous research has linked these factors to adverse health conditions. Adverse health conditions affect not only the professional drivers' wellbeing but potentially also commercial motor vehicle (CMV) operators' safe driving ability and public safety for others sharing the roadway. The prevalence of health conditions with high impact on roadway safety in North American CMV drivers necessitates empirical epidemiological research to better understand and improve driver health. The paper presents four challenges in conducting epidemiological research with truck and bus drivers in North America and potential resolutions identified in past and current research. These challenges include (1) the correlation between driving performance, driving experience, and driver demographic factors; (2) the impact of medical treatment status on the relationship between health conditions and driver risk; (3) capturing accurate data in self-report data collection methods; and (4) reaching the CMV population for research. These challenges are common and influential in epidemiological research of this population, as drivers face severe health issues, health-related federal regulations, and the impact of vehicle operation on the safety of themselves and others using the roadways.

Blood Pressure Response to Interrupting Workplace Sitting Time With Non-Exercise Physical Activity: Results of a 12-Month Cohort Study

Objective:

To evaluate the blood pressure (BP) effects of a yearlong e-health solution designed to interrupt prolonged occupational sitting time.

Methods:

BP data of 228 desk-based employees (45.1 ± 10.5 years) were analyzed at baseline, 3, 6, 9, and 12 months.

Results:

Systolic BP significantly reduced from baseline for the first 9 months (1.0 to 3.4 mmHg; P < 0.01) while diastolic and mean arterial pressure decreased for the full 12-months (4 to 5 mmHg for diastolic pressure and 3.6 to 4.2 mmHg for MAP; all P < 0.01).

Participants used the e-health solution 5.5 ± 2.0 times/day in the first 3 months which reduced to 4.2 ± 2.5 times/day by the end of the study (P < 0.05).

Conclusions:

An e-health solution designed to increase non-exercise physical activity by interrupting sitting time in the workplace is feasible and produced long-term reductions in blood pressure.

Early Detection of Undiagnosed Hypertension Based on Occupational Screening in the Hotel and Restaurant Industry

Blood pressure is the most important, modifiable risk factor for cardiovascular diseases. Lifestyle factors and also workload are the main, potential risk factors for the development of hypertension. This study focused on the early detection of unknown hypertension by screening employees in the hotel and restaurant industry (HRI). 148 HRI employees without hypertension (mean age: 34 years, men: 45%) self-measured their blood pressure during rest and for 24 hours of a normal workday. Individuals with a resting blood pressure ≥ 135/85 mmHg were classified as hypertensive. A further analysis investigated whether the currently applicable thresholds for hypertension during work, leisure, and sleep were exceeded on a working day. At rest, 36% of the study participants suffered from hypertension, which increased to 70% under workload and 46% during leisure time and dropped to 8% during sleep. Normal nocturnal dipping (10–20%) occurred only in 18% of cases; 78% were extreme dippers (>20%). Occupational hypertension screening is a suitable component of preventive healthcare. Resting blood pressure measurement alone is insufficient for the early detection of risk individuals and should be supplemented by 24-hour ambulatory blood pressure monitoring under working conditions. The impact of workload on blood pressure needs to be given more attention in the guidelines.

Interrupting prolonged sitting with brief bouts of light walking or simple resistance activities reduces resting blood pressure and plasma noradrenaline in type 2 diabetes

OBJECTIVE

Prolonged sitting is increasingly recognized as a ubiquitous cardiometabolic risk factor, possibly distinct from lack of physical exercise. We examined whether interrupting prolonged sitting with brief bouts of light-intensity activity reduced blood pressure (BP) and plasma noradrenaline in type 2 diabetes (T2D).

METHODS

In a randomized crossover trial, 24 inactive overweight/obese adults with T2D (14 men; mean ± SD; 62 ± 6 years) consumed standardized meals during 3 × 8 h conditions: uninterrupted sitting (SIT); sitting + half-hourly bouts of walking (3.2 km/h for 3-min) (light-intensity walking); and sitting + half-hourly bouts of simple resistance activities for 3 min (SRAs), each separated by 6-14 days washout. Resting seated BP was measured hourly (mean of three recordings, ≥20-min postactivity). Plasma noradrenaline was measured at 30-min intervals for the first hour after meals and hourly thereafter.

