RESEARCH ARTICLES

Alcohol use and health conditions among truck drivers

Josélia Benedita Carneiro Domingos^I, Sandra Cristina Pillon^II, Manoel Antônio dos Santos^III, Ronildo Alves dos Santos^IV, Natália Prioli Jora^V, Paulo Sérgio Ferreira^VI

^INurse. Sc.D. from the Postgraduation Program in Psychiatric Nursing. Nursing School of Ribeirão Preto. University of São Paulo. Ribeirão Preto, São Paulo, Brazil. E-mail: joselia.domingos@usp.br
^IIFull Professor. Department of Psychiatric Nursing and Human Sciences. Nursing School of Ribeirão Preto. University of São Paulo. Ribeirão Preto, São Paulo, Brazil. E-mail: pillon@eerp.usp.br
^IIIAssociate Professor 3. Department of Psychology. Faculty of Philosophy, Sciences and Letters of Ribeirão Preto. University of São Paulo. Ribeirão Preto, São Paulo, Brazil. E-mail: masantos@ffclrp.usp.br
^IVPh.D. Professor. Department of Psychiatric Nursing and Human Sciences of University of São Paulo. Nursing School of Ribeirão Preto. University of São Paulo. Ribeirão Preto, São Paulo, Brazil. E-mail: ronildo@eerp.usp.br
^VNurse. Sc.D. from the Postgraduation Program in Psychiatric Nursing. Nursing School of Ribeirão Preto. University of São Paulo. Ribeirão Preto, São Paulo, Brazil. E-mail: natalia_jora@hotmail.com
^VISpecialist Nurse. Department of Psychiatric Nursing and Human Sciences. Nursing School of Ribeirão Preto. University of São Paulo. Ribeirão Preto, São Paulo, Brazil. E-mail: pausefer@eerp.usp.br

ABSTRACT: This study aimed to identify the alcohol use and the health condition of truck drivers participating in a health campaign. The methodological design is an descriptive of the quantitative approach. Data collection was conducted between August and October 2006 on a highway in São Paulo State, Brazil, by means of a questionnaire containing demographic information, Alcohol Use Disorders Identification Test (AUDIT) and health conditions issues. Among 1087 participants, 827 were truck drivers, predominantly male, adult, white, and married, with low level of education and Catholic religion. The results pointed out a list of risks among drivers who scored more than eight points in the AUDIT, who had high blood pressure, glucose and cholesterol levels above normal, and overweight and obesity. Early identification of both problems is a valid alternative to the implementation of preventive actions to this population.

Keywords: Alcohol-related disorders; health promotion; nursing; drivers.

INTRODUCTION

The literature brings well documented the role of alcohol consumption in the onset of several chronic health conditions, which is happening increasingly due to the nutritional and epidemiological transition. Although alcohol consumption is considered a factor that enhances the probability of developing chronic diseases (NCCDs), this area has received little attention when assessed from the perspective of chronicity and, especially, of the need for early identification of risk factors for these diseases and possible preventive interventions^1-3.

There is a disjunction between the damage caused by alcohol use and the initiatives of control or effective management of potential negative outcomes. Professionals and the population in general are still little aware about the most serious consequences of alcohol abuse, as observed in the situation of drinking and driving. The consequences in the medium and long term, such as the NCCDs related to alcohol consumption, have been little investigated. In clinical research, in assisting and in developing public health policies aimed at NCCDs, the privileged focus has been to identify risk factors related to the use of psychoactive substances (particularly alcohol and tobacco) and to lifestyle (physical activities and healthy eating patterns)¹.

In 2008, the Law 11,705/2008 was enacted, which established zero blood alcohol content (BAC) for the vehicle driver in Brazil. After the adoption of this Law, there was an immediate reduction in traffic accident rates⁴. Examination of BAC has been a focus of intense discussion in the Brazilian media as the main strategy to promote effective reduction of morbidity and mortality in traffic due to the binomial drinking and driving. However, there are few studies that indicate the relationship between consumption and NCCDs. The research on this type of consequence is relevant, especially when the NCCDs are installed and clinical conditions are aggravated, the driver is probably already unable to drive. In such cases, preventive control measures, focusing on the relationship between driving and alcohol, are no longer effective.

Considering the need to seek evidence to elucidate the relations between alcohol consumption and health, this study aimed to identify the use of alcohol and health conditions in truck drivers.

