A blueprint for a new commercial driving epidemiology: An emerging paradigm grounded in integrative exposome and network epistemologies

Excess health and safety risks of commercial drivers are largely determined by, embedded in, or operate as complex, dynamic, and randomly determined systems with interacting parts. Yet, prevailing epidemiology is entrenched in narrow, deterministic, and static exposure-response frameworks along with ensuing inadequate data and limiting methods, thereby perpetuating an incomplete understanding of commercial drivers' health and safety risks. This paper is grounded in our ongoing research that conceptualizes health and safety challenges of working people as multilayered "wholes" of interacting work and nonwork factors, exemplified by complex-systems epistemologies. Building upon and expanding these assumptions, herein we: (a) discuss how insights from integrative exposome and network-science-based frameworks can enhance our understanding of commercial drivers' chronic disease and injury burden; (b) introduce the "working life exposome of commercial driving" (WLE-CD)-an array of multifactorial and interdependent work and nonwork exposures and associated biological responses that concurrently or sequentially impact commercial drivers' health and safety during and beyond their work tenure; (c) conceptualize commercial drivers' health and safety risks as multilayered networks centered on the WLE-CD and network relational patterns and topological properties-that is, arrangement, connections, and relationships among network components-that largely govern risk dynamics; and (d) elucidate how integrative exposome and network-science-based innovations can contribute to a more comprehensive understanding of commercial drivers' chronic disease and injury risk dynamics. Development, validation, and proliferation of this emerging discourse can move commercial driving epidemiology to the frontier of science with implications for policy, action, other working populations, and population health at large.

The indispensable whole of work and population health: How the working life exposome can advance empirical research, policy, and action

OBJECTIVES

The thesis of this paper is that health and safety challenges of working people can only be fully understood by examining them as wholes with interacting parts. This paper unravels this indispensable whole by introducing the working life exposome and elucidating how associated epistemologies and methodologies can enhance empirical research.

METHODS

Network and population health scientists have initiated an ongoing discourse on the state of empirical work-health-safety-well-being research.

RESULTS

Empirical research has not fully captured the totality and complexity of multiple and interacting work and nonwork factors defining the health of working people over their life course. We challenge the prevailing paradigm by proposing to expand it from narrow work-related exposures and associated monocausal frameworks to the holistic study of work and population health grounded in complexity and exposome sciences. Health challenges of working people are determined by, embedded in, and/or operate as complex systems comprised of multilayered and interdependent components. One can identify many potentially causal factors as sufficient and component causes where removal of one or more of these can impact disease progression. We, therefore, cannot effectively study them by an a priori determination of a set of components and/or properties to be examined separately and then recombine partial approaches, attempting to form a picture of the whole. Instead, we must examine these challenges as wholes from the start, with an emphasis on interactions among their multifactorial components and their emergent properties. Despite various challenges, working-life-exposome-grounded frameworks and associated innovations have the potential to accomplish that.

CONCLUSIONS

This emerging paradigm shift can move empirical work-health-safety-well-being research to cutting-edge science and enable more impactful policies and actions.

Work Challenges and Health of Immigrant Hotel Housekeepers: Part 2

Background:

Hotel housekeepers’ major responsibility is to perform cleaning tasks. In the course of performing their duties, hotel housekeepers are disproportionately exposed to multiple workplace hazards (i.e., physical, chemical, biological, and psychosocial hazards) that put them at risk of adverse health consequences. This study aims to discover the occupational and health challenges encountered by immigrant hotel housekeepers in Orlando, Florida, and help hotel management to develop strategies to improve their occupational health.

Methods:

This study adopted an interviewer-administered survey method for data collection. Data were collected from members of the United Here Union, Local 7373 in Orlando, Florida. Trained Spanish–English bilingual associates of the Union administered the surveys through interviews with participants. Descriptive statistics and stepwise multiple regression were employed to analyze data ( n = 140) using SPSS 22.

Findings:

This study shows that Florida hotel housekeepers participating in this study worked under great time pressures, endured excessive workloads, did not have enough time to rest and recover, and often skipped or shortened lunch breaks. Participants believed that their employers valued work productivity more than their safety and health. More than half of the respondents experienced racial discrimination at their workplaces.

Conclusion/Application to Practice:

The article brings an important contribution to the awareness of housekeepers’ feelings toward their work and the need for effective safety and health policies and programs.

Does sarcopenia predict perioperative mortality in patients with advanced ovarian cancer?

OBJECTIVE

The aim of this study was to assess prognostic value of frailty for the prediction of surgical complications and mortality in women with end-stage ovarian cancer subjected to curative oncological surgery and its value for long-term follow-up.

PATIENTS AND METHODS

A total of 75 advanced-stage consecutive ovarian cancer patients who underwent elective surgery were investigated. The demographic data and clinical information related to the oncologic treatment were collected in the electronic and physical case records and included the following: age, ethnic group, comorbidities, staging of cancer, surgical procedure details, lymphadenectomy, American Society of Anesthesiology (ASA) grade, anesthetic technique, operative blood loss, operative time, and residual disease. A radiologist, who was blinded to patient outcomes, performed quantitative assessment of psoas muscle areas using the available computed tomography scan images at the caudal end of the third lumbar vertebra.

RESULTS

The mean age was 61.2 ± 18.2 years, and the percentage of patients over 65 years was 78%. Comorbidities (hypertension, diabetes, chronic obstructive pulmonary disease, renal insufficiency) were seen in 37 patients (49%). Histological types were adenocarcinoma in all patients (0) mostly serous adenocarcinoma (62%) and stage 3 (58%). According to psoas muscle measurement, 55 patients (73%) were nonsarcopenic and 20 patients (26%) were sarcopenic. Debulking procedures were performed on all patients. Also, bowel resection was applied in 40% of patients. Preoperative anesthetic examinations had shown that they were mostly ASA score 2 (44 patients). Moreover, 26 patients were ASA score 3. Generally, total operative time was between 121-240 minutes, and total blood loss was generally under 500 ml. Postoperative complications were seen in 26% of the patients. Non-surgical complications were observed in 14% of the patients, while non-surgical complications were observed in 12%. Length of the hospital stay >10 days was seen in 10 patients. Mortality was seen in 1 patient 30 days after operation. Nonsurgical complications (pneumonia, urinary tract infections, cardiac complications) were significantly higher in comparison to nonsarcopenic patients. However surgical complications were comparable between each group. Mortality after hospitalization and length of hospital stay were significantly higher in sarcopenic patients in comparison with the nonsarcopenic group.

