Accepted: 31 January 2018

DOI: 10.1002/ajim.22821

RESEARCH ARTICLE

Relationships of working conditions, health problems and

vehicle accidents in bus rapid transit (BRT) drivers

Viviola Gómez-Ortiz PhD1 | Boris Cendales PsyD2 | Sergio Useche Ps, MA3 |
Juan P. Bocarejo PhD4

1 Department of Psychology, School of Social

Sciences, University of Los Andes, Bogotá, Background: The aim of this study was to estimate accident risk rates and mental health
Colombia
of bus rapid transit (BRT) drivers based on psychosocial risk factors at work leading to
2 Schoolof Economic and Administrative
Sciences, El Bosque University, Bogotá,
increased stress and health problems.
Colombia Methods: A cross-sectional research design utilized a self-report questionnaire
3 UniversityResearch Institute on Traffic and
completed by 524 BRT drivers.
Road Safety (INTRAS), University of Valencia,
Valencia, Spain Results: Some working conditions of BRT drivers (lack of social support from
4 Department of Civil Engineering, School of supervisors and perceived potential for risk) may partially explain Bogota's BRT drivers’
Engineering, University of Los Andes, Bogotá,
involvement in road accidents. Drivers’ mental health problems were associated with
Colombia
higher job strain, less support from co-workers, fewer rewards and greater signal
Correspondence
Viviola Gómez-Ortiz, PhD, Department of
conflict while driving.
Psychology, School of Social Sciences, Conclusions: To prevent bus accidents, supervisory support may need to be increased.
University of los Andes, Carrera 1 No. 18A-
12, Bogotá, Colombia.
To prevent mental health problems, other interventions may be needed such as
Email: vgomez@uniandes.edu.co reducing demands, increasing job control, reducing amount of incoming information,

Funding information
simplifying current signals, making signals less contradictory, and revising rewards.
Vice Presidency for Research at Universidad
de los Andes (Colombia) KEYWORDS
accidents, BRT drivers, job stress, mental health, occupational health

1 | INTRODUCTION
Bus rapid transit (BRT) systems (eg, the Transmilenio system in Bogota)
are a growing means of transportation globally.1 Empirical evidence
gathered over the past 50 years indicates that, compared to other
occupational groups, commercial or professional drivers, in general,
have a greater risk of suffering chronic cardiovascular, musculo-
skeletal, and gastrointestinal diseases, obesity, and hypertension, as
well as mental health problems such as anxiety, depression, and post-
traumatic stress disorder due to traffic accidents and working
conditions.2–6 Futhermore, considering the strong similarity between
working conditions of BRT drivers and other groups of commercial
Institution at which the work was performed: University of Los Andes, Bogotá, Colombia.
drivers (eg, city and intercity bus drivers, and cargo carrier drivers), it is
possible that BRT drivers, like commercial drivers, face risk factors for
accidents such as monotonous conditions, bad roads, consumption of
CNS stimulants, age as well as work stressors such as time pressures,
time-binding, shift-work, high physical and mental demands, and job
strain.
BRT drivers in Bogotá drive in somewhat different conditions than
other urban bus drivers (eg, they have an exclusive bus lane and they
don’t receive money from the passengers), so one would expect for
their conditions to be more favorable. On the other hand, they are
often exposed to other sources of psychosocial stress such as strict
external control and massive passenger flows. It is known, specifically,
that stress associated with professional driving is associated with
aberrant driving behaviors and fatigue,7,8 which in turn can be related
to road accidents.2,4,9,10 However, there is a notable lack of research

336 | © 2018 Wiley Periodicals, Inc. wileyonlinelibrary.com/journal/ajim Am J Ind Med. 2018;61:336–343.


