Public Health Sciences (School of)

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This is the collection for the University of Waterloo's School of Public Health Sciences. The School was known as the Department of Public Health and Health Systems until January 2021.

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Alcohol and Select Medications as Fall Risk Factors in Community Dwelling Older Adults in Canada
(University of Waterloo, 2018-05-04) Laberge, Sarah; Crizzle, Alexander; Bigelow, Philip; Lagarde, Emmanuel
Abstract Introduction: Falls are the leading cause of accidental injury in community dwelling older adults, often resulting in emergency room visits, hospitalization and early admission to long-term care. Studies have identified many risk factors for falls including increasing age, diagnosis of a chronic disease, poor vision, fear of falling, hazards in the home, alcohol and prescription medications. While studies have examined many risk factors associated with falls, there is limited information on whether prescription medications and alcohol are risk factors in community dwelling older adults. Purposes: The primary thesis objectives were to: i) conduct a literature review to synthesize the literature on whether alcohol and psychotropic, anti-depressant and anti-hypertensive medications are risk factors for falls in community dwelling older adults; ii) examine what health and social factors are associated with high-risk alcohol use in community-dwelling older adults in Canada,; and iii) examine whether alcohol and select medications are predictive of falls in community dwelling older adults. Methods: The first aspect of this thesis was to conduct a literature review on select medications (psychotropics, benzodiazepines or anti-psychotics, anti-depressants, and anti-hypertensives) and alcohol, both singly and in combination, on fall risk in community dwelling older adults using the following search terms: drug or medication, aged or elderly or older adult or senior, accidental falls or falls or falling, and alcohol or alcohol drinking. These search terms were entered into four databases (PubMed, EMBASE, CINAHL and SCOPUS). A total of 1,146 articles were retrieved and screened for inclusion. Studies were included if 1) was a primary study; 2) included community dwelling persons aged 60 years and older; 3) included alcohol use as an independent variable; 4) included medications of interest; 5) falls were the primary outcome variable; and 6) published in English. We excluded studies if they were: 1) review articles, conference proceedings, books, editorial, case studies or commentary; 2) if articles relied on qualitative data (interviews, focus groups); 3) if they were not in English; and 4) included institutionalized persons (e.g. living in LTC or hospital). Chapters 3 and 4 used data from the Canadian Injury Prevention Survey. The survey was distributed online to local, provincial and national organizations across Canada that cater to older adults (2016-2017) and collected information on demographics, perception of physical and mental health, fall history, alcohol use, use of psychotropic, anti-depressant and anti-hypertensive medication use, smoking status, diagnosis of a chronic disease, physical activity, usual sleep quantity, likelihood of daytime sleepiness, and executive duties. While data was collected on community dwelling individuals 45 years and older, only data of those 65 years and older was examined in the present thesis (n=2,281). Chapter 3 examined alcohol use in community dwelling older adults (n=2,279). Participants reported the number of drinks they consumed per week and the number of days per week they consumed alcohol. The purpose of this chapter was to: 1) examine alcohol use in community dwelling older adults in Canada using current alcohol consumption guidelines; 2) develop and test new alcohol consumption guidelines to determine if they better differentiate drinking habits on health outcomes; and 3) determine risk factors of high-risk drinking. Low risk drinking was defined as 1-2 drinks per week for both males and females. Moderate drinking was defined as 3-9 drinks per week for males and 3-6 drinks for females. High risk drinking limits were defined as 10 drinks per week for males and 7 drinks per week for females. Using logistic regression, we examined demographic and health factors to predict low and high-risk drinking. Multinomial regression was used to examine predictors of low, moderate and high-risk drinking. Chapter 4 examined the use of alcohol and select medications as risk factors for falls, both as independent predictors of falls, and together with alcohol (n=2,281). Participants reported prescription medication, alcohol use on a weekly basis and fall history. Medications examined included psychotropic (anxiolytics, anti-psychotics, hypnotics/sedatives), anti-depressants (selective serotonin reuptake inhibitors (SSRI), serotonin antagonist reuptake inhibitors (SARI), serotonin-norepinephrine reuptake inhibitors (SNRI), tricyclic anti-depressants, or other) and cardiovascular agents (diuretics, beta-blockers, angiotensin converting enzyme inhibitors, angiotensin II receptor antagonist, calcium channel blockers) on fall risk. Correlations were performed to determine health factors correlated with falls. Logistic regression determined medications predictive of falls. Results: The literature review (Chapter 2) found 29 observational studies that met the inclusion criteria after screening. Sample sizes ranged from 307 to 321,422. Twenty-six studies examined the effects of benzodiazepines, hypnotics/sedatives or anti-psychotic use on falls, and twenty found benzodiazepines, hypnotics/sedatives or anti-psychotics were predictive of falls. Thirteen studies examined anti-depressant use and falls; 10 studies found that anti-depressants are predictive of falls. Twelve studies examined anti-hypertensives as a risk factor for falls and four found anti-hypertensives were predictive of falls. Fifteen studies examined alcohol use and five found alcohol was a predictor of falls. Findings from Chapter 3 show that 70% of participants reported drinking at least once per week. Using the current Canadian alcohol consumption guidelines, 6.2% of older males and 10.1% of older females were classified as high-risk drinkers. Moderate drinking was reported by 32.8% of males and 23.3% of females. When comparing current alcohol consumption guidelines to the new additional category (moderate drinking), there were no significant difference on health outcomes. Findings from Chapter 4 show that 33.4% of older adults had a fall in the previous two years. In fallers, 5.3% reported psychotropic use, 10.4% reported anti-depressant use, and 51.6% reported anti-hypertensive use. Anti-hypertensive medication and alcohol use was not associated with falls. As a group, psychotropic drug use was predictive of falls after controlling for potential confounding factors (p<0.05). Anti-depressant sub-classes SSRIs, SARIs and SNRIs were predictive of falls on their own and when controlling for sex (p<0.05). Conclusions The literature review found benzodiazepines, hypnotics/sedatives, anti-psychotic and anti-depressants are predictive of falls in community dwelling older adults. Anti-hypertensive medication and alcohol use were not predictive of falls. Compared to females, males were more likely to be moderate drinkers, however, overall adding a moderate drinking category did not help differentiate health and social factors associated with alcohol consumption. Psychotropic drug use overall, as well as individual anti-depressant drug classes (i.e. SSRI, SNRI and SARI) were all predictive of falls after controlling for sex. Anti-hypertensives and alcohol were not predictors of falls in community dwelling older adults based on the survey data. Findings of the literature review and survey data confirm psychotropic and anti-depressant use increase fall risk in community dwelling older adults. Clinicians should exercise caution when prescribing psychotropic and anti-depressant medications to older adults.