RESULTS

Compared with SIT, mean resting SBP and DBP were significantly reduced (P < 0.001) for both light-intensity walking (mean ± SEM; -14 ± 1/-8 ± 1 mmHg) and SRA (-16 ± 1/-10 ± 1 mmHg), with a more pronounced effect for SRA (P < 0.05 versus light-intensity walking). Similarly, mean plasma noradrenaline was significantly reduced for both light-intensity walking (-0.3 ± 0.1 nmol/l) and SRA (-0.6 ± 0.1 nmol/l) versus SIT, with SRA lower than light-intensity walking (P < 0.05). Mean resting heart rate was lowered by light-intensity walking (-3 ± 1 bpm; P < 0.05), but not SRA (-1 ± 1 bpm).

CONCLUSION

Interrupting prolonged sitting with brief bouts of light-intensity walking or SRA reduces resting BP and plasma noradrenaline in adults with T2D, with SRA being more effective. Given the ubiquity of sedentary behaviors and poor adherence to structured exercise, this approach may have important implications for BP management in patients with T2D.

Globalization, Work, and Cardiovascular Disease

Cardiovascular disease (CVD), a global epidemic, is responsible for about 30% of all deaths worldwide. While mortality rates from CVD have been mostly declining in the advanced industrialized nations, CVD risk factors, including hypertension, obesity, and diabetes, have been on the increase everywhere. Researchers investigating the social causes of CVD have produced a robust body of evidence documenting the relationships between the work environment and CVD, including through the mechanisms of psychosocial work stressors. We review the empirical evidence linking work, psychosocial stressors, and CVD. These work stressors can produce chronic biologic arousal and promote unhealthy behaviors and thus, increased CVD risk. We offer a theoretical model that illustrates how economic globalization influences the labor market and work organization in high-income countries, which, in turn, exacerbates job characteristics, such as demands, low job control, effort-reward imbalance, job insecurity, and long work hours. There is also a growing interest in “upstream” factors among work stress researchers, including precarious employment, downsizing/restructuring, privatization, and lean production. We conclude with suggestions for future epidemiologic research on the role of work in the development of CVD, as well as policy recommendations for prevention of work-related CVD.

Investigating obesity among professional drivers: the high risk professional driver study

OBJECTIVE

The aim of this study is to detect the main individual and transportation factors associated with obesity and its prevalence among Italian professional drivers (PDs).

METHODS

We performed a cross-sectional questionnaire survey. Data from PDs (n = 497) were used for analyses.

RESULTS

Sixty-one percent of participants were either overweight or obese according to their body mass index. Predictive factors for obesity were traveling more than 40,000 miles per year (odds ratio [OR] 4.20, confidence interval [CI] 1.41-12.56) and hours spent behind the wheel per day (OR 1.27, CI 1.02-1.58). Bus drivers had half the risk of being obese compared to truck drivers (OR 0.45, CI 0.23-0.87). An inverse association was detected between educational attainment and obesity (OR 0.32, CI 0.11-0.90).

CONCLUSIONS

PDs with high number of driving hours per day, miles driven per year, and low educational level should be subject to special educational programs to reduce and prevent obesity.

Breaking up prolonged sitting reduces resting blood pressure in overweight/obese adults

AIM

To compare the effect of 7 h of prolonged sitting on resting blood pressure with a similar duration of sitting combined with intermittent brief bouts of light-intensity or moderate-intensity physical activity.