LITERATURE REVIEW

The relationship between alcohol use and NCCDs is a major global public health problem. It is the leading cause of mortality and disability, representing a serious threat to human health and development. Data from the World Health Organization (WHO)² indicate that, globally, the use of alcohol accounts for 3.2% of all deaths and 4% of all diseases^3,5, resulting in high social and economic costs. According to the WHO, there is a causal relationship between alcohol consumption and more than 60 types of diseases^1-3,5, including cardiovascular, gastrointestinal and neuropsychiatric conditions and a variety of cancers. The role that alcohol plays in the development of NCCDs is particularly important in light of consumption habits observed in different population groups, which indicates the importance of considering this causal link when policies and measures to tackle the problem in terms of prevention and treatment are planned⁵.

In recent decades, alcohol consumption has been increasing in many countries, and most of that increase is happening in developing countries. Not only in Brazil, alcohol (6.2%), tobacco (2.0%), hypertension (2.5%), altered cholesterol (1.9%), Body Mass Index (BMI) (2.7%) and overweight with high mortality rate (14.9%) are factors that contribute to the increase of disabling health problems^6-9.

Conceptually, alcoholism is characterized as a chronic degenerative disease, which comprises a set of signs and symptoms with high relapse rates. The severity develops along a continuum and can appear suddenly or install insidiously over time⁷.

Furthermore, the NCCDs are those that require some time to develop, last for a long time and require the management of multiple intervention strategies. These conditions require treatment for a long time and generate overload in the healthcare system. It is also observed that many of the negative aspects resulting from these conditions are irreversible and may require a continuum of prolonged care and rehabilitation^1-3.

The NCCDs have also been described as lifestyle diseases, characteristic of contemporary society, triggered by multiple and complex risk factors, related to areas such as: eating behavior, working conditions, physical activity, sleep patterns, medication use, stress management, drug use (alcohol and tobacco), high-risk behavior (exposure to accidents and situations of violence) and dysfunctional familial and social relationships^8,9.

In recent years, issues related to alcohol use and health-related aspects in the Brazilian context have been emphasized when considering the group of drivers, especially truck drivers^10-17. This group of professionals is prominent for the difficulty in maintaining a healthy lifestyle, which puts them in a situation of high psychosocial vulnerability because of the long working hours and the little time available for physical activity. The combination of these factors favors the development of overweight, obesity and other NCCDs^10,11,17.

Studies in this population group were developed in order to identify the risk factors, associating the use of alcohol, tobacco and amphetamines to health conditions such as blood pressure, blood glucose, cholesterol, triglycerides, overweight and obesity^10,14-17. In this context, the literature on the use of alcohol and the aspects related to the health conditions of truck drivers have presented alarming rates. The good news is that most of the risk factors are modifiable behaviors, i.e., liable to preventive actions.

Therefore, it becomes important to identify the use of alcohol and the health conditions of truck drivers in order to contribute to the development of public policies and prevention programs regarding the use of psychoactive substances and hazards of chronic consumption. Moreover, the study supports the nurses in their prevention activities, helping to delineate their role and assistance activities in this area of knowledge, in order to integrate them as active professionals who participate autonomously, individually or in partnership with other health professionals in the prevention of alcohol use and in health promotion aimed at truck drivers.

METHOD

The methodological design of the study is descriptive, with quantitative approach. This research was developed as part of a university extension project, which involves performing a preventive health campaign aimed at drivers that occurs every three months on a highway in the São Paulo state countryside.

Of the 1,186 participants attended in six days of two health on the road campaigns, conducted between August and October 2006, 1,014 (85.5%) drivers who agreed to participate were interviewed. Of these, 827 (81.5%) truck drivers were selected for the sample of this study.

The individuals were selected according to pre-established eligibility criteria: age ≥ 18 years; being a truck driver and being a participant in the health on the road campaign. Exclusion criteria: age ≤ 18 years, not being a truck driver.

To collect data, a questionnaire with closed questions was used, which contained sociodemographic information and the AUDIT, consisting of 10 questions that assess the level of risk with regard to drinking¹⁷. Information on the aspects related to health, such as the presence of chronic diseases (severe hypertension, Diabetes mellitus), cholesterol, medication use and BMI. Thus, the participant with a BMI below 25 kg/m2 was considered of normal weight, those with a BMI equal or higher than 30 kg/m2 were considered obese, and those with a BMI between 25 and 30 kg/m2 were considered overweight, according to the WHO^11-14. Data collection was performed by the authors, and the BMI assessment was conducted by a qualified technician.

