Applied Ergonomics 47 (2015) 236e241

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Applied Ergonomics
journal homepage: www.elsevier.com/locate/apergo

Thermal discomfort and hypertension in bus drivers and chargers in

the metropolitan region of Belo Horizonte, Brazil


Adriano Marçal Pimenta a, *, Ada Avila ~o b
Assunça
a
Department of Maternal and Child Nursing and Public Health, School of Nursing, Federal University of Minas Gerais, Av. Alfredo Balena, 190,
CEP 30130-100, Belo Horizonte, Minas Gerais, Brazil
b
Department of Preventive Medicine, School of Medicine, Federal University of Minas Gerais, Av. Alfredo Balena, 190, CEP 30130-100, Belo Horizonte, Brazil

a r t i c l e i n f o a b s t r a c t

Article history: This study aimed to assess the relationship between perception of temperature inside the bus and hy-
Received 28 April 2014 pertension among 1126 collective transportation workers in metropolitan region of Belo Horizonte,
Accepted 6 October 2014 Brazil. Thermal discomfort was determined based on the perception of temperature inside the bus.
Available online
Hypertension was determined if participant had a medical diagnosis of this disease. Prevalence ratios
(PR) for hypertension and their respective 95% confidence intervals (95% CI) were adjusted using
Keywords:
multivariate Poisson regression analysis. The perceptions of temperature inside the bus were tolerable
Bus driver
(26.5%), disturbs a little (28.6%), disturbs a lot (34.8%) and unbearable (10.2%). The prevalence of hy-
Hypertension
Hot temperature
pertension was 14.3%. The thermal discomfort categories of disturbs a lot (PR ¼ 1.41; 95% CI ¼ 1.02e1.95)
and unbearable (PR ¼ 1.75; 95% CI ¼ 1.16e2.63) were independently related to hypertension. Thermal
discomfort was associated with a higher prevalence of hypertension. This finding should be considerate
in new policies for public transportation.
© 2014 Elsevier Ltd and The Ergonomics Society. All rights reserved.

1. Introduction thus justifying the focus on occupational groups, among other

Hypertension is a serious public health problem in Brazil. In a
recent survey conducted with a representative sample of a Brazilian
adult population, the prevalence of self-reported hypertension was
20% (Brazil, 2012). In the City of Belo Horizonte, the diagnosis of
hypertension was reported at 20.8% of the adult population (Lima-
Costa et al., 2012).
Increased arterial pressure represents a linear, continuous and
independent risk factor for cardiovascular diseases (CVDs), which
are responsible for more than a third of all deaths in this country,
with emphasis on ischemic heart disease (IHD) and brain stroke
(BS). It is estimated that hypertension explains 47% and 54% of the
multifactorial etiology of IHD and BS, respectively (Williams, 2010).
Apart from the high magnitude of CVDs, they are responsible for
a large proportion of hospital admissions, generating social and
economic burdens. Almost 20% of expenditure relating to hospi-
talizations in the Brazilian public healthcare system in 2006 was
due to CVDs-related costs (Brazil, 2013). Early retirement due to
disability and prolonged absenteeism are reflections of diminished
capacity to work caused by CVDs sequelae (Azambuja et al., 2008),
* Corresponding author. Tel.: þ55 31 34099180; fax: þ55 31 34099860.
E-mail address: adrianomp@ufmg.br (A.M. Pimenta).
reasons.
The findings of previous studies demonstrated the relationship
between individual and behavioral factors with hypertension
(Echouffo-Tcheugui et al., 2013). However, the association between
the working environment and hypertension is little explored,
despite the plausibility of this relationship (Lin et al., 2009).
Regarding the bus microclimate, there are only a few studies con-
cerning this topic, which have shown inconsistent results (Li et al.,
2011; Vangelova & Deyanov, 2007).
Therefore, the aim of the present study was to analyze the
relationship between perceptions of the internal temperature of
buses and detection of hypertension among collective trans-
portation workers in the metropolitan region of Belo Horizonte.
2. Materials and methods
2.1. Subjects
The present study was cross-sectional and formed part of a
broader project that included other outcomes and was named
“Health and working conditions of drivers and chargers of urban
public transportation in the cities of Belo Horizonte, Betim and
Contagem, MG, Brazil”.

http://dx.doi.org/10.1016/j.apergo.2014.10.011
0003-6870/© 2014 Elsevier Ltd and The Ergonomics Society. All rights reserved.

