Opinions of taxi drivers regarding occupational risks and prevention strategies: A cross- sectional study in Turkey

1 Introduction

Physical, chemical, biological, and psychosocial risks are the most significant occupational risks connected with professional driving. These are dangerous to one’s health and driving behaviors and can have a negative impact on one’s health [1, 2]. Vibration, carrying a large weight, pulling, pushing, and long-term sitting are all physical risks for professional drivers. Exposure to toxic gases and other contaminants poses chemical and biological dangers. Stress and violence are classed as psychosocial risks, while smoking, alcohol consumption, and the status of physical activity are identified as individual behavior risks [2, 3]. Drivers suffer from musculoskeletal system (MSS) disorders, cardiovascular diseases (CVD), obesity issues, digestive issues, stress, exhaustion, psychological issues like mood and sleeping disorders, respiratory diseases, and bladder problems as a result of these risks [4–10].

The most popular form of a professional driver is a taxi driver. The dangers that induce systemic disorders in taxi drivers are defined as a result of the literature review. Risk factors for MSS diseases include vehicles not designed for long work shifts, continuous exposure to low-level vibrations for long periods, uncomfortable ergonomic design of some vehicles, sitting in the wrong position, carrying heavy objects, lack of adequate breaks, working for many years, long working hours, insufficient rest, and psychosocial factors (job stress, job dissatisfaction) are known as risk factors for drivers arising from the obligation brought by the job [7, 11]. Individual characteristics like age, gender, weight, height, body mass index (BMI), and general health have also been linked to MSS diseases [12–15]. These risk factors cause some problems, and research shows that upper extremity pain (back, neck, shoulder, wrist, hand, and arm) and lower extremity pain (leg, knee, and foot) are common in taxi drivers, depending on their job [11, 16].

Long working hours, irregular shift work, sedentary lifestyles, stress, and exposure to many forms of pollution are all factors that affected taxi drivers at risk for cardiovascular disease [17, 18]. A wide range of health concerns experienced by taxi drivers have been discovered in studies conducted by academics in various countries. Obesity, eye issues, hypertension, diabetes, and dyslipidemia were all shown to be more common among Iranian taxi drivers in a cross-sectional study [19].

Long hours driving and self-reported obesity, hypertension, diabetes, and high cholesterol were all identified to be significant cardiovascular risk factors among Singapore drivers [20]. They comprehensively described risk factors such as tobacco, diet, physical activity, stress, depression, body mass index/waist circumference, cholesterol, blood sugar/diabetes, air pollution, sleep, blood pressure/hypertension, heart disease, and stroke in a recent systematic review evaluating the CVD risk factors of taxi drivers [4]. Increased BMI and high cholesterol levels are problems for drivers, leading to diabetes, hypertension, heart attack, and CVD [21].

As a result of burning fossil fuels, taxi drivers are exposed to hazardous gases and compounds that pollute the environment, such as benzene, lead, and carbon dioxide. Due to their job in city traffic, taxi drivers are exposed to substances such as exhaust fumes, which can cause respiratory and cardiovascular problems [22]. Taxi drivers are exposed to polycyclic aromatic hydrocarbons (PAHs) and carbon monoxide (CO) gas, both of which contribute to traffic pollution, and the risk grows with smoking [23, 24].

Similar anxiety conditions, such as economic concerns, weariness, and competition, are among the factors influencing taxi drivers’ mental status [25, 26]. Long hours of sitting, the insufficient time between shifts, an unhealthy diet, and time pressure are all risk factors for taxi drivers’ occupational stressors [17]. According to a study of professional drivers in Colombia, the amount of burnout increases as stress rises [27]. In addition, sleeplessness and burnout appear to have a beneficial association [20]. Stress was found to be a major predictor of smoking and sleep disturbances in cab drivers in a study conducted in New York [28].

