title: Understanding health risk factor prevalence and enhancing health behaviours of airline pilots

authors: Wilson, Daniel

subjects: Aviation medicine

abstract: Cardiometabolic non-communicable diseases (NCD) and their major risk factors are associated with adverse acute and chronic health outcomes and may pose risks to flight safety and economic burden. Restorative sleep, healthy nutrition, and sufficient physical activity are powerful lifestyle behaviours that are fundamental for human health and well-being, and each are independently associated with NCD risk reduction. Although occupational preventive medicine research is increasing, airline pilots are largely underrepresented in the literature. Through a series of seven studies, this PhD thesis aimed to enhance the understanding of modifiable health risk factor status for airline pilots and to investigate evidence-based strategies for promoting positive health, wellness, and NCD risk factor mitigation among airline pilots.
To identify priority health risks among airline pilots and to serve as a foundation for further studies within the thesis, Study One systematically explored the global literature pertaining to the prevalence of cardiometabolic health risk factors among airline pilots. Study Two investigated the prevalence and distribution of subjective and objective cardiometabolic health risk factors among New Zealand airline pilots and compared these with the general population. Study Three synthesised global literature and summarised evidence-based considerations regarding the health benefits of sleep hygiene, healthy eating, and physical activity for cardiometabolic health promotion in airline pilots and further discussed evidence-based considerations for enhancing health behaviours in this occupational group. Study Four evaluated the efficacy of a 17-week, three-component personalised sleep, healthy eating, and physical activity lifestyle intervention for enhancing self-report health parameters during the coronavirus disease 2019 (COVID-19) pandemic. Subsequently, Study Five performed a 12-month follow-up investigation of the longitudinal effects of the 17-week intervention on self-report health parameters in addition to body mass and blood pressure management. Study Six further evaluated the effects of the three-component lifestyle intervention with utilisation of a wider range of objective cardiometabolic health parameters. Finally, Study Seven evaluated the efficacy of a smartphone-based app delivery of the three-component lifestyle intervention as a potentially scalable strategy for enhancing health and fitness parameters in airline pilots.
In Study One, A total of 47 studies derived from 20 different countries among a total pooled sample of 36,454 airline pilots were reviewed. The systematic review revealed substantial prevalence of > 50% for overweight and obesity, insufficient physical activity, and elevated fatigue among airline pilots globally. Further, this study highlighted the heterogeneity in methodology and lacking quality and quantity among the current literature pertaining to airline pilots, identifying the need for further research to better understand health risk factors and risk factor mitigation strategies among airline pilots.
In Study Two, the cross-sectional comparison of health risk factor prevalence between airline pilots (n = 504) and the general population (n = 2,033) identified notable and similar health risk factor prevalence between groups, with elevated prevalence of short sleep, physical inactivity, ‘at risk’ for hypertension, and lower positive self-rated health among airline pilots. Accordingly, findings called for further research to examine targeted, cost-effective intervention methods for promoting healthy body weight, managing blood pressure, and enhancing health behaviours to mitigate the risks of occupational morbidity, medical conditions causing loss of license, medical incapacity, and to support flight safety.
In Study Three, the narrative review outlined occupational health risks in airline pilots, summarised the evidence on health benefits of sleep hygiene, healthy eating, and physical activity as preventive medicine, and discussed evidence-based considerations for promoting health behaviours in this occupational group.
In Study Four, 38 airline pilots completed an acute 17-week personalised sleep hygiene, healthy eating, and physical activity intervention which elicited significant improvements in sleep quality and quantity, fruit and vegetable intake, and moderate-to-vigorous physical activity compared to the control group and suggested that achieving health guidelines for these behaviours promoted positive mental and physical health.
Study Five, provides further support that the personalised three-component lifestyle intervention can elicit and sustain long-term improvements in body mass and blood pressure management, health behaviours, and perceived subjective health in overweight and obese airline pilots and may support quality of life during an unprecedented global pandemic.
In Study Six, further implementation of the personalised three-component lifestyle intervention among 67 overweight airline pilots elicited significant (p = < 0.001) positive change associated with moderate to large effects sizes for objective health measures (VO2max, body mass, skinfolds, girths, blood pressure, resting heart rate, push-ups, plank isometric hold) and self-report health (weekly moderate-to-vigorous physical activity, sleep quality and quantity, fruit and vegetable intake, and self-rated health) at 4-months post-intervention, relative to the control group (n = 58).
Lastly, Study Seven utilised a randomised control trial design to deliver a smartphone-based app three-component lifestyle intervention among 94 airline pilots, which elicited positive changes associated with trivial to large effects sizes for objective health measures (Cooper’s 12-minute exercise test, resting heart rate, push-ups, plank isometric hold) and self-report health (weekly moderate-to-vigorous physical activity, sleep quality and quantity, fruit and vegetable intake, self-rated health, and perceived stress and fatigue) at 4-months post-intervention, relative to the control group (n = 92).
In summary, the studies in this thesis provide a foundation for understanding cardiometabolic health risk factor prevalence among airline pilots. Furthermore, our series of controlled clinical trials provide preliminary evidence that a personalised three-component physical activity, healthy eating, and sleep hygiene intervention can elicit short-term improvements and may promote sustained long-term positive adaptations in objective and subjective health parameters in airline pilots.
These findings are important for health care professionals and researchers to provide insight regarding the efficacy of lifestyle interventions for promoting health, and to inform practices relating to disease prevention, health promotion, and public health policy making. Furthermore, in relation to the limited literature base pertaining to health behaviour intervention research among airline pilots, our findings provide novel contributions to this field.

