Health has always been closely linked with occupation. Sound health in relation to vocation and employment is the most important aspect of the very life of an individual who works and to the society as a whole. ^[1-3] Occupational hazards natural in the work environment have become more prominent in the post-industrial societies. These include a wide range of health problems ranging from asthma, heart attack, high blood pressure, stress and other psychological disorders, with many more to list. ^[4]

Bus drivers play a critical role in public transportation systems, ensuring mobility and accessibility for the general population. However, the occupational hazards associated with the profession have been largely overlooked. Research indicates that the physical and psychological toll of the job contributes significantly to long-term health complications. ^[5]

Transport in India is an imperative part of the nation's financial system. The rapid augmentation of India's urban population has put colossal strain on all transport systems. Bus drivers are the main pillar of transport system all over the world. ^[6] In West Bengal, 70% of bus route are operated by the individual or private organizations. A large number of people are depended on the privately operated buses. ^[7]

In this profession bus drivers, were suffered from musculoskeletal pain indifferent body parts like back, neck, and leg and these problems were related to some occupational risk factors. Bus drivers have to work in different environmental condition. ^[8] Pollution is one of the main hindrances of their day-to-day work. As because of different environmental exposure drivers are exposed different type of respiratory problems. In driving performance, the physical and psychological health of the bus driver is a serious factor. Concentration is another important requirement for the bus driving job. ^[9]

The present study is an attempt to explore the health hazards among the bus drivers and conductors employed in State Road Transport Corporations. The attempt is directed at investigating risk factors at micro-level in a community of drivers and conductors. ^[15] It not only establishes the link between health and work environment but also facilitates in assessing the adverse impacts that may be expected. ^[10]

Apart from physiological factors, environmental and occupational hazards also play a significant role in the health risks faced by bus drivers. Air Pollution and Traffic-Related Toxins: Continuous exposure to vehicle emissions increases the risk of respiratory diseases and cardiovascular issues. ^[10] Fine particulate matter and other air pollutants have been linked to lung diseases, reduced lung function, and oxidative stress. Long-term inhalation of pollutants may also contribute to inflammation and weakened immune responses. ^[11]

Irregular Work Schedules and Shift Work are Working long hours and irregular shifts disrupt the body’s natural rhythms, contributing to fatigue, gastrointestinal disorders, and decreased immune function. ^[12] This also affects social and family life, further impacting mental well-being. Sleep deprivation increases the risk of road accidents, further emphasizing the importance of regulated work schedules. ^[13]

This is a prospective, observational and Randomized study. The present study was carried out with the participation of 90 College bus drivers working in Index Medical College transportation system from 2022 to 2024. As the population size was limited, all drivers have been invited to participate in the study. It is worth mentioning that having at least one year of experience, not having severe mental disorders as well as not having a second job was considered as initial criteria to include drivers in the study.

In this study, data collection has been conducted in several phases. As the primary phase, the information related to bus drivers' demographic and job characteristics as well as baseline job stress was obtained.

Then, physiological parameters included systolic blood pressure (BP), diastolic blood pressure, and heart rate (HR) was measured twice; the first measurements were done before driving, in a situation in which the drivers were exposed to the minimum levels of environmental stressors. Then, the measurements were repeated as soon as a whole cycle of driving was completed.

The differences between the values of BP and HR in the two measurements were registered and considered for the next analysis. The last phase of the study included of measurement the environmental stressors such as noise, whole-body vibration (WBV), and hand-arm vibration (HAV) which bus drivers were exposed to in their working day. These data was assessed between the two measurements of the above-mentioned physiological parameters.

Previous studies introduced several tools to assess the job stress among various occupational settings such as the job demand-control model [1] and the effort-reward imbalance model [2]. Another well-known model for the assessment of job stress has been developed by Philip L. Rice [3], which was used in previous related research to study the job stress among drivers. In the present study, we applied the Philip L. Rice occupational stress assessment method, which individuated three dimensions of stress among drivers.

These dimensions include "interpersonal relationships", "physical conditions", and "job interests". The questionnaire has 57 items with five choices Likert-based scoring system (from 1 for "rarely" to 5 for "most of the time"). The questionnaire was developed in 1992 by Philip L. Rice [3] and translated to Persian with psychometric analysis by Hatami et al. in 1999. They reported its validity as 0.92 and its reliability as 0.89 [4]. It should be noted that the Persian version of this tool has been used frequently by Iranian researchers which indicates that it has good reliability for the Iranian working population [5]. Also, it has been used among a relatively same sample of bus drivers by Golmohammadi et al. in 2014 [6].

Analysis of data

The mean and the standard deviation (SD), as well as number and percentage, was reported to describe the data. Then, the normality of data was tested by means of the Kolmogorov-Smirnov tests. Using the independent-samples T-tests and One-way ANOVA tests, the mean of variables were compared within various groups. Also, the before and after changes for BP and HR wasdf studied using the paired samples T-tests. Moreover, the multivariate linear regression (MLR) models were applied to determine the relation between the predictive variables, such as the noise and WBV and HAV exposure levels, and the physiological parameters. All statistical analyses were performed using the SPSS 29.

Graph 1: Demographic and Job Characteristics

This table provides an overview of the study participants. The mean age of the bus drivers is 42.5 years, with an average of 10.3 years of experience. They work 8 hours per day and 6 days per week, which indicates a consistent exposure to occupational stressors. The relatively high experience level suggests that most participants are familiar with their job but may still face long-term stress-related impacts.