Breast cancer risk associated with phosphate toxicity
(University of Waterloo, 2024-07-18) Brown, Ronald B; Bigelow, Philip
Background - The essential dietary mineral phosphorus in the form of inorganic phosphate (PO43-) is regulated in the blood serum by a sensitive network of endocrine hormones released from bone, kidneys, parathyroid glands, and intestines. Western dietary patterns are high in phosphorus-rich foods, including dairy, meats, grain products, and foods processed with phosphate additives. Consequently, average phosphate intake is far above the U.S. dietary reference intake of 700 mg for adults. Phosphate toxicity, the accumulation of excess inorganic phosphate throughout the body from dysregulated phosphate metabolism, is associated with tumorigenesis as high levels of inorganic phosphate within the tumor microenvironment stimulate cell signaling pathways and promote cancer cell proliferation. Breast cancer in women is projected to increase to 3-million new cases globally by 2040, yet much of the public remains unaware that breast cancer is associated with alcohol consumption, and phosphate toxicity may play a mediating role in the association of alcohol with breast cancer. Phosphate toxicity is also associated with osteolytic loss of bone mineral density and abnormal osteoblastic bone mineral deposition. Methods - This thesis presents three studies investigating the association of phosphate toxicity with risk of breast cancer in women related to alcohol consumption, high dietary phosphate intake, and disorders of spinal bone mineral density. A grounded theory literature-review method was used in the first study to retrieve research findings from the literature on alcohol, kidney function, phosphate metabolism, rhabdomyolysis, and breast cancer. Findings were compared and categorized into concepts and themes and were synthesized into a theory positing a mechanism by which the association of breast cancer with alcohol consumption is mediated by phosphate toxicity. The second study used a nested case-control design to measure the relative risk of breast cancer incidence associated with dietary phosphate intake levels in a cohort of middle-aged women from the Study of Women’s Health Across the Nation. The lowest level of 800 to 1000 mg phosphorus per day, based on recommendations from the United States National Kidney Foundation, was used as the reference level to calculate the relative risk of breast cancer in the higher levels of phosphorus intake. The third study used a mixed-methods grounded theory design to synthesize a theory relating phosphate toxicity with breast cancer and spinal bone mineral disorders. Based on the theory, the study used a mixed-effects model to test the hypothesis that changes in spinal bone mineral density are associated with incidence of breast cancer in women from the Study of Women’s Health Across the Nation. Results - Results of the first study found that alcohol burdens renal function, which can impair the regulation of inorganic phosphate, reduce excretion of excess serum phosphate, and increase phosphate toxicity, a potential mediating factor in breast cancer risk. Alcohol can also cause nontraumatic rhabdomyolysis which ruptures cell membranes and releases inorganic phosphate, contributing to hyperphosphatemia (blood serum phosphate levels above 4.5 mg/dL) with increased breast cancer risk. Furthermore, phosphate toxicity potentially mediates the risk of cancer associated with kidney disease in the medical specialty of onco-nephrology. In the second study, the highest daily intake of dietary phosphorus in the cohort from the Study of Women’s Health Across the Nation, >1800 mg, is approximately equivalent to menus promoted by the United States Department of Agriculture. This level of dietary phosphorus was associated with a 2.3-fold increase in the risk of breast cancer incidence compared to the reference level of 800 to 1000 mg (RR: 2.30, 95% CI: 0.94–5.61, p = 0.07). The study’s clinically significant effect size, specificity, biological gradient, and other findings meet Bradford Hill’s criteria for causative inference from epidemiological associations. Randomized trials are warranted to test epidemiological associations of dietary components with reduced risk of cancer, as recommended by the National Cancer Institute The analysis of findings from the reviewed literature in the third study confirmed an association of phosphate toxicity with bone mineral disorders and tumorigenesis. In the follow-up study to test the hypothesis that bone mineral disorders are associated with tumorigenesis, women in the Study of Women’s Health Across the Nation who self-reported breast cancer were found to have higher bone mineral density at baseline. But these women also had more rapid losses in bone mineral density during follow-up visits compared to women in the control group who remained cancer free. These findings are consistent with osteolytic and osteoblastic bone mineral changes associated with breast cancer. Conclusions - Thesis findings provide the rationale for further clinical studies to test dietary phosphate as a modifiable cause of breast cancer and bone mineral disorders. The effect of alcohol associated with phosphate toxicity can also be disseminated to the public to increase awareness of the risk of breast cancer associated with alcohol consumption.