text: Understanding health risk factor prevalence and enhancing health behaviours of airline pilots Cardiometabolic non-communicable diseases (NCD) and their major risk factors are associated with adverse acute and chronic health outcomes and may pose risks to flight safety and economic burden. Restorative sleep, healthy nutrition, and sufficient physical activity are powerful lifestyle behaviours that are fundamental for human health and well-being, and each are independently associated with NCD risk reduction. Although occupational preventive medicine research is increasing, airline pilots are largely underrepresented in the literature. Through a series of seven studies, this PhD thesis aimed to enhance the understanding of modifiable health risk factor status for airline pilots and to investigate evidence-based strategies for promoting positive health, wellness, and NCD risk factor mitigation among airline pilots.
To identify priority health risks among airline pilots and to serve as a foundation for further studies within the thesis, Study One systematically explored the global literature pertaining to the prevalence of cardiometabolic health risk factors among airline pilots. Study Two investigated the prevalence and distribution of subjective and objective cardiometabolic health risk factors among New Zealand airline pilots and compared these with the general population. Study Three synthesised global literature and summarised evidence-based considerations regarding the health benefits of sleep hygiene, healthy eating, and physical activity for cardiometabolic health promotion in airline pilots and further discussed evidence-based considerations for enhancing health behaviours in this occupational group. Study Four evaluated the efficacy of a 17-week, three-component personalised sleep, healthy eating, and physical activity lifestyle intervention for enhancing self-report health parameters during the coronavirus disease 2019 (COVID-19) pandemic. Subsequently, Study Five performed a 12-month follow-up investigation of the longitudinal effects of the 17-week intervention on self-report health parameters in addition to body mass and blood pressure management. Study Six further evaluated the effects of the three-component lifestyle intervention with utilisation of a wider range of objective cardiometabolic health parameters. Finally, Study Seven evaluated the efficacy of a smartphone-based app delivery of the three-component lifestyle intervention as a potentially scalable strategy for enhancing health and fitness parameters in airline pilots.
In Study One, A total of 47 studies derived from 20 different countries among a total pooled sample of 36,454 airline pilots were reviewed. The systematic review revealed substantial prevalence of > 50% for overweight and obesity, insufficient physical activity, and elevated fatigue among airline pilots globally. Further, this study highlighted the heterogeneity in methodology and lacking quality and quantity among the current literature pertaining to airline pilots, identifying the need for further research to better understand health risk factors and risk factor mitigation strategies among airline pilots.
In Study Two, the cross-sectional comparison of health risk factor prevalence between airline pilots (n = 504) and the general population (n = 2,033) identified notable and similar health risk factor prevalence between groups, with elevated prevalence of short sleep, physical inactivity, ‘at risk’ for hypertension, and lower positive self-rated health among airline pilots. Accordingly, findings called for further research to examine targeted, cost-effective intervention methods for promoting healthy body weight, managing blood pressure, and enhancing health behaviours to mitigate the risks of occupational morbidity, medical conditions causing loss of license, medical incapacity, and to support flight safety.
In Study Three, the narrative review outlined occupational health risks in airline pilots, summarised the evidence on health benefits of sleep hygiene, healthy eating, and physical activity as preventive medicine, and discussed evidence-based considerations for promoting health behaviours in this occupational group.
In Study Four, 38 airline pilots completed an acute 17-week personalised sleep hygiene, healthy eating, and physical activity intervention which elicited significant improvements in sleep quality and quantity, fruit and vegetable intake, and moderate-to-vigorous physical activity compared to the control group and suggested that achieving health guidelines for these behaviours promoted positive mental and physical health.
Study Five, provides further support that the personalised three-component lifestyle intervention can elicit and sustain long-term improvements in body mass and blood pressure management, health behaviours, and perceived subjective health in overweight and obese airline pilots and may support quality of life during an unprecedented global pandemic.
In Study Six, further implementation of the personalised three-component lifestyle intervention among 67 overweight airline pilots elicited significant (p = < 0.001) positive change associated with moderate to large effects sizes for objective health measures (VO2max, body mass, skinfolds, girths, blood pressure, resting heart rate, push-ups, plank isometric hold) and self-report health (weekly moderate-to-vigorous physical activity, sleep quality and quantity, fruit and vegetable intake, and self-rated health) at 4-months post-intervention, relative to the control group (n = 58).
Lastly, Study Seven utilised a randomised control trial design to deliver a smartphone-based app three-component lifestyle intervention among 94 airline pilots, which elicited positive changes associated with trivial to large effects sizes for objective health measures (Cooper’s 12-minute exercise test, resting heart rate, push-ups, plank isometric hold) and self-report health (weekly moderate-to-vigorous physical activity, sleep quality and quantity, fruit and vegetable intake, self-rated health, and perceived stress and fatigue) at 4-months post-intervention, relative to the control group (n = 92).
In summary, the studies in this thesis provide a foundation for understanding cardiometabolic health risk factor prevalence among airline pilots. Furthermore, our series of controlled clinical trials provide preliminary evidence that a personalised three-component physical activity, healthy eating, and sleep hygiene intervention can elicit short-term improvements and may promote sustained long-term positive adaptations in objective and subjective health parameters in airline pilots.
These findings are important for health care professionals and researchers to provide insight regarding the efficacy of lifestyle interventions for promoting health, and to inform practices relating to disease prevention, health promotion, and public health policy making. Furthermore, in relation to the limited literature base pertaining to health behaviour intervention research among airline pilots, our findings provide novel contributions to this field.