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The eligible population in the three cities investigated was
17,470 workers (Belo Horizonte ¼ 6500 drivers and 6750 chargers;
Betim ¼ 696 drivers and 524 chargers; Contagem ¼ 1800 drivers
and 1200 chargers) (Traffic and Transport Company of Belo
Horizonte city, 2009).
In the sample calculation, the prevalence of the hypertension
outcome was taken to be 22% (Benvegnu et al., 2008), with 80%
statistical power, 95% confidence level, prevalence ratio of 2.00
and expected losses of 20%, thus yielding a total of 526 subjects.
The sampling process was performed with selection of
quotas proportional to the total number of professionals in each
of the three cities, according to their occupation (drivers and
chargers).
However, this was a wider survey in which other outcomes of
lower prevalence were also investigated and, in the end, 1607 in-
dividuals were interviewed, of whom 853 were drivers and 754
were chargers. Their distribution was as follows: Belo Horizonte
(72% drivers and 80% chargers), Contagem (20% drivers and 14%
chargers) and Betim (8% drivers and 6% chargers). Therefore, the
number of respondents was 114% above the calculated sample size
for the outcome of interest (hypertension) and, thus, the statistical
power increased considerably.
2.2. Data collection
Data collection was carried out by means of face-to-face in-
terviews with the aid of netbooks between April and June 2012, in
the morning and afternoon shifts. Exclusive software was devel-
oped for the research project, taking into consideration the objec-
tives of making it possible for the interviewer to fill out a digital
questionnaire, and enabling online data processing.
Data from the literature and previous interviews with union
representatives and workers were the basis for designing the tool
for data collection. It included 82 questions relating to the
following factors: demographic data (sex, age, skin color and
marital status); socioeconomic data (schooling and family in-
come); working conditions (job, working shift, number of hours at
work, length of time worked at the company, holidays and
working schedule); internal working environment (noise, vibra-
tion, illumination and temperature); external working environ-
ment (traffic and noise); ergonomics; personal protective
equipment; lifestyle and habits (smoking, drinking, physical ac-
tivity and sociocultural activities); health conditions (medications
used and diseases diagnosed); anthropometric data (weight and
height); violence (traffic accidents and conflicts with passengers);
and quality of life.
Research procedures and instruments were previously tested in
a pilot trial (30 participants). Specific workshops led by the
research coordinators were held in order to train the 22 in-
terviewers, who were recruited from courses at the Federal Uni-
versity of Minas Gerais. The reliability of the interview was assessed
by reapplying some selected questions from the original ques-
tionnaire to some of the same respondents (12% of all participants).
The interviews were carried out at four metro/bus stations in
Belo Horizonte and at 35 resting places in the three cities. These
resting places were selected because they concentrate the majority
of the buses, trips and registered workers. They are used by bus
workers to have a pause after a trip of 60e90 min. An average of
80% of all passengers using the bus services pass through these four
selected stations (Traffic and Transport Company of Belo Horizonte
city, 2009).
The research project was widely publicized through a local radio
station, in a program specifically directed towards urban collective
transportation workers. Furthermore, posters and leaflets were
distributed before the field team began its work.
237
2.3. Exposure variable
The exposure variable “thermal discomfort” was determined
based on the answers to the following question in the question-
naire: During the time you are working, what is your perception of the
temperature inside the bus? The possible answers were: tolerable,
disturbs a little, disturbs a lot or unbearable.
2.4. Covariables
The following variables were considered to have the potential to
confound the relationship between the internal temperature of the
bus and hypertension: sex (male or female); age (18e29 years of
age, 30e39 years, 40e49 years, 50e59 years or 60 or more years);
family income (up to two minimum salaries, two to four minimum
salaries, or four or more minimum salaries; the minimum monthly
salary at that time was R$ 622.00); smoking (Considering smoking
to be the habit of having smoked at least 100 cigarettes or five
packs, how do you classify yourself? Nonsmoker, former smoker,
current smoker); physical activity (How often do you practice
physical activities? Never, once to twice a week, three or more
times a week); sociocultural activities (Do you participate in cul-
tural activities (cinema, theater or exhibitions)? No or yes); body