Despite the availability of studies in the literature demonstrating the occupational risks and health effects of taxi drivers, it has been discovered that relatively few studies have been undertaken on the drivers’ degree of occupational risk knowledge. These studies primarily focus on drivers’ occupational risk perceptions in terms of traffic accidents, violence, and safety perceptions [29–31]. Traffic accidents, attacks, noise, and lengthy periods of sitting were identified as occupational risks in a study of taxi drivers’ knowledge, attitudes, and practices regarding occupational risks in Colombia [29]. Taxi drivers were shown to be unable to benefit from health insurance and health services in a study conducted in New York [32]. The knowledge, attitudes, and beliefs of taxi drivers on CVD disorders were explored in a study conducted in South Asia, and it was discovered that drivers expressed CVD as a risk factor as a result of stress, physical inactivity, malnutrition, and incapacity to access health care [33]. Another research examined at taxi drivers’ risk perceptions of respiratory system disorders and found that the majority of them believed they were exposed to polluted air [17]. In research to identify the healthy lifestyle practices of taxi drivers in Turkey, 65.0 % of the drivers reported they were healthy, while 15.4 % said they were unaware of the issue [34].

Professional drivers’ health and safety are considered major public health concerns. Public health nursing assesses the work environment of community employees, identifies dangers, and develops health promotion initiatives [35]. Professional drivers’ health concerns were also addressed within the scope of public health nursing research, which focuses on professional drivers [36]. In a study dealing with the function of public health nurses in the safety of drivers, it was stressed that the educator role of nurses regarding risky driving behaviors in drivers is crucial. Public health nurses, as well as periodic monitoring of professional drivers, cognitive screening, driving assessments and counseling, and political initiatives to support safe driving, all play essential roles in enhancing public road safety [31]. Determining how public health nurses perceive occupational hazards and risks in improving driver health and what is considered for protection from them will help with the health education that will be given. It is clear that the literature mostly provides information about occupational risks in specific areas, that studies that address preventive behaviors holistically are limited, and that studies in the field of nursing are restricted. Therefore, the current study was undertaken to examine the knowledge level of taxi drivers against occupational dangers and their attitudes on protection methods for these risks.

The following review questions were used: What level of awareness do taxi drivers have about work hazards? What is the level of understanding of taxi drivers regarding the protection against risks?

2 Method

3 Results

In this study the opinions of 524 taxi drivers working in taxi stations in Ankara were evaluated regarding occupational risks and prevention strategies. All drivers were men, 79.4% were married and 66.3% were older than 38 years old. While 11% of the taxi drivers had a university education, 52.9% have worked in this job for less than 14 years and 46.4% were working for more than 14 hours per day.

It was also found that 37.7% of the drivers had diabetes disease in their families; and in terms of chronic diseases, 10.7% were diagnosed with hypertension, cardiac disease, diabetes, hypercholesterolemia, renal disease, intestinal problems, back-neck hernia, cancer, and depression and double and triple combinations of these. When states of chronic disease after professional life were examined, it was seen that 25.2% were presented with hypertension, cardiac disease, diabetes, hypercholesterolemia, renal disease, intestinal problems, back-neck hernia, and depression.

In the study, it was determined that 71.9% of the drivers were overweight, 26.3% went to check up regularly and 40.7% of these individuals were going for a check-up once in six months. While 13% of the drivers stated to do exercise, 50% declared that they did exercise once a week and 45.6% indicated that the duration of exercise was one hour. Moreover, it was observed that 65.3% of the taxi drivers were smoking and 43.6% of them were smoking an average of 11–20 cigarettes per day. Moreover, 30.1% of the drivers were consuming alcohol and 43.0% of these were drinking alcohol once a week.

Opinions of taxi drivers regarding disease risks were presented in Fig. 1. Among the drivers in the study, risks were indicated in terms of musculoskeletal diseases by 67%, cardiovascular diseases by 68.3%, respiratory diseases by 46.9% and psychosocial problems by 80% (Fig. 1).

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Fig. 1

Statements of taxi drivers regarding disease risks (opinions).