GÓMEZ-ORTIZ ET AL.
that assesses the specific psychosocial working conditions of BRT
drivers and how these conditions impact the risk of involvement in
motor vehicle accidents or of suffering health problems.
The aim of this study was to investigate the association between
work stress, mental health, and accident involvement of BRT drivers in
Bogotá Utilizing recognized psychosocial risk factors as sources of job
stress (proposed by the job demand-control-support (DCS) and effort-
reward imbalance (ERI) models, as well as the Occupational Stress
Index-OSI), we developed a study to estimate its specific contribution
to BRT drivers’ risk of accidents and experiencing mental health
problems. Psychosocial risk associated with work can be defined and
measured generically for all occupations or, specifically, for a single
occupation. Research suggests generic measurements should be
4,11
complemented with specific measures for each occupation.
our study, we assessed both the psychosocial risk factors that are
common to all workers (ie, with the demand-control-support and
effort-reward imbalance models), and those stressors that are specific
to bus drivers (using the Occupational Stress Index (OSI)).
This study is based on three theoretical models developed
respectively by Karasek and Theorell,12 Siegrist,13 and BelkiĆ.14 The
first two models (demand-control-support and effort-reward imbal-
ance) are the most commonly studied internationally and have
instruments validated in many countries around the world (JCQ and
ERI). Moreover, both models have been shown to impact the health of
workers in different occupations.15 The job demand-control-support
(DCS) model affirms that working conditions with job strain (work
characterized by a high number of psychological demands and few
control options ie, low decision latitude and skill discretion) lead to the
greatest health risks. However, co-worker and supervisor social
12
support can help mitigate the impact of job strain. The effort-reward
imbalance (ERI) model states that the imbalance between the efforts
(extrinsic and intrinsic) made to respond to demands at work and the
rewards received (in terms of salary, recognition, and job security)
fosters stress responses.13
The DCS and ERI were supplemented by the OSI (Occupational
Stress Index), developed by BelkiĆ,14 which is derived from the field of
cognitive ergonomics that studies the way in which humans process
16
information, make decisions, and perform actions. It is an additive
burden model (mental and physical) that incorporates some of the
elements from the other models, while adding concepts developed
within the perspective of cognitive ergonomics.
The OSI analyses work in terms of mental demands and how
such demands are controlled by the individual in the context of
energy regulation theory.17 The OSI conceptualizes the work
environment as a whole, including issues related to broader task,
schedule and chemical, physical, and organizational factors that
contribute to the global burden.18 Among the novel factors that have
been included, the authors of the OSI highlight so-called threat-
avoidant vigilance, a factor not considered in other work stress
models, yet high in occupations such as driving. To be vigilant, in
order to avoid threat or danger, requires continuously tracking
information and indicators that can help prevent errors whose
consequences could be catastrophic. This factor characterizes a
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| 337
number of occupational groups including doctors, nurses, air
controllers, and professional drivers, and it is usually associated
with an increased risk of cardiovascular problems.16
Studies by BelkiĆ16 involving professional drivers indicate high
demands (an average of 16.1, SD 2.1) compared with other
occupational groups with similar socioeconomic conditions (an
average of 6.4, SD 3.8). The OSI identifies the pressure to keep within
established schedules during long working days as psychosocial factors
contributing to hypertension and ischemic cardiovascular disease.
As mentioned previously, psychosocial conditions that may be a
source of stress specifically for BRT drivers have scarcely been studied.
The only study identified that approaches the goal(s) of the present
paper is a pilot study undertaken to assess the mental workload of BRT
In drivers driving on an exclusive, but narrow, lane. It was assumed that
both the narrowness of the lane and the need to anticipate the risk of
accidents in adjacent lanes were significant risk factors that ought to be
studied in order to improve operational safety and driver health.
Despite the fact that in heavy traffic, mobility, and safety in an
exclusive lane is superior, there was no evidence of a reduction in the
drivers’ mental workload. In the conclusion, the authors of this study
highlight the need to evaluate the impact of BRT operation on the
mental workload and stress levels of the drivers of such types of
transport systems.19
In this report, it is hypothesized that drivers who perceive greater
psychosocial risk factors in the work environment are more likely to
have a higher report of accidents in the past 3 years. It is also expected
that the accident number will be higher for drivers with higher levels of
psychological distress (lower levels of mental health). Finally, it is
expected to find greater psychological distress in drivers who report
more psychosocial risk factors at work.
2 | MATERIALS AND METHO DS
2.1 | Design
The study utilized a cross-sectional design with self-report question-
naires to assess exposures and outcomes.
2.2 | Participants
Five hundred and twenty-four BRT operators from four BRT
companies in Bogota, Colombia, were invited to participate in the
study. The invitation was made to all the employees of the companies
by means of posters, phone messages, and personal invitation when
the drivers were at the stations resting or waiting for their shift to
begin. The average age of the participants was 40.5 (SD 7.7) and all
were male. The average time as drivers was 17.62 years (SD 7.31) and
the operators had been working for the current company for at least a
year. This guaranteed that the self-reporting of the working conditions
referred to current characteristics and that if any relationship with
accident rates and health were established, there would be greater
certainty that the working conditions in question were the most recent
and associated with their current job.
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338 | GÓMEZ-ORTIZ ET AL.