mass index (BMI) (calculated by means of the following equation:
weight (kg)/height (m)2; <25 (normal), 25e29.9 (overweight);
or  30 (obese); both weight and height were self-reported by the
participant); vibration of the body (During your work, do you feel
your body vibrate? Never, rarely, sometimes, often or always);
illumination inside the bus (During your work, what do you think
about the lighting inside the bus? Good, average, bad or very bad);
and noise inside the bus (In general, the noise inside the bus is:
minimal, reasonable, high or unbearable).
2.5. Outcome variable
The outcome variable, hypertension, was determined from the
answers to two questions: (1) Do you have a medical diagnosis of
high pressure (hypertension)? (2) At present, are you using medica-
tions prescribed by a doctor to treat high pressure (hypertension)? For
both questions, the possible answers were no and yes.
Individuals were considered to have hypertension if the answer
to at least one of the questions was yes. When the participant
answered no to both questions, this person was classified as having
normal blood pressure.
2.6. Statistical analyses
The sample was characterized through calculating the absolute
and relative frequencies of the following variables: demographic
(sex and age), socioeconomic (family income), lifestyle (smoking,
physical activity and sociocultural activities), anthropometric (BMI)
and conditions inside the bus (temperature, vibration of the body,
noise and illumination), according to the categories of the exposure
variable (internal temperature of the bus). Statistical differences
were assessed using the Pearson chi-square test.
Bivariate analysis was carried out to assess the crude association
between the perception of temperature inside the bus and each
covariable of interest with hypertension. The strength of the asso-
ciations was measured by means of prevalence ratios (PR) and their
respective 95% confidence intervals (95% CI).
The independent association between the perception of the
temperature inside the bus and hypertension was assessed by
means of multiple Poisson regression models with robust variance,
adjusted for potential confounding factors. Thus, the PR and its
respective 95% CI were calculated using the category “tolerable” as
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A.M. Pimenta, A.A. ~o / Applied Ergonomics 47 (2015) 236e241
the reference, regarding the perception of temperature inside the
bus. In model 1, the adjustment variables considered were sex, age
and family income. For model 2, all variables of model one were
considered and, additionally, smoking, physical and sociocultural
activities done and BMI were included. Finally, for model 3, the
variables from model two were considered and, additionally, vi-
bration of the body, illumination and noise inside the bus were
included.
We also produced interactions terms between the temperature
and other environmental factors inside the bus, such as the driver's
body vibration, illumination and noise. The independent associa-
tions between these interactions with hypertension were also tested.
For all analyses, the statistical significant level was set at 5%
(p < 0.05).
In this study, we have opted to use PR estimated by Poisson
regression models with robust variance as measure of strength
association. However, it is very important to highlight that there is
no consensus regarding which measure of strength association is
best for cross-sectional studies, PR or Odds Ratio. The latter mea-
sure was judged inappropriate because it overestimates the
strength of association when a higher rate of the outcome is ex-
pected. In this case, PR was proposed as an adequate measure of
strength association (Barros and Hirakata, 2003; Coutinho et al.,
2008).
This research project was approved by the Ethics Committee for
Research on Humans of the Federal University of Minas Gerais
(Protocol number CAAE e 02705012.4.0000.5149). All participants
signed a free and informed consent statement.
3. Results
Regarding the exposure variable, the participants perceived the
temperature inside the bus as follows: tolerable ¼ 26.5%; disturbs a
little ¼ 28.6%; disturbs a lot ¼ 34.8%; and unbearable ¼ 10.2%.
Most workers were male (87.1%), aged less than 40 years of age
(67.4%), with family income of up to four minimum salaries (68.7%),
reporting sociocultural activities (67.7%), sedentary (50.9%) and
weight and height compatible with excess weight (overweight/
obesity ¼ 49.2%). In addition, 15.8% of the participants were
smokers (Table 1).
There were a higher proportion of individuals over the age of 50
years (15.2%), who earned up to two minimum salaries (32.9%) and
who did not have sociocultural activities (42.1%), among those who
considered the temperature inside the bus to be unbearable
(Table 1).
Considering the internal environment of the bus, 33.4% of the
participants reported that they never or hardly ever felt their body
vibrating, and the majority of them reported that they worked in-
