Health promotion in the Danish maritime setting: challenges and possibilities for changing lifestyle behavior and health among seafarers.

Lulu Hjarnoe,Anja Leppin

doi:10.1186/1471-2458-13-1165

Abstract

BackgroundSeafaring is a risky occupation when compared to land-based industries as incidence rates of mortality and morbidity are higher. This trend is partly due to a higher number of accidents but also higher incidence of lifestyle-related diseases like cardiovascular disease and lung cancer. In Denmark, the proportion of smokers as well as of overweight and obese persons is higher among seafarers compared to the general population. This high burden of risk indicates that this occupational group might be a growing challenge at sea in regard to safety and health issues and there is a need to further our understanding of the health promotion approaches that work.MethodsA single-group pre-post design was conducted in 2008–2009 in order to identify changes in lifestyle related behaviors and health risk factors among seafarers (N: 606) in two Danish shipping companies after implementing two structural health promotion interventions (healthy cooking courses for ship cooks and improvement of fitness facilities) as well as health education interventions (smoking cessation courses, individual exercise guidance and extra health check-ups) at the maritime workplace. Baseline and follow-up data were collected with a self-administrated standardized questionnaire and individual health profiling assessing parameters such as physical health and physical fitness. In addition, qualitative interviews with participants and non-participants were conducted in order to gain in-depth information on experiences with the intervention processes.ResultsSignificant changes were identified for levels of fitness, daily sugar intake and metabolic syndrome. However, these results were not associated with participating in the health educational interventions. One possible explanation for the improved fitness rate could be the upgrading of fitness equipment onboard the ships provided by the management level. The decrease in daily sugar intake and prevalence of seafarers with metabolic syndrome might be associated with the cooking course intervention which aimed at providing healthier daily meals on board.ConclusionThe findings suggest that a multicomponent health promotion intervention program has the potential to achieve change in seafarers’ health behavior and health parameters. In the future, studies with more rigorous designs, separately testing the contribution of different types of interventions are needed.

Highlights

Seafaring is a risky occupation when compared to land-based industries as incidence rates of mortality and morbidity are higher
Differentially afflicted and beyond factors such as age, gender, socio-economic background or education, type of occupation seems to be associated with different levels of risk
Recent studies from Poland, France, Norway, Germany and Denmark have reported that high blood pressure, high triglycerides, diabetes and obesity as well as risk behaviors such as smoking and physical inactivity are highly prevalent in seafarers [6,7,8,9,10,11,12,13] and are much more common than among respective general populations [9,10,14,15]

Summary

Introduction

Seafaring is a risky occupation when compared to land-based industries as incidence rates of mortality and morbidity are higher. In Denmark, the proportion of smokers as well as of overweight and obese persons is higher among seafarers compared to the general population This high burden of risk indicates that this occupational group might be a growing challenge at sea in regard to safety and health issues and there is a need to further our understanding of the health promotion approaches that work. Lifestyle behaviors, such as smoking, consuming foods high in fat and sugar, being overweight and physical inactivity constitute the key modifiable risk factors for many chronic health problems, among them in particular cardio-vascular diseases (CVDs), the number one cause of death globally [1]. This often results in a stronger reliance on traditional high-fat, high-sugar foods with lesser emphasis on healthy eating

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