CONCLUSIONS

The use of the value of the psoas muscle region is considered to be a method to predict the in-hospital mortality when there is an available abdominal CT scan that has already been performed for ovarian cancer patients with a significant comparable clinical and laboratory background. According to the findings, patients had worse surgical outcomes and higher postoperative nonsurgical complication rate when sarcopenic patients were compared to nonsarcopenic patients. Moreover, postoperative mortality and length of hospital stay were significantly higher in sarcopenic patients in comparison to non-sarcopenic group.

Psychometric Properties of the Turkish Version of the Coronavirus-Related Health Literacy Scale

Background

This study aims to assess the validity and reliability of the Coronavirus-Related Health Literacy Questionnaire adapted to Turkey and examine the levels of coronavirus-related health literacy among the adults.

Methods

This cross-sectional study was carried out in Turkey. The tools were applied to a total sample population of 452 people. Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA) were calculated to determine the construct validity of the questionnaire with the IBM SPSS Amos program version 24.0.

Results

The validity and reliability analyses of the Coronavirus-Related Health Literacy (HLS-COVID-Q22) questionnaire were adapted to Turkish. Internal consistency was very high (α = 0,963) and construct validity suggests a sufficient model fit, making HLS-COVID-Q19 a feasible tool for assessing coronavirus-related health literacy in population surveys. The findings show that the questionnaire is a valid and reliable tool consisting of 19 items and 3 subdivisions. The mean coronavirus-related health literacy score of the participants was found to be 2.92 (±0.51), meaning that it was on average. The coronavirus-related health literacy level of 18.8% of the participants was found to be ‘inadequate’ while 37.8% had ‘problematic’ and 43.4% ‘sufficient’ health literacy. The HLS-COVID-Q19-TR scores of those in the young age group (18-29 years old), married, employed, university graduates, and vaccinated against COVID-19 were found to be higher, and a statistically significant difference was found (p = 0.049, p = 0.009, p = 0.029, p = 0.012 and p = 0.051, respectively).

Conclusions

The results of the research reveal that the HLS-COVID-Q19-TR is a valid and reliable tool. In this study, more than half of the participants were found to have “inadequate” or “problematic” coronavirus-related health literacy levels. For this reason, studies aimed at improving society's coronavirus-related health literacy should be conducted.

Key messages

Occupational Health and Safety of Immigrant Hotel Housekeepers

BACKGROUND

The accommodations sector is one of the largest employers of immigrant and minority workers in the United States. Hotel housekeepers represent the industry's largest workforce while facing difficult work conditions, health hazards, and psychological stress. This is one of the few empirical studies that address the working conditions of housekeepers in the United States and their perspective of health challenges they face.

METHODS

A cross-sectional survey study was conducted with hotel housekeepers (N = 140) in Florida and in collaboration with the local labor union as a rapid assessment of occupational health and safety risk exposures, work-related injuries, coping mechanisms, and perceived management responses. Experienced union workers recruited study participants and administered interviewer-administered surveys. The analysis included descriptive statistics and multivariate regression.

FINDINGS

Sampled hotel housekeepers were found to work under significant time pressures to complete excessive workloads and to experience chemical and biological exposures and physical and psychosocial strains. Poor work equipment/insufficient supplies had a negative impact on hotel housekeepers' health, these include heavy wet towels vacuum cleaners having a significant effect on (p < .001) sprains and strains. Poor cleaning supplies had a significant effect (p < .001) on chemical burns. Other significant findings are provided in the article.

CONCLUSION/APPLICATION TO PRACTICE

While housekeeping work conditions include many challenges, relatively simple changes by hotels' management can provide potential relief and improve workers' health and safety outcomes, such as functional equipment, sufficient inventory, management support, and proper rest breaks-subsequently increasing workers' health and reducing accidents, and thus potentially improving productivity at a relatively low cost.

Work, physical activity, and metabolic health: Understanding insulin sensitivity of long-haul truck drivers

BACKGROUND

Long-haul truck drivers are disproportionately exposed to metabolic risk; however, little is known about their metabolic health and the role of physical activity and other risk factors in metabolic outcomes.

OBJECTIVE

This study compares truck drivers' insulin sensitivity, and associations between metabolic risk factors and insulin sensitivity, with those of the general population.

METHODS

Survey, anthropometric, and biometric data were collected from 115 long-haul truckers, which were then compared to the general population data using the National Health and Nutrition Examination Survey (NHANES) dataset. The quantitative insulin sensitivity check index (QUICKI) was used to estimate insulin sensitivity.

RESULTS

Truck drivers had lower QUICKI scores than the general population cohort. Sagittal abdominal diameter and exercise were predictive for QUICKI among combined cohorts. Waist circumference and perceived health were more predictive for QUICKI among truck drivers, and sagittal abdominal diameter and income were more predictive for QUICKI among the general population.

CONCLUSIONS

Long-haul truckers appear to represent a subset of the general population regarding the impact of physical activity and other metabolic risk factors on QUICKI. Accordingly, comprehensive efforts which target these factors are needed to improve truckers' physical activity levels and other metabolic risks.

