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2020 T R A N S I T C O O P E R A T I V E R E S E A R C H P R O G R A M TCRP RESEARCH REPORT 217 Research sponsored by the Federal Transit Administration in cooperation with the Transit Development Corporation Subject Areas Public Transportation â¢ Administration and Management â¢ Policy Improving the Health and Safety of Transit Workers with Corresponding Impacts on the Bottom Line Jennifer Stoloff Frankie Clogston Fred Bellemore Cynthia Khan Jeff Pongsiri Timothy Beggs EconomEtrica, inc. Bethesda, MD a n d Xinge Wang Karitsa Holdzkom transportation LEarning cEntEr Silver Spring, MD
TCRP RESEARCH REPORT 217 Project F-26 ISSN 2572-3782 ISBN 978-0-309-67361-7 Â© 2020 National Academy of Sciences. All rights reserved. COPYRIGHT INFORMATION Authors herein are responsible for the authenticity of their materials and for obtaining written permissions from publishers or persons who own the copyright to any previously published or copyrighted material used herein. Cooperative Research Programs (CRP) grants permission to reproduce material in this publication for classroom and not-for-profit purposes. Permission is given with the understanding that none of the material will be used to imply TRB, AASHTO, FAA, FHWA, FTA, GHSA, NHTSA, or TDC endorsement of a particular product, method, or practice. It is expected that those reproducing the material in this document for educational and not-for-profit uses will give appropriate acknowledgment of the source of any reprinted or reproduced material. For other uses of the material, request permission from CRP. NOTICE The research report was reviewed by the technical panel and accepted for publication according to procedures established and overseen by the Transportation Research Board and approved by the National Academies of Sciences, Engineering, and Medicine. The opinions and conclusions expressed or implied in this report are those of the researchers who performed the research and are not necessarily those of the Transportation Research Board; the National Academies of Sciences, Engineering, and Medicine; or the program sponsors. The Transportation Research Board; the National Academies of Sciences, Engineering, and Medicine; and the sponsors of the Transit Cooperative Research Program do not endorse products or manufacturers. Trade or manufacturersâ names appear herein solely because they are considered essential to the object of the report. TRANSIT COOPERATIVE RESEARCH PROGRAM The nationâs growth and the need to meet mobility, environmental, and energy objectives place demands on public transit systems. Cur- rent systems, some of which are old and in need of upgrading, must expand service area, increase service frequency, and improve efficiency to serve these demands. Research is necessary to solve operating prob- lems, adapt appropriate new technologies from other industries, and introduce innovations into the transit industry. The Transit Coopera- tive Research Program (TCRP) serves as one of the principal means by which the transit industry can develop innovative near-term solutions to meet demands placed on it. The need for TCRP was originally identified in TRB Special Report 213âResearch for Public Transit: New Directions, published in 1987 and based on a study sponsored by the Urban Mass Transportation Administrationânow the Federal Transit Administration (FTA). A report by the American Public Transportation Association (APTA), Transportation 2000, also recognized the need for local, problem- solving research. TCRP, modeled after the successful National Coop- erative Highway Research Program (NCHRP), undertakes research and other technical activities in response to the needs of transit ser- vice providers. The scope of TCRP includes various transit research fields including planning, service configuration, equipment, facilities, operations, human resources, maintenance, policy, and administrative practices. TCRP was established under FTA sponsorship in July 1992. Proposed by the U.S. Department of Transportation, TCRP was authorized as part of the Intermodal Surface Transportation Efficiency Act of 1991 (ISTEA). On May 13, 1992, a memorandum agreement outlining TCRP operating procedures was executed by the three cooperating organi- zations: FTA; the National Academies of Sciences, Engineering, and Medicine, acting through the Transportation Research Board (TRB); and the Transit Development Corporation, Inc. (TDC), a nonprofit educational and research organization established by APTA. TDC is responsible for forming the independent governing board, designated as the TCRP Oversight and Project Selection (TOPS) Commission. Research problem statements for TCRP are solicited periodically but may be submitted to TRB by anyone at any time. It is the responsibility of the TOPS Commission to formulate the research program by identi- fying the highest priority projects. As part of the evaluation, the TOPS Commission defines funding levels and expected products. Once selected, each project is assigned to an expert panel appointed by TRB. The panels prepare project statements (requests for propos- als), select contractors, and provide technical guidance and counsel throughout the life of the project. The process for developing research problem statements and selecting research agencies has been used by TRB in managing cooperative research programs since 1962. As in other TRB activities, TCRP project panels serve voluntarily without compensation. Because research cannot have the desired effect if products fail to reach the intended audience, special emphasis is placed on disseminat- ing TCRP results to the intended users of the research: transit agen- cies, service providers, and suppliers. TRB provides a series of research reports, syntheses of transit practice, and other supporting material developed by TCRP research. APTA will arrange for workshops, train- ing aids, field visits, and other activities to ensure that results are imple- mented by urban and rural transit industry practitioners. TCRP provides a forum where transit agencies can cooperatively address common operational problems. TCRP results support and complement other ongoing transit research and training programs. Published research reports of the TRANSIT COOPERATIVE RESEARCH PROGRAM are available from Transportation Research Board Business Office 500 Fifth Street, NW Washington, DC 20001 and can be ordered through the Internet by going to https://www.nationalacademies.org and then searching for TRB Printed in the United States of America