2.3 | Instruments work-related communication, complex decision making, decisions

that affect others and rapid decision-making, heterogeneous
Information was collected through written instruments/surveys. We
tasks, simultaneous execution of simultaneous tasks, and rapid
used the instruments based on the previously mentioned models to
task execution.
measure psychosocial job strain: the JCQ (Job Content Questionnaire)
 Rigor: strict requirements for signal detection, limited number of
and the short version of the effort-reward imbalance (ERI) question-
decision making strategies, limited number of correct decisions
naire, both adapted to the Colombian population.20,21
made, and strict compliance to a defined standard.
The number of items of the JCQ scales and the reliability values
 Extrinsic time pressure: no control over the speed of incoming signals,
obtained with this group are described as follows: skill discretion (6 items
decisions cannot be postponed, no control over task execution rate,
, range 12-48, alpha = 0.45), decision latitude (3 items, range 12-48,
acceleration, and time pressure.
alpha = 0.61), control of work processes (9 items, range 24-96,
 Harmful exposures: glare and noise, vibration, isometric stress, heat,
alpha = 0.65), psychological demands (5 items, range 12-48, alpha
cold, harmful fumes, and dust.
= 0.66), supervisor support (4 items, range 4-16, alpha = 0.76),
 Avoidance (potential disaster or symbolic aversiveness): high level of
co-worker support (4 items, range 4-16, alpha = 0.72), and job insecurity
attention, serious consequences for momentary errors or inatten-
(3 items, range 3-12, alpha = 0.61). Job strain was calculated as a
tion, wrong decisions can lead to serious consequences that may
continuous value (a ratio of psychological demands divided by control).
potentially be mortal, dangerous tasks, occupational accidents, and
Examples of the questions included are: My job requires that I learn new
being witness to accidents.
things; My job allows me to make a lot of decisions on my own; My job
 Conflicts/uncertainty: signal/noise conflict, signal/signal conflict,
requires working very fast.
lack of information for adequate decision making, contradictory
There are three scales included in the ERI (extrinsic effort,
information, the occurrence of unexpected events that may change
rewards, and overcommitment). In this study, extrinsic effort and
work plans, conflictive time-space tasks, external factors that hinder
rewards were assessed. The reliability values obtained were as follows:
the execution of tasks, and emotionally charged working environ-
extrinsic effort (3 items, alpha = 0.73), rewards (7 items, alpha = 0.77).
ments (interpersonal conflicts).
Greater scores in each sub-scale indicated greater extrinsic efforts and
rewards. The effort-reward imbalance score is a continuous value that
One example of the kind of questions included in the OSI is the
reflects the balance or lack thereof between the two factors. Given the
following:
drivers’ work characteristics, it was not considered pertinent to apply
With respect to time pressure at work:
the overcommitment (or intrinsic effort) scale, given that over-
involvement in work is an unlikely trait in this occupation. Examples
 I don't experience any substantial time pressure at work. It is only
of the questions included are: I have a lot of responsibility in my job; I
important that I arrive at my destination within a reasonable amount
experience adequate support in difficult situations; I am treated
of time.
unfairly at work.
 Sometimes I must arrive at a given time.
To assess the specific working conditions of BRT operators, we
 I have an extremely tight schedule. If I arrive late, I face
used the Occupational Stress Index (OSI) for professional drivers
unpleasantness or even penalty. However, I can usually arrive on
developed by BelkiĆ.14 Each OSI component describes the stress
schedule.
factors at the moment in which the information is processed, making it
 I have an extremely tight schedule. If I arrive late, I face
possible to carry out summations both in terms of stress levels and
unpleasantness or even penalty. It happens, that despite my efforts,
factors. This, in turn, allows the evaluation of various combined
and for objective reasons, I sometimes or often arrive late.
effects.14 The researchers translated the questionnaire into Spanish
and adapted some of the questions to the specific conditions affecting
The General Health Questionnaire (GHQ-12), used for measuring
BRT drivers in Bogotá. The clarity of the questions was tested in a pilot
mental health, assesses specific symptoms that indicate a decrease of
study with drivers of the BRT of Bogotá. Given the particularity of the
mental health. A greater score on the scale indicates more distress and
method in which the OSI is scored, it is impossible to calculate
worse mental health. The Cronbach alpha obtained was 0.68.
reliability data.
The survey also asked about a number of self-reported health
The stress factors that can be calculated using the OSI
indicators that for ethical reasons could not be obtained from the
questionnaire are as follows:
company records (hypertension, diabetes, cardiovascular problems,
ergonomic problems, weight, and height). The number of traffic
 Low demand: homogeneous incoming signals, low frequency of accidents experienced by each of the BRT operators was obtained
outgoing signals, working alone, making automatic decisions, from databases from participating Transmilenio companies containing
homogeneous, and simple tasks, and little to do. records of incidents and accidents. Unfortunately, the available
 High demand: having to simultaneously respond to a barrage of records included different types of accidents and incidents1 combined
information and signals, heterogeneous signals, high frequency of into one single category named “accidents” due to the infrequency of
incoming signals, signals in three sensory modalities, essential occurence.
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GÓMEZ-ORTIZ ET AL.
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2.4 | Procedure TABLE 1 Descriptive statistics of the study variables

