Work organization, health, and obesity in urban transit operators: A qualitative study.

BACKGROUND: Urban transit operators have high rates of obesity, hypertension, and other cardiovascular risk-factors compared to other occupations. There have been few qualitative studies exploring the interrelationships between the organization of transit work, stress, and health including obesity, from the perspective of operators. METHODS: Five focus groups were conducted at five Divisions in a transit authority in Southern California and included 65 bus and rail operators. RESULTS: Operators reported a great deal of stress related to their work, including 1) time pressures and lack of recovery time; 2) long work shifts and overtime; 3) feeling unsafe when dealing with the public; 4) lack of respect from supervisors and management. Operators believed stressful working conditions negatively impacted their health and weight. CONCLUSION: This qualitative study yielded new as well as confirmatory data about stress and transit work organization, health, and weight in operators. This study will add to future survey research and interventions in this population.

Twenty-four-hour work shifts, increased job demands, and elevated blood pressure in professional firefighters.

PURPOSE: To investigate whether working conditions (number of 24-h shifts, number of calls, sedentary work, job strain, effort-reward imbalance, and physical demands) are associated with elevated blood pressure and hypertension among professional firefighters. METHODS: A total of 330 (321 males and 9 females) firefighters were chosen for this study among the Southern California firefighters who participated in a work and obesity project. Working conditions were measured with a firefighter-specific occupational health questionnaire. Blood pressure was clinically assessed, and hypertension was defined according to the contemporary standard classification. RESULTS: About 11 % of the firefighters had hypertension. Fifty percent of the hypertensive firefighters (mostly mild hypertensive) had uncontrolled high blood pressure. Hypertension was more prevalent in male, older, and high-rank firefighters and firefighter who reported low numbers of daily calls. In male firefighters who were normotensive or hypertensive without taking anti-hypertensive medication, additional 24-h shifts in the past month increased the risk of elevated diastolic blood pressure (DBP) than those who reported a standard work schedule (eight to eleven 24-h shifts). Particularly, firefighters who reported sixteen 24-h shifts had 5.0 mmHg higher DBP (p < 0.01). Body mass index attenuated the association between number of shifts and blood pressure to some extent. Firefighters who reported "increased job demands over the past years" had 3.0 mmHg (p = 0.06) higher systolic blood pressure. Other working conditions were not associated with elevated blood pressure and hypertension. CONCLUSIONS: Many additional 24-h shifts and increased job demands were risk factors for elevated blood pressure in male firefighters. Optimal collective and individual workload and improved hypertension management are warranted for enhancing the cardiovascular health of firefighters.

Comparison of body mass index with waist circumference and skinfold-based percent body fat in firefighters: adiposity classification and associations with cardiovascular disease risk factors.

PURPOSE: This study aims to examine whether body mass index (BMI) overestimates the prevalence of overweight or obese firefighters when compared to waist circumference (WC) and skinfold-based percent body fat (PBF) and to investigate differential relationships of the three adiposity measures with other biological cardiovascular disease (CVD) risk factors. METHODS: The adiposity of 355 (347 males and eight females) California firefighters was assessed using three different measures. Other CVD risk factors (high blood pressure, high lipid profiles, high glucose, and low VO2 max) of the firefighters were also clinically assessed. RESULTS: The prevalence of total overweight and obesity was significantly (p < 0.01) higher by BMI (80.4 %) than by WC (48.7 %) and by PBF (55.6 %) in male firefighters. In particular, the prevalence of overweight firefighters was much higher (p < 0.01) by BMI (57.3 %) than by WC (24.5 %) and PBF (38.3 %). 60-64 % of male firefighters who were assessed as normal weight by WC and PBF were misclassified as overweight by BMI. When overweight by BMI was defined as 27.5-29.9 kg/m(2) (vs. the standard definition of 25.0-29.9 kg/m(2)), the agreement of the adiposity classification increased between BMI and other two adiposity measures. Obese firefighters had the highest CVD risk profiles across all three adiposity measures. Only when overweight by BMI was defined narrowly, overweight firefighters had substantially higher CVD risk profiles. Obesity and overweight were less prevalent in female and Asian male firefighters. CONCLUSIONS: BMI overestimated the prevalence of total overweight and obesity among male firefighters, compared to WC and skinfold-based PBF. Overweight by BMI needs to be more narrowly defined, or the prevalence of BMI-based overweight (27.5-29.9 kg/m(2)) should be reported additionally for prevention of CVD among male firefighters.