A Community-Based Pilot Study Exploring Work-Related Musculoskeletal Disorders (WMSD) Perception Among Recently Relocated Syrian Refugees in Canada
(University of Waterloo, 2020-02-18) Nazari, Roghiyeh (Mehrnaz); Bigelow, Philip
Refugees, a vulnerable population, usually end up in precarious work situations, which are very common in small businesses (SBs). SBs, where 69.7% of the total private labor force is employed, often hire unskilled workers and immigrants to perform manual labor and have few resources for musculoskeletal disorder (MSD) or occupational health and safety (OHS) prevention. A research group at the University of Waterloo has responded to this concern and developed a simple message about proper techniques for manual material handling (MMH) that was found to be a useful preventative approach to convey ergonomics knowledge and potentially lower the burden of MSDs among workers in SBs. This study followed up on research on the simple educational message “Leave objects off the floor” conducted by Binh Ngo in 1995. In his before-after study of the intervention, participants were asked to rate 44 videos of typical lifting tasks, from 0-10, on how likely they believed the task they just saw could eventually lead to a low back injury or low back pain (LBP). Based on the positive outcomes in Ngo’s study, it was hypothesized that this simple educational message could lead to positive outcomes among newly resettled Syrian workers to improve their knowledge of identifying LBP risk factors. Syrian refugees who had been relocated in Ontario, Canada for less than six years were recruited with the help of staff at settlement agencies in Hamilton, Kitchener, and Waterloo. An explanatory sequential mixed-method approach was utilized to understand refugee workers’ knowledge before and after the simple educational message. A total of 92 participants rated the 44 video clips before and after the simple educational message and 15 participated in semi-structured interviews. Statistical analysis of the lifting task rating data illustrated that the study participants were able to correctly identify LBP-associated risks, including the risk factors of vertical height, horizontal distance, weight, twisting, coupling, and repetitive movements with the exception for lifting and lowering. These findings were evident both before and after receiving the simple educational message. A primary hypothesis was that participants would rate more lifting tasks which included the risk factor of vertical height as risker after they were exposed to the educational message (vertical height is the focus of the message). This hypothesis was supported as for the vertical lifting tasks the increase in mean risk ratings in post-tests ranged from 13 to 35%. Analysis of the interview data helped explain specific findings from the ratings of lifting tasks that were unusual or unexpected. For example, for ratings for the task of lifting off the floor using the squat lifting technique were lower than expected and participants explained that they had heard in the past that squatting while lifting was the preferred approach. Similarly, participants ranked lowering objects as less risky than lifting based on their own perceptions when in fact the scientific evidence does not support differences in risk. An important message from the study is that simple messages can be effective but will be less effective if past experience/knowledge of participants is discordant. The interviews provided rich information regarding factors contributing to MSD development in refugee workers. Findings suggest that due to the usual gradual onset of symptoms in the early stages, alongside the general lack of knowledge, MSDs are not considered a serious health concern. Many accept its development as a natural part of the work experience, and thus inevitable. Participants described how institutional and personal barriers played a role in their exposure to MSD risk factors in Canadian workplaces and their reluctance to report hazardous conditions even if they experienced musculoskeletal pain. Many participants reported to be lax about protecting themselves from work-related hazards when faced with the demands of their jobs and other factors that discouraged safe work practices. These influential considerations included environmental factors, e.g., managers’ attitudes which focused more on customer service or productivity, MSDs being seen as less important than injuries and accident prevention, small businesses being in a survival mode with no resources for MSD prevention, participants’ own economic transition and their need to keep their job, as well as different levels of discrimination embedded in workplace structures.
A Critical Realist, Retroductive Multiple Cross Case Analysis: Exploring Psychosocial Factors Underlying Industrial Wind Turbine Exposure
(University of Waterloo, 2019-12-18) Yates, Susan, 1969-; Bigelow, Philip; McColl, Stephen
Few people today would deny the negative impact of non-renewable energy sources on the health of our planet. Around the globe, efforts are underway to reduce the world’s reliance on fossil fuel and nuclear energy. The rapid implementation of new renewable energy technologies, like Industrial Wind Turbines (IWTs) in rural environments has raised concerns regarding the potential effects of these technologies on human health. The mechanisms by which IWTs may affect local residents’ physical, emotional, and social health and well-being have yet to be determined. The purpose of this thesis is to intentionally explore psychosocial health factors underlying the IWT phenomenon, critically examine individual and group IWT experiences and perceptions, and triangulate multiple sources of data from which to further the understanding of the IWT health phenomenon. This study utilizes a qualitative multiple cross case study design and retroductive approach to explore, through social ecological and critical realism lenses, the lived experiences of adults from three wind farm communities in south western Ontario, living within five kilometres of one or more IWTs. A systematic scoping review of IWT health literature as well as environmental health literature was completed. IWT and health literature has increased, especially since 2013. A full text analysis of 217 articles was conducted and findings suggest that psychological and sociological (psychosocial) dimensions, including fear-perceptions, personality traits, attitudes, and community conflict, may be associated with reported adverse health effects. However, there continues to be several gaps in IWT research including; longitudinal studies, baseline studies pre-IWT installation, research regarding community response to IWT development (including noise, planning, landscape change), qualitative and field-based research. This thesis will serve to address and contribute to the latter identified gap. Thirty-one interviews were conducted with participants representing three Ontario wind development communities. Interview transcripts underwent a narrative thematic analysis. Interview findings revealed that both IWT supporters and non-supporters have some degree of worry or distress regarding financial implications of IWT installations and believe there is a global need to reduce the reliance on fossil fuels. Majority of IWT non-supporters described IWTs as visually annoying and reported associated