Exploring the Role of Social Network Structure in Disease Risk among U.S. Long-haul Truck Drivers in Urban Areas

Objective: Using mixed methods, we explored properties of long-haul truckers' social networks potentially influencing STI/BBI acquisition and transmission. Methods: We recruited inner-city drug and sex network members (N = 88) for interviews. Blood and urine samples and vaginal swabs were collected to test for STIs/BBIs. Data were collected on participants' role in the network (trucker, sex worker, or intermediary), sexual and substance-use behaviors, and dyadic relationships with drug and/or sex contacts. We analyzed network data using UCINET. Results: Data revealed 2 major network clusters (58 male truckers, 6 male intermediaries, and 24 female sex workers; 27.3% STI/BBI positive). Overall, 18.8% of network members had more than one type of risky relationship with the same person (multiplexity), 11.4% of dyads were between 2 STI/ BBI positive people (assortative mixing), 36.4% were between one STI/BBI positive person and one negative person (disassortative mixing), 44.3% of people were connected to more than one person who was STI/BBI positive (concurrency), and 62.5% of nodes were just one path removed from an STI/BBI positive individual (bridging). Conclusion: Despite only 27.3% of the network being STI/BBI positive, our results revealed network characteristics (and potential intervention points) that amplify risk of disease spread within trucker-centered networks.

Syndemic frameworks to understand the effects of COVID-19 on commercial driver stress, health, and safety

INTRODUCTION

U.S. commercial drivers are entrenched in a stressogenic profession, and exposures to endemic chronic stressors shape drivers' behavioral and psychosocial responses and induce profound health and safety disparities. To gain a complete understanding of how the COVID-19 pandemic will affect commercial driver stress, health, and safety over time, and to mitigate these impacts, research and prevention efforts must be grounded in theoretical perspectives that contextualize these impacts within the chronic stressors already endemic to profession, the historical and ongoing forces that have induced them, and the potentially reinforcing nature of the resulting afflictions.

METHODS

Extant literature reveals how an array of macro-level changes has shaped downstream trucking industry policies, resulting in stressogenic work organization and workplace characteristics. Emerging evidence suggests that the COVID-19 pandemic exacerbates existing stressors and introduces novel stressors, with potentially exacerbatory impacts on health and safety disparities.

RESULTS

As COVID-19 exerts an array of multi-level stressors on commercial drivers, syndemic frameworks can provide the appropriate theoretical lens to guide research and prevention. Syndemic frameworks can provide the grounding to allow foregoing commercial driver COVID-19 research to transcend the limitations of prevailing research frameworks by contextualizing COVID-19 stressors holistically within the complex system of endemic chronic stressors and interrelated health and safety afflictions. Syndemic-informed prevention efforts can then be implemented that simultaneously tackle multiple afflictions and the macro-level forces that result in the emergence of commercial drivers' health and safety disparities over time.

CONCLUSIONS

The impacts of the COVID-19 pandemic on commercial drivers cannot be adequately understood or acted upon in isolation from the endemic chronic stressors and interrelated health and safety disparities that characterize the profession. Instead, commercial driver COVID-19 research and prevention needs syndemic frameworks to holistically understand the impacts of COVID-19 on commercial driver stress, health, and safety, and to identify high-leverage preventive actions.

A novel COVID-19 based truck driver syndemic? Implications for public health, safety, and vital supply chains

U.S. long-haul truck drivers traverse great distances and interact with numerous individuals, rendering them vulnerable to acquiring and transmitting coronavirus disease 2019 (COVID-19). Together, the unique co-occurrence of pronounced health disparities and known COVID-19 infection, morbidity, and mortality risks suggest the possibility of a novel COVID-19 based truck driver syndemic due to advanced driver age and endemic health issues. In turn, COVID-19 sequelae may perpetuate existing health disparities. The co-occurrence of afflictions may also result in compromised safety performance. To curb the likelihood of a COVID-19 based truck driver syndemic, several action stepsare needed. First, key COVID-19 metrics need to be established for this population. Second, relationships between long-haul trucker network attributes and COVID-19 spread need to bedelineated. Third, mutually reinforcing interactions between endemic health disparities and COVID-19 vulnerability need to be elucidated. Finally, grounded in the aforementioned steps, policies and interventions need to be identified and implemented.

A novel COVID-19 based truck driver syndemic? Implications for public health, safety, and vital supply chains

U.S. long-haul truck drivers traverse great distances and interact with numerous individuals, rendering them vulnerable to acquiring and transmitting coronavirus disease 2019 (COVID-19). Together, the unique co-occurrence of pronounced health disparities and known COVID-19 infection, morbidity, and mortality risks suggest the possibility of a novel COVID-19 based truck driver syndemic due to advanced driver age and endemic health issues. In turn, COVID-19 sequelae may perpetuate existing health disparities. The co-occurrence of afflictions may also result in compromised safety performance. To curb the likelihood of a COVID-19 based truck driver syndemic, several action stepsare needed. First, key COVID-19 metrics need to be established for this population. Second, relationships between long-haul trucker network attributes and COVID-19 spread need to bedelineated. Third, mutually reinforcing interactions between endemic health disparities and COVID-19 vulnerability need to be elucidated. Finally, grounded in the aforementioned steps, policies and interventions need to be identified and implemented.

Understanding the effects of COVID-19 on the health and safety of immigrant hospitality workers in the United States

The U.S. tourism and hospitality workforce is disproportionately represented by immigrants and minorities, particularly in low-wage jobs with adverse work conditions. Immigrant hotel and foodservice workers face excess chronic stress and related syndemic risks, exacerbated by social, political, and economic inequities. COVID-19 has suddenly intensified the stressful and already difficult circumstances of immigrant service sector workers. The travel and tourism sector is one of the hardest hit due to widespread travel restrictions and shelter-in-place orders designed to curb infection spread. Restrictions and lockdowns have devastated tourism-dependent destinations and displaced millions of vulnerable workers, causing them to lose their livelihoods. Compared to the general workforce, a sizeable increase in occupational stress has already been observed in the hospitality/tourism sector over the past 15-20 years. COVID-19 and related fears add further strains on immigrant hotel and foodservice workers, potentially exerting a significant toll on mental and physical health and safety.