The National Academy of Sciences was established in 1863 by an Act of Congress, signed by President Lincoln, as a private, non- governmental institution to advise the nation on issues related to science and technology. Members are elected by their peers for outstanding contributions to research. Dr. Marcia McNutt is president. The National Academy of Engineering was established in 1964 under the charter of the National Academy of Sciences to bring the practices of engineering to advising the nation. Members are elected by their peers for extraordinary contributions to engineering. Dr. John L. Anderson is president. The National Academy of Medicine (formerly the Institute of Medicine) was established in 1970 under the charter of the National Academy of Sciences to advise the nation on medical and health issues. Members are elected by their peers for distinguished contributions to medicine and health. Dr. Victor J. Dzau is president. The three Academies work together as the National Academies of Sciences, Engineering, and Medicine to provide independent, objective analysis and advice to the nation and conduct other activities to solve complex problems and inform public policy decisions. The National Academies also encourage education and research, recognize outstanding contributions to knowledge, and increase public understanding in matters of science, engineering, and medicine. Learn more about the National Academies of Sciences, Engineering, and Medicine at www.nationalacademies.org. The Transportation Research Board is one of seven major programs of the National Academies of Sciences, Engineering, and Medicine. The mission of the Transportation Research Board is to provide leadership in transportation improvements and innovation through trusted, timely, impartial, and evidence-based information exchange, research, and advice regarding all modes of transportation. The Boardâs varied activities annually engage about 8,000 engineers, scientists, and other transportation researchers and practitioners from the public and private sectors and academia, all of whom contribute their expertise in the public interest. The program is supported by state transportation departments, federal agencies including the component administrations of the U.S. Department of Transportation, and other organizations and individuals interested in the development of transportation. Learn more about the Transportation Research Board at www.TRB.org.
C O O P E R A T I V E R E S E A R C H P R O G R A M S AUTHOR ACKNOWLEDGMENTS The authors wish to thank the following individuals whose contributions through emails and discus- sions shaped the development of the case studies: Roy Luster, President of Amalgamated Transit Union (ATU) Local 1070, and Teresa Boone, Director of Employee Services at IndyGO, Indianapolis, Indiana; Renee Elwood, Director of Well-Being and Inclusion, Krystle Hall, Director of People, Performance, and Development, and Jacques Chapman, President, all of ATU Local 282 at Regional Transit Service (RTS), Rochester, New York; Mathias Hamilton, President of ATU Local 1447, and Melissa Fuqua, Benefits Manager at the Transit Authority of River City (TARC), serving Louisville, Kentucky, and the greater Louisville region; Emily McMahon, Human Resources Manager, and Katie Stull, Chief Human Resources Officer for the Des Moines Area Regional Transit Authority (DART); John Rugama, President and Business Agent of ATU Local 441 in Des Moines, Iowa; Amy Calvin, Wellness Manager at the International Association of Sheet Metal, Air, Rail and Transportation (SMART)âMetropolitan Transportation Authority (MTA) Trust Fund, Irwindale, California; Quintin Wormley, Vice-General Chairman of SMART Local 1565 in Los Angeles, California; and William A. Carroll, Survey Statistician, Agency for Healthcare Research and Quality at the United States Department of Health and Human Services. CRP STAFF FOR TCRP RESEARCH REPORT 217 Christopher J. Hedges, Director, Cooperative Research Programs Lori L. Sundstrom, Deputy Director, Cooperative Research Programs Gwen Chisholm Smith, Manager, Transit Cooperative Research Program Lawrence D. Goldstein, Senior Program Officer Anthony P. Avery, Senior Program Assistant Eileen P. Delaney, Director of Publications Natalie Barnes, Associate Director of Publications Sharon Lamberton, Editor TCRP PROJECT F-26 PANEL Field of Human Resources Shawn M. Donaghy, C-TRAN, Vancouver, WA (Chair) Robin Gillespie, City University of New York (CUNY), New York, NY Anne Kirsch, Metropolitan Transportation Authority, New York, NY Rodney P. Massman, Missouri Public Service Commission, Columbia, MO Gordon D. Proctor, Gordon Proctor & Associates, Inc., Dublin, OH Norman, J. Waitzman, University of Utah, Salt Lake City, UT Edward F. Watt, Amalgamated Transit Union, Silver Spring, MD (Retired) Diana C. Wurn, King County Metro Transit, Seattle, WA Kenneth Blacks, FTA Liaison Cammie Chaumont Menendez, National Institute for Occupational Safety and Health (NIOSH) Liaison