Graph 2: Job Stress Summary

Interpersonal Relationships (3.4 ± 0.8): Moderate stress level, indicating that social interactions at work might be a challenge.

Physical Conditions (4.1 ± 0.7): The highest stress dimension, suggesting that environmental factors such as noise, vibration, and work conditions significantly impact drivers.

Job Interests (3.8 ± 0.6): Relatively high, indicating that despite some dissatisfaction, drivers still find some level of motivation in their jobs.

Graph 3: BP and HR Before and After Driving

• Systolic BP increased by 14 mmHg (from 124 to 138 mmHg).
• Diastolic BP increased by 7 mmHg (from 78 to 85 mmHg).
• Heart Rate increased by 8 bpm (from 72 to 80 bpm).

This increase indicates that the driving task significantly raises physiological stress markers. The magnitude of the changes suggests a potentially harmful long-term impact on cardiovascular health.

Graph 4: BP and HR Statistical Test Results

Measures

BP and HR Statistical Test Results

This table reports the statistical significance of BP and HR changes:

• Systolic BP (t=4.23, p<0.001) → Highly significant increase.
• Diastolic BP (t=3.18, p=0.002) → Significant increase.
• Heart Rate (t=5.02, p<0.001) → Highly significant increase.

Since all p-values are below 0.05, the increases in BP and HR are statistically significant. This confirms that driving causes acute physiological stress.

Graph 5: Regression Model Results

Regression Model Results (Noise, WBV, HAV Predicting BP and HR)

This table provides insights into how noise, WBV, and HAV predict BP and HR changes.

• Noise level has the highest impact on BP (β=0.45, p=0.001) and HR (β=0.52, p<0.001).
• WBV also significantly affects BP (β=0.39, p=0.003) and HR (β=0.42, p=0.002).
• HAV has a weaker but still significant effect on BP (β=0.21, p=0.048) and HR (β=0.27, p=0.035).

The demographic data indicate that the bus drivers in this study had a mean age of 42.5 years and an average of 10.3 years of experience. This suggests that most drivers are in their mid-career phase and may have adapted to the demands of their profession. However, their long working hours—averaging 8 hours per day and 6 days per week—expose them to sustained occupational stressors. Such prolonged exposure to work-related stress can contribute to fatigue, reduced cognitive function, and increased risk of cardiovascular diseases. Studies have shown that long working hours and job-related stress significantly correlate with hypertension and cardiovascular morbidity (Kivimäki et al., 2015). ^[14] Mechanistically, prolonged working hours lead to dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis, which results in chronic cortisol elevation and subsequent cardiovascular strain. Additionally, chronic stress increases inflammatory markers like C-reactive protein (CRP), which can contribute to endothelial dysfunction and cardiovascular disease progression.

The job stress assessment revealed that physical conditions were the highest stress factor (4.1 ± 0.7), followed by job interests (3.8 ± 0.6) and interpersonal relationships (3.4 ± 0.8). The high stress score related to physical conditions highlights the impact of environmental factors, such as prolonged sitting, noise, and vibration, on drivers' well-being. Job interest scores suggest that while drivers find some motivation in their work, challenges like monotony and limited career progression may affect their job satisfaction. Interpersonal relationship stress, though moderate, indicates that workplace dynamics and interactions with passengers or colleagues contribute to the overall stress burden. These findings are consistent with previous studies that have linked physical work environments to increased stress and mental health decline (Sauter et al., 1990). ^[15] Mechanistically, occupational stress activates the sympathetic nervous system, increasing blood pressure and heart rate through catecholamine release. Chronic stress exposure also alters hippocampal and prefrontal cortex function, affecting decision-making and emotional regulation, which could worsen job dissatisfaction.

This table presents clear physiological changes after a driving session, with systolic BP increasing by 14 mmHg, diastolic BP by 7 mmHg, and heart rate by 8 bpm. These findings suggest a direct physiological response to driving stress, likely triggered by prolonged focus, environmental stressors, and physical strain. The increases in BP and HR are significant and indicate heightened sympathetic nervous system activity. Previous studies have shown that chronic elevation in these markers is linked to long-term cardiovascular risks, including hypertension and arterial stiffness (Munzel et al., 2017). ^[16] Mechanistically, increased sympathetic activation leads to vascular constriction, increased cardiac output, and ultimately higher blood pressure and heart rate. Repeated episodes of transient hypertension due to work-related stress can contribute to left ventricular hypertrophy and increased risk of myocardial infarction.

The statistical analysis confirmed the significance of changes in BP and HR, with all p-values below 0.05. The t-values indicate a strong effect of driving on these physiological parameters, reinforcing the role of occupational stress in cardiovascular risk. These results align with existing literature, which links prolonged job-related stress with elevated sympathetic nervous system activation, contributing to hypertension and cardiac workload (Ganster & Rosen, 2013). ^[17] Mechanistically, chronic stress leads to persistent activation of the HPA axis, causing increased cortisol secretion, vascular resistance, and reduced heart rate variability. This, in turn, can contribute to arterial stiffness, increased cardiac workload, and long-term cardiovascular risk.

Driving tasks significantly increase systolic BP (14 mmHg), diastolic BP (7 mmHg), and heart rate (8 bpm), indicating acute physiological stress. Statistical tests confirm these changes are highly significant (p < 0.05), suggesting potential long-term cardiovascular risks. Noise shows the strongest correlation with BP (r=0.65) and HR (r=0.72), followed by WBV and HAV. Regression models confirm noise as the most influential predictor of BP (β=0.45) and HR (β=0.52), with WBV also having a significant impact.

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