METHODS AND RESULTS

Overweight/obese adults (n = 19; aged 45-65 years) were recruited for a randomized three-treatment crossover trial with a one-week washout between treatments: 1) uninterrupted sitting; 2) sitting with 2 min bouts of light-intensity walking at 3.2 km/h every 20 min; and, 3) sitting with 2 min bouts of moderate-intensity walking at between 5.8 and 6.4 km/h every 20 min. After an initial 2 h period seated, participants consumed a test meal (75 g carbohydrate, 50 g fat) and completed each condition over the next 5 h. Resting blood pressure was assessed oscillometrically every hour as a single measurement, 5 min prior to each activity bout. GEE models were adjusted for sex, age, BMI, fasting blood pressure and treatment order. After adjustment for potential confounding variables, breaking up prolonged sitting with light and moderate-intensity activity breaks was associated with lower systolic blood pressure [light: 120 ± 1 mmHg (estimated marginal mean ± SEM), P = 0.002; moderate: 121 ± 1 mmHg, P = 0.02], compared to uninterrupted sitting (123 ± 1 mmHg). Diastolic blood pressure was also significantly lower during both of the activity conditions (light: 76 ± 1 mmHg, P = 0.006; moderate: 77 ± 1 mmHg, P = 0.03) compared to uninterrupted sitting (79 ± 1 mmHg). No significant between-condition differences were observed in mean arterial pressure or heart rate.

CONCLUSION

Regularly breaking up prolonged sitting may reduce systolic and diastolic blood pressure.

TRIAL REGISTRATION NUMBER

ACTRN12609000656235 (http://www.anzctr.org.au) TRIAL REGISTRATION DATE: August 4th 2009.

Development of a logic model for a physical activity-based employee wellness program for mass transit workers

Transportation workers, who constitute a large sector of the workforce, have worksite factors that harm their health. Worksite wellness programs must target this at-risk population. Although physical activity is often a component of worksite wellness logic models, we consider it the cornerstone for improving the health of mass transit employees. Program theory was based on in-person interviews and focus groups of employees. We identified 4 short-term outcome categories, which provided a chain of responses based on the program activities that should lead to the desired end results. This logic model may have significant public health impact, because it can serve as a framework for other US mass transit districts and worksite populations that face similar barriers to wellness, including truck drivers, railroad employees, and pilots. The objective of this article is to discuss the development of a logic model for a physical activity–based mass-transit employee wellness program by describing the target population, program theory, the components of the logic model, and the process of its development.

Prevalence of undiagnosed diabetes mellitus and cardiovascular risk factors in Hong Kong professional drivers

AIMS

To investigate the prevalence of undiagnosed diabetes mellitus (DM) and cardiovascular risk factors among professional drivers in Hong Kong.

METHODS

Chinese professional drivers with no history of DM were invited to complete a questionnaire on their health status, followed by taking their body measurements, fasting blood glucose (FG) and lipids. 75g OGTT were performed when FG≥5.6 to <7.0mmol/L.

RESULTS

Of these 3376 drivers (male 92.6%, mean age 50.9±7.6 years), the prevalence of undiagnosed DM, prediabetes, and metabolic syndrome was 8.1% (272/3376, 95% CI 7.1-9.0%), 10.0% (337/3376, 95% CI 9.0-11.0%) and 26.8% (904/3376, 95% CI 25.3-28.3%) respectively, while the corresponding WHO Standard Population age-standardized prevalence was 7.8%, 9.0% and 24.7% respectively. Many of them were obese (51.2%), had hypertension (57.0%) and high cholesterol (58.7%), and a third had hypertriglyceridaemia (34.9%) and low HDL-cholesterol (29.3%). Their median working hours were 60.0 (IQR 14)h. Majority had exercise <1h/week (56.0%) and ate out ≥6times/week (54.9%).

CONCLUSIONS

Hong Kong professional drivers have higher prevalence of undiagnosed DM, cardiovascular risk factors and metabolic syndrome than the general population. Therefore, health care measures targeting against them should be taken to prevent and detect DM and cardiovascular diseases.

