Health Status and Behaviors among Casino Gaming Employees Population-based Epidemiological Analyses
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Background: Previous studies reported the health effects associated with such harmful occupational exposures as environmental tobacco smoke (ETS), stress, working shift and noise. Currently more than 300,000 employees in the US who are working on the casino gaming floor potentially exposed to these working environment hazards. However, research on health conditions among the casino gaming employees is extremely limited. The present project is the first study which utilizes statewide population-based survey data to analyze health status and behaviors among the casino gaming employees in Nevada, which has more than 50% of the US casino operations. Methods: General health status, chronic disease indicators, behavior risk factors and preventive indicators among Nevada respondents were collected through 2012, 2013 and 2014 Nevada Behavior Risk Factor Surveillance Systems (BRFSS). The casino gaming employment experience of respondents was asked. The complex stratified-cluster sampling method was used for data collection. In order to minimize such selection bias as non-response and non-coverage, weighing procedures and weighted multiple logistics models were conducted. Multiple imputation technique was used for handling missing values. Latent Class Analysis (LCA) was conducted to categorize the chronic disease indictors to groups with a high or low risk for chronic disease. Multilevel mixed model checked the nested cluster effects for variables from individual or community (county/region) multilevel (hierarchical) data. The statistical software M-Plus and SAS 9.4 were utilized. 7 Results: Among 13,646 respondents who completed the survey, 1,384 reported that they have worked on a casino gaming floor (weighted prevalence 11.2%), who reflect the 317,979 Nevada residents have ever worked on a casino gaming floor (CGFE). Results tend to suggest that CGFE is relatively less paid and with lower socioeconomic status. The groups with the highest percentage of CGFE exposure within a demographic category are Clark county (Las Vegas Area, 11.6%), female (12.3%), age group of 55-64 (16.1%), divorced (18.4%), high school or GED education (13.9%), household income at $35-49,999 (15.2%), and Race/Ethnicity as Black nonHispanic (16.2%), respectively. In four categories total, thirty-three (33) health indicators were compared between CGFE and non-CGFE. After controlling for potential confounding factors, gaming floor employees are statistically significantly (p<0.05) associated with the following indicators: 1) General Health Status: Adjusted odds ratios (AOR) for fair/poor general health are 1.37 (95% CI 1.08-1.72, p < 0.01), experienced confusion or memory loss 1.63 (95% CI 1.212.19, p =0.001), and poor physical health (1.33, 95% CI 1.10-1.61, p <0.001) respectively; 2) Chronic disease Indictors: Asthma 1.32 (95% CI 1.01-1.75, p =0.04 ), COPD 1.45 (95% CI 1.06-1.96, p=0.02 ) arthritis 1.23 (95% CI 1.00-1.52, p = 0.048), Depression disorder 1.56 (95% CI 1.23-2.00, p=0.000), diabetes 1.47 (95% CI 1.09-1.96, p=0.01); 3) Behavior Risk Factors: Current smoking 1.52 (95% CI 1.20-1.92), binging drinking 1.37 (95% CI 1.05-1.82), heavy drinking 1.64 (95% CI 1.11-2.44), pain killer use 1.85 (95% CI 0.68-5.00) and attempting suicide 2.66 (95% CI 1.26- 5.58), respectively; 4) Preventive Health Indicators: CGFE has generally shown in positive direction with higher healthcare plans and higher preventive tests. After controlling confounding factors, most indicators no longer showed the significant difference except for HIV test 1.65 (95% CI 1.35-2.02, p<0.0001). CGFE is also highly 8 associated with a high risk of chronic disease conditions (AOR=1.52, 95% CI 1.20-1.93, p= 0.0005). Conclusions: People who have ever worked on a casino gaming floor (CGFE) are in relatively lower socioeconomic status. Although the current study does not provide the causal relationship, comparing to non-CGFE people, CGFE had significantly adverse effects in their health status and behavior risk factor indictors, especially in their risks for chronic diseases. Healthier employees are more productive and less costly, therefore the casino industry should be highly encouraged to work on employee quality of life assessment and motivated to minimize and eventually completely eliminate such occupational hazards as environmental tobacco smoke. In order to reveal the causal-effect relationships, further studies with advanced epidemiological designs on casino gaming floor occupational health are needed.