side the bus with good illumination (67%) and with high/unbear-
able noise (51.1%) (Table 1).
Among the participants who classified the internal temperature
of the bus as unbearable, there were higher proportions of in-
dividuals who also reported that during their work they always felt
their body vibrating (47.6%), perceived that the internal illumina-
tion was very bad (6.1%) and said that the noise inside the bus as
unbearable (48.8%) (Table 1).
In general, the prevalence of hypertension was 14.3% and, at the
bivariate level, the following characteristics were significantly
associated with this outcome: 1) positive association e female sex,
older age, overweight/obesity, former smoker and perception of the
internal temperature of the bus as unbearable; 2) negative associ-
ation e participation in sociocultural activities and physical activity
once or twice a week (Table 2).
In the multivariate analysis on the data, after adjustment for sex,
age and family income (Model 1), the thermal discomfort remained
independently associated with hypertension: disturbs a lot
(PR ¼ 1.46; 95% CI ¼ 1.07e1.99); unbearable (PR ¼ 1.66; 95%
CI ¼ 1.14e2.43) (Table 3). The additional adjustment for smoking,
physical activity, sociocultural activities and BMI (Model 2)
decreased the strength of the associations between thermal
discomfort and hypertension: disturbs a lot (PR ¼ 1.38; 95%
CI ¼ 1.01e1.89) and unbearable (PR ¼ 1.65; 95% CI ¼ 1.13e2.42)
(Table 3). Finally, the additional adjustment for vibration of the
body, illumination and noise inside the bus (Model 3) led to
increased strength of association with hypertension: disturbs a lot
(PR ¼ 1.41; 95% CI ¼ 1.02e1.95) and unbearable (PR ¼ 1.74; 95%
IC ¼ 1.16e2.63) (Table 3).
The interactions between temperature and other environmental
factors inside the bus, such as vibration of driver's body, illumina-
tion and noise were not independently associated with hyperten-
sion (data not shown).
4. Discussion/conclusions
The prevalence of hypertension in the group of bus workers was
14.3%. Thermal discomfort was independently associated with this
outcome [disturbs a lot (PR ¼ 1.41; 95% CI ¼ 1.02e1.95) and un-
bearable (PR ¼ 1.74; 95% CI ¼ 1.16e2.63)]. Therefore, the prevalence
of hypertension was 41% and 74% higher, respectively, in the groups
that reported thermal discomfort at levels that disturbed a lot or
were unbearable, in comparison with those who qualified the in-
ternal temperature of the bus as tolerable. However, although
consistent, interpretation of these results requires care for at least
three reasons: a) the information on hypertension was not obtained
by measuring the arterial pressure, but from self-reports. However,
this has been a standard for hypertension diagnosis, already vali-
dated in other observational studies, including cohorts of interna-
tional importance (Fiebach et al., 1989; Alonso et al., 2005); b) in
cross-sectional studies, it is not possible to identify the direction of
observed associations; c) although subjective evaluation of thermal
discomfort is valid, the individual's emotional status influences the
response and may be affected not only by the working environment
but also by family life. Personality traits influence individual
vulnerability to the hazards of work, thus modulating the responses
to questionnaires. However, there are advantages in this study that
addressed the occupational exposure variable through subjective
data. Subjective assessment in conjunction with physical parame-
ters can be used, by means of questionnaires, to investigate the
correlation between objective and subjective data regarding the
thermal environment. It is worth emphasizing that thermal com-
fort is a mental expression that means satisfaction with the envi-
ronmental temperature. Therefore, in order to address this subject,
it is necessary to use subjective evaluation (Shek and Chan, 2008).
The prevalence of hypertension observed in our study was lower
than what has been estimated in other epidemiological in-
vestigations on groups of urban public transport workers
(Benvegnú et al., 2008; Costa et al., 2003; Gus et al., 2004; Wang
and Lin, 2001). The difference may be due to methodological var-
iations. In the present study, the outcome of interest was obtained
through self-reports based on two objective questions: (1) Do you
have a medical diagnosis of high pressure (hypertension)? (2) At
present, are you using medications prescribed by a doctor to treat high
pressure (hypertension)? Using this approach, subjects with hyper-
tension without confirmation by a medical doctor would not be
taken into consideration. On the other hand, in the above-
mentioned studies, hypertension was confirmed through specific
reading of arterial pressure. Even if this methodological procedure
can be accepted in population inquiries, the possibility of over-
estimation of the obtained rates cannot be discarded (Brazilian
Hypertension Society, 2010).