year: 2022

title: The impact of the Papua New Guinea Free Education Policy on the School Executive's Decision Making in the management of Class SIze

authors: Abady, Roddy

abstract: The Papua New Guinea National Government’s directives on educational policies are expected to be implemented effectively throughout the country, in educational institutions that are solely or partly funded by the government. The Free Education Policy (FEP), also known as Tuition Fee Free Policy (TFFP) is a governmental directive that is implemented in elementary, primary and secondary schools. The implementation of FEP is perceived as a device for fulfilling the National Government’s Universal Basic Education (UBE) Plan (Guy, 2009; Swan & Walton, 2014) that aims to provide formal education for children between the ages of six and eighteen. The 2012 implementation of FEP in secondary schools, created a significant increase in student population thus (Marshall, 2002) creating class sizes to exceed forty-eight students. 
This study was conducted to explore how classroom teachers are assisted by school leaders in the management of large class sizes as influenced by FEP. Participants included ten school leaders from two separate secondary schools which are currently implementing FEP in the National Capital District of Papua New Guinea. 
A qualitative research methodology was used, based on the interpretivist paradigm. Guided questions were deliberated and utilised in collecting data through semi-structured and focus group interviews. The data was collated then analysed thematically. The findings indicate that school leaders are very much challenged in assisting classroom teachers manage large class sizes. The main factors that appear to undermine the success of effectively assisting classroom teachers are inadequate facilities, insufficient resource materials and the shortage of teachers. The amount of time classroom teachers have for classroom preparations and presentations are also encumbered by the number of classes with large class sizes.
It was apparent that while the National Government’s directive of FEP gives an opportunity for all school aged children to receive formal education, there are setbacks that impede effective implementation of this policy specifically in secondary schools. The implications suggest that as specialised teachers, classroom teachers need to be assisted in managing classes in overcrowded classrooms.