The distribution of taxi drivers according to the risk causes of occupational diseases is presented in Table 1. It was determined that 107 people (30.5%) who were the subject of the study, sitting in the same position and sitting incorrectly were effective in terms of musculoskeletal risk. It was determined that 193 (55%) of the drivers caused the musculoskeletal diseases by double, triple, quadruple combinations of the same position, repetitive movement, work stress, time pressure, and the characteristics of the vehicle. In 257 drivers (71.8%), it was determined that both inability to move, fatigue, stress and smoking, alcohol, weight gain, fatty foods, irregular diet, and insufficient sleep cause cardiovascular risk. In terms of the risk of respiratory diseases, it was determined that 73 drivers (29.7%) were constantly exposed to exhaust, the vehicle was unfiltered, and the lack of ventilation in the vehicle caused this risk. In terms of respiratory problems, 150 (61%) of taxi drivers found that smoking and pollution were factors. In terms of the risk of psychosocial problems, 265 drivers (63.3%) suffered from both overload, long working hours, not being able to rest, short lunch breaks, pressure to train jobs and insufficient wages, inability to spare time for social life, poor communication with customers, exposure to violence, traffic problems determined to cause this risk (Table 1).

Opinions of taxi drivers regarding prevention from occupational disease risks are presented in Fig. 2. Among the drivers included in the study, diseases prevented were stated as musculoskeletal by 30.2%, cardiovascular by 34%, respiratory by, 31.3% and psychosocial by 40.1% (Fig. 2).

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Fig. 2

Opinions of taxi drivers regarding prevention strategies.

Behaviors of taxi drivers regarding prevention from musculoskeletal diseases are presented in Table 2. Prevention strategies were stated as doing exercise, changing position and having breaks by 43.7%, paying attention to nutrition by 15.2% and having a supportive seat, and ensuring not to carry heavy things by 10.1%. Behaviors concerning prevention from cardiovascular diseases were shown in Table 2. Prevention strategies were reported as having a diet and regular nutrition and medication by 33.7%, exercising and having breaks by 16.9%, and staying away from stress and sleeping regularly by 11.8%. Behaviors regarding prevention from respiratory system diseases were shown in Table 2. Drivers’ statements for prevention were ventilating the car continuously and using filters by 91.5% and using masks and having dust measurement and regular inspection of the vehicle by 1.8%. Behaviours regarding prevention from psychosocial problems were given in Table 2 determined that 40% of the drivers were sleeping regularly, paying attention to working hours, providing anger control and establishing healthy communication and 23.8% were spending time with family, having hobbies, going for holidays and getting psychological support.

Distribution of occupational risks stated by taxi drivers based on their characteristics are shown in Table 3. When data for professional years, familial inherited disease, exercise, BMI, and diagnosed disease after professional life were considered, statistically significant relationship factors were found in terms of having risks for musculoskeletal diseases (p < 0.05). No statistically significant relationship factors were found based on the variables including marital status, age groups, education level, average working hours, smoking, medical examination before professional life, regular checkup, diagnosed disease before professional life, meals, and working times (p > 0.05). The profession was found to be significantly risky based on the characteristics such as marital status, age groups, education level, professional years, familial inherited disease, exercise, and BMI, diagnosed disease after professional life, and main meals including breakfast and lunch in terms of cardiovascular diseases (p < 0.05). No statistically significant relationships were found in terms of average working hours, smoking, medical examination before professional life, regular checkup, diagnosed disease before professional life, the main meal including dinner, and working times (p > 0.05). The profession was found to be significantly risky for respiratory system diseases based on the diagnosed disease before professional life (p < 0.05). The variables such as marital status, age groups, education level, professional years, average working hours, smoking, medical examination before professional life, state of familial inherited disease, exercise, regular checkup, BMI, diagnosed disease after professional life, main meals, and working times were not found to be significantly correlated (p > 0,05). Drivers were also found to be under risk for psychosocial problems based on the data including medical examination before professional life, state of having a familial inherited disease, diagnosed disease after professional life, and main meal including lunch (p < 0.05). Variables of marital status, age groups, education level, professional years, average working hours, smoking, exercise, regular checkup, BMI, main meals including breakfast and dinner, and working times were not found to be associated with risk for psychosocial problems (p > 0.05).