Improved blood pressure control among school bus drivers with hypertension

The impact of a hypertension awareness and educational program, BP DownShift, was evaluated among school bus drivers in a southern US state. At baseline (August 2007), blood pressure (BP) measurements, self-reported demographics, and hypertension awareness and management practices were collected from drivers who consented to participate in the study. Interventions included 4 educational mailings, installation of BP machines at all bus terminals, and access to free dietitian consultations and gym memberships. BP was evaluated using Department of Transportation guidelines. BP was remeasured and a survey was administered at follow-up (May 2008). At baseline, 208 drivers consented to the BP screening; 120 (58%) returned for a follow-up assessment. Most participants completing the study were female (73%) and African American (72%). Mean age was 50 years and mean body mass index was 32 kg/m(2); 52% of participants were obese. In all, 58% of participants reported a prior diagnosis of hypertension by a physician, and 63% reported taking antihypertensive medication. Both systolic and diastolic BP (SBP and DBP) were lower at follow-up (135/82 mmHg vs. 145/87 mmHg at baseline; P < 0.001, both comparisons); 42% had a reduction in SBP > 10 mmHg, and 44% had a reduction in DBP > 5 mmHg. At follow-up, 58% were controlled to BP < 140/90, compared to 38% at baseline (P < 0.001). At follow-up, an increased proportion of previously diagnosed drivers reported home BP monitoring, healthy diet, and regular exercise as components of hypertension self-management. The implementation of our hypertension education, self-management, and awareness program was associated with an improvement in BP control, which may positively impact commercial driver's license recertification as well as improve employee health.

Prevalência de hipertensão arterial entre motoristas de ônibus em Santa Maria, Rio Grande do Sul

OBJETIVOS: O objetivo deste estudo foi identificar a prevalência de hipertensão arterial sistêmica (HAS) em motoristas de ônibus urbanos de Santa Maria/RS e estudar fatores associados à mesma nesta categoria profissional. METODOLOGIA: Realizou-se um estudo epidemiológico do tipo transversal com 214 motoristas e igual número de vizinhos, selecionados por sexo e idade. Foi utilizado um questionário individual padronizado e realizadas medidas da pressão arterial, peso e altura no domicílio do entrevistado. RESULTADOS: A prevalência de HAS entre os motoristas foi de 22,4%, não apresentando diferença significativa entre os grupos, mesmo controlados os fatores de confusão. Entretanto, entre os motoristas, a obesidade (RP 2,30 IC95% 1,04-5,07) e os problemas psiquiátricos menores (RP 2,26 IC95% 1,15-4,43) estiveram associados à HAS. CONCLUSÕES: O FAto de Santa Maria ser uma cidade do interior, com um trânsito menos intenso e de menor complexidade pode ser uma explicação para que os motoristas não apresentem maior prevalência de HAS do que seus vizinhos. O perfil de classe parece ser mais importante do que as características específicas do trabalho de dirigir ônibus.

Alcohol, stress-related factors, and short-term absenteeism among urban transit operators

Transit operators, relative to workers in many other occupations, experience high levels of work-related stress, as documented through neuroendocrine elevations on the job vis-a-vis resting states (J Occup Health Psychol. 1998;3:122-129). Previous research suggests that self-reported job stress is associated with higher levels of alcohol consumption among transit operators (Alcohol Clin Exp Res. 2000;24:1011-1019) and with absenteeism (Working Environment for Local Public Transport Personnel, Stockholm: Swedish Work Environmental Fund, 1982; Work Stress. 1990;4:83-89). The purpose of this study was to examine the interrelationships between alcohol use, stress-related factors (stressful life events, job stressors, and burnout), and short-term absenteeism among a multiethnic cohort of urban transit operators. Self-reported measures of alcohol, stress-related factors, and short-term absenteeism were obtained from a sample (n=1,446) of San Francisco municipal transit operators who participated in the 1993-1995 Municipal Railway Health and Safety Study. Multivariate logistic regression analyses showed that absenteeism among drinkers was associated with risk for alcohol dependence [odds ratio (OR)=2.46, heavy drinking (OR=1.87), alcohol-related harm (OR=2.17), increased drinking since becoming a transit operator (OR=1.74), and having any problem drinking indicator (OR=1.72). The association between absenteeism and stress-related factors varied by gender and drinking status. Final multivariate models among drinkers indicated that among males, problem drinking (OR=1.82), stressful life events (OR=1.62), and job burnout (OR=1.22) were independently associated with elevated odds of absenteeism. Among female drinkers, only stressful life events (OR=5.17) was significantly associated with elevated odds of absenteeism. Findings suggest that workplace interventions that address both individual and environmental stressors are most likely to have a positive impact on health-related outcomes, including problem drinking, thereby reducing absenteeism.