Transit workers experience more health and safety problems than the general workforce, primarily as a result of a combination of physical demands, environmental factors, and stresses related to their jobs. In response, TCRP Research Report 217 focuses on the preva- lence of these conditions, costs associated with these conditions, and statistical analysis of data on participation in and the results of health and wellness promotion programs. The objective of the analysis was to improve understanding of how extensive these problems are and to identify potential approaches that transit agencies can undertake to develop an effective response. In preparing this study, the research team undertook a multifaceted approach that used diverse sources of information including case studies, interviews with industry and health experts, primary data collection, and rigorous statistical-econometric analysis. This study will be of interest to transit agencies, transit employees, and others actively involved in improving health conditions for transit workers. Health and safety risk factors for transit workers include the sedentary nature of the job, shift work, environmental factors (e.g., noise and air quality in and around the vehicle), constant daily interaction with hundreds of passengers (any of whom might engage in unruly or risky behavior), continual stressful engagement in traffic (performing difficult maneuvers), responsibility for fare collection, and a work schedule that limits the ability to maintain healthy habits such as regular exercise, sufficient sleep, and a healthy diet. Additionally, prior research demonstrates that transit work is associated with higher rates of risky behaviors (including poor diet, smoking, and alcohol use) and chronic conditions (such as diabetes, primarily Type 2; cardiovascular disease; and musculoskeletal dis orders). Annual health-related costs are higher for transit workers compared to the average worker, and the excess costs were also observed in the payment types examined (injury, death, absenteeism, workersâ compensation, disability [SSDI and SSI], and Medicare). In all cases, the annual costs of these categories for transit workers exceeded the costs for the average worker. This report examines the reasons for these outcomes and provides potential strategies to improve transit worker health. The study includes a summary of previous research on methods to improve the workplace environment and to establish effective practices for health promotion and wellness programs. To date, there is limited research on the effective- ness of health promotion programs for transit workers. This report provides some addi- tional research on that topic, measured by the reduction of sick or personal days, workersâ compensation payments, or health claims. The report also includes case studies on health and wellness programs at five transit agencies. The report documents the substance of the programs and the resources and F O R E W O R D By Lawrence D. Goldstein Staff Officer Transportation Research Board
organizational strategies agencies and unions have used to put sustainable programs in place. While no programs address all the chronic conditions most common among transit workers (i.e., few appear to address respiratory health), they do focus on issues that affect transit workersâ overall health and work performance. The statistical analysis incorporated in the study is more suggestive than definitive, but it does provide a model that agencies with access to the appropriate data could use to evaluate their programs. In addition, the information provided about the health and wellness programs in the case studies and the implementation strategy chapter offer further assistance to transit agencies currently improving existing or designing new health, wellness, and safety programs. Overall, the report adds an important layer of research to past studies that explore health and safety outcomes for transit workers and health promotion programs. In particular, the report quantifies the costs of widespread and consistently poor health and safety outcomes and the cost savings, if any, of those health promotion programs. Dangerous and strenu- ous work environments exact a toll on workers that affects their employers specifically and society in general. A better understanding of that toll, its costs, and potential mitigation measures is a valuable contribution to the literature on the subject.
1 Summary 8 Chapter 1 Introduction: How to Read This Report 11 Chapter 2 Research Design 11 2.1 Introduction 11 2.2 Research Questions 12 2.3 Analysis of National Safety, Health, and Health Cost Data 14 2.4 Case Study Identification: Local Health Promotion Programs That Measure Cost-Effectiveness 15 Chapter 3 Literature Review and Baseline Data 15 3.1 Introduction 15 3.2 Workforce Conditions: Health and Safety Outcomes 17 3.3 Workforce Conditions: Costs 18 3.4 Programs to Mitigate Negative Health and Safety Outcomes 20 3.5 Cost-Effectiveness of Health and Safety Intervention Programs 22 3.6 Conclusions 24 Chapter 4 Prevalence and Costs of Health Conditions 24 4.1 Introduction 26 4.2 Key Characteristics of Transit Workforce 28 4.3 Identify Common Health Conditions Associated With Transit Workers 33 4.4 Identify Estimates of Costs for Health Conditions 35 4.5 Conclusions 36 Chapter 5 Additional Costs to Individuals, Employers, and Society 36 5.1 Introduction 36 41 51 51 5.2 The Individual Transit Worker: Fatalities and Injuries 5.3 Cost to Employers and Society 5.4 Additional Costs to Society 5.5 Conclusions 53 Chapter 6 Case Studies: Health Promotion Programs 53 6.1 Introduction 54 6.2 IndyGo 61 6.3 RTS 69 6.4 TARC 74 6.5 DART 81 6.6 LA Metro 85 6.7 Summary of Case Studies C O N T E N T S
91 Chapter 7 Implementation Strategies 91 7.1 Scalable and Sustainable Strategies of Transit Wellness Programs 96 7.2 Measures and Methods for Benefit-Cost and Cost-Effectiveness Analysis 100 7.3 Implementation Plan and Next Steps 102 Chapter 8 Conclusions 102 8.1 Overview 104 8.2 Key Findings 105 8.3 Study Limitations 106 8.4 Areas for Further Research 108 References A-1 Appendix A Case Study Identification B-1 Appendix B Case Study and Benefit-Cost Data Collection C-1 Appendix C Regression Models for Indianapolis, Indiana; Rochester, New York; and Louisville, Kentucky D-1 Appendix D Implementation Memo