Standard
All the drivers were invited to participate through a text message sent
Variable Average deviation
to their cellular phones and posters put up at the stations. Ninety-eight
No. of accidents in the last 3 years 0.63 0.95
percent of drivers agreed to answer the questionnaire at work during
Control over work processes 64.70 11.00
work hours in training spaces provided by the company for the study.
(JCQ)
The questionnaires were identified with each operator's personal code
Job demands (JCQ) 29.80 6.60
thus, protecting their identity and at the same time allowing the
Job strain (JCQ) 0.97 0.32
researchers to match the self-reported data with the accident rate data
(reported by the Transmilenio company) for each driver. The drivers Supervisor social support (JCQ) 12.30 2.10

reported their identification code in the system, accepting the
researchers’ guarantee that such information would only be used to
identify accident rate data. Drivers signed a written informed consent.
The study was approved by the Ethics Committee of the
Universidad de los Andes in Bogotá, Colombia.
2.5 | Data analysis
Descriptive statistics and Pearson correlation between the study
variables were obtained. Data were then analyzed using linear
regressions. Each group of independent variables was first regressed
on each of the two outcome variables separately (accidents and
mental health). The groups of variables were the following:
a. confounding variables including age and physical health indicators;
b. variables of the demand-control model; c. variables of the ERI
model; and d. variables of the OSI model. The variables of each group
that significantly predicted some of the variance of each outcome
were then tested together using hierarchical regressions trying to
explain the most variability in each dependent variable with the
fewest, but adequate, predictors of the different models assessed.
Age and health variables were introduced first (step 1) to control for
them before assessing work and personal variables (mental health in
the case of accidents). The effect of the general working conditions
(evaluated with the DCS and ERI model) were tested next (step 2)
before those working conditions specific of drivers (evaluated with
the OSI model) (step 3). Data analysis was performed using IBM
SPSS version 21.0.
3 | RE SULTS
The averages of all the analyzed variables are presented in Table 1.
The range of accidents over the past 3 years was between 0 and 7
accidents per driver with an mean of 0.63 (SD = 0.95). We found a
broad range of distribution in this number possibly due to the
inclusion of events of differing severity.
Table 2 shows the regression data illustrating that 8.7% of
variance in the frequency of accident involvement over the past
3 years could be predicted based on age and whether the driver suffers
from hypertension (F(2482) = 10.63 P < 0.01), had less support from
supervisors (F(3481) = 12.10 P < 0.01) and avoidance or perception of
potential risk by the drivers (F(5479) = 9.1 P < 0.01). The second
hypothesis that accident risk could be predicted based on mental
health was not confirmed.
Co-worker social support (JCQ) 11.70 2.30
Effort (ERI) 7.20 2.00
Reward (ERI) 18.80 3.60
E/R imbalance 0.97 0.46
Total OSI 63.80 3.08
Mental health (GHQ-12) 19.95 3.85
In Table 3, 30.8% of the mental health variance was predicted
based on age and reported health problems (less age and having or
developing ergonomic problems predicts greater problems with
mental health; F(2308) = 15.9 P < 0.001). In addition, psychosocial risk
factors at work explain some of the mental health variance: job strain
(F(2.384) = 45.5 P < 0.001) and OSI conflict (F(9301) = 14.8 P < 0.001)
predict more problems; on the other hand, also as predicted, the
absence of co-worker support (F(4306) = 25.9 P < 0.001) and fewer
rewards (F(6304) = 19.8 P < 0.001) predict greater mental health
problems.
4 | DISCUSSION
This study suggests that some of the working conditions of the BRT
drivers might, in part, explain why BRT drivers in Bogota are involved in
accidents. The accident variance that could be explained by the studied
variables is small, but statistically significant. Many variables, not
included in this study (such as experience as a driver, road and climatic
conditions, mechanical conditions of buses), possibly play an additional
important role in explaining driving accidents.
The results partially confirm our expectations in the sense that
those drivers who perceived greater psychosocial risk factors at work
had more accidents over the past 3 years. The psychosocial risk factors
at work that seemed to be most relevant were the perception of a lack
of supervisor support and greater reports of avoidance or perception
of possible risks.
As the variables considered here are mutable and explain part of
the variance, they should be taken into consideration when it comes to
improving driving safety. We believe that social support of supervisors,
as potentially the most modifiable variable is one of the most
important. Suggestions about how to offer good support from
supervisors can be found in the literature. For example, ILO document
on stress prevention at Work Checkpoints22 offers ideas like listening
carefully to the opinions and complaints of workers about workplace
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340 | GÓMEZ-ORTIZ ET AL.