Work-Life Conflict among U.S. Long-Haul Truck Drivers: Influences of Work Organization, Perceived Job Stress, Sleep, and Organizational Support

Work-life balance and job stress are critical to health and well-being. Long-haul truck driving (LHTD) is among the unhealthiest and most unsafe occupations in the U.S. Despite these disparities, there are no extant published studies examining the influence of work, stress and sleep outcomes on drivers’ work-life balance. The current study investigated whether adverse work organization, stress, and poor sleep health among LHTDs are significantly associated with work-life conflict. Logistic regression was used to examine how work organization characteristics, job stress, and sleep influenced perceived stress and a composite measure of work-life conflict among a sample of 260 U.S. LHTDs. The pattern of regression results dictated subsequent analyses using structural equation modeling (SEM). Perceived job stress was the only statistically significant predictor for work-life balance. Fast pace of work, sleep duration and sleep quality were predictors of perceived job stress. SEM further elucidated that stress mediates the influences of fast work pace, supervisor/coworker support, and low sleep duration on each of the individual work-life balance indicators. There is an urgent need to address work conditions of LHTDs to better support their health, well-being, and work-life balance. Specifically, the findings from this study illustrate that scheduling practices and sleep outcomes could alleviate job stress and need to be addressed to more effectively support work-life balance. Future research and interventions should focus on policy and systems-level change.

The Impact of Work Organization, Job Stress, and Sleep on the Health Behaviors and Outcomes of U.S. Long-Haul Truck Drivers

Background. Compared with other occupations, long-haul truck drivers (LHTD) engage in excessively unhealthy behaviors and experience disproportionately poor health outcomes. Health promotion efforts targeting LHTDs focus on improving individual-level behaviors; however, this occupation is replete with adverse work organization characteristics, high job stress, and compromised sleep health, which are hypothesized to cause poor health behaviors and outcomes among LHTDs. Therefore, the purpose of this study was to explore the connections between work characteristics, job stress, and sleep outcomes, and health behaviors and physical and mental health outcomes among LHTDs. Method. This was a cross-sectional study, using interviewer-administered surveys with LHTDs (n = 260). Bivariate correlation analysis was used to explore the associations among work organization, job stress, sleep health, and health behaviors and outcomes. Logistic regression analyses were used to determine whether these work organization, job stress, and sleep factors predicted health behaviors and outcomes. Results. Long work hours of more than 11 hours daily (odds ratio [OR] = 2.34) resulted in increased odds of high caffeine consumption. High job stress (OR = 0.48) and poor sleep quality (OR = 0.42) led to decreased odds for spending at least 1 hour daily for cooking/eating. Low sleep duration, less than 7 hours daily (OR = 2.55), led to increased odds of a physical health diagnosis. Both high job stress (OR = 3.58) and poor sleep quality (OR = 2.22) resulted in increased odds of a mental health diagnosis. Conclusion. Health promotion efforts targeting LHTDs need to be coupled with upstream policy, environmental, and systems-level change, especially at the governmental and trucking industry levels.

Occupational health disparities among U.S. long-haul truck drivers: the influence of work organization and sleep on cardiovascular and metabolic disease risk

OBJECTIVE

The organization of work has undergone vast transformations over the past four decades in the United States and has had profound impacts on worker health and wellbeing. The profession of commercial truck driving is one of the best examples. Particularly for long-haul truck drivers, changes in work organization have led to disproportionately poor physiological, psychological, and sleep health outcomes.

METHODS

The present study examined disparities in cardiometabolic disease risk among long-haul truck drivers and the general population, and the influence of work organization and sleep in generating these outcomes. Researchers collected survey data from 260 drivers, and blood assay samples from 115 of those drivers, at a large highway truck stop in North Carolina. Comparisons were made for cardiovascular and metabolic risk against the 2011-2012 National Health and Nutrition Examination Survey (NHANES). In addition, logistic regression was used to explore predictive relationships between work organization and sleep and risk for cardiovascular and metabolic disease.

RESULTS

There were statistically significant mean differences between the long-haul truck driver sample and the NHANES sample for both cardiovascular (3.71 vs. 3.10; p <0.001) and metabolic (4.31 vs. 3.09; p <0.001) disease risk. The truck driver sample was less physically active and had lower HDL cholesterol along with greater levels of smoking, BMI, and metabolic syndrome diagnosis. More years of driving experience and poor sleep quality were statistically significant predictors for both cardiovascular and metabolic disease risk.

CONCLUSIONS

Study findings implicate elements of the occupational milieu experienced by long-haul truck drivers that induce disproportionate cardiometabolic disease risk. Sleep quality, largely compromised by poor work conditions and workplace environments, plays a significant role in increased risks for cardiometabolic disease. There is an urgent need for longitudinal studies of this critical occupational sector as well as intervention research centered on policy and systems level change.

Can subjective sleep problems detect latent sleep disorders among commercial drivers?

INTRODUCTION

Long-haul truck drivers experience poor sleep health and heightened accident rates, and undiagnosed sleep disorders contribute to these negative outcomes. Subjective sleep disorder screening tools may aid in detecting drivers' sleep disorders. This study sought to evaluate the value of subjective screening methods for detecting latent sleep disorders and identifying truck drivers at-risk for poor sleep health and safety-relevant performance.

MATERIALS AND METHODS

Using cross-sectional data from 260 long-haul truck drivers, we: 1) used factor analysis to identify possible latent sleep disorders; 2) explored the construct validity of extracted sleep disorder factors by determining their associations with established sleep disorder risk factors and symptoms; and 3) explored the predictive validity of resulting sleep disorder factors by determining their associations with sleep health and safety-relevant performance.

RESULTS

Five latent sleep disorder factors were extracted: 1) circadian rhythm sleep disorders; 2) sleep-related breathing disorders; 3) parasomnias; 4) insomnias; 5) and sleep-related movement disorders. Patterns of associations between these factors generally corresponded with known risk factors and symptoms. One or more of the extracted latent sleep disorder factors were significantly associated with all the sleep health and safety outcomes.

DISCUSSION

Using subjective sleep problems to detect latent sleep disorders among long-haul truck drivers may be a timely and effective way to screen this highly mobile occupational segment. This approach should constitute one component of comprehensive efforts to diagnose and treat sleep disorders among commercial transport operators.