Distribution of the statements of taxi drivers regarding prevention strategies are given in Table 4. Statistically significant relationships were found between prevention strategies stated by the drivers for musculoskeletal diseases based on their education level, average working hours, medical examination before professional life, exercise, regular checkup, BMI, and working times (p < 0.05). However, the variables of marital status, age groups, professional years, smoking, state of having familial inherited disease, diagnosed disease before professional life, and diagnosed disease after professional life was not found to be significantly associated (p > 0.05). There were statistically significant relationships between prevention strategies stated by the drivers for cardiovascular diseases in terms of features such as marital status, medical examination before professional life, familial inherited disease, exercise, regular checkup, and main meals (p < 0.05). No statistically significant relationships were found in terms of other variables including age groups, education level, professional years, average working hours, smoking, BMI, diagnosed disease before professional life, diagnosed disease after professional life and working times (p > 0.05).

Statistically significant relationship factors were observed between prevention strategies stated by the drivers for respiratory system disorders based on their education level, medical examination before professional life, exercise, regular checkup, and main meals (p < 0.05). On the contrary, no significant relationship were found between prevention strategies for respiratory system risks of the profession and drivers’ characteristics including marital status, age groups, professional years, average working hours, smoking, state of familial inherited disease, BMI, diagnosed disease before professional life, diagnosed disease after professional life and working times (p > 0.05). There were a statistically significant relationship between prevention strategies of drivers for psychosocial problems based on the variables such as medical examination before professional life, exercise, regular checkup, and main meals including breakfast and lunch (p < 0.05). No statistically significant relationships were found in terms of the others including marital status, age groups, education level, professional years, average working hours, smoking, familial inherited disease, BMI, diagnosed disease before professional life, diagnosed disease after professional life, the main meal of dinner and working times (p > 0.05).

Taxi drivers experience many health problems related to their profession. Taxi drivers are at risk for a number of health problems, according to the study, as is their level of knowledge about occupational health risks and how they design a strategy to mitigate these risks. The current study, which indicates how people perceive occupational risk and how they may protect themselves from it, has been broken down into systemic disorders one by one (musculoskeletal, cardiovascular, respiratory, psychosocial).

According to the DALY (Disability Adjusted Life Years) risk factor results from the Global Burden of Disease Studies, the biggest risk factor in the world is maternal and child nutritional deficiencies, unfortunately in Turkey, smoking, high body mass index, high blood pressure, and diabetes are seen as risk factors [37]. According to the current study, 65.6 % of the drivers indicated that they experienced problems such as low back pain, neck pain, knee pain, blood pressure, sugar, cholesterol, heart discomfort, shortness of breath, obesity, asthma, bronchitis, lack of focus, and depression after beginning the job. In the current study, 65.3 % of drivers smoke, and 71.9 percent of drivers are overweight or obese, both of which are risk factors. Taxi drivers, according to the findings of this study, are in a high-risk group due to their working conditions.

The level of occupational risk knowledge of drivers is only mentioned in a few research in the literature. In terms of occupational risk perception, 67 % of the drivers who took part in the study said that their profession was risky in respect of MSS diseases (Fig. 1). They also claimed in this study that they consider elements such as sitting position, lack of movement, carrying heavy weights, work-related time pressure, not taking adequate breaks, vehicle vibration, and heat to be MSS diseases risks (Table 1).

According to the Turkish Statistical Institute’s (Turkstat) “Work-Related Health Problems” research published for the general population in 2013, work-related health problems are primarily caused by bone, joint, and muscle problems affecting the back or waist (24.9 %) and stress, depression, and anxiety problems (20%) [38]. Vibration, psychological variables, repetitive movement, and work-related stress were found to induce MSS disorders in a study conducted with taxi drivers in Turkey [39]. The MSS risk and etiology of Turkish taxi drivers are similar to those found in the literature.