TABLE 2 Hierarchical regression for variables (JCQ, ERI, and OSI models) predicting accidents over the past 3 years
Variables Step 1 Step 2 Step 3
Constant −0.832 (0.325) 0.010 (0.389) −0.087 (0.393)
Age hypertension 0.018 (0.006)** 0.019 (0.006)** 0.019 (0.006)**
0.742 (0.242)** 0.656 (0.240)** 0.687 (0.238)**
Supervisor support −0.070 (0.018)** −0.062 (0.019)**
Aversiveness avoidance 0.056 (0.043)
−0.113 (0.043)**
R2 0.042** 0.070** 0.087**
2
R adjusted 0.038** 0.064** 0.077**
No. of observations 484 484 484

Standard errors are reported in parentheses.

*, ** Indicates significance at the 95% and 99% level, respectively.

problems and making the effort to take necessary measures to solve
the problems. It would be important to encourage workers to
cooperate with managers in identifying and solving workplace
problems. Workers often know the background and possible solutions
to such problems and can help managers make necessary changes.
During informal conversations with the researchers, some managers of
the participating companies reported the existence of a social support
system that could be classified as co-worker support, whereby more
experienced drivers coordinate small groups of co-workers in order to
offer social support. However, it may be necessary to implement
additional forms of social support, in particular from supervisors, and
assess their effectiveness, given that our results indicate that it is
precisely the lack of such support that is associated with increased risk
of accident. The literature reports numerous studies indicating that
social support from supervisors prevents or reduces different health
problems of their workers.22–24
The operation of motor vehicles implies sustained attention
(vigilance) in order to avoid threat or danger.16 According to findings
from the field of cognitive ergonomics, staying vigilant and
permanently tracking information and indicators that help avoid errors
and consequences that could be catastrophic, uses some of the
attention or information processing capacity of drivers and affects
their reaction time or selection of an appropriate response. This finding
could explain, in part, the occurrence of accidents. Another possible
explanation for the relationship between accidents, supervisory
support and vigilance, is that people who have had accidents may
be more aware of threat and danger and may experience lower support
from supervisors. Given the small variance of accidents explained by
the psychosocial condition in the present study and that the direction
of causality is impossible to establish with these data, it seems
appropriate to suggest further detailed evaluation before some
reasonable intervention can be suggested.
Contrary to what we expected, the drivers’ mental health
problems, at least in terms of the distress expressed by the
participants, does not represent a risk for unsafe driving. However,
the study also indicates that the mental health of the drivers, although
acceptable according to the GHQ scores, is related to the stressful
psychosocial work conditions. The proportion of mental health

