Association between low health literacy and adverse health behaviors in North Carolina, 2016

Introduction: Health literacy (HL) is an urgent public health challenge facing the U.S. HL is a critical factor in health inequities and exacerbates underlying social determinants of health. Purpose: This study assesses the association between low HL (LHL) and adverse health behaviors, which contribute to poor health. Methods: Researchers used North Carolina’s 2016 Behavioral Risk Factor Surveillance System data, namely, the Health Literacy optional module which asks respondents to rate how difficult it is for them to get health-related advice or to understand medical information (verbal or written). Health behaviors analyzed were excessive alcohol consumption, lack of adequate exercise and sleep, and irregular medical and dental check-ups. The sample was divided into four age categories (18–49, 50–64, and 65–75, and 76 and older) for statistical comparisons. Stata 15 and a user-written Stata command, -psacalc-, were used to examine the relationships by addressing omitted variable bias in OLS regressions. Results: Findings indicate that LHL has a direct robust relationship with not exercising, inadequate sleep, irregular health and dental checkup, and health screenings across different age groups. Among women, LHL is associated with getting a Pap test in 3 years as opposed to more than 3 years. Implications: The adverse behaviors can explain the mechanisms underlying the link between LHL and adverse health outcomes. Further research on the causal relationship between LHL and adverse health behaviors using longitudinal data on a broader geographic region is warranted

U.S. 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

Work And Sleep Among Transport Operators: Disparities And Implications For Safety

The transportation and warehousing sector employs nearly 5 million individuals, many of whom are transport operators. Transport operators have experienced changes in work organization in recent decades; however, little is known about the impacts of these changes and how these impacts differ between operator types. Therefore, using two directly comparable transport operator datasets – one of all transport operator types by the National Sleep Foundation, and another of exclusively long-haul truck drivers called the Trucker Sleep Disorders Survey (TSLDS) – we sought for the first time to evaluate disparities between transport operators’ work organization; sleep characteristics; sleep problems and sleep disorders; and safety outcomes. We also explored associations between work organization and sleep characteristics, problems, and disorders with safety outcomes. Many significant differences were found across transport operator sectors. In particular, the TSLDS long-haul truck drivers largely fared worse when compared to other transport operators across a number of characteristics, including shift length, shift work, sleep latency, and the number of safety outcomes due to sleepiness. These cross-sectoral differences suggest the need for tailored interventions to address the unique configurations of demographic, work organization, sleep, and safety characteristics found in different transport operator sectors. However, across all transport operator sectors, latent sleep disorders appeared ubiquitous; thus, universal efforts to screen, diagnose, and treat sleep disorders should be a public health imperative. Differences were found transport operator in patterns of significant associations between work organization and sleep with safety outcomes, further suggesting the need for tailored interventions. However, sleep quality, sleep sufficiency, and whether one's workday schedule allowed adequate sleep were the most strongly associated with safety, suggesting that addressing these issues could benefit many transport operators. Further research, including a national study of transport operators, would help guide future interventions to enhance safety

U.S. Long-Haul Truck Driver Health Demands Integrated Approach

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. 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. 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. 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

The Work Organization Of Long-Haul Truck Drivers And The Association With Body Mass Index

Objective: The aim of this study was to examine relationships between work organization features of work hours, work schedules, and job stress with body mass indexes (BMIs) of long-haul truck drivers. Methods: Face-to-face survey data were collected first, followed by collection of anthropometric measures including height and weight (n¼ 260). Logistic regression (backward stepwise model) was used to identify significant predictors of BMI and to analyze odds ratios. Results: Mean BMI was 33.40 kg/m2, with 64.2% obese (BMI > 30 kg/m2) and 18.4% extreme/morbidly obese (BMI > 40 kg/m2). Working more than 11 daily hours was associated with statistically significant increased odds for being extreme obese. Conclusion: Findings suggest that longer work hours (>11 hours daily) have a major influence on odds for obesity among this population. The results align with recent NIOSH calls for integrated approaches to worker health

Health Disparities Of Latino Immigrant Workers In The United States

The purpose of this paper is to provide an overview of the literature pertaining to occupational health disparities experienced by Latino immigrant workers in the USA and to advance a general framework based on systems science to inform epidemiological and intervention research. Using papers and other sources from 2000 to the present, the authors examined the employment conditions and health outcomes of Latino immigrant workers and critically analyzed the pervasive evidence of health disparities, including causal mechanisms and associated intervention programs. The occupations, including the work environment and resultant living conditions, frequently performed by Latino immigrants in the USA represent a distinct trigger of increased injury risk and poor health outcomes. Extant intervention programs have had modest results at best and are in need of more comprehensive approaches to address the complex nature of health disparities. An integrated, systems-based framework concerning occupational health disparities among Latino immigrant workers allows for a holistic approach encompassing innovative methods and can inform high-leverage interventions including public policy. Reductionist approaches to health disparities have had significant limitations and miss the complete picture of the many influences. The framework the authors have provided elucidates a valuable method for reducing occupational health disparities among Latino immigrant workers as well as other populations

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

Can Subjective Sleep Problems Detect Latent Sleep Disorders Among Commercial Drivers?

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. 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. 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. 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

Social Determinants Of Health And The Effects On Quality Of Life And Well-Being In 2 Rural Appalachia Communities

Recent evidence highlights health disparities among rural communities. The purpose of this study was to learn from members of 2 Appalachia communities in North Carolina about barriers to health and well-being. Researchers conducted 3 focus groups (n = 24), which were coded and analyzed by a team of researchers to identify themes. Researchers identified 5 themes: (1) poverty/lack of economic opportunity; (2) access to health care and health resources; (3) social/mental health challenges; (4) food insecurity/hunger; and (5) youth/older adults being most vulnerable to health disparities. Ample evidence suggests that rural Appalachia is in dire need of public health attention

Active Living In Rural Appalachia: Using The Rural Active Living Assessment (RALA) Tools To Explore Environmental Barriers

People residing in rural communities are more likely to be physically inactive and subsequently have elevated risks for chronic disease. Recent evidence has shown this could stem from environmental barriers, inadequate programming and policies directed at the promotion of physical activity (PA) in rural settings. The objective of this research was to assess active living features in rural towns and townships (n = 16) across seven counties in northwestern North Carolina (NC). The study utilized the Town-Wide and Street Segment components of the Rural Active Living Assessment (RALA) as well as the 2014 American Community Survey results. The assessments were conducted in the summer of 2016 in the rural Appalachia region of NC. Using the RALA town-wide assessment scoring system (0 -100), the range of scores was 18–84, with the mean being 50.06. Three towns had no sidewalks, nine towns had sidewalks on only one side of the main streets, and four had sidewalks on both sides of the main streets. One town was rated as highly walkable, seven towns as moderately walkable, five towns as moderately unwalkable, and three towns as highly unwalkable. The rural Appalachia region of NC offers unique topographic, geographic and environmental barriers to PA. However, our findings indicate many rural towns offer common PA amenities. Future research should utilize qualitative methods and a community-based participatory research approach to more fully understand the challenges with increasing PA in the rural and often isolated Appalachia communities