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A.M. Pimenta, A.A. ~o / Applied Ergonomics 47 (2015) 236e241 239

Table 1
Distribution of studied sample according to sociodemographic, lifestyle, anthropometric and internal working environment characteristics. Metropolitan region of Belo
Horizonte city Brazil, 2012.

Variables Temperature inside the bus Total

Tolerable Disturbs a little Disturbs a lot Unbearable

n (%) n (%) n (%) n (%)

Sex
Male 359 (84.5) 402 (87.6) 496 (88.7) 143 (87.2) 1400 (87.1)
Female 66 (15.5) 57 (12.4) 63 (11.3) 21 (12.8) 207 (12.9)
Age (years)a
18e29 141 (33.2) 179 (39) 187 (33.5) 48 (29.3) 555 (34.5)
30e39 135 (31.8) 151 (32.9) 189 (33.8) 54 (32.9) 529 (32.9)
40e49 105 (24.7) 87 (19) 138 (24.7) 37 (22.6) 367 (22.8)
50e59 33 (7.8) 34 (7.4) 39 (7) 23 (14) 129 (8)
60 or more 11 (2.6) 8 (1.7) 6 (1.1) 2 (1.2) 27 (1.7)
Family income (minimum salaries)a
Up to 2 100 (23.5) 108 (23.5) 120 (21.5) 54 (32.9) 382 (23.8)
2e4 179 (42.1) 218 (47.5) 258 (46.2) 66 (40.2) 721 (44.9)
4 or more 146 (34.4) 133 (29) 181 (32.4) 44 (26.8) 504 (31.4)
Smoking
Nonsmoker 276 (64.9) 336 (73.2) 393 (68.5) 119 (72.6) 1114 (69.3)
Former smoker 76 (17.9) 51 (11.1) 87 (15.6) 25 (15.2) 239 (14.9)
Current smoker 73 (17.2) 72 (15.7) 89 (15.9) 20 (12.2) 254 (15.8)
Physical activity
Never 191 (44.9) 233 (50.8) 303 (54.2) 91 (55.5) 818 (50.9)
1 to 2 times a week 118 (27.8) 123 (26.8) 121 (21.7) 37 (22.6) 339 (24.8)
3 or more times a week 116 (27.3) 103 (22.4) 135 (24.2) 36 (22.0) 390 (24.3)
Sociocultural activitiesa
No 123 (28.9) 122 (26.6) 205 (36.7) 69 (42.1) 519 (32.3)
Yes 302 (71.1) 337 (73.4) 354 (63.3) 95 (57.9) 1088 (67.7)
Body mass index (kg/m2)
<25 209 (49.1) 243 (52.9) 273 (48.8) 91 (55.5) 816 (50.8)
25e29.9 164 (38.6) 153 (33.3) 190 (33.9) 51 (31.1) 558 (34.7)
30 52 (12.2) 63 (13.7) 96 (17.2) 22 (13.4) 233 (14.5)
Vibration of the bodya
Never 212 (49.9) 168 (36.6) 127 (22.7) 31 (18.9) 538 (33.4)
Rarely 22 (5.2) 24 (5.2) 42 (7.5) 12 (7.3) 100 (6.2)
Sometimes 74 (17.4) 110 (24) 120 (21.5) 34 (20.7) 338 (21)
Often 17 (4) 34 (7.4) 34 (6.1) 9 (5.5) 94 (5.9)
Always 100 (23.5) 123 (26.8) 236 (42.2) 78 (47.6) 537 (33.4)
Illumination inside the busa
Good 335 (78.8) 315 (68.6) 334 (59.8) 92 (56.1) 1076 (67)
Average 68 (16) 112 (24.4) 178 (31.8) 42 (25.6) 400 (24.9)
Bad 18 (4.2) 29 (6.3) 34 (6.1) 20 (12.2) 101 (6.3)
Very bad 4 (0.9) 3 (0.7) 13 (2.3) 10 (6.1) 30 (1.9)
Noise inside the busa
Minimum 47 (11.1) 27 (5.9) 38 (6.8) 7 (4.3) 119 (7.4)
Reasonable 245 (57.7) 236 (51.4) 158 (28.3) 31 (18.9) 670 (41.7)
High 88 (20.7) 129 (28.1) 215 (38.5) 46 (28.1) 478 (29.7)
Unbearable 45 (10.6) 67 (14.6) 148 (26.5) 80 (48.8) 340 (21.2)
a
p < 0.05 by Pearson's chi-square test.

