NEAT (non-exercise activity thermogenesis) is defined as the calorie expenditure of any activity other than sport-like exercises and has been shown to reduce weight gain.    An example of a NEAT program is a dynamic sit-stand work-station that allows students/adults to stand during classroom instruction or work.  A pilot study using dynamic sit-stand work-stations in elementary schools showed that 70% of students were SOLELY standing at the 12th week of intervention, and overweight and obese students burned an average of 23% more calories in the time spent standing in the classroom compared to their seated peers.  The desk/stool units cost less than $200 per unit (retail value) and have a lifespan of 20 year.  For around $10 per student, this simple environmental modification can be used to prevent and reduce adolescent obesity.  An additional benefit is that the sit-stand work station design promotes better posture, which could also reduce chronic back pain in the target population.

            Children and teenagers’ lives can be divided into three categories: sleep, time in school, and time not in school.   Regulating what happens when students are not in school can be extremely difficult and sleep time has few possibilities for obesity interventions.  This leaves time in school as a period to positively affect lifestyle changes in youth.  As discussed previously, several school policies and programs are addressing obesity from the nutrition/caloric intake and/or physical activity.  However, despite research showing positive signs for these types of interventions, the obesity in youth continues to rapidly increase—suggesting an additional component is needed.  NEAT strategies address environmental changes in the classroom that foster more physical activity, without reducing instructional time. 

Please click on the image to view in full size

            Benden M, Blake J, Wendel M, Huber J.  The Impact of Stand-Biased Desks in Classrooms on Calorie Expenditure in Children. Am J Public Health. 2011 Mar 18. [Epub ahead of print]

            Benden, M.  (2007).  Could You Stand to Lose? Weight Loss Secrets for Office Workers.  Dallas, TX:  Trinity River Publishing. ISBN 978-60402-234-6.

            Lanningham-Foster, L., Foster, R.C., McCrady, S.K., Manohar, C.U., Jensen, T.B., Mitre, N.G., Hill, J.O. & Levine, J.A.  (2008).  Changing the school environment to increase physical activity in children.  Obesity, 16(8):  1849-1853.

            Levine, J. A. (2007). Nonexercise activity thermogenesis–liberating the life-force. J Intern Med, 262(3), 273-287.

            Levine, J. A., Eberhardt, N. L., & Jensen, M. D. (1999). Role of nonexercise activity thermogenesis in resistance to fat gain in humans. Science, 283(5399), 212-214.

            Levine, J. A., Schleusner, S. J., & Jensen, M. D. (2000). Energy expenditure of nonexercise activity. Am J Clin Nutr, 72(6), 1451-1454.

Family-owned business is commonly treated like the corporate businesses but when it comes to general workplace safety- tighter restrictions need to be applied. For example, working in a family restaurant is more “laid back” because, after all, it’s the parents you are working for- not a third party “boss”. Therefore, the things that teens can get away with at home are often carried over to the workplace- with no regards to obeying “by the book”.

This study distributed a questionnaire to over 8,000 teens in Wisconsin. Of those, 42% worked- and of those, 34% were employed in a family business. It was discovered that the teens in the family businesses had more severe injuries compared to the other working teens. The most common injury in the family businesses working teens was broken bones (17%); only 5% of other working teens had broken bones. Also, the teens working in family businesses filed for workers compensation more than the other working teens. Also, which seems like a given to me, the teens working at their family business engaged in more horseplay and dangerous tasks, some of which were illegal.

How do we deal with this? A family business is meant to stay in the family- which means, teens need to be taught the skills and given the opportunities to succeed. However, altering the “mind” of a teenager to say “even though you’re working for your parents, you need to pretend your ‘boss’ is an actual ‘boss’” is very difficult. Either- more strict regulations need to be developed which tighten down on small, family businesses or the family businesses need to hire a “non-family” supervisor that really “cracks down” on the teens working for him/her.

Zierold KM, Appana S, Anderson HA. “Working for Mom and Dad” Are Teens More Likely to Get Injured Working in Family-Owned Businesses?”  J.Community Health 2011; ePub. http://www.safetylit.org/citations/index.php?fuseaction=citations.viewdetails&citationIds%5B%5D=citjournalarticle_303458_8

-Megan H

Fast-forward to a few weeks ago when I heard an interesting story on NPR (National Public Radio) about a new technology that has been developed to prevent lacerations and amputations from power saws.  My interest was piqued.   I wondered how many occupational injuries could be prevented by this new technology. Unfortunately, in my searches, I could only find a study conducted on non-occupational injuries based on emergency room statistics.  Nevertheless, I think this information has applicability in the work environment.  This study was conducted by the Consumer Products Safety Commission based on information in the National Electronic Injury Surveillance System which collects data from U.S. hospital emergency rooms (Adler, 2003).