health effects, including poorer mental health. A minority of non-supporters indicated that IWT noise was annoying. Very few participants attributed noise annoyance to sleep disturbance. Irrespective of participants’ support or non-support of IWTs, several interesting manifest (public) and latent (private) factors emerged from the interviews. Almost all participants reported being more concerned about the financial aspects of IWT development, government-decision making, and the perceived fairness in IWT siting than feeling concerned about potential health effects of IWT exposure. Additionally, a previous significant life event and a person’s level of attachment to their home, land and community appeared to influence perception, the ability to adapt to environmental change, and extent to which one experienced psychological distress. Triangulated results of thematic analysis from multiple data sources including literature, interviews and health assessment data revealed that changes to rural community and home environment (landscape) may affect person-place bonding and restorative properties of nature and home, while fear-inducing media and opposition messaging may amplify visual and noise annoyance and financial worry that may be associated with poorer self-rated health. Results from multisource data identified psychosocial factors associated with exposure potentially contribute to or be a consequence of actual or perceived environmental change. Further analysis suggests health effects may be explained by a combination of psychological (internal), socially influenced (external), and either amplifying or mediating factors. These factors informed a revision and a design of two conceptual models. The main components of these models consist of; external variables; mediating variables; and outcome variables. Individual characteristics like values and beliefs along with community-related variables suggest the explanatory power of personality traits, life stress and coping skills, and person-place bonding as well as site-related characteristics like social networks and approach to communication and site planning. Based on these themes a revised IWT health model and what is believed to be the first IWT social ecological concept model are presented. This work confirms previous studies that identified a need to expand policy decisions and environmental health assessments to include a holistic and ecological assessment of health impacts. In the context of wind energy and wind farm development, this multiple case study contributes to IWT literature by deepening the understanding of the dynamic interconnection between psychosocial factors and IWT development. The identification of differences between manifest and latent perspectives provides important insights into factors that may be associated with or contributed to reported health concerns. The resulting analysis elucidated that psychological processes and socially influencing factors and complex mechanisms may be indirectly associated to individual perception of wind turbines and self-rated health. Caution must be taken in interpreting the findings of this study. Given the complex mechanisms and diversity of variables of the findings, and models conclusions regarding a cause and effect relationship to IWTs must not be made. This work highlights the need for environmental health assessments to include specific requirements that could address, alleviate, or prevent psychosocial effects from IWTs or industrialization of rural communities.
Effects of Seat Suspension Types on Truck Drivers’ Vigilance
(University of Waterloo, 2016-01-22) Du, Bronson; Bigelow, Philip; Wells, Richard
Background: Due to long work hours and irregular work schedules, truck drivers can become fatigued, which can increase the risk of traffic collisions. Further, professional truck drivers are at an increased risk for musculoskeletal problems such as low back pain due to prolonged sitting, poor posture and whole-body vibration (WBV). In particular, WBV has been shown to be correlated with many adverse health effects including headaches, sleeping problems and low back pain which may effect the drivers’ ability to remain vigilant on the driving task. The purpose of this study was to determine whether prolonged driving and different levels of WBV exposures affected truck drivers’ response times over a workday and workweek. The results of this study may be important in understanding how prolonged driving and WBV may affect driver performance in real life settings. Methods: This study used a repeated measures crossover design with 5 line-haul truck drivers (ages 43-64) who had a regular route typically lasting 10 hours a day. The first week (5 days) drivers operated their truck with their existing, air-suspension truck seat; then an electromagnetically active vibration-cancelling (EAVC) seat was installed, and the drivers operated their truck with the EAVC seat in the second week. Previous studies have shown the EAVC seats can reduce WBV exposure by 50% on average. For five days each week, each participant completed a questionnaire about their sleep, caffeine consumption, and discomfort and a 10-minute sustained reaction time task called the Psychomotor Vigilance Task (PVT) was performed immediately before and after their shift. The PVT characterized response times (RT) by the mean RT, inverse mean RT, 10% fastest and 10% slowest RT, variability of the RT and lapses, which are the number of responses greater than 500 ms. WBV exposures were also collected from the drivers’ seat using a tri-axial accelerometer. The average changes in PVT response times pre- and post-shift were calculated and compared using mixed model methods to determine whether response times increased over the workday as workweek, as well as whether there were differences between the two seating conditions. In addition, z-axis daily time weighted average A(8) WBV exposures were also calculated to verify that the WBV exposures were different between the two seats. Results: Four and five WBV measurements were completed on the existing and EAVC seats, respectively. There was a significant difference (p < 0.001) in A(8) WBV exposures between the existing and the EAVC seats with mean (standard error) z-axis exposures of 0.49 m/s2 (±0.03) and 0.22 m/s2 (±0.01). With respect to driver vigilance, out of 25 possible measurements, 20 pre-shift and 20 post-shift PVT were collected in the existing air suspension seating condition and 22 pre-shift and 22 post-shift PVT were collected in the EAVC seating condition. Regardless of the seat being used, degradation in PVT performance after the work shift was found in mean 1/RT and variability of RT. Further, there were significant degradations in PVT performance (increases in mean RT and fastest 10% RT) over the course of the workday with the existing seats but not the EAVC seats (p=0.47 and p=0.020, respectively). Discussion: The purpose of this study was to determine whether truck driving had any effect on RT and whether the RT may be influenced by reducing drivers’ exposure to WBV. The study results indicated increased RT after a full day of driving and that reducing drivers’ exposure to WBV may have a positive effect on RT, which may translate to lower risks of truck collisions. Five truck drivers represent a relatively small sample; so repeating this study on a larger scale is merited.