When we compare the proportion of participants diagnosed
with hypertension in our study (14.3%) with the frequency of self-
reported hypertension evidenced in adult population of the City of
Belo Horizonte (20.8%), once again, the prevalence that we identi-
fied was lower. However, in this case, there were no methodological
variations in hypertension diagnosis, and the differences of prev-
alence might be explained due to a healthy worker effect (Monson,
1986; Koskela, 1997). The logic underlying of healthy worker effect
is an expression of the relationship between the demand and the
supply of jobs available in a society. Healthy individuals are more
active in seeking a job (self-selection) and more easily selected
(employer selection). However, when a worker is sick, he or she
leaves or is formally withdrawn from work place (sick leave,
transfer to the administrative sector or early retirement) (Monson,
1986; Koskela, 1997).
With regard to an association between the internal temperature
of the bus and arterial hypertension, this is a plausible and pio-
neering finding in Brazil. Hemodynamic changes are part of the
thermoregulatory system, and higher heart rate and higher cardiac
debit are expected when vasodilation of blood vessels located on
the body surface takes place in response to an increase in envi-
ronmental temperature. The signals that are picked up by ther-
moreceptors located in the skin are interpreted by the anterior
hypothalamus, thus leading to a physiological repercussion that
aims to maintain an adequate internal body temperature for organs
and tissues to function. However, maintenance of thermoregula-
tory mechanisms under situations of prolonged exposure to ther-
mal stressors may change these physiological responses to
pathological ones (Lin et al., 2009). In summary, the characteristics
of the thermal environment are considered to be strong stressor
factors that can be directly associated with changes to the car-
diocirculatory system.
Repeated cardiovascular hyperactivity and/or incomplete re-
covery of cardiovascular changes induced by thermal stress and
other types of stress may lead to development of essential arterial
hypertension (Schnall et al., 1998). Persistent and significant in-
creases in blood pressure may be attributed to stressful working
conditions, leading to hypertension. A study that assessed workers
at a wood processing plant in Botucatu, SP, Brazil, concluded that
the group subjected to higher environmental stress presented
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Table 2 Table 3
Association between temperature inside the bus and covariables with hypertension. Independent association between temperature inside the bus and hypertension.
Metropolitan region of Belo Horizonte city Brazil, 2012. Metropolitan region of Belo Horizonte city Brazil, 2012.