Taxi drivers had longer working hours, were more exposed to work stress, had insufficient breaks, and had higher job dissatisfaction rates than office workers, according to a study conducted in Arabia. It has been determined that MSS diseases are more common among taxi drivers as a result of the factors mentioned [9]. Drivers stated that muscle pain (back, knee) from prolonged sitting is an occupational concern in research done in the United States. Furthermore, they stated that the profession’s hazards are effective against CVD, cause many fatalities from these diseases, and are linked to stroke and hypertension [40].

In the current study, 68.3 % of the drivers believed that their employment was CVD-risky (Fig. 1), and that factors including inactivity, poor sleep, irregular food, stress, smoking, and drinking were effective (Table 1). When taxi drivers’ knowledge, attitudes, and beliefs regarding CVD were questioned in a study conducted in South Asia, they expressed similar information to the risk variables in this study, and they saw CVD as an occupational risk factor due to the inability to obtain health services [33]. When taxi drivers were informed about the danger of heart disease and stroke in a Chicago research, 72 % of them said the conditions were asymptomatic [41].

According to the present study, 46.9% of people believe that taxi drivers’ profession promotes respiratory diseases (Fig. 1). It has been stated that exhaust, insufficient ventilation, smoking and exposure are effective risk factors (Table 1). Smoking was reported by 65.3 % of the drivers who participated in the study. The majority of drivers (80 %) were found to be smokers in an Indian study [42]. The percentage of smoking was found to be 63.9 % in a study conducted with a similar number of taxi drivers in Turkey [43]. According to the results, the rates are similar. Men smoked 44.1 % more than women in 2016, according to the Global Adult Tobacco Survey Turkey Report [44]. All taxi drivers in Turkey are male drivers. When the report’s findings are compared to the findings of the study, it is clear that the normal population’s smoking rate is lower than that of drivers. Taxi drivers are exposed to air pollution in measurements made with dust measuring instruments, according to a research [22]. When the research is analyzed, it is discovered that the risk factors for respiratory system diseases are the root causes of disease. As the number of vehicles on the road grows, drivers are exposed to hazardous substances as a result of air pollution. In this study, nearly half of the drivers believe their employment is not dangerous in terms of respiratory diseases (Fig. 1). In the literature, there is an example of research on knowledge levels associated to occupational risks. In a risk perception study conducted in New York, more than 56 % of taxi drivers were exposed to air pollution when compared to other drivers, and 81% stated air pollution causes health problems and poses a risk. They claimed that air pollution can induce disorders of the lungs, heart, and brain [17]. The findings of this study supported the current results.

According to the findings of the study, stress is one of the occupational risks faced by taxi drivers, and long working hours, insomnia, short break times, an unhealthy diet, and time pressure are some of the variables that contribute to this. According to the findings of a study done in Mexico, excessive workload, long working hours, low earnings, and fear of losing a job are among the causes of stress [45]. In a study of Colombian bus drivers, it was discovered that when stress levels rise, so does the level of burnout [27]. Burnout was seen in drivers who had poor sleep quality and worked more than 10 hours per day in research done in Singapore [20]. In the current study, 63.3 % of drivers identified insufficient earnings, communication problems, violence, and traffic problems as job risks as contributors among psychosocial problems (Table 1). There has been no research on the knowledge levels of drivers on occupational risk factors in this regard, and research has focused on the dangers and diseases caused by psychosocial disorders.

When looking through the relevant literature, it becomes clear that the impacts of occupational risk factors on the systems are studied independently in each study. There are few studies on drivers’ level of knowledge about occupational dangers in the literature. In Colombia, a study was undertaken on taxi drivers’ knowledge, attitudes, and practices regarding occupational dangers. They classified road accidents, assault, noise, and lengthy periods of sitting as job hazards. They anticipated that cell phone use would reduce concentration and that exhaustion, intoxication, excessive speed, and poor road markings were all important risks [46]. According to a research of Iranian drivers, the occupational risk perceptions of drivers include violence and speed [29]. Drivers frequently regard risk perception studies as elements that cause road accidents. Despite the fact that conditions vary depending on the level of development in the same occupational group in different regions of the world, a consistent result underscores the importance of occupational system disorders. The importance of questioning one’s degree of knowledge in order to understand how serious the threats are was a major theme in this study.