US long-haul truck driver work organization and the association with cardiometabolic disease risk

Work organization, including long working hours, irregular work schedules, and job stress, has been associated with increased cardiometabolic disease (CMD) risk for numerous working populations. The purpose of this study was to examine the associations between work hours, work schedules, job stress, and CMD risk for a sample of US long-haul truck drivers (LHTDs). A nonexperimental, descriptive, cross-sectional design was employed to collect survey and anthropometric data from 260 US LHTDs at a major truck stop. The mean BMI was 33.40 kg/m² and mean waist circumference was 114.77 cm. Using logistic regression, researchers found longer work hours, especially greater than 11 hours daily, were associated with increased odds for an extremely high risk of CMD. Results support comprehensive and integrated approaches that address work organization, and in particular long working hours, to reduce drivers' CMD risk.

Perceived workplace mistreatment: Case of Latina hotel housekeepers

BACKGROUND

Latina hotel housekeepers' social class, gender, race/ethnicity, nationality, and United States immigration status render them particularly vulnerable to workplace mistreatment.

OBJECTIVE

We sought to reveal the array of policy- and interpersonal-related mistreatment experienced by Latina hotel housekeepers in the southeastern United States employed at 75 local hotels which included 4-star, 3-star, 2-star, and 1-star properties.

METHODS

This ethnographic study involved 27 in-depth interviews with Latina hotel housekeepers. Using semi-structured in-depth interview guides, participants were interviewed until collected data reached saturation. Data were coded to explore themes and relationships for the housekeepers' work environments, and thick descriptions of these environments were developed.

RESULTS

Participants ranged in work experience from 1 to 15 years, with all but one unable to reach full-time status, and were paid between $7.25 and $8.00 per hour. Policy-related phenomena, such as low pay, lack of paid sick leave or overtime, and absence of appropriate cleaning tools or protective equipment were all perceived as forms of mistreatment by Latina hotel housekeepers. Interpersonal mistreatment in the form of supervisor favoritism, unfair work assignments, biased allocation of cleaning supplies, disrespect, and verbal abuse due to ethnicity was also perceived.

CONCLUSIONS

Latina hotel housekeepers endure mistreatment that impacts their psychosocial and physical occupational health. We provide recommendations to minimize workplace mistreatment and improve well-being of Latina hotel housekeepers.

Understanding the role of sleep quality and sleep duration in commercial driving safety

INTRODUCTION

Long-haul truck drivers in the United States suffer disproportionately high injury rates. Sleep is a critical factor in these outcomes, contributing to fatigue and degrading multiple aspects of safety-relevant performance. Both sleep duration and sleep quality are often compromised among truck drivers; however, much of the efforts to combat fatigue focus on sleep duration rather than sleep quality. Thus, the current study has two objectives: (1) to determine the degree to which sleep impacts safety-relevant performance among long-haul truck drivers; and (2) to evaluate workday and non-workday sleep quality and duration as predictors of drivers' safety-relevant performance.

MATERIALS AND METHODS

A non-experimental, descriptive, cross-sectional design was employed to collect survey and biometric data from 260 long-haul truck drivers. The Trucker Sleep Disorders Survey was developed to assess sleep duration and quality, the impact of sleep on job performance and accident risk, and other relevant work organization characteristics. Descriptive statistics assessed work organization variables, sleep duration and quality, and frequency of engaging in safety-relevant performance while sleepy. Linear regression analyses were conducted to evaluate relationships between sleep duration, sleep quality, and work organization variables with safety composite variables.

RESULTS

Drivers reported long work hours, with over 70% of drivers working more than 11h daily. Drivers also reported a large number of miles driven per week, with an average of 2,812.61 miles per week, and frequent violations of hours-of-service rules, with 43.8% of drivers "sometimes to always" violating the "14-h rule." Sleep duration was longer, and sleep quality was better, on non-workdays compared on workdays. Drivers frequently operated motor vehicles while sleepy, and sleepiness impacted several aspects of safety-relevant performance. Sleep quality was better associated with driving while sleepy and with job performance and concentration than sleep duration. Sleep duration was better associated with accidents and accident risk than sleep quality.

DISCUSSION

Sleep quality appears to be better associated with safety-relevant performance among long-haul truck drivers than sleep duration. Comprehensive and multilevel efforts are needed to meaningfully address sleep quality among drivers.

US long-haul truck driver health demands integrated approach

Purpose

The purpose of this paper is to provide a review of both occupational safety and health (OSH) and worksite health promotion (WHP) efforts targeted at long-haul truck drivers (LHTDs) and to identify strengths and weaknesses to inform future interventions and/or policy changes.

Design/methodology/approach

Review of the literature was done to identify theoretical and methodological approaches frequently used for protecting and promoting the health and well-being of LHTDs.

Findings

Health and safety issues impacting LHTDs are complex and naturally interrelated. Historically, the majority of approaches to the health and safety of LHTDs have emphasized the safety side and there has been a lack of comprehensive and integrated WHP/OSH attempts.

Originality/value

The literature pertaining to LHTD health has expanded in recent years, but intervention and policy efforts have had limited success. Several scholars have discussed the need for integrating WHP/OSH efforts for LHTD health, but have not actually provided a description or a framework of what it entails in which the authors provide a conclusion to the review of the literature. The authors provide a critical discussion regarding a collaborative approach focused on National Institute of Occupational Safety and Health’s Total Worker Health model. The integration further promotes an advancement of theoretical and methodological strategies.

Obesity indices are predictive of elevated C-reactive protein in long-haul truck drivers

BACKGROUND

Obesity rates in long-haul truck drivers have been shown to be significantly higher than the general population. We hypothesized that commercial drivers with the highest levels of general obesity and abdominal adiposity would have higher concentrations of high sensitivity C-reactive protein (CRP), a marker of inflammation.

METHODS

Survey and anthropometric data were collected from 262 commercial drivers. Weight, circumference measures, and blood analysis for CRP (N = 115) were conducted and compared to National Health and Nutrition Examination Survey (NHANES) data. CRP values were non-normally distributed and logarithmically transformed for statistical analyses.

RESULTS

BMI, waist circumference, sagittal abdominal diameter, and CRP were significantly higher than in the general population. Anthropometric indices that included height (BMI, waist-to-height ratio, and sagittal diameter-to-height ratio), were most predictive of CRP values.