24-hour work shifts, sedentary work, and obesity in male firefighters.

BACKGROUND: Little is known about the occupational risk factors for obesity in US firefighters. METHODS: 308 male California firefighters, who participated in a work and obesity project, were chosen. Working conditions were measured with a firefighter-specific occupational health questionnaire. Adiposity was clinically assessed using body mass index (BMI), waist circumference (WC), and body fat percent. RESULTS: In a multivariate analysis, the prevalence of obesity by all measures was significantly higher (PRs = 3.69-6.03, P < 0.05) in the firefighters who reported seventeen to twenty-one shifts than those who reported eight to eleven shifts in the past month. Prolonged sedentary work was also a risk factor for obesity by BMI (PR = 4.18, P < 0.05). Furthermore, there was a linear dose-response relationship of obesity by BMI and WC with the number of 24-hr shifts and sedentary work. CONCLUSIONS: Many additional 24-hr shifts and prolonged sedentary work substantially increased the risk for obesity in male firefighters. Am. J. Ind. Med. 59:486-500, 2016. © 2016 Wiley Periodicals, Inc.

Short-term test-retest reliability of the Job Content Questionnaire and Effort-Reward Imbalance Questionnaire items and scales among professional firefighters.

Relatively little is known about the short-term test-retest reliability of the Job Content Questionnaire (JCQ) and Effort-Reward Imbalance Questionnaire (ERIQ). Seventeen JCQ and six ERIQ items were qualitatively reviewed by 19 firefighters in focus groups. The items were then administered twice to 81 firefighters with a time interval of 1-8 weeks. The short-term reliability of the JCQ and ERIQ items and scales with the four-point Likert item responses was at least fair or moderate with several complementary statistical methods. It improved substantially when the four-point responses were simplified into the two ('agree' or 'disagree') responses. The JCQ psychological demands and the ERIQ effort scales were among the least reliable scales and their items were most frequently indicated by the firefighters to be clarified. The responses of professional firefighters to the JCQ and ERIQ items and scales were stable during an 8-week period, particularly when dichotomous item responses were used.

Job strain and ambulatory blood pressure: a meta-analysis and systematic review.

We reviewed evidence of the relationship between job strain and ambulatory blood pressure (ABP) in 29 studies (1985-2012). We conducted a quantitative meta-analysis on 22 cross-sectional studies of a single exposure to job strain. We systematically reviewed 1 case-control study, 3 studies of cumulative exposure to job strain, and 3 longitudinal studies. Single exposure to job strain in cross-sectional studies was associated with higher work systolic and diastolic ABP. Associations were stronger in men than women and in studies of broad-based populations than those with limited occupational variance. Biases toward the null were common, suggesting that our summary results underestimated the true association. Job strain is a risk factor for blood pressure elevation. Workplace surveillance programs are needed to assess the prevalence of job strain and high ABP and to facilitate workplace cardiovascular risk reduction interventions.

Exploring occupational and health behavioral causes of firefighter obesity: a qualitative study.

BACKGROUND: Firefighters, as an occupational group, have one of the highest prevalence rates of obesity. A qualitative study investigated occupational and health behavioral determinants of obesity among firefighters. METHODS: Four focus groups were conducted with firefighters of every rank as Phase I of the FORWARD study which was designed to assess health behavioral and occupational characteristics related to obesity in firefighters. RESULTS: Analysis revealed five main themes of central importance to firefighters: (1) fire station eating culture; (2) night calls and sleep interruption; (3) supervisor leadership and physical fitness; (4) sedentary work; and (5) age and generational influences. CONCLUSION: The results showed a strong interrelationship between occupational and health behavioral causes of obesity in firefighters. The relevance of these qualitative findings are discussed along with the implications for future obesity interventions with firefighters.