Examining the impact of a restrictive retail food environment intervention on pharmacy sales over time in Baddeck, Nova Scotia
(University of Waterloo, 2017-12-21) Zummach, Dana; Minaker, Leia; Bigelow, Philip
Introduction: Sugar-sweetened beverages are a significant source of dietary sugar intake for both adults and children in Canada and around the world. Consumption of excessive amounts of sugar is a risk factor for a variety of chronic diseases, including obesity, type 2 diabetes and cardiovascular disease. The retail food environment influences how individuals choose and access food. This study examines the impact of removing all sugar-sweetened beverages from a rural pharmacy on the mean expenditure per transaction for four product categories: minimally processed beverages; minimally processed snack food; ultra-processed beverages; and ultra-processed snack food. Methods: Sales data were obtained from a pharmacy in Baddeck, Nova Scotia, Canada, from September 1, 2013 to September 30, 2015. The NOVA classification system was used to categorize items for analysis. The primary outcome measure was mean expenditure per transaction for each of the four product categories. Results: Overall, the number of beverage sold decreased substantially (-34%) after the intervention. Prior to the intervention, ultra-processed beverages accounted for half of all beverages sold. The intervention removed this entire product category, so while minimally processed beverages and other beverages saw an increase in the number of items sold, this increase did not compensate for the removal of all ultra-processed beverages. During the same time period, the number of food products and prescriptions sold increased slightly (4% and 9%, respectively) and the number of non-food products sold decreased slightly (-2%). Revenue from beverages decreased by 20% after the intervention, yet revenue from food and non-food products increased (17% and 2%, respectively). Revenue from prescriptions decreased by 2% after the intervention. While there was no significant change in the percentage of total store revenue that food and beverages accounted for before and after the intervention, the food and beverage category as a whole makes up such a small fraction of overall store sales that these changes result in a relatively minor loss of revenue at the pharmacy. After the intervention, a larger proportion of transactions contained at least one minimally processed beverage; minimally processed snack food and processed snack food. The mean expenditure per transaction did not change significantly after the intervention. Conclusions: This study is one of the first to examine the impact of a restrictive retail food environment intervention on pharmacy sales. With the expanding selection of food and beverage products available in pharmacies, pharmacies play an increasingly important role in creating healthy food environments. Findings from this study suggest that this type of restrictive intervention can be implemented with a very minor loss to overall store revenue after the removal of all sugar-sweetened beverages. These findings also suggest opportunities for further research using sales data in different contexts and jurisdictions.
In Danger? An Exploration of Canadian Truck Drivers’ Health through the Canadian Community Health Survey
(University of Waterloo, 2016-01-04) Wawzonek, Peter Aaron; Bigelow, Philip; Arocha, Jose
Background: There exists substantive evidence showing that the health status of truck drivers from the United States (US) is much poorer than the general US population. Comparatively there is much less research on Canadian truck drivers, however the macroergonomics of the motor carrier industry in both countries makes it challenging for drivers to maintain a healthy lifestyle. Thus Canadian truck drivers may also be at risk for poor health outcomes. The objectives of this thesis are threefold; to: (1) estimate the prevalence of chronic diseases in Canadian truck drivers and determine if the prevalence rates are higher than in the Canadian population, (2) identify and quantify the risk factors for chronic diseases in Canadian truck drivers, and (3) elucidate the variables that significantly correlate to BMI in Canadian truck drivers. Methods: A sample of 991 male truck drivers was compared to 29,958 male respondents of a similar demographic profile in the Canadian Community Health Survey (CCHS) from 2009-2010 (Cycle 5.1). The samples were comprised of those who were aged 18-65, worked 10-130 hours a week, had an income of at least $20,000, and had a Body Mass Index less than 60. The sample was restricted to males since female truck drivers make up less than 5% of the truck driver population, and there would be an insufficient sample size of female truck drivers to generate statistically sound confidence intervals. Furthermore female truck drivers have similar morbidities when compared to males. Cycle 5.1 of the 2009-2010 CCHS was used as this was the last year that occupation was measured in the CCHS. The reporting of occupation made this analysis on truck drivers possible. The CCHS is a cross sectional design survey which had a multi-stage stratified clustering sample design which obtained samples from all health regions of Canada. Chi-squared and regression analyses were performed, following bootstrapping and application of sample weights. Results: When compared to other working males in the CCHS, male truck drivers had an adjusted Prevalence Ratio (PR) of 1.45 (p<0.05) for heart disease, thus male truck drivers were 1.45 times as likely to report having heart disease as compared to other male workers. Prevalence ratios reported were adjusted for age, hours worked per week, household income, marital status, and education, as these were significantly different between populations in the Chi Square analysis. Truck drivers also had other adjusted PRs with p<0.05; higher BMI (PR of 1.69 for being obese, and 1.45 for being overweight, versus having a BMI in the normal range) higher amphetamine usage (PR of 2.04 for reporting usage “More than once” versus no usage), lower seat belt usage (PR of 5.99 for reporting using a seatbelt “Rarely” or “Never” versus “Always” or “Most of the Time”), higher rates of smoking (PR of 1.49 for being a daily smoker versus never smoking), high rates of fatigue (PR of 2.74 for the reported frequency of driving while tired being “Often” versus “Never”), lower levels of physical activity (PR of 0.52 for being active [versus inactive]) and lower fruit/vegetable intake (PR of 0.76 for reporting consuming 5-10 fruits/vegetables per day vs less than 5 fruits/vegetables per day). Although these prevalence ratios were expected based upon the literature review, some findings were unexpected: truck drivers lower prevalence ratios for frequency of having 5 or more drinks, prevalence of mood disorders, and self-perceived work stress and self-perceived life stress. Linear regression analysis on BMI was performed, elucidating that smoking status and daily physical activity over 15 minutes long significantly explained the variation in BMI; the more one smoked and the more active one was, the lower their predicted BMI was. Conclusion: This sample of truck drivers was markedly different from other employed Canadian workers with respect to chronic disease prevalence and overweight status. Findings, such as the relationship between smoking, physical activity and BMI, will be useful in designing intervention studies to improve the health of truck drivers.