CONCLUSIONS

Abdominal obesity is prevalent in commercial vehicle drivers and is an important indicator of the presence of inflammation in this population. Am. J. Ind. Med. 59:665-675, 2016. © 2016 Wiley Periodicals, Inc.

Work patterns, sleeping hours and excess weight in commercial drivers

BACKGROUND

Work and sleep patterns for commercial motor vehicle (CMV) drivers often include long working hours, shift work and diminished sleep duration and quality, which have been linked to overweight, obesity and other problems.

AIMS

To explore possible connections between work, sleep and obesity among CMV drivers.

METHODS

Survey and anthropometric data were collected from male long-haul CMV drivers in central North Carolina, USA, over a period of 6 months. Drivers' body mass index (BMI) was used as a measure of total body obesity and sagittal abdominal diameter (SAD) as a measure of central adiposity.

RESULTS

Among the 260 study subjects, mean BMI was 33.1 (64% were obese or morbidly obese) and mean SAD was 32.3cm, classifying 89% of drivers as being at high or very high cardiometabolic risk. About 83% of drivers worked an irregular daily schedule, 64% worked irregular total daily hours, 32% worked irregular days of the week and 46% reported getting <7h of sleep during work nights. Significant predictors of BMI included the number of hours worked daily (P < 0.05) and the age (P < 0.01) of the driver, while age was also a significant predictor for SAD (P < 0.05). Significant predictors of sleep quality included the extent of shift work (P < 0.05) and sleep duration (P < 0.001).

CONCLUSIONS

Work and sleep configurations appear to affect the weight status of CMV drivers. Shift work and sleep duration are both associated with the weight status of CMV drivers, and both appear to function as indicators of their sleep quality.

Mapping U.S. long-haul truck drivers' multiplex networks and risk topography in inner-city neighborhoods

This article illustrates how urban inner-city trucking milieux may influence STI/BBI/HIV acquisition and transmission risks for U.S. long-haul truckers, as well as their social and risk relationships. Using mixed methods, we collected ethnoepidemiological and biological data from long-haul truck drivers and their risk contacts in inner-city trucking milieux in Atlanta, Georgia, United States. Key findings indicate that within the risk-endemic environment of distressed inner-city areas, diverse trucking risk milieux can amplify STI/BBI/HIV risk for multiplex networks of truckers. Inner-city neighborhood location, short geographic distance among risk contacts, and trucker concurrency can potentially exacerbate transmission via bridging higher-risk individuals with lower-risk populations at disparate geographic and epidemiological locations.

Surveying the Impact of Work Hours and Schedules on Commercial Motor Vehicle Driver Sleep

Background

Given the long hours on the road involving multiple and interacting work stressors (i.e., delivery pressures, irregular shifts, ergonomic hazards), commercial drivers face a plethora of health and safety risks. Researchers goal was to determine whether and to what extent long-haul trucker work schedules influence sleep duration and quality.

Methods

Survey and biometric data collected from male long-haul truck drivers at a major truckstop in central North Carolina over a six month period.

Results

Daily hours worked (mean = 11 hours, 55 minutes) and frequency of working over government-mandated daily HOS regulations (23.8% “frequently or always”) were statistically significant predictors of sleep duration. Miles driven per week (mean = 2,812.61), irregular daily hours worked (63.8%), and frequency of working over the daily hour limit (23.8% “frequently or always”) were statistically significant predictors of sleep quality.

Conclusion

Implications of findings suggest a comprehensive review of the regulations and operational conditions for commercial motor vehicle drivers be undertaken.

Health survey of U.S. long-haul truck drivers: work environment, physical health, and healthcare access

OBJECTIVE

While trucking in industrialized nations is linked with driver health afflictions, the role of trucking in U.S. truckers' health remains largely unknown. This paper sheds light on links between the trucking work environment and drivers' physical health.

METHODS

Using a cross-sectional design, 316 truckers were enrolled in the Healthy Trucker Survey. Questions included work history, physical and mental health, and healthcare access. PASW 18 was used to examine patterns among factors.

PARTICIPANTS

316 truckers participated.

RESULTS

Respondents were mainly full-time, long-haul drivers with over 5 years of experience, and who spent over 17 days on the road per month. While almost 75% described their health as good, 83.4% were overweight/obese, 57.9% had sleeping disturbances, 56.3% fatigue, 42.3% musculoskeletal disorders, and about 40% cardiovascular disease concerns. About 33% had no health insurance, 70% had no regular healthcare visits, 24.4% could not afford insurance, and 42.1% took over-the-counter drugs when sick, while 20.1% waited to reach home for medical care. Exercise facilities were unavailable in over 70% of trucking worksites and 70% of drivers did not exercise regularly.

CONCLUSIONS

The trucking occupation places drivers at high risk for poor health outcomes. Prospective studies are needed to delve into how continued exposure to trucking influences the progression of disease burden.

Risks endemic to long-haul trucking in North America: strategies to protect and promote driver well-being

Long-haul truck drivers in North America function in a work context marked by excess physical and psychological workload, erratic schedules, disrupted sleep patterns, extreme time pressures, and these factors' far-reaching consequences. These work-induced stressors are connected with excess risk for cardiometabolic disease, certain cancers, and musculoskeletal and sleep disorders, as well as highway crashes, which in turn exert enormous financial burdens on trucking and warehousing companies, governments and healthcare systems, along with working people within the sector. This article: 1) delineates the unique work environment of long-haul truckers, describing their work characteristics and duties; (2) discusses the health hazards of long-haul trucking that impact drivers, the general population, and trucking enterprises, examining how this work context induces, sustains, and exacerbates these hazards; and (3) proposes comprehensive, multi-level strategies with potential to protect and promote the health, safety, and well-being of truckers, while reducing adverse consequences for companies and highway safety.

Sex work in trucking milieux: "lot lizards," truckers, and risk

BACKGROUND

Long-haul truckers often engage in risk-laden sexual mixing and drug exchanges with female sex workers while on the road, which increase their vulnerability to sexually transmitted infections/blood borne infections (STI/BBI).