TABLE 3 Hierarchical regression for variables (JCQ, ERI, OSI models) predicting mental health
Variables Step 1 Step 2 Step 3 Step 4
Constant 20.977 (1.281) 20.392 (1.796) 16.987 (2.029) 11.404 (2.776)
Age ergonom. probs. −0.107 (0.028)** −0.74 (0.026)** −0.075 (0.025)** −0.066 (0.25)**
2.915 (0.645)** 1.805 (0.605)** 1.638 (0.598)** 1.372 (0.597)*
Job strain co-worker support 3.902 (0.625)** 2.540 (0.743)** 2.408 (0.740)**
−0.271 (0.096)** −0.196 (0.097)* −0.193 (0.096)*
Effort reward 0.153 (0.122) 0.056 (0.125)
0.178 (0.070)* 0.159 (0.069)*
Extrinsic time pressure 0.091 (128)
Aversiveness conflict 0.003 (193)
0.563 (0.211)**
R2 0.094** 0.254** 0.281** 0.308*
R2 adjusted 0.088** 0.244** 0.267** 0.287*
No. of observations 391 391 391 391

Standard errors are reported in parentheses.

*, ** Indicate significance at the 95% and 99% level, respectively.

GÓMEZ-ORTIZ ET AL.
variance explained as an outcome was high and more variables from
the three models considered contributed further to this explanation,
the most important being job strain and co-worker support. Based on
these results, and given that the factors identified are well-defined and
theory-grounded psychosocial job factors whose deleterious effects
on health have been demonstrated in various work settings, as well as
covered in the validated instruments we used to measure them, we
suggest a number of potential interventions that may improve the
mental health of drivers:
1 Reducing demands and increasing control (equivalent to reducing
job strain): reducing the number of driving hours or/and increasing
opportunities for rest and recuperation and offering more control
and social support at work. If any of these measures were
implemented their impact would need to be assessed.22,24 Previous
studies have evaluated the effectiveness and positive impact on the
health of workers of this kind of interventions.25,26
2 Reducing incoming information and simplifying current signals,
making them less contradictory and exploring other sources of
conflict. The OSI scale of conflict, which showed a positive
relationship with mental health problems, refers to receiving
contradictory information, continually experiencing events that
are impossible to predict and can alter established plans, conflicting
time-space demands, and interpersonal conflicts. The drivers rated
those aspects high. Reducing such conflicts requires, in our opinion,
discussing details of any given conflict situation with the drivers
involved, allowing them to share their opinions insofar as problem
identification and to make suggestions as to how a specific situation
can be improved. Such procedures can help increase the drivers’
perception of their levels of control over their work processes. Job
strain decreases as levels of control increase. Due to their nature,
many driving conditions cannot be changed in order to give drivers a
greater perception of control. However, allowing them to take part
in the design of their own working conditions is an alternative that
has been identified as having a favorable impact in previous
studies.22,24
3 Reward distribution needs to be revised. Some drivers perceive that
the rewards they receive do not sufficiently compensate their
efforts, and when such a perception exists (effort-reward imbalance)
the drivers’ psychological well-being is negatively affected.13 As in
point 1, listening to what the drivers have to say may provide
interesting ideas for change.22,24–26
Despite the interesting results it provides, this study also presents
a number of limitations that are important to point out:
1 This was a cross-sectional study and did not allow for the
determination of the existence of causal relationships between
the studied variables. Assessing the change in accident rates or
health conditions according to modifications made to the psycho-
social work factors (natural experiment), would be one important
way of achieving greater certainty of the type of relationship
between the variables.
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| 341
2 Another limitation of the study was that the data were gathered
almost exclusively through self-reported information (with the
exception of the accident report). Self-reporting is a relatively
inexpensive way of gathering the perceptions of large groups of
workers, even though, it may introduce some unreliability or
possibly offer a slightly overestimated view of the problems that
may exist.27
3 We also know that evaluating a homogeneous occupation reduces
the variability of the assessed working conditions, which leads to a
decreased possibility of finding important relationships among
variables (underestimation of impact).20 Thus, some factors that may
be affecting the safety and mental health of the BRT drivers in
Bogota may have been underestimated or gone unnoticed in this
study.
4 The participating drivers belonged to just four Trasmilenio system
operator companies in Bogotá. Through informal conversations with
company operators and administrators, we found that some of the
working conditions are not the same in the four companies. We do
not know, in this case whether they are better or worse, thus, the
results of this work cannot necessarily be generalized to all BRT
operators in Bogotá.
5 The number of accidents represents the sum of the four categories
defined by Transmilenio: unpredictable operational events with
death and/or disabling injury of one or more of those involved;
unpredictable operational events with injured parties that require
outpatient care and/or significant operational damage to the
infrastructure or vehicles involved that is higher than 5 statutory
monthly minimum wages; unpredictable operational events that
cause damage to materials and infrastructure or to the vehicles
involved of between 2 and 5 statutory monthly minimum wages,
that requires the immobilization of the vehicle and/or injured parties
that require first aid; unpredictable operational events without
personal injuries and slight losses—up to 2 statutory monthly
minimum wages—and/or injuries that do not cause disability. Given
that each of these categories had a low frequency, to establish any
relationship of them with the psychosocial working conditions
required aggregation. It is possible that this grouping may introduce
a limitation and that results be different for each category.
In conclusion, selected working conditions of BRT drivers in
Bogotá (Colombia) might, in part, explain why they are involved in
accidents though more research clearly needs to be conducted on this
topic. It may be necessary to implement additional forms of
supervisory social support and assess their effectiveness. Drivers’
mental health problems, at least in terms of the distress expressed by
the participants, may not represent a risk for unsafe driving in this
study. However, this study also shows that the mental health of the
drivers, although acceptable, is related to their stressful psychosocial
work conditions. Reducing demands and increasing control (equivalent
to reducing job strain) should be considered to alleviate mental health
problems. In the case of BRT drivers, this could be achieved by
reducing the number of driving hours and/or increasing opportunities
for rest and recuperation, offering the drivers more control over their