Investigation of Effects of Wind Turbine Noise on General Health and Sleep Disturbance
(University of Waterloo, 2016-12-23) Jalali, Leila; Bigelow, Philip; Stephen, McColl
ABSTRACT Background: Although wind energy is now one of the fastest growing sources of power in Canada and many other countries, the growth in both number and size of wind turbines (WTs) has raised questions regarding potential health impacts on individuals who live close to such turbines. Suspected health-related effects of exposure to WT noise have attracted much public attention, with symptoms such as sleep disturbance reported by residents living close to wind energy developments. Objective: The overall objective of this study was to better understand and investigate the association between WT noise exposure and self-reported and objective measures of sleep and general health in nearby residents. Methods: This thesis consists of four studies: 1) a narrative review of the literature pertaining to general health and sleep effects related to WT noise, 2) a health and quality of life (QoL) field study exploring changes in QoL by using standard scales, 3) a sleep survey study evaluating self-reported sleep quality of residents by standard and validated sleep questionnaires, and 4) an objective sleep and noise study that included polysomnography and inside noise measurements during two consecutive nights. Participants also completed sleep diaries over a one week period. The field studies employed a prospective cohort design, with two data-collection times: before and after WT operation. Results: The literature review was intended to examine the peer-reviewed literature regarding evaluations of potential health effects such as degraded QoL, annoyance, and sleep disturbance among people living near WTs. Of 200 relevant articles, 30 articles (reporting on 11 cross-sectional studies) investigated a relationship between WTs and health, and fulfilled the inclusion criteria. The evidence, found in the review, was judged to be not sufficient to establish a cause-and-effect relationship. To address the limitations in existing research, it was recommended that a prospective study, with objective sleep and noise measurements before and after operation of WTs, be conducted. In the health and QoL study, the mean values for the Mental Component Score of SF12 (p<0.001), Satisfaction with Life Scale (p=0.002), Wind Turbine Syndrome Index (p<0.001), and Canadian Community Health Survey- Satisfaction with Life (p=0.048) significantly worsened after WT operation. These results were strongly associated with concerns about property values, attitude to WTs, noise sensitivity and visual and noise annoyance. In the subjective sleep study, the mean scores of the Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS) and Insomnia Severity Index (ISI) significantly increased. Changes in PSQI scores over time were strongly associated with negative attitudes to WTs, turbine visibility, and concerns about property values. Changes of ISI scores were also strongly related to property devaluation concerns and negative attitudes to WTs. No major differences were found in the objective sleep data of participants in terms of the effects on whole-night sleep parameters, sleep discontinuity, sleep quantity, and sleep efficiency. The reported effects on sleep, obtained by sleep diaries, support the findings from polysomnography in regards to sleep quantity. The average A-weighted noises measured in Time1 (T1) and Time2 (T2) observations were not significantly different, with means of 36.55 dB(A) (SD=4.18) in T1 and 36.50 dB(A) (SD=4.20) in T2 for Total Time in Bed (TIB) (p=0.959). The average Z-weighted sound pressure levels measured in T1 and T2 observations were also not significantly different, with means of 63.78 dB (Z) (SD=25.75) in T1 and 61.93 dB (Z) (SD=36.07) in T2 for TIB (p=0.218). Conclusions: The results of this study based on advanced sleep recording methodology together with extensive noise measurements, in an ecologically valid setting, cautiously suggest that there are no major changes in the sleep of participants newly exposed to WTN. Results of the subjective data provide evidence for the role of individual differences and psychological factors in reports of sleep disturbance and degraded QoL by people living near WTs.
Knowledge Transfer and Exchange in Work and Health Research
(University of Waterloo, 2016-09-28) Van Eerd, Dwayne; Bigelow, Philip; Wells, Richard
Knowledge transfer and exchange (KTE) is the practice of preparing and disseminating research to those who can use it. The burden of workplace injury and illness can be great affecting workers, workplaces, the medical system, insurance systems and society as a whole. Occupational health and safety is an important aspect of prevention of workplace injury and illness. However prevention activities are varied and may not be based on the best available evidence, being therefore less effective than possible. The overall aim of the thesis is to examine and evaluate KTE activities and the conceptual basis for KTE in work and heath research. Specific objectives include i) providing an overview of the KTE approaches from the literature which target workplace audiences; ii) disseminating and documenting the uptake and use of an evidence-based tool (PE guide) across British Columbia; iii) document and describe the dissemination activities and the KTE experiences of research staff within work and health research organizations; and iv) examine the conceptual basis of the work and health KTE activities. This thesis consists of four manuscripts that describe three studies: a narrative review of the literature summarizing KTE approaches in work and health research, a study exploring the dissemination and use of an evidence-based guide, and a survey study evaluating the KTE activities of work and health researchers. Though different methodologies were employed the three studies used an organizing conceptual framework by Lavis et al. (2003) comprised of five questions: (1) What (information disseminated), (2) To Whom (target audience, and context), (3) By Whom (messengers), (4) How (KTE approach), (5) What effect (outcomes, impact). The review findings suggest a variety of KTE approaches to transfer work and health research knowledge to workplaces. The KTE approaches address various target audiences and workplace contexts related to health and safety and tended to be guided by conceptual frameworks. The evaluation of KTE approaches is challenging and future research should be designed to allow for more rigorous evaluation. The study describing the dissemination and use of an evidence-based tool reveals that respondents felt the greatest barrier to using the tool was a lack of time. However those that did use the guide reported using it for training purposes, sharing it, and integrating the tool into existing programs. In addition, new actions related to tool use included training, defining team responsibilities and suggesting program implementation steps. The dissemination study suggests that when evidence-based tools were used they helped work and health audiences overcome some challenges involved in using evidence in implementing injury reduction programs. The study provided a better understanding about the uptake and use of this type of tool. Work and health researchers reported that KTE activities were important and they felt confident about interactions with knowledge users. Respondents reported engaging in various KTE activities that extended beyond the typical academic approaches of ‘publish and present’. However they reported that processes supporting KTE as well as the promotion and evaluation of research use could be improved. The KTE activities of work and health research staff address the categories of two popular KTE conceptual frameworks. However, only one-third of respondents reported using guidance from conceptual frameworks in practice. Future research should examine whether KTE activities based on conceptual frameworks have greater impact than those that are not so guided. Taken together the chapters provide a comprehensive picture of KTE in work and health research. The findings reveal important common elements of KTE from the literature as well as work and health research staff. The findings also provide some evidence that disseminating an evidence-based tool has impacts on practice. However work and health research staff KTE activities still focus on traditional academic avenues and often lack guidance form conceptual frameworks. Future research is necessary to further evaluate KTE practice in work and health.