OBJECTIVE

An ethnoepidemiological study of STI/BBI in trucker-centered populations was conducted at four truckstops in the United States. This article reports findings from an analysis of the female sex worker data, which show how mobility and transience, as well as poverty, homelessness, and exposure to violence, have the potential to exacerbate the occupational health risks of female sex workers.

METHODS

Phase 1 involved nonparticipant observation of trucker risk network groups in public and semi-public settings at two Arizona truckstops. Phase 2 was a large-scale ethnoepidemiological study of STI/BBI risk among trucker networks at two Georgia truckstops. Ten sex workers in Phoenix and 29 in Atlanta were interviewed individually or in focus groups. Textual data were analyzed using QSR NVivo 8 and serological data collected from the Georgia sample were analyzed for STIs/HIV.

RESULTS

Infections occur within these populations, where the existence of multiple risks delivered via multiple channels within physical proximity maintains infection and transmission.

CONCLUSIONS

Environmental-level interventions, such as better security at truck stops, and individual-level interventions, such as STI/BBI infection education and testing for FSWs and truckers, can contribute to safer settings for truckers, sex workers, and their sex and drug partners.

Trucking organization and mental health disorders of truck drivers

There are over 3 million truck drivers employed in the commercial transportation and material moving occupations, one of the largest occupational groups in the United States. Workers in this large and growing occupational segment are at risk for a range of occupational health-induced conditions, including mental health and psychiatric disorders due to high occupational stress, low access and use of health care, and limited social support. The purpose of this study was to explore male truck drivers' mental health risks and associated comorbidities, using a cross-sectional and quantitative design. Data were collected from a random sample of 316 male truckers between the ages of 23 and 76 at a large truck stop located within a 100-mile radius of Greensboro, North Carolina, USA, using a self-administered 82-item questionnaire. Surveyed truckers were found to have significant issues affecting their mental health, such as loneliness (27.9%), depression (26.9%), chronic sleep disturbances (20.6%), anxiety (14.5%), and other emotional problems (13%). Findings have potential to help researchers develop interventions to improve the emotional and occupational health of truck drivers, a highly underserved population. Mental health promotion, assessment, and treatment must become a priority to improve the overall trucking environment for truckers, the transportation industry, and safety on US highways.

Human rights and health disparities for migrant workers in the UAE

Systematic violations of migrant workers' human rights and striking health disparities among these populations in the United Arab Emirates (UAE) are the norm in member countries of the Gulf Cooperation Council (GCC). Migrant laborers comprise about 90 percent of the UAE workforce and include approximately 500,000 construction workers and 450,000 domestic workers. Like many other GCC members countries, the UAE witnessed an unprecedented construction boom during the early 2000s, attracting large numbers of Western expatriates and increasing demand for cheap migrant labor. Elite Emiratis' and Western expatriates' dependence on household staff further promoted labor migration. This paper offers a summary of existing literature on migrant workers and human rights in the UAE, focusing on their impact on related health ramifications and disparities, with specific attention to construction workers, domestic workers, and trafficked women and children. Construction workers and domestic laborers are victims of debt bondage and face severe wage exploitation, and experience serious health and safety problems resulting from inhumane work and living conditions. High rates of physical, sexual, and psychological abuse impact the health of domestic workers. Through a review of available literature, including official reports, scientific papers, and media reports, the paper discusses the responsibility of employers, governments, and the global community in mitigating these problems and reveals the paucity of systematic data on the health of migrant workers in the Gulf.

Cruising for truckers on highways and the internet: sexual networks and infection risk

Empirical evidence on the heterosexual partnerships of long-haul truckers suggests connections among occupational stressors, substance misuse, structural factors, and risk for sexually transmitted infections and HIV. Yet the potential risks associated with same-sex partnerships of truckers and truckchasers (men who specifically cruise for truckers) remain largely unknown. Drawing from diverse sources as well as primary and secondary data from 173 truckers and "truckchasers," we discuss how trucking and cruising contexts, in conjunction with Internet fora, jointly create a risk-enabling environment for truckers and their sex contacts. Findings point toward an elusive but extensive sexual network that spans across the Internet and highways and takes advantage of truckers' mobility as it bridges disparate epidemiological spaces and populations. The delineation of cruising within the hypermasculine occupational sector of trucking adds new insights to the study of sexual health, which is particularly important considering the riskladen sex contacts of truckers and truckchasers and potential for infection spread.

Occupational stressors and the mental health of truckers

Trucking has been classified as one of the highest-risk occupations in the United States. Occupational stress is even greater for long-haul truckers who are away from home, family, friends, and other support networks for several days or weeks at a time. Occupational stressors and the mental health of truckers was studied using data collected as part of a large multisite ethno-epidemiological study of trucker networks. Findings from the current study show that truckers face many occupational stressors including constant time pressures, social isolation, disrespectful treatment from others, driving hazards such as weather changes, traffic, and road conditions, and violence or fear of violence. Facing such stressors may be a factor in the prevalence of risky behaviors including drug use and paying for sex. Therefore, mental health promotion and treatment for truckers is an important area of concern and must be examined within the broader context of the transportation environment.

Worksite-induced morbidities among truck drivers in the United States

A critical review was conducted of social, psychological, and health science literature on the array of health risks and morbidities of truckers. Multilevel worksite-induced strains (e.g., long work hours and fatigue, shift work and sleep deprivation, postural fatigue and exposure to noise and vibration, sedentary lifestyle and unhealthy diet, exposure to diesel exhaust fumes, and other occupational stressors) were categorized into six primary morbidities for truckers: (1) psychological and psychiatric disorders; (2) detriments resulting from disrupted biological cycles; (3) musculoskeletal disorders; (4) cancer and respiratory morbidities; (5) cardiovascular disease; and (6) risk-laden substance use and sexual practices. Elevated morbidity risks suggest the need for the design and implementation of systematic epidemiological research and environmental interventions in the transport sector.