text: The impact of the Papua New Guinea Free Education Policy on the School Executive's Decision Making in the management of Class SIze The Papua New Guinea National Government’s directives on educational policies are expected to be implemented effectively throughout the country, in educational institutions that are solely or partly funded by the government. The Free Education Policy (FEP), also known as Tuition Fee Free Policy (TFFP) is a governmental directive that is implemented in elementary, primary and secondary schools. The implementation of FEP is perceived as a device for fulfilling the National Government’s Universal Basic Education (UBE) Plan (Guy, 2009; Swan & Walton, 2014) that aims to provide formal education for children between the ages of six and eighteen. The 2012 implementation of FEP in secondary schools, created a significant increase in student population thus (Marshall, 2002) creating class sizes to exceed forty-eight students. 
This study was conducted to explore how classroom teachers are assisted by school leaders in the management of large class sizes as influenced by FEP. Participants included ten school leaders from two separate secondary schools which are currently implementing FEP in the National Capital District of Papua New Guinea. 
A qualitative research methodology was used, based on the interpretivist paradigm. Guided questions were deliberated and utilised in collecting data through semi-structured and focus group interviews. The data was collated then analysed thematically. The findings indicate that school leaders are very much challenged in assisting classroom teachers manage large class sizes. The main factors that appear to undermine the success of effectively assisting classroom teachers are inadequate facilities, insufficient resource materials and the shortage of teachers. The amount of time classroom teachers have for classroom preparations and presentations are also encumbered by the number of classes with large class sizes.
It was apparent that while the National Government’s directive of FEP gives an opportunity for all school aged children to receive formal education, there are setbacks that impede effective implementation of this policy specifically in secondary schools. The implications suggest that as specialised teachers, classroom teachers need to be assisted in managing classes in overcrowded classrooms.

year: 2015

title: Transitioning from kōhanga reo to kura

authors: Hohepa, Margie Kahukura

abstract: This is a collaborative cross-sector research project involving a kōhanga reo (Māori immersion early childhood language nest) kura (Māori language immersion school) and university-based researchers. It focuses on tamariki (children) moving from kōhanga reo to kura classrooms and will examine the development of an 'akoranga whakawhiti', a transition programme that will be based at Te Kōhanga Reo o Ngā Kuaka in Hamilton. The over arching research question for this project is: Pēhea rā te āhuatanga me te kounga o ngā whakawhitinga mai i te kōhanga ki te kura mō ngā tamariki, whānau, kaiako me te hāpori? - What do effective transitions from kōhanga reo to kura look like, feel like, and sound like, for tamariki, whānau, kaiako and the community? The project aims to provide important new insights into learning and teaching in Māori-medium settings and into ways of enhancing transitions from Maori-medium early childhood education to Māori medium classrooms.

text: Transitioning from kōhanga reo to kura This is a collaborative cross-sector research project involving a kōhanga reo (Māori immersion early childhood language nest) kura (Māori language immersion school) and university-based researchers. It focuses on tamariki (children) moving from kōhanga reo to kura classrooms and will examine the development of an 'akoranga whakawhiti', a transition programme that will be based at Te Kōhanga Reo o Ngā Kuaka in Hamilton. The over arching research question for this project is: Pēhea rā te āhuatanga me te kounga o ngā whakawhitinga mai i te kōhanga ki te kura mō ngā tamariki, whānau, kaiako me te hāpori? - What do effective transitions from kōhanga reo to kura look like, feel like, and sound like, for tamariki, whānau, kaiako and the community? The project aims to provide important new insights into learning and teaching in Māori-medium settings and into ways of enhancing transitions from Maori-medium early childhood education to Māori medium classrooms.

year: 2014