Understanding the Experiences of Retirement Transitions Amongst Older Workers in Physically Demanding Occupations
(University of Waterloo, 2020-10-21) Nur, Teeyaa; Bigelow, Philip
Background and Objectives Approximately 60% to 70% of Ontario workers have no pension – nonunionized workers are most affected, leaving many older workers in vulnerable positions. This vulnerability is exacerbated for individuals in physically demanding jobs. However, we know little about retirement motivations and how work affects health in this context. Precarity and financial insecurity in retirement planning and motivations are complex, multifaceted, and intersectional, especially for those in physically demanding occupations. Specifically, looking at these experiences as an account from the workers themselves is of increased importance. This is increasingly important to address in the Canadian context. This work presents an understanding of the ageing population's experiences, from the vantage point of older workers in physically demanding occupations, specifically as they approach retirement. Methods This study uses a qualitative research design to explore older workers' experiences and retirement motivations in physically demanding jobs. This study used convenience and snowball sampling to recruit 19 participants who were between the ages of 55 and 68, education (9), hospitality and tourism (3), food production (1) and Healthcare industries (6). This study used Semi-structured telephone interviews. Interviews were audio-recorded and transcribed using NVivo 12. This study used thematic analysis and a deductive approach to develop interview questions and analyze the data guided by the lidA Conceptual Framework using three thematic fields; Work Environment, Health, and Sociodemographic characteristics. Results Findings from this study identified that sociodemographic characteristics such as immigration and financial insecurities play a role in shaping participant retirement motivations. Themes were uncovered reflexively and revealed the impact each had on the precarity and insecurity of retirement and work motivations in later life. The following themes emerged: 1. Workers' demographic backgrounds are influential factors in determining precarity and insecurity; Systemic issues and organizational structures contribute to poor working environments that make working there more difficult and problematize retirement plans; 3. Physically demanding work exacerbates health issues and injuries; 4. How work is embedded in older workers' identities; 5. Social networks and individual strategies improve workers' outlook on work and retirement; and 6. Mentally demanding aspects of work feed into physical exertion. Conclusion By analyzing the experiences of older workers in physically demanding occupations, this study sought to illustrate how these workers experience ageing and retirement as they approach retirement. This was done by examining their motivations for retirement or continued workforce participation. Secondly, this study sought to dissect how workers feel their work affects their health and how their health affects their work. The study's findings found that the experiences of older workers in physically demanding occupations as they approach or transition into retirement, with a particular emphasis on the interrelationship between work and health. This study identified the factors (motivations) that lead to early or delayed retirement linked to broader social structures through an account of their experiences, informed by previous findings of the lidA conceptual framework. This study elucidated the importance of further research on a larger scale to target areas and policies that could improve older workers transition into retirement better and reduce the burden of precarity and insecurity in later life for workers in physically demanding work.
Using Qualitative Methodologies to Explore the Lived Experience of Chronic Pain and Chronic Pain in the Workplace
(University of Waterloo, 2021-09-23) Stein, Matthew Lawrence; Bigelow, Philip; Fenton, Nancy
Introduction: Chronic pain is a significant and challenging issue, impacting an increasingly large number of Canadians. The impacts from chronic pain are individually felt on a biological, psychological and sociological level and as a result proliferate one’s life in entirety. The workplace being a key domain in one’s life creates an additional layer of complexity in managing chronic pain conditions, both from the perspective of the worker with a chronic pain condition and the employer as well. This dissertation consists of three manuscripts, all using qualitative methodologies to explore issues of chronic pain in the work environment. Manuscript 1 - Contemporary Approaches to Phenomenology: This manuscript reviews two contemporary approaches to phenomenology in Jonathan Smith’s Interpretative Phenomenological Analysis and Maxwell van Manen’s contemporary approach to phenomenology and provides a comparison and critique of both of these approaches. Through detailing these approaches on a critical level should be feasible for novice researchers to adequately ascertain whether these particular applications on phenomenology are beneficial and applicable to their research. Manuscript 2 – Autoethnography of a Young Adult with Chronic Pain: This manuscript explores the author’s personal experience in navigating their chronic pain condition as a young adult. From the narrative of these experiences, three major themes were discussed and analyzed through the existing literature in the field. These themes included: interactions of young adults with health care providers, impacts by and on caregivers in supporting a loved one with a chronic pain condition and the specific challenges of managing reduced capacity in the workplace environment. Manuscript 3 - An Interpretative Phenomenological Analysis of Chronic Pain in those who are Self-Employed or Teleworking: This final manuscript utilizes Interpretative Phenomenological Analysis (as discussed in Manuscript 1) to discuss the lived experience of four individuals who shifted to some form of self-employment or telework to help manage their chronic pain condition. Common themes emerged from the interviews completed, including: the strategies adopted to manage their chronic pain condition in their home-based work environment and the benefits and challenges that occurred with self-employment and telework and their chronic pain. Self-employment and telework were regularly found to be a necessary approach for managing their chronic pain given the increased self-efficacy and autonomy despite the number of challenges that they faced in this particular work environment. Conclusions: These three manuscripts work together in order to successfully apply a variety of qualitative methodologies to help increase the understanding of these nuanced conditions. The particular area of chronic pain among those who are self-employed and teleworking is a valuable groundwork paper in the current workplace environment where more people are participating in various forms of self-employment or telework.