342 | GÓMEZ-ORTIZ
working conditions and facilitating co-workers’ social support at work.
In addition, incoming information should be reduced, and current
signals should be simplified, making them less contradictory. Reward
distribution needs, also, to be revised. Some drivers perceive that the
rewards they receive do not sufficiently compensate their efforts,
(effort-reward imbalance), and the drivers’ psychological wellbeing is
negatively affected.
AUTHORS’ CONTRIBUTIONS
Viviola Gómez-Ortiz was the director of the project; participated in the
conception of the research; visited organizations that could be
interested in the project; designed the questionnaire; did analysis
and interpretation of data; and wrote the final manuscript for
publication. Boris Cendales and Sergio Useche participated in the
conception of the research; contacted and visited possible interested
organizations; design and pilot test of the questionnaire; collected,
analyzed and interpreted the data; wrote some sections of the
manuscript, revised and commented on the final manuscript. Juan
Pablo Bocarejo co-directed the project; made possible the contact with
the organizations and participated in the visits with them; made
comments to all the materials and data analysis; and made important
comments to the manuscript.
ACKNOWLEDGMENT
Authors acknowledge contribution and support for this research of
Dr. Peter Schnall.
FUNDING
This study was made possible thanks to funding granted by the Vice-
Presidency for Research at Universidad de los Andes, through a grant
given to projects done between different schools (in this case the
School of Social Sciences and the School of Engineering).
ETHICS APPROVAL AND INFORMED CONSENT
The study was approved by the Ethics Committee at Universidad de los
Andes. Participants signed written informed consent.
DISCLOSURE (AUTHORS)
The authors declare no conflicts of interest.
DISCLOSURE BY AJIM EDITOR OF RECORD
Steven B. Markowitz declares that he has no competing or conflicts of
interest in the review and publication decision regarding this article.
DISCLAIMER
None.
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ET AL.
ENDNOTE
1
The number of accidents represents the sum of the four categories
defined by Transmilenio: Type 1 accidents: unpredictable operational
events with deaths and/or disabling injury of one or more of those
involved. Type 2 accidents: unpredictable operational events with injured
parties that require outpatient care and/or significant operational damage
to the infrastructure or vehicles involved that is higher than 5 statutory
monthly minimum wages. Incident: unpredictable operational events that
cause damage to materials and infrastructure or to the vehicles involved
of between 2 and 5 statutory monthly minimum wages, that requires the
immobilization of the vehicle and/or injured parties that require first aid.
Minor accident: unpredictable operational events without personal
injuries and slight losses—up to 2 statutory monthly minimum wages—
and/or injuries that do not cause disability.
ORCID
Viviola Gómez-Ortiz http://orcid.org/0000-0002-1066-9483
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How to cite this article: Gómez-Ortiz V, Cendales B, Useche
S, Bocarejo JP. Relationships of working conditions, health
problems and vehicle accidents in bus rapid transit (BRT)
drivers. Am J Ind Med. 2018;61:336–343.
https://doi.org/10.1002/ajim.22821