Based on the investigations of 225 incidents occurring between October 1, 2001 and December 31, 200, the Consumer Products Safety Commission Directorate for Epidemiology estimated that there were about 52,000 injuries (CV = 0.12, n = 225) treated in U.S. hospital emergency rooms associated with stationary saws for the calendar year 2001.  Of these injuries, the majority occurred from contact with the saw blade while the saw was in operation.   The study also found that in only 22% of the cases was the blade guard attached at the time of the incident (Adler, 2003). 

The new technology is pretty amazing (watch it in action:  www.sawstop.com ), and would virtually eliminate all injuries associated with blade contact.  In the NPR story the reporter interviewed some of the leading manufacturers of power tools (Arnold, 2011).  Their argument against installing better protection is that it would add $100 to $300 to the price of a power saw, and consumers would be unwilling to spend that kind of money. (Personally, I think fingers are worth at least $300 each.) Nevertheless, it appears that the Consumer Product Safety Commission is going to push for legislation mandating improved safeguards on power saws (Arnold, 2011).  I hope that they are successful, for the sake of anyone who has ever been injured by power saws either on or off the job. 

References

Adler, P. (2003). Injuries Associated with Stationary Power Saws. Washington, DC: US Consumer Products Safet Commission. (www.cpsc.gov/library/foia/foia03/os/powersaw.pdf)

Arnold, C. (2011, May 25). Advocates Urge Lawmakers to Make Table Saws Safer. Morning Edition.  National Public Radio. (www.npr.org/2011/05/25/136617222/advocates-urge-lawmakers-to-make-table-saws-safer)

One objective of Booster Breaks is to transform work place culture so that management supports and encourages Booster Breaks during the work day and that groups of co-workers regularly participate in Booster Break sessions to provide social support and promote enjoyment. In many work places, the usual 10- to 15-minute work breaks in the morning and afternoon can be organized as Booster Breaks to enable a regular practice of a health-promoting behavior at the work place in work clothes during the work day. Ideally, each company would have Booster Break facilitators (i.e., company employees trained to lead the activity) who guide each session.

 The concept of booster breaks was put forward in an article by Dr. Taylor in the American Journal of Preventive Medicine in 2009.  Sedentary behavior is responsible for a variety of health problems including obesity and coronary heart disease. Physical activity and meditation can improve not only the physical but mental health as well. The most common reason for lack of physical activity cited by people is “no time from work”. With this ingenious idea by Dr. Taylor, people can actually use their “work” time to engage in physical activity. Additionally, the booster breaks will improve the psychologic well being of the workers as well and could potentially improve the work efficiency, as healthy workers are better workers. Hence the companies shall also have an incentive to arrange for an organized booster break session. It is also purported to improve the social well being of the workplace environment, as the workers shall bond with each other during these breaks. Moreover, it would replace the unhealthy “coffee breaks”.

One of the biggest criticizations has been that how much improvement in the health would a 10-15 min schedule bring? However, there have been scientific records that regular physical activity of even a short duration as this can improve health in the long term. With its manifold advantages, other then the primary motive of improving health, I see no reason why booster breaks should not be implemented more widely.

Neeraj Shah

MPH student (Epidemiology)

PH2760 Occupational Epidemiology

University of Texas School of Public Health

Additionally, being away from family, friends, and usual family traditions and routines makes truck drivers feel apart from the family unit. An interview on their family/friend relationships indicated that 23.7% of the truck drivers considered their relationships as either “not good”, “strained”, or “stressful”. (1)

Another cross-sectional study of 300 male truck drivers also reported that truck drivers were at increased risk for depression when compared to the general population. (2) Long-haul truck drivers are also highly vulnerable to sexually transmitted diseases (STD) and drug use. (3)

Further studies among train drivers and bus drivers need to be conducted in order to know whether this only happened among truck drivers or has already been a general problem throughout the transport industry.