The Healthy Work Survey: A Standardized Questionnaire for the Assessment of Workplace Psychosocial Hazards and Work Organization in the United States.

OBJECTIVES: Work-related psychosocial stressors have been recognized as occupational hazards and assessed in workplaces in many countries for decades. Identifying tools to measure work-related psychosocial hazards to increase awareness in the United States about the impact on employees' health and safety is critical ( J Occup Environ Med. 2021;63:e245-e249). METHODS: We describe the development and psychometric validation of an online tool, the Healthy Work Survey, utilizing items from the National Institute for Occupational Safety and Health Quality of Work Life questionnaire. RESULTS: There are 55 items in the final core work section of the HWS. Factor analyses confirmed nine factors, and the subsequent multi-item scales had acceptable internal consistency. A user-friendly, online system and automated report compares individual's and organization's scores to distributions from a representative US working population (General Social Survey Quality of Work Life). DISCUSSION: The HWS is a reliable, valid tool for organizations and individuals to assess psychosocial work hazards.

Sedentary work, low physical job demand, and obesity in US workers.

BACKGROUND: Little is known about the role of low physical activity at work (sedentary work or low physical job demand) in the increasing prevalence of obesity of US workers. METHODS: This cross-sectional and secondary data analysis included 1,001 male and 1,018 female workers (age range: 32-69) from the National Survey of Midlife Development in the United States (MIDUS) II study (2004-2006). Sedentary work and physical job demand were measured by questionnaire items. Total obesity (based on body mass index) and central obesity (based on waist circumference) were defined using WHO criteria. RESULTS: After controlling for covariates (socio-demographic, psychosocial working conditions, health status, and health behaviors), sedentary work, low physical job demand, or their combination increased the risk for total and central obesity in male workers, particularly when they worked longer than 40 hr per week. Sedentary work marginally increased the risk for total and central obesity in female workers. CONCLUSIONS: Low physical activity at work is a significant risk factor for total and central obesity in middle-aged US male workers.

A socioecological framework for research on work and obesity in diverse urban transit operators based on gender, race, and ethnicity.

Urban transit (bus and rail) operators, totaling nearly 700,000 persons, are one of the heaviest occupational groups in the United States (US). Little is known about occupational risk factors for weight gain and obesity and their interrelationship with health-related behaviors, particularly among female minority (African Americans and Hispanics) transit operators who are at greater risk for obesity. As a step towards developing successful obesity interventions among urban transit operators, this paper aims to present a new socioecological framework for studying working conditions, chronic strain, health-related behaviors, weight gain/obesity, and obesity disparity in diverse urban transit operators based on gender, race, and ethnicity. Our framework is a synthesis of several different theories and disciplines: the resource-work load model (work stress), occupational ergonomics, the theory of intersectionality, and worksite health promotion. The framework was developed utilizing an extensive literature review, results from our on-going research on obesity, input from focus groups conducted with Los Angeles transit operators as well as interviews and meetings with transit operator stakeholders (management, unions, and worksite transit wellness program), and ride-along observations. Our hypotheses highlighted in the framework (see Fig. 1) are that adverse working conditions, largely characterized as a combination of high demands and low resources, will increase the risk for weight gain/obesity among transit operators directly through chronic strain and hypothalamic dysfunction (hyper-and hypo-activations), and indirectly through health-related behaviors and injuries/chronic severe pain. We also hypothesize that the observed increase in adiposity among female minority operators is due to their greater exposure to adverse occupational and non-occupational conditions that reflect their intersecting social identities of lower social class and being a minority woman in the US. Our proposed framework could greatly facilitate future transit worksite obesity studies by clarifying the complex and important roles of adverse working conditions in the etiology of weight gain/obesity and obesity disparity among transit operators and other working populations.

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.