The AUDIT is a screening tool to detect the abuse of alcohol that was developed by the WHO¹⁸. This test is widely used in many countries because of its easy application and low cost. The total score ranges from zero to 40 points, which identifies two levels of alcohol use or risk areas, i.e., a score ≤ 7 means abstainer or of low risk, and ≥ 8 means risky or problematic use.

This study followed the ethical standards and procedures in accordance with the Resolution No. 196/96. The project was approved by the Research Ethics Committee of the Nursing School of Ribeirão Preto, University of São Paulo (Process No. 033/2007).

For statistical analysis, a database was prepared using the Statistical Package for Social Sciences (SPSS) version 17 for Windows and Stata 7.0, which consisted of sample description and analysis through logistic regression (gross odds ratio, OR, and adjusted odds ratio, ORA), to assess risk associations between alcohol consumption, sociodemographic information and health conditions. Evidences of association can be observed if the value one is not contained in the interval with 95% confidence (CI 95%).

RESULTS

The sample consisted of 827 (81.5%) truck drivers, aged between 21-72 years, mean of 41.3±9.8 years, predominantly male – 821 (99.3%) –, married/cohabiting – 707 (85.5%) –, white – 551 (66.7%) –, with low education level (complete or incomplete Middle School) – 554 (67%) –, declared as being Catholic – 584 (70, 6%). Data not presented in table.

Variables such as age group from 30-45 years, Catholic religion, no religion and religious practice were identified as predictors of risk factors for alcohol use (AUDIT ≥ 8) for truck drivers, with statistically significant values. However, other variables such as skin color, marital status and education presented no significant values in this sample. The variable female is noteworthy. Although there were few women in the sample, they were identified as a group of potential risk factor, since most presented a score ≥ 8 in the AUDIT (Table 1).

TABLE 1. Logistic regression between sociodemographic information and score in the AUDIT of the truck drivers, Campanha Saúde na Estrada [Health on the Road Campaign]. Ribeirão Preto, SP, 2006 (N=827).

Individuals who declared being Catholic, Spiritist or of no religion, when compared to Evangelicals, presented a score ≥ 8 in the AUDIT, with odds ratios of 3.09, 2.49 and 3.20, respectively. The variable of belonging to an evangelical religion is presented as a protective factor, since a considerable number of participants of that religious belief scored ≤ 8 in the AUDIT, as presented in Table 1.

Concerning truck drivers, 610 (73.8%) used alcohol regardless of the level of risk. It is noteworthy that 265 (32%) consumed in low-risk levels, and 264 (31.9%) had high-risk use. The data are presented in Table 2.

Except for the use of medications and the presence of chronic diseases, although there were no statistically significant associations, the highest risk was found in drivers who scored ≥ 8 in the AUDIT, in addition to the presence of diseases such as: hypertension, diabetes and cholesterol levels above normal. Among the risk factors, an association was identified between AUDIT ≥ 8, overweight and obesity, as presented in Table 3.

TABLE 3. Logistic regression between score in the AUDIT and health conditions of the truck drivers participating in the Campanha Saúde na Estrada [Health on the Road Campaign]. Ribeirão Preto, SP, 2006 (N=827)

DISCUSSION

This study assessed the use of alcohol and health conditions in truck drivers participating in a preventive campaign of health on the road.

The sample was characterized predominantly by males, adults, married and/or cohabiting, white, with low level of education and Catholic. These findings are consistent with the literature that assesses this professional category^10-17. The studies demonstrated that there is a negative association between heavy alcohol consumption and socioeconomic status, education, occupation and income.

The sociodemographic characteristics identified among the participants of this study support the proposals of the health on the road campaign, which aims to reach this audience and offer a preventive work of social and health promotion to drivers, especially truck drivers^10,12. This is considered a priority group for the development of actions and preventive and health promotion strategies, since it belongs to an economically active portion of the country, it is more vulnerable to developing high-risk behaviors, NCCDs and sexually transmitted diseases (STDs), alcohol use, tobacco and other drugs with potential deleterious consequences for health^1,2.