Variables Hypertension PR 95% CI p

n (%) PR 95% CI p-value Model 1a

Temperature inside the bus
Sex
Tolerable 1.00 e e
Male 190 13.6 1.00 e e
Disturbs a little 1.23 0.87e1.73 0.244
Female 40 19.3 1.42 1.05e1.94 0.025
Disturbs a lot 1.46 1.07e1.99 0.016
Age (years)
Unbearable 1.66 1.13e2.43 0.009
18e29 24 4.3 1.00 e e
Model 2b
30e39 59 11.2 2.58 1.63e4.08 <0.001
Temperature inside the bus
40e49 84 22.9 5.29 3.43e8.17 <0.001
Tolerable 1.00 e e
50e59 53 41.1 9.50 6.10e14.79 <0.001
Disturbs a little 1.20 0.86e1.69 0.286
60 or more 10 37 8.56 4.57e16.06 <0.001
Disturbs a lot 1.38 1.01e1.89 0.045
Family income (minimum salaries)
Unbearable 1.65 1.13e2.42 0.010
Up to 2 53 13.9 1.00 e e c
Model 3
2e4 101 14 1.01 0.74e1.37 0.951
Temperature inside the bus
4 or more 76 15.1 1.09 0.79e1.50 0.615
Tolerable 1.00 e e
Smoking
Disturbs a little 1.19 0.85e1.68 0.295
Nonsmoker 145 13 1.00 e e
Disturbs a lot 1.41 1.02e1.95 0.036
Former smoker 43 18 1.38 1.01e1.89 0.041
Unbearable 1.75 1.16e2.63 0.008
Current smoker 42 16.5 1.27 0.93e1.74 0.137
a
Physical activity Model 1: Adjusted by sex, age and family income.
b
Never 130 15.9 1.00 e e Model 2: Model 1 additionally adjusted by smoking, physical activity, socio-
1 to 2 times a week 46 11.5 0.73 0.53e0.99 0.045 cultural activity and body mass index.
c
3 or more times a week 54 13.9 0.87 0.65e1.17 0.357 Model 3: Model 2 additionally adjusted by vibration of the body, illumination
Sociocultural activities inside the bus, and noise inside the bus.
No 88 17 1.00 e e
Yes 142 13.1 0.77 0.60e0.98 0.036
2
Body mass index (kg/m )
<25 81 9.9 1.00 e e Prevention of hypertension depends on intervention in its main
25e29.9 91 16.3 1.64 1.24e2.17 <0.001 risk factors, particularly modifiable ones like occupational hazards
30 58 24.9 2.51 1.85e3.40 <0.001
that can directly influence arterial pressure levels. Habits and life-
Temperature inside the bus
Tolerable 49 11.5 1.00 e e style traits such as excess weight/obesity, salt and alcohol intake
Disturbs a little 58 12.6 1.10 0.77e1.57 0.615 and sedentary life are also modifiable (Artazcoz et al., 2007;
Disturbs a lot 89 15.9 1.38 0.99e1.91 0.052 Brazilian Hypertension Society, 2010; Pimenta et al., 2012).
Unbearable 34 20.7 1.80 1.21e2.68 0.004 Changes in habits and lifestyle are influenced by work character-
Vibration of the body
Never 69 12.8 1.00 e e
istics. It is worth emphasizing that labor environments are impor-
Rarely 9 9 0.70 0.36e1.36 0.294 tant scenarios for implementation of health promotion programs
Sometimes 55 16.3 1.27 0.91e1.76 0.154 (World Health Organization, 2010).
Often 16 17 1.33 0.81e2.18 0.265 To ensure passengers' comfort during the bus ride, it has been
Always 81 15.1 1.18 0.87e1.58 0.286
suggested that the equipment needs to be adequate (Han and
Illumination inside the bus
Good 155 14.4 1.00 e e Naeher, 2006). However, the approaches used for passengers do
Average 55 13.8 0.95 0.72e1.27 0.749 not mention the bus workers who share the same environment.
Bad 13 12.9 0.89 0.53e1.51 0.676 Passengers are disadvantaged through the workers' clear vulnera-
Very bad 7 23.3 1.62 0.83e3.15 0.155 bility caused by the length of exposure.
Noise inside the bus
Policies for safe and healthy transportation, to promote healthy
Minimum 14 11.8 1.00 e e
Reasonable 102 15.2 1.29 0.77e2.18 0.335 municipalities, aim to decrease the occurrence of traffic accidents,
High 68 14.2 1.21 0.70e2.07 0.490 attenuate noise on the streets and in homes, and control pollutant
Unbearable 46 13.5 1.15 0.66e2.01 0.625 emission. Collective urban transportation is also a strategic way to
reduce urban agglomeration, traffic chaos and stress on main roads
(Pan American Health Organization, 2009). However, it is rare to
greater elevation of blood pressure and heart rate (Rocha et al., see interest in protecting the health of the professionals who are
2002). Excessive cardiovascular morbidity was documented in the essential for providing these services.
subgroup of drivers (Rydstedt et al., 1998). The transport sector is an important arena of demands and
General symptoms like fatigue and mood fluctuations were different agendas within Brazilian society (Vasconcellos et al.,
more notable in a group of subjects exposed to higher temperatures 2011). The study participants who were approached in the field
(30  C) than in a group exposed to average temperatures (22  C), by the trained team only rarely refused to provide information, and
which led to impairment of performance of the first group's ac- this shows the strength of the present survey for its intended
tivities (Lan et al., 2011a, 2011b). Thermal and climate conditions purposes. The results presented here call for reflection on the social
that are inappropriate for development of activities may worsen protection needed for this work and the workers, while also
the working environment, compromise physical and mental per- encouraging linkage between collective transport policies and ac-
formance and increase the risk of accidents (Martinet and Meyer, tions within the occupational sphere, focusing on transformation of
1999). Microclimate design failures, air pollution and low humidi- the climatic conditions of buses.
ty have a negative effect on the performance of activities. Inade-
quate humidity may lead to excessive sweating and evaporation of Disclosure statement
liquid from the respiratory tract, thereby affecting the drivers'
performance. These are situations that give rise to reduced safety in No authors in this study have actual or potential conflict of in-
traffic. terest including any financial, personal or other relationships with

Assunça
A.M. Pimenta, A.A. ~o / Applied Ergonomics 47 (2015) 236e241
other people or organizations within three (3) years of beginning
the work submitted that could inappropriately influence this work.
Acknowledgments
The authors wish to thank the collaboration of the bus drivers
and chargers, participants of this study.
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