Choi BongKyoo, Schnall Peter, Dobson Marnie, Yang Haiou, Baker Dean, Seo YoungJu
Center for Occupational and Environmental Health, University of California Irvine, 100 Theory, Suite 100, Irvine, CA 92617 USA.
Department of Sociology, University of Massachusetts Amherst, 200 Hicks Way, Amherst, MA 01003 USA.
Ann Occup Environ Med. 2017 May 17;29:15. doi: 10.1186/s40557-017-0171-2. eCollection 2017.
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.
城市公交（巴士和铁路）运营商总数近70万人，是美国从业人数最多的职业群体之一。对于体重增加和肥胖的职业风险因素以及它们与健康相关行为的相互关系，我们知之甚少，尤其是在肥胖风险更高的女性少数族裔（非裔美国人和西班牙裔）公交运营商中。作为在城市公交运营商中开展成功的肥胖干预措施的第一步，本文旨在提出一个新的社会生态框架，用于研究不同性别、种族和族裔的城市公交运营商的工作条件、慢性压力、健康相关行为、体重增加/肥胖以及肥胖差异。我们的框架是几种不同理论和学科的综合：资源-工作负荷模型（工作压力）、职业工效学、交叉性理论以及工作场所健康促进。该框架是通过广泛的文献综述、我们正在进行的肥胖研究结果、与洛杉矶公交运营商进行的焦点小组讨论的意见、以及与公交运营商利益相关者（管理层、工会和工作场所公交健康项目）的访谈和会议，还有随车观察而制定的。我们在框架中突出的假设（见图1）是，恶劣的工作条件，主要表现为高要求和低资源的结合，将直接通过慢性压力和下丘脑功能障碍（功能亢进和功能减退）增加公交运营商体重增加/肥胖的风险，并间接通过健康相关行为以及受伤/慢性剧痛增加风险。我们还假设，女性少数族裔运营商中观察到的肥胖增加是由于她们更多地暴露于不利的职业和非职业条件下，这些条件反映了她们在美国社会阶层较低且身为少数族裔女性的交叉社会身份。我们提出的框架可以通过阐明恶劣工作条件在公交运营商和其他工作人群体重增加/肥胖及肥胖差异病因中的复杂而重要的作用，极大地促进未来公交工作场所肥胖研究。