For a very long time, the literature has indicated that there is complex relations between alcohol consumption and the health conditions of drivers^12-17, which often present themselves as precarious. This corroborates the data of the literature, which present the causal relationship of chronic use of alcoholic beverages with more than 60 types of diseases5 such as obesity, hypertension and poor control of Diabetes mellitus^12-15.

Regarding alcohol consumption, 73.8% of the drivers consumed it, regardless of the risk level scored by the AUDIT. These rates are considered very high when compared to other Brazilian studies^12-17. As for the classification of risk levels in relation to drinking, 265 (32%) drivers consumed alcohol at low-risk levels, while 264 (31.9%) had high-risk use, according to Table 2. This means that truck drivers are consuming alcohol in alarming quantities, despite the international health organizations recommending that the sensible drinking is characterized by a consumption that presents no harm to oneself, no risk to one’s health and no risk to the health of others¹⁸. Thus, it is questionable how effective have been the control measures concerning the association between drinking and driving, as well as alcohol use prevention campaigns for drivers. Although the country has a highly coercive law (prohibition in relation to drinking and driving), it must work towards a tighter control on the roads.

It is noteworthy that alcohol use has been a major global public health problem^1-3, not only for people who have already developed alcohol dependence, but mainly for those who use it in high-risk and harmful levels. Most negative consequences (for the individual, the family and the community) related to alcohol use are not a result of alcohol dependence, because the percentage of dependents in relation to those who have high-risk use is relatively smaller and often they are already out of the labor market due to the disability generated by alcoholism. Generally, the existing problems appear more often among those drinking at high-risk levels, associated with the different patterns of mortality and morbidity¹⁸. Thus, the focus of the campaigns and other preventive strategies should be directed to the segment of consumers at risky and harmful levels.
Understanding the impact of alcohol use on health conditions in truck drivers implies multiple challenges, noting that alcohol-related problems result not only from excessive drinking and intoxication. In fact, even low or moderate levels of alcohol consumption can have deleterious effects, including job performance, traffic safety and risk of developing NCCDs¹.

Finally, the results of this study are remarkable because it refers to category of workers that present several behaviors that involve risk of developing health problems, such as stressful working hours, unhealthy eating habits, precarious self-care and low rate of seeking healthcare^13-17.

With regard to NCCDs, increased risk was present in drivers who consumed alcohol at problematic levels (AUDIT ≥ 8), in addition to presenting symptoms that suggested diseases such as severe hypertension, Diabetes mellitus and levels of cholesterol higher than expected. Among risk factors, associations between AUDIT ≥ 8, overweight and obesity were identified (Table 3). One of the greatest challenges for public health for the years to come is to control the ongoing progress of obesity in the country, which already affects 16.9% of the adult Brazilian women and 12.4% of the adult Brazilian men^5,7.

According to the literature, the health risks associated with acute and chronic use of alcohol are different. For example, an individual who consumes 14 doses on a single occasion presents higher probability of involvement in traffic accidents, while an individual who consumes more than two doses daily has a higher risk of developing NCCDs^2,6.

CONCLUSION

This study enabled identifying the use of alcohol and health conditions in truck drivers participating in a campaign of health on the road. The results showed risk factors that can be modified through prevention and health promotion strategies aimed at this population.

The problems associated with alcohol use and health conditions, especially the NCCDs, have reached worrying levels in recent years, contributing consistently to the development of various diseases, precarious health conditions, involvement in high-risk behaviors, triggering of mental illnesses and traffic accidents. Traffic accidents already are one of the main causes of mortality in the world.

Given the magnitude of the risks associated with the use of alcohol and chronic degenerative diseases, it is imperative to rethink strategies for prevention and health promotion in a continuous and sustainable manner, in order to increase knowledge of the risk factors for noncommunicable diseases and conditions and hence lead to changes in lifestyle.

One limitation of this study is the methodological design used (cross-sectional study). Future studies should address the need for research with longitudinal design and assess the effectiveness of the use of other resources to identify alcohol use by drivers, such as the breathalyzer test. Another limitation is the fact that, in the health on the road campaign, truck drivers participated voluntarily. Thus, it is plausible to think that there may have been a portion of drivers using the road system that consumed alcohol and were not evaluated. We also suggest the development of studies to evaluate the possible use of other drugs, such as amphetamine, cocaine and crack.

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