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8 This report provides a literature review, research design, findings on prevalence and costs, five detailed case studies, and an implementation strategy. This chapter briefly describes the contents of each chapter and explains how they work together. Chapter 2 presents the research design for the project (see Figure 1). This chapter lays out the authorsâ analytical approach and contextualizes the research questions, connecting them to the different chapters of the report and explaining how the research team planned to answer the questions. Following this framework, the authors organized the research so that each stage was built on the previous one, emphasizing practical considerations that transit agencies can use to understand the health and safety issues related to transit workers. Having developed the framework, the research began with a review of literature (as sum- marized in Chapter 3) to compile a summary of the health and safety issues faced by transit workers. The literature review updates work from previous studies about transit operators. The work builds on prior research, particularly TCRP Report 169: Developing Best-Practice Guidelines for Improving Bus Operator Health and Retention (Gillespie, Wang, and Brown 2014) and TCRP Report 174: Improving Safety Culture in Public Transportation (Roberts, Retting, and Webb et al. 2015). It refers to both prior reports frequently, and the authors consider the current work to be an extension of those studies. The research team reviewed scholarly literature and other reports to identify the key health issues related to transporta- tion workers and understand how to better focus our research efforts. The literature review contains sections on health and safety outcomes, costs, programs to mitigate negative health and safety outcomes, and the cost-effectiveness of health and safety programs. The most common issues discovered were muscu loskeletal pain, acute back pain, and chronic health conditions such as diabetes, which are exacerbated by fatigue and stress. The research team also found that transit operators face safety issues from their own sleep deprivation and unruly passengers. Access to safe and sanitary restrooms was also a common problem. Several examples of workplace interventions, such as encouraging gym use, were found to have limited evidence of effectiveness. Some research on making changes to seating posi- tions suggested that it would be effective in reducing muscu loskeletal pain; however, very little of the research reviewed showed a direct link between health and safety programs and improvements in transit workersâ actual health and safety. Chapter 4 presents a description of the key demographic characteristics of the transit worker population to help contextualize the findings. Most transit workers are involved in vehicle operations (72%) and of these, just over 50% are bus operators. Most transit workers are male (63%), over age 45 (66%), and White (63%); however, disproportionately more African Americans are employed in transit than are employed in the general population as a whole, and disproportionately fewer women. The chapter identifies prevalence rates of health C H A P T E R 1 Introduction: How to Read This Report
Introduction: How to Read This Report 9 conditions and risk factors affecting transit workers, in particular six chronic conditions that are more prevalent among transit workers than among the general population: cardio- vascular disease, hypertension, diabetes, musculoskeletal conditions, mental health, and respi- ratory disease. National medical expenditures are estimated as a function of these conditions, whichâas expectedâare in excess of the expenditures for the general worker. Several secondary national data sources are used for the analysis. Chapter 5 provides estimates of transit worker health costs to individuals, employers, and society by examining cost estimates for injuries, deaths, absenteeism, workersâ compensation, and disability programs. Cost estimates ranged from $115 million for Supplemental Security Income (SSI) to $854 million for injury costs. For each category, the cost attributed to transit workers exceeded that of the general population because the transit worker population had higher incidence rates, claim rates, or disability prevalence. Figure 1. How to read this report.
10 Improving the Health and Safety of Transit Workers with Corresponding Impacts on the Bottom Line Chapter 6 details the information the research team obtained about health and wellness programs at five sites. Details about all aspects of program development, organization, and activities are shared, participation rates at all sites are provided, and outcome measures at four sites are discussed. (The process for selecting the sites described in this chapter is provided in Appendices A and B.) The chapter also presents the results of a multivariate data analysis that was conducted for four of the sites. (Appendix C presents the models for the three sites with no statistically significant results.) The most common health issues cited were hypertension, followed by diabetes and musculoskeletal issues, which aligned with the prior findings of the research. The programs offered various benefits, including gym access, healthy snacks, workshops, health screenings, and many more. Although these programs mostly showed no direct impacts on the participants, they did provide useful examples of common health pro- motion strategies. Chapter 7 assesses the implementation of programs for each site and provides guidance for transit agencies developing programs to address health problems that face transit workers. While communicating with the agencies during the preparation of the case studies, the research team sought their input to determine transit agency requirements, opportunities, and constraints for implementing potential solutions and tools that promote a healthy workforce and positively impact the bottom line. Chapter 8 concludes the report and provides an overview of the project, key findings, and suggestions for future research.