Taxi drivers’ level of protection in terms of system diseases was found to be lower than their risk information. Protection levels vary according to systematic diseases (Fig. 2). In this study, 43.7% of the drivers who were protected from occupational risks stated that they took precautions such as exercise, breaks, and not staying in the same position for lengthy periods of time (Table 2). Furthermore, the health of drivers who were assessed prior to entering the profession, as well as frequent health checks and exercise, all indicated a substantial link in terms of preventing system diseases (Table 4). The obesity rate among taxi drivers in Japan was shown to have decreased by 1.4 times as a result of an exercise program [47]. The risk of the job was shown to be associated only in CVD (Table 3), and in statements about protection, only MSS and respiratory system diseases showed a significant relationship as the education level of the drivers in the study increased (Table 4). As the level of education increased, it could be expected that the level of knowledge about risks would increase and the precautions taken to protect against all system diseases would be at the same level. This condition is supposed to reflect the state of knowing in accordance with Social Learning Theory, and it illustrates the consequence of a learning style in which drivers collaborate and rely on their interactions with other drivers. Social learning involves interacting with people to make sense of information and ideas, as well as learning from them in this way, implying that showing desired behavior may be insufficient [48]. The fact that drivers only visit health centers in the case of illness and that they always seek secondary care in health services suggests that occupational risks and inadequacy of preventative behaviors are considered effective in the current study. The lack of access to preventative health treatments is a significant factor. Occupational health nurses or public health nurses are regarded to be able to motivate employees to improve their health behaviors at this time. Changes in employee behavior should be taken into account when developing healthy behaviors.

Given the lack of dedicated preventive health services for drivers, it is clear that the drivers in the current study are not at a sufficient level in terms of understanding hazards and demonstrating protective behavior against these risks. This finding emphasizes the need for preventive health programs in terms of both understanding risks and changing driver behavior to avoid them. It has been reported that the need to develop healthy lifestyles through health education and the improvement in healthy behaviors as a result of education [47, 49]. In the study conducted in China on taxi drivers, the individual was asked questions about their own health perceptions and health education needs. Nearly half of the drivers were aware of chronic diseases, and 90% of them stated that regular health examinations were necessary. Regarding their health training needs, they stated that taxi drivers have an important need because only 17.9% of the participants stated that they received health training, 87.0% of the drivers stated that the training provided was beneficial and more effort should be made in this area [8]. It is seen as one of the basic roles of nursing and especially public health nurses to provide health education systematically in order to protect and develop the health of the individual, family, and society, to heal in case of illness, and to gain the right health behaviors.

Nurses are expected to be completely autonomous in this role and to determine the content and delivery of education [31]. Planning training and health control programs for all employees, taking appropriate measures to control work-related hazards, and collaborating with the essential personnel to achieve a healthy workforce are all significant aspects of the occupational health nurse’s professional practice [50, 51].

5 Conclusions and suggestions

At the end of the study, professional driving was indicated as risky by 67% of taxi drivers for MSD, by 68.3% for CVD, by 46.9% for respiratory system and by 63.3% for psychosocial terms. When opinions of the drivers concerning prevention from these risks were evaluated, prevention was stated in terms of musculoskeletal diseases by 30.2%, cardiovascular diseases by 34%, respiratory diseases by 31.3% and psychosocial problems by 40.1%. It is a striking finding that there was a decrease in the number of drivers who showed preventive behaviors towards these risks although they had knowledge on these occupational risks. It was concluded that drivers were not sufficient in terms of both having knowledge on health risks of their profession and their state of implementing preventive strategies.

Based on the results of the study, it is considered that drivers require education for the health risks of the job they have and prevention from these risks. It is suggested to organize training programs on occupational risks and prevention strategies for the taxi drivers through their professional organizations and primary healthcare institutions. Also, it is recommended to conduct similar studies on the drivers having distinct socioeconomic and cultural characteristics and to perform randomized controlled studies evaluating behavioral changes through training that improve preventive behaviors.

Conflict of interest

The authors have no conflicts of interest to report.