Health Behaviors of Operating Engineers

1. Health Behaviors of Operating Engineers Sonia A. Duffy, Ph.D., R.N., FAAN The University of Michigan

2. Research Team Investigators • Sonia Duffy, PhD, RN • David Ronis, PhD • Andrea Waltje, RN, MS • Lee Ewing, MPH • Seung Hee Choi, PhD, RN Students • Cody Carey • Samantha Louzon • Corinne Lee, RN, MSN

3. What is an Operating Engineer (OE) • An OE is responsible for the operation and maintenance of heavy earthmoving equipment used in the construction of buildings, bridges, roads, and other facilities (Stern & Haring-Sweeney, 1997).

4. Three Studies of Operating Engineers Study 1: Cross-sectional Study of Health Behaviors of Operating Engineers (funded by NINR) Study 2: A Randomized Control Trial of the Tobacco Tactics Website for Operating Engineers vs.. 1-800-QUIT NOW (funded by Blue Cross/Blue Shield of Michigan Foundation and NIH R21) Study 3: A Randomized Control Trial of Sun Protection Interventions for Operating Engineers (funded by Blue Cross/Blue Shield of Michigan Foundation)

5. Study 1: Health behaviors of Operating Engineers Cross-sectional survey Winter of 2008 Convenience sample of 498 Operating Engineers in MI (return rate: 90%) Variables included health behaviors (smoking, alcohol use, diet, physical activity, BMI, & sleep quality), health conditions (medical comorbidities & depressive symptoms), health-related quality of life, and demographics

6. Description of Sample

7. Health behaviors of the Sample

8. Background: Smoking • Disparities in smoking prevalence between white collar workers (20.3%) and blue collar workers (35.4%) • Blue collar workers do not benefit from worksite anti-smoking legislation as much as white collar workers (Rachiotis et al., 2009) • Blue collar workers have relatively limited accesses to health promoting programs (Okechukwu et al., 2009) • Few studies on smoking and smoking interventions have been conducted among blue collar workers (Lee et al., 2004)

9. Factors Associated With Smoking Behavior

10. Background: Smokeless Tobacco Use • Blue collar workers showed higher prevalence in smokeless tobacco compared to white collar workers (Lee et al., 2007) • 13.6% of the sample reported past month smokeless tobacco use (Population 3.5%, Dietz et al., 2011)

11. Factors Associated With Smokeless Tobacco Use

12. Background: Obesity • Blue collar workers are less likely to have recommended fruit and vegetable intake and rank among the lowest in leisure time physical activity (Beydoun & Wang, 2009) • 40.2% of the sample were overweight and 44.6% were obese

13. Factors Associated With Obesity

14. Factors Associated With Obesity (Cont.)

15. Background: Sleep Quality • Blue collar workers are exposed to high job stress, loud noises at work, and more prevalent in smoking and problem drinking, all of which are associated with poor sleep quality (Deatherage et al., 2009). • 33.9% of the sample showed interest in health service for better sleep quality.

16. Factors Associated With Sleep Quality

17. Background:Sun Exposure Behaviors • While outdoor workers are exposed to high UV levels and at greater risk of developing skin cancer, the rates of receiving skin examination and the use of sun protection are lower (LeBlanc et al., 2008) • Over 80% reported spending 4-5 hours in the sun during weekdays and about ⅔ spent 4-5 hours in the sun on weekends • While 50% reported 2 or more sunburns in summer, 37% never used sunscreen and 38% rarely used sunscreen • 22.8% of the sample showed interest in sun protection guidance

18. Factors Associated With Sunburns

19. Factors Associated With Blistering

20. Factors Associated With Use of Sun block

21. Background: Health-related Quality of Life • Blue collar workers are more likely to have depressive symptoms and engage in poor health behaviors, such as smoking, problem drinking, unhealthy diet, and low physical activity level, which deteriorate health-related quality of life.

22. Factors Associated With Health-related Quality of Life

23. Background: Occupational Exposures and Cigarette Smoking • Blue collar workers smoke more and are exposed to occupational hazards at work, which have a synergic effect of developing lung cancer with smoking. • Majority of the sample were exposed to various occupational hazards: heat stress (75.7%), concrete dust/milling (75.5%), welding fumes (71.4%), asphalt fumes (63.6%), solvents (58.0%), silica (56.8%), asbestos (51.2%), lead/lead paint (40.3%), and benzene (37.9%).

24. Occupational Exposures as Predictors of Cigarette Smoking a Occupational Exposure Factor 1: Lead/Lead paint + Benzene + Asbestos + Solvents + Silica b Occupational Exposure Factor 2: Asphalt fumes + Heat stress + Concrete dust + Welding fumes

25. Conclusions • Poor Health behaviors cluster together. Examples: • Smoking: problem drinking, physical inactivity, low BMI • Sleep Quality: smoking with nicotine dependence • Risky Sun Exposure Behaviors: problem drinking, high BMI, poor sleep quality • Health-Related Quality of Life: smoking, diet (less fruit/vegetable intake), physical inactivity, poor sleep quality

26. Conclusions Health behaviors are poor among Operating Engineer’s increasing the risk of developing chronic diseases. 0 % Operating Engineer’s met the criteria of healthy lifestyle (3% general population). Health behavior interventions are needed for Operating Engineer’s.

