Rethinking Efforts to Improve Dietary Patterns Among Long-Haul Truck Drivers: Transforming Truck Stop Retail Food Environments Through Upstream Change.

A multitude of upstream occupational exposures influence poor dietary patterns that contribute to cardiometabolic health disparities among long-haul truck drivers in the United States. Herein, we delineate the unique characteristics of the truck driving profession that shape dietary patterns. Next, we discuss current health promotion efforts and why they are unlikely to be sufficient for improving population-level dietary patterns. We then advocate for prioritizing health promotion efforts that target upstream factors that influence population dietary patterns and have the potential to holistically and sustainably support drivers' nutrition. Finally, we propose novel research directions to catalyze upstream-oriented health promotion efforts.

Rural-urban, age, and gender disparities and trends in suicide and homicide: Multistate evidence across 12 years.

PURPOSE: Few studies have simultaneously assessed age and gender trends in homicide and suicide across the rural-urban continuum. Herein, we examine geographic and demographic trends in suicide and homicide death rates by: (1) determining overall macro and disaggregated trends; (2) examining differences in trends based on rural-urban county classification; and (3) identifying differences in stratified trends among age and gender classifications. METHODS: A retrospective study design used suicide and homicide data (n = 199,456) from years 2005to 2017 across 16 US states. Suicide and homicide deaths were grouped by age, gender, and rural-urban classification for descriptive analyses, and trends were analyzed using Joinpoint trend analysis software. FINDINGS: Violence resulted in 142,470 suicide and 56,986 homicide deaths between 2005 and 2017. Among both males and females, overall macro trends of suicide and homicide rates generally increased with greater rurality, and trends in rural rates differed from those in nonrural areas. Joinpoint trend analysis revealed significant increases in male suicide rates in large metropolitan (1.66%), micropolitan (1.78%), and rural areas (1.77%); female suicide rates in large metropolitan (2.17%), small metropolitan (3.25%), and micropolitan areas (3.26%); male homicide rates in large metropolitan areas (10.19%); and female homicide rates in rural areas (8.29%). Finally, when stratified by age, several significant trends were found, including increases in suicide rates among females aged 64 and older in rural areas (11.71%). CONCLUSIONS: Heterogeneous trends were found in suicide and homicide rates within specific rural-urban, age, and gender subgroups. Prevention efforts should proactively target those subgroups identified herein as most at-risk of violence.

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.

Syndemic Perspectives to Guide Black Maternal Health Research and Prevention During the COVID-19 Pandemic.

The coronavirus 2019 (COVID-19) pandemic and related policies have led to an unequal distribution of morbidity and mortality in the U.S. For Black women and birthing people, endemic vulnerabilities and disparities may exacerbate deleterious COVID-19 impacts. Historical and ongoing macro-level policies and forces over time have induced disproportionately higher rates of maternal morbidity and mortality among Black women and birthing people, and contemporary macroeconomic and healthcare policies and factors continue to hold particular consequence. These factors induce detrimental psychological, health, and behavioral responses that contribute to maternal health disparities. The COVID-19 pandemic is likely to disproportionately impact Black women and birthing people, as policy responses have failed to account for the their unique socioeconomic and healthcare contexts. The resulting consequences may form a 'vicious cycle', with upstream impacts that exacerbate upstream macro-level policies and forces that can further perpetuate the clustering of maternal morbidity and mortality in this population. Understanding the impacts of COVID-19 among Black women and birthing people requires theoretical frameworks that can sufficiently conceptualize their multi-level, interacting, and dynamic nature. Thus, we advocate for the proliferation of syndemic perspectives to guide maternal disparities research and prevention during the COVID-19 pandemic. These perspectives can enable a holistic and nuanced understanding of the intersection of endemic and COVID-19-specific vulnerabilities and disparities experienced by Black women and birthing people. Syndemic-informed research can then lead to impactful multi-level prevention strategies that simultaneously tackle both endemic and COVID-19-specific factors and outcomes that lead to the clustering of vulnerabilities and disparities over time.

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.

Embracing Causal Complexity in Health Disparities: Metabolic Syndemics and Structural Prevention in Rural Minority Communities.

Chronic discrimination and associated socioeconomic inequalities have shaped the health and well-being of Black Americans. As a consequence of the intersection of these factors with rural deprivation, rural Black Americans live and work in particularly pathogenic environments that generate disproportionate and interacting chronic comorbidities (syndemics) compared to their White and/or urban counterparts. Traditional prevention research has been unable to fully capture the underlying complexity of rural minority health and has generated mostly low-leverage interventions that have failed to reverse adverse metabolic outcomes among rural Black Americans. In contrast, novel research approaches-such as system dynamics modeling-that seek to understand holistic system structure and determine complex health outcomes over time provide a robust framework to develop a more accurate understanding of the key factors contributing to type 2 diabetes. This framework can then be used to establish more efficacious interventions to address disparities among minorities in rural areas. This paper advocates for a unified complex systems epistemology and methodology in advancing rural minority health disparities research. Toward this goal, we (1) provide an overview of rural Black American metabolic health research, (2) introduce a complex systems framework in rural minority health disparities research, and (3) demonstrate how community-based system dynamics modeling and simulation can help us plow new ground in rural minority health disparities research and action. We anticipate that this paper can serve as a catalyst for a long-overdue discourse on the relevance of complex systems approaches in minority health research, with practical benefits for numerous disproportionately burdened communities.

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.

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.

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.

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.