References:

1, Mona Shattell et al. “Occupational Stressors and the mental health of truckers.”  Issues in Mental Health Nursing 2010(31): 561 – 568, DOI: 10.3109/016128.2010.488783

2, Francisco Pereira da Silva-Júnior et al. “Risk factors for depression in truck drivers.” Social Psychiatry and Psychiatric Epidemiology 2009(44): 125-128, DOI: 10.1007/s00127-008-0412-3

3, Donna Hubbard McCree et al. “Sexual and drug use behaviors of long-haul truck drivers and their commercial sex contacts in New Mexico.” Public Health Reports January – February 2010(125): 52-60

Samuel and Emily constructed a research to estimate the extent of individual risks according to the person’s branch of service, rank, age, sex, race and ethnicity. In the paper, the source data were provided by the Department of Defense on their website, with supplementary tabulations supplied by the Defense Manpower Data Center(2006). The death rates in the research were given for members of military who were deployed in Iraq. Their paper was posted at http://repository.upenn.edu/psc_working_papers/1. Welcome to visit it for more details.

According to the report, a total of 2321 deaths happened to US troops in Iraq between March 21^st, 2003 and March 31^st, 2006. This number includes all deaths whether combat-related or not. The total person-years of troops were estimated around 592,002 during this period. Therefore, the death rate by chance is approximately 1/255 per year, which is nearly less than half of the death rate for US civilian population in 2003 (1/119 reported by National Center for Health Statistics, 2006a). But if we look at the death rate for US men who aged 18-39 (1/654), it’s only 40% of that of soldiers inIraq. Of course, the death rate in Iraq is much lower than that in Vietnam, which was 56,838 deaths among members of military who had a total 2,608,650 person-years servicing time so that the final death rate was nearly 5.6 times greater than that in Iraq.

The highest death rate (1/118) can be observed in Marines when we compared them among different branch of service. The members in the active Army forces had three times higher risk of death than ones in Army reservists. The social scientists used to claim that the lower-ranking persons in military had more risk of death than higher-ranking ones, which could be demonstrated by the death rates of US troops in Iraq. In Marines, Lance Corporals had 4.8 times risk of death greater than Major/Colonel/General. If we looked at the age distribution of all deaths, soldiers who aged 17-19 had a death risk which was 4.6 times that of persons aged 50 or higher.

More comparisons and variability of death rates can be observed in this paper.

As of May 2011, there were 153.7 million people employed in the United States (2).  Further, it has been reported that as adults, we spend half our waking hours at work (3).  So, maybe it makes sense to blame employers since the majority of Americans are spending the majority of their time working, chained to a desk.  But, let’s look at the prevalence of obesity in the U.S workforce compared to national statistics.

The NHANES 1999 – 2000 survey showed a 44% increase in obesity among U.S. workers from 20.4% to 29.4% with a modest increase of 4.5% for overweight workers and a 23% decline in the number of normal weight workers (4).  In the U.S. workforce, the proportion of overweight individuals is similar to the national prevalence of 34.2%; however, the prevalence of obesity is slightly less than the national average of 33.8% (5).  The smaller proportion of obese employees in the workforce may be due to the healthy worker effect, where employed individuals have lower morbidity and mortality rates (6).  However, it appears that the current workforce is still facing obesity issues.

Ok, so it does seem like obesity persists in the workplace.  While it is true that our nation is shifting to a more white collar, office job setting, I think employers really have another reason to take up this issue besides rising obesity rates.  Specifically, as employees’ waistlines are increasing, employers’ bottom line is decreasing.  Many studies have shown that as an individual’s BMI increases, so do medical costs and absenteeism, while productivity decreases (7, 8, 9).  Furthermore, a recent study indicated that a normal weight worker would have $114 of health care costs and 27.21 absent hours, whereas an obese worker would have $620 of health care costs and 35.52 absent hours (8).  However, these are not the only costs employers are losing.  It was also found that overweight and obese employees used more sick leave, disability time, and had more workplace injuries (10).  The profound financial implications of overweight and obesity in the workplace are leaving employers to deal with rising health care cost and declining productivity.  So, if things don’t change, we will either work ourselves to death, or become obese trying.

*******

(1)    Church, T. S., Thomas, D. M., Tudor-Locke, C., Katzmarzyk, P. T., Earnest, C. P., Rodarte, R. Q., . . . Bouchard, C. (2011). Trends over 5 decades in U.S. occupation-related physical activity and their associations with obesity. PLoS ONE [Electronic Resource], 6(5), e19657.

(2)    U.S. Department of Labor Bureau of Labor Statistics.  (2011).  The Employment Situation – May 2011.  (Publication No. USDL-11-0809).  Washington, DC: U.S. Government Printing Office.