27. STUDY 2:TOBACCO TACTICS WEBSITE FOR OPERATING ENGINEERS

28. Aims Aim 1: Compare the efficacy of the Tobacco Tactics website intervention to the state sponsored 1-800-QUIT-NOW telephone line in improving cessation including: a) 30-day and 6-month quit rates; b) 6-month cotinine levels; c) 30-day and 6-month cigarettes smoked/day; d) 30-day and 6-month number of quit attempts; and e) 30-day and 6-month nicotine addiction. Aim 2: Compare Operating Engineers randomized to the Tobacco Tactics website to those randomized to the 1-800-QUIT-NOW telephone quit line in terms of: a) number of contacts with the intervention; b) medications used; and c) satisfaction with the intervention.

29. Methods • RCT of Tobacco Tactics versus 1-800-Quit Now • Convenience sample of 146 Operating Engineers recruited at training center • Baseline, 1 month and 6 month follow up surveys • Tobacco Tactics Intervention • Nurses introduces website at training center • Nurse calls to arrange for nicotine replacement therapy which is then mailed • Nurse makes 4 follow up counseling calls • Nurse-moderated chat room 3 times per week • Control group counseled and given card for 1-800-Quit- Now state-supported phone line • Operating Engineer calls the phone line • Is assigned a counselor that makes 4 calls • Can be mailed NRT if it is not covered by their insurance

30. http://bcbsm-operatingengineers.nursing.umich.edu/ User Name: Guest Password: Test

31. Description of Sample

32. Description of Sample * Based on 6-month survey findings

33. Aim 1: 1-month Efficacy of the Tobacco Tactics Website versus 1-800-QUIT-NOW a Values for both assessment points b Includes results from Mini-Survey

34. Aim 2: Process Measures

35. Aim 2 (cont)

36. Conclusions "The project described was supported by Grant Number 1465.RFP from the Blue Cross Blue Shield of Michigan Foundation and by Grant Number R21CA152247 from the National Cancer Institute.” Operating Engineers in the intervention group had: • significantly better quit rates, • significantly higher rate of contacts with the intervention, • significantly higher rates of NRT use. Six-month data collection is still ongoing. Once a web-based intervention has been built, the cost of reaching a million smokers is not much more than reaching a 1000 smokers. The goal is for high reach, high efficacy, and a low cost.

37. STUDY 3:A RANDOMIZED CONTROLLED TRIAL OF 4 SUN PROTECTION INTERVENTIONS FOR OPERATING ENGINEERS

38. Aims • Aim 1: Determine differences in changes in sunscreen use and sun burning among Operating Engineers randomized to four sun protection interventions: a. education only; b. education and mailed sunscreen; c. education and text message reminders; and, d. education, mailed sunscreen, and text message reminders. • Aim 2: Explore if particular subgroups of Operating Engineers (e.g., problem drinkers or job type subgroups) differ in changes in sunscreen use and sun burning pre-and post-intervention.

39. methods RCT of 4 interventions conducted at OE training center 2012 Convenience sample of 231 Operating Engineers All given 1 hour of educational ppt, then randomized to nothing more, sunscreen, text messages, or both Text messages sent 3 times per week on random days from May thru Sep. 2 large containers of sunscreen mailed twice May and July Half received spray and half received lotion Baseline surveys, mini-surveys each month, and larger follow up survey in October

40. Sample of 60 unique Text Messages Smile and put on sunscreen today Your family and friends love you - put on sunscreen! Oh boy, it’s a hot one— use sunscreen Yikes it’s hot—put on sunscreen Only 10% of OE’s use sunscreen – do you? Look young – use sunscreen Catch some rays...with sunscreen Big muscles need strong sunscreen. Wear a 30! Got sunscreen? It’s a sin to neglect your skin – USE SUNSCREEN! Looking good with sunscreen!  Don't be a prune!  Use sunscreen

41. Description of Sample

42. RESULTS RELATED CHANGES IN CONSTRUCTS OF THE HEALTH BELIEF MODEL (self-efficacy, perceived barriers, perceived benefits, susceptibility, and perceived severity) BEFORE AND AFTER EDUCATION

43. What they told us Sunscreen makes hands slippery on steering wheel. Sunscreen smudges glasses when driving. Don’t want to smell like coconut oil. Spray might be better.

44. Lesson Learned Computerized text messaging program by law must tell participant that they may be charged for these texts and they can reply “STOP” to cancel 20% dropped out of the text messaging arm within minutes of the first text. Many were contacted and if they had free texting came back on, but many were lost

45. This study is ongoing The project described is supported by Grant Number 1899.II from the Blue Cross Blue Shield of Michigan Foundation.

46. Publications Duffy, S.A., Missel, A.L., Waltje, A.H., Ronis, D.L., Fowler, K.E., Hong, O. (2011). Health Behaviors of Operating Engineers. American Association of Occupational Health Nurses Journal. 59 (7), 293-301. Duffy, S.A., Ronis, D.L., Richardson, C., Waltje, A.H., Ewing, L.A., Noonan, D., Hong, O., Meeker, J. (2012). Protocol of a randomized control trial of the Tobacco Tactics website for Operating Engineers. BMC Public Health, 12:335. Duffy, S.A., Cohen, K.A., Choi, S.H., McCullagh, M.C., Noonan, D. (2012). Predictors of Obesity in Michigan Operating Engineers. Journal of Community Health. 37, 619-625. Duffy, S.A., Choi, S.H., Hollern, R., Ronis, D.L. (2012). Factors Associated With Risky Sun Exposure Behaviors Among Operating Enginners. American Journal of Industrial Medicine. 55 (9), 786-792. Noonan, D., Duffy, S.A. (2012). Smokeless Tobacco Use Among Operating Engineers. Journal of Addictions Nursing. 23 (2), 132-136. Choi, S.H., Redman, R.W., Terrell, J.E., Pohl, J.M., Duffy, S.A.: Factors associated with health-related quality of life among Operating Engineers. In press. Journal of Occupational and Environmental Medicine.