The effect of topical doxycycline usage on gingival crevicular fluid MMP-8 levels of chronic and aggressive periodontitis patients: a pilot study

The aim of this study was to evaluate the efficacy of topical subgingival application of doxycycline hyclate (DH) gel adjunctive to non-surgical periodontal therapy on gingival crevicular fluid (GCF) matrix metalloproteinase (MMP)-8 levels in chronic and aggressive periodontitis patients. Forty teeth of 10 chronic periodontitis patients and 32 teeth of eight aggressive periodontitis patients were screened for 6 months. Scaling and root planing (SRP) was applied to the control sites and DH gel adjunctive to SRP was applied to the test sites of each patient simultaneously. GCF MMP-8 levels were analysed at baseline, 7 days; and at 1, 3 and 6 months by Sandwich Elisa Method. At 1, 3 and 6 months, probing depth (P < 0.0051) and plaque scores and bleeding on probing values (P = 0.000) significantly decreased in each group when compared with the baseline, but there was no statistically significant difference between the test and control sites. GCF MMP-8 levels reduced presenting statistically significant differences on 7 days, 1, 3 and 6 months in four of the groups (P < 0.05); however, intergroup differences were not statistically significant. Developing functional and immunological-based chair-side MMP tests might serve as useful adjunctive diagnostic tools when monitoring the effects of DH gel application.

HIV-risk behaviours of American spring break vacationers: a case of situational disinhibition?

Young adults are at high risk for acquiring STDs/HIV due primarily to multiple sex partners, unprotected sex, and substance use combined with sexual activity. Contranormative settings--such as the annual spring break vacation--provide ideal conditions for the potentially lethal interaction between alcohol, drugs, and sexual risk-taking. As a steadily growing form of youth travel and characterized by binge drinking, illicit drug use, and unsafe sexual practices, spring break has become a North American institution involving large numbers of travellers. In this study, the theory of interpersonal behaviour was used to explain college students' health-risk behaviours in the context of spring break and pre- and post-spring break surveys were used to examine casual sex and condom use behaviours. Multivariate analyses revealed peer influences, prior experiences with casual sex, alcohol consumption prior to sex, and impulsivity to be significant predictors of casual sex, while impulsivity and condom availability were significant predictors of students' use of condoms during casual sex.

Effects of norepinephrine on NMDA-induced neurotoxicity in cerebellar granular cell culture of rat pups

In this study, norepinephrine was tested in 0.1, 1, 10, 25 and 50 microM doses in 100 microM NMDA toxicity on cerebellar granular cell culture of rats. NMDA in 100 microM concentration induced cell death significantly with respect to controls. Death cell population was 1.08 +/- 0.44% in control and 22.15 +/- 2.46% in 100 microM NMDA (P < 0.0001). None of the norepinephrine concentrations administrated 15 min prior to NMDA was able to reduce death cell scores to control levels. Results were 8.75 +/- 0.83% in 0.1 microM, 7.0 +/- 1.01% in 1 microM, 17.25 +/- 1.31% in 10 microM, 35.5 +/- 1.38% in 25 microM and 17.9 +/- 1.72% in 50 microM norepinephrine plus 100 microM NMDA administrated groups (P < 0.0001 for all with respect to control). Labetalol, as an alpha and beta blocker in 0.5 microM concentration which was given 15 min prior to norepinephrine was able to block the effects of it. In comparison with 100 microM NMDA administered group, only low doses of norepinephrine reduced the death cell scores significantly (for 0.1 and 1 microM norepinephrine plus NMDA groups; P < 0.0001). For 10 and 50 microM norepinephrine plus NMDA groups, death cell scores were found statistically insignificant from the NMDA-administered group (P > 0.05 for both) while for the 25 microM norepinephrine plus NMDA group, the death cell score was found to be statistically increased (P < 0.0001).

Response to nimodipine in caffeine-induced neurotoxicity in cerebellar granular cell culture of rat pups

Methylxanthines (theophylline, theobromine and caffeine) are widely used as central nervous system stimulants and caffeine is used in the treatment of apnea in newborns. Plasma therapeutic concentration of caffeine is around 110 microM. Caffeine diffuses the blood brain barrier easily, increasing oxygen consumption in neurones and leading to cell death. In the present study, 4-7-day-old rats were used to obtain cerebellar granular cell cultures. Caffeine was used 50, 150, 250 and 350 microM concentrations and the most toxic dose for it was found to be 350 microM. Death cell scores were 0.9+/-0.63 for control, 1.1+/-0.63 for 50 microM, 0.89+/-0.47 for 150 microM (P>0.05 for both), 3.84+/-0.8 for 250 microM (P=0.024) and 6.2+/-0. 86 for 350 microM (P=0.001) caffeine concentrations. The role of voltage-dependent calcium channels in caffeine-induced neurotoxicity was tested with the doses of 100 and 200 microM nimodipine 45 min before or after the 350 microM caffeine. Both doses of nimodipine after caffeine administration were found to be ineffective in blocking neurotoxicity. Doses administered 45 min prior to caffeine, reduced death cell score to 0.89+/-0.23 (P=0.000) for 100 microM nimodipine and 2.35+/-0.96 (P=0.000) for 200 microM nimodipine administration into the cultures. A dose-dependent manner of nimodipine in ischemic states is well-known. In the light of these results, nimodipine may be used in the treatment of newborn apneas together with caffeine to prevent neurotoxic side effects of high or repeated doses of it.

High frequency of sister chromatid exchanges in lymphocytes of the patients with Behçet's disease

Behçet's disease (BD) (OMIM 109650) is an immunogenetically based multisystem disease, characterized by iridocyclitis, arthritis, orogenital ulcerations and pustular skin lesions. Viral and autoimmune etiologies have been suggested and HLA-B5 has been found to predominate in BD. The disease is most seen in Turkey and Japan. Although familial cases have been reported, the mode of inheritance is not clear. To determine the genetic instability in BD, sister chromatid exchange (SCE) analysis has been performed on peripheral lymphocytes in 23 patients and 20 healthy controls. We found significantly higher SCE rates in the patient group (p < 0.0001). Our results may indicate that genetic impairment and genetic instability may play an important part in the etiology of BD.