Occupational stressors and hypertension: a multi-method study using observer-based job analysis and self-reports in urban transit operators

This multi-method study aimed to disentangle objective and subjective components of job stressors and determine the role of each for hypertension risk. Because research on job stressors and hypertension has been exclusively based on self-reports of stressors, the tendency of some individuals to use denial and repressive coping might be responsible for the inconclusive results in previous studies. Stressor measures with different degrees of objectivity were contrasted, including (1) an observer-based measure of stressors (job barriers, time pressure) obtained from experts, (2) self-reported frequency and appraised intensity of job problems and time pressures averaged per workplace (group level), (3) self-reported frequency of job problems and time pressures at the individual level, and (4) self-reported appraised intensity of job problems and time pressures at the individual level. The sample consisted of 274 transit operators working on 27 different transit lines and four different vehicle types. Objective stressors (job barriers and time pressure) were each significantly associated with hypertension (casual blood pressure readings and/or currently taking anti-hypertensive medication) after adjustment for age, gender and seniority. Self-reported stressors at the individual level were positively but not significantly associated with hypertension. At the group level, only appraisal of job problems significantly predicted hypertension. In a composite regression model, both observer-based job barriers and self-reported intensity of job problems were independently and significantly associated with hypertension. Associations between self-reported job problems (individual level) and hypertension were dependent on the level of objective stressors. When observer-based stressor level was low, the association between self-reported frequency of stressors and hypertension was high. When the observer-based stressor level was high the association was inverse; this might be indicative of denial of stress or alexithymia. We feel that multi-method studies are useful for disentangling the relations between objective and subjective stress and hypertension.

Coenzyme Q10-containing composition (Immugen) protects against occupational and environmental stress in workers of the gas and oil industry

The manual workers of the gas-and-oil extraction industry are exposed to hostile environmental and occupational conditions, resulting in elevated mortality and disability, due to chronic neurological and cardiovascular diseases. We evaluated the degree of oxidative stress, often associated with these pathological features, in the blood of manual and office employees of Russian Siberian extraction plants, and their psycho-physiological conditions. Results showed increased levels of spontaneous (p < 0.05) and PMA-activated (p < 0.01) luminol-dependent chemiluminescence (LDCL) in the white blood cells (WBC), and decreased peroxynitrite levels (p < 0.05) in the group of manual workers, and less markedly in the clerks and technicians working on spot, vs. a control group of city clerks. Superoxide release by WBC, and plasma/WBC membrane ubiquinol levels did not display major differences in the three groups. A relevant percentage of manual/office workers of extraction platforms presented impaired cardiovascular and neurological functions. The short term administration of a nutraceutical formulation based on coenzyme10, vitamin E, selenium, methionine and phospholipids led to significant improvement of cardiovascular parameters and psycho-emotional status, consistent with the normalization of LDCL and peroxynitrite production by WBC, with a good compliance to treatment confirmed by the increased blood levels of ubiquinol.

Hospital admissions among male drivers in Denmark

OBJECTIVES

To facilitate decisions about interventions and to establish baseline values for future evaluation of preventive efforts, the aim of the present study was to elucidate the disease pattern among male professional drivers in Denmark. The study differentiated between drivers of goods vehicles and drivers of passenger transport.

METHODS

Cohorts of all 20-59 year old Danish male professional drivers in the years 1981, 1986, 1991, and 1994 were formed, to calculate age standardised hospital admission ratios (SHRs) and time trends (1981-97) for many diagnostic aggregations.

RESULTS

SHRs for diseases in practically all systems and organs of the body were higher among professional drivers than they were in the male working population at large. Also drivers of passenger transport, compared with drivers of goods vehicles, had significantly high SHRs due to infectious and parasitic diseases, diseases of the circulatory system, and diseases of the respiratory system, and significantly lower rates of injury. For both driver groups, the SHRs for acute myocardial infarction increased with time whereas the SHR for acute gastritis decreased, and for drivers of passenger transport an increasing SHR for chronic obstructive pulmonary disease, was found over time.

CONCLUSION

Drivers of passenger transport and drivers of goods vehicles differ in their disease patterns. The results support the hypothesis that preventive efforts are needed in both groups, but underline that different strategies are required for different categories of drivers.