Utilizing Construction Safety Leading and Lagging Indicators to Measure Project Safety Performance: a case study
(University of Waterloo, 2018-07-10) Versteeg, Katelyn; Bigelow, Philip
Background Construction accounts for 22% of all workplace fatalities in Ontario (Association of Workers' Compensation Boards of Canada, 2015), although construction only accounts for 7% of Ontario’s workforce (Statistics Canada, 2017a). Due to the dangers of the construction industry, safety indicators, termed leading and lagging, have been developed to measure safety performance and prevent further injury. Objective The objective of this thesis is to determine whether the relationship between safety leading and lagging indicators have predictable relationships, as they are on an industry level, when measured on a company level using company administrative data. Methods The case study involved the collection of safety indicators from 47 construction projects. An evaluation of available safety indicators was conducted and in the end 5 indicators were chosen for use in this study. These being counts of site inspections, toolbox talks, subcontractor notice of offenses, medical injuries, first aid injuries and project length. Since counts for the outcome variables exhibited an excess of zeros, the counts are assumed to be produced by two distributions, one being described by a standard Poisson process and the other a process that always produces a zero count. Four zero-inflated Poisson models were run to determine whether the leading indicator, site inspections or toolbox talks, led to a decrease in the value of the lagging indicators, medical injuries or first aid injuries. Model 1 tested the effect of site inspections on zero counts of medical injuries. Model 2 tested the effect of toolbox talks on zero counts of medical injuries. Model 3 tested the effect of site inspections on zero counts of first aid injuries. Model 4 tested the effect of toolbox talks on zero counts of first aid injuries. Results Models 1 and 2 found that number of medical injuries were not significantly related to either site inspections or toolbox talks. Models 3 and 4 found that first aid injuries were significantly related to site inspections and toolbox talks, when run independently. Yet, the estimate sizes of all four models were very small. Goodness of Fit tests were run to ensure that the sample distributions fit the hypothesized distributions of the models selected. These results showed that the lagging indicators were either not related to or had a small association to each of the leading indicators. Discussion This study showed that identifying the relationship between leading and lagging indicators may not be as easy as the theory suggests. This study had several limitations including use of administrative data, small sample size, and concern about data quality. Furthermore, theories about accident prevention and prevention research are also discussed. One theory discussed is that early accident prevention models suggest that some accidents are unpreventable. In the context of this study, it is possible that the few accidents that did occur were unpreventable in nature and could not be prevented through leading indicators. The second theory discussed was that Geoffrey Rose’ Theory of Prevention suggests that concepts tested on a population level may not work on an individual level. For this study, it means that the leading and lagging indicators developed on an industry level, may not be appropriate for testing on a company level. Finally, suggestions to how the participating company could improve safety research and their safety performance were given including collecting a safety climate indicator, conducting bi-annual meetings with safety reporting personnel, improving documentation of subcontractor safety performance, and reorganizing MB’s administrative data. Conclusion In conclusion, despite the fact that leading and lagging indicators have been developed on a simple assumption, there needs to be more research in order to better understand this relationship on a company level. Research needs to be completed to determine how the legislated paperwork that companies collect can be used to support injury prevention and decision making.
Work-related psychosocial stress and allostatic load within firefighters
(University of Waterloo, 2018-01-10) Igboanugo, Somkene; Mielke, John; Bigelow, Philip
The aim of this study was to investigate the nature and type of psychosocial stress experienced by firefighters through investigating the cumulative effects of work-related factors on their health by reviewing current literature. In addition, the study investigated a range of physiological markers of chronic stress experience (i.e., an allostatic load index), and determined relationships between allostatic load and work-related stressors amongst 6 firefighters. Results from the systematic review showed the significant role psychosocial stressors played on the health outcomes of the studied firefighters. Psychosocial factors (including social support, job demand/pressure, lack of reward, organizational system, occupational climate/environment, self-esteem, rank of work, shift work, shift work and self esteem) showed various associations with unfavourable health outcomes in firefighters. The pilot study revealed high perceived stress levels among the sample population. Significant associations were observed between hair cortisol level (stress response) and perceived stress reported by the firefighters. Systolic blood pressure and HbA1c levels also showed a positive correlation with perceived stress. The study population reported significant concern on the following psychosocial factors: organizational structure, clear leadership and expectations, involvement and influence, and workload management. The allostatic load index (ALI) in our study population was relatively high when compared with other population groups. Certain biomarkers of the ALI surpassed their accepted cut-off levels (systolic blood pressure, BMI and hair cortisol levels). Despite high perceived stress levels and corresponding ALI, we were unable to find a significant association between ALI and workplace stressors in our study population. Future research should include a longitudinal study with an effective sample size using multi-systemic variables (ALI) to investigate biologic wear and tear associated with firefighting.

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