(3)    Engbers, L. H., van Poppel, M. N., Chin A Paw, M. J., & van Mechelen, W. (2005). Worksite health promotion programs with environmental changes: A systematic review. American Journal of Preventive Medicine, 29(1), 61-70.

(4)    Hertz, R. P., Unger, A. N., McDonald, M., Lustik, M. B., & Biddulph-Krentar, J. (2004). The impact of obesity on work limitations and cardiovascular risk factors in the U.S. workforce. Journal of Occupational & Environmental Medicine, 46(12), 1196-1203.

(5)    National Center for Health Statistics. (2010). Health, United States, 2010 Special Feature on Death and Dying. Hyattsville, Maryland.

(6)    Checkoway H, Pearce NE, Kriebel  D.  Research Methods in Occupational Epidemiology.  Second Edition.  New York:  Oxford University Press, 2004.

(7)    Aldana, S.G. and Pronk, N.P.  (2001).  Health Promotion programs, modifiable health risks, and employee absenteeism.  JOEM, 43, 36-46.

(8)    Bungum, T., Satterwhite, M., Jackson, A.W., Morrow, J.R.  (2003). The Relationship of body mass index, medical costs, and job absenteeism.   American Journal of Health Behavior, 2, 456-463.

(9)    Ricci, J.A. and Chee, E.  (2005).  Lost productive time associated with excess weight in the US workforce.  JOEM, 47, 1227 – 1234.

(10)Schmier J.K., Jones M.L., Halpren M.T.  (2006).  Cost of obesity in the workplace.   Scand J Work Environ Health, 32, 5–11.

Life expectancy at birth (a composite measure of mortality experience of a population) has been shown to vary greatly by country. While it seems clear that economic factors play a major part in these differences, there is the obvious potential for independent genetic and cultural causes as well.

This led me and my colleague Steven Day to wonder if the relative mortality experience of baseball players from other countries would mirror that of the general populations in question. That is, would players from somewhere such as the Dominican Republic — which has a lower life expectancy at birth than does the U.S. — have higher mortality than U.S. players, or would it even matter? What about players from Canada, where life expectancy is actually higher than the U.S.? Would those players continue to experience lower mortality or would their participation in MLB alter their experience somehow? We hypothesized that players from first-world countries with high standards of living would display no differences in mortality compared to U.S. players, while countries from Latin America and the Caribbean (with their high crime rates and extreme poverty) would demonstrate higher mortality rates than U.S. players. This research is the basis for a poster we are presenting at the 3rd North American Congress of Epidemiology next week, on June 23, 2011.

To test these hypotheses we used data on all baseball players who debuted in MLB between 1900 and 1999. From these, we selected all the players from the 6 best-represented nations: Canada, Cuba, Dominican Republic, Mexico, Puerto Rico, and Venezuela. Since many of these nations did not have any players in MLB until the 1950s, the study period was limited to 1950-1999. We calculated age and decade-specific Standardized Mortality Ratios (SMR) using mortality rates from U.S. baseball players as the population comparison rate.

Results show that for the most part MLB seems to homogenize mortality among the players. SMR for all the nations except D.R. and Venezula were very close to 1.00 with confidence intervals that included 1.00. The SMR for D.R. was fairly high at 2.38, but the 95% confidence interval of 0.90 to 5.06 includes 1.00. Venezuela had significantly elevated mortality risk, with an SMR of 3.14 (95% CI = 1.10, 6.95).

Though we cannot be sure, we speculate that Venezuela’s increased mortality is the result of Third-World violence. The CIA Factbook warns would-be travelers against Veneuzuela’s high crime rate, particularly murders, for which Venezula is a world leader. That D.R.’s mortality rates were elevated and approached significance supports this idea, as they too have widespread poverty and a high crime rate, though to a lesser extent than Venezuela. Though it may be tempting to wonder why Mexico did not show an increase in mortality given its recent rise in violence, recall that this study was through 1999 only.

It seems then that the lifestyle of MLB — physical fitness, travel, money, fame, access to health care, etc. — pulls the mortality of players from most nations up or down to unity with that of players from the United States, an idea we intend to test further in the near future. If true, it is an important piece of the puzzle concerning mortality rates, athleticism, and economics.

I hope you’ll find this blog a valuable tool to expand your interest and knowledge of Occupational Epidemiology. Please feel free to add relevant information.

If you have a problem posting, it’s probably because of your sharing rights (so email me and let me know- Christina.M.Socias@uth.tmc.edu).