Taxi drivers are a marginalized, large, growing, minority male population with multiple health risks. In New York City (NYC) alone, there are over 50,000 yellow taxi drivers and a similar number of livery drivers. Ninety nine percent of the taxi driver population in NYC is male. A large majority, 94 percent, are immigrants, mainly originating from India, Bangladesh, Pakistan, the Dominican Republic, Haiti, and West African countries. Taxi drivers are at greater risk for cardiovascular disease (CVD) and its associated risk factors, and for lung cancer, compared with the general population. They are a sedentary population with high rates of stress and overweight/obesity, have high rates of uninsurance, long work hours that often interfere with their ability to access primary care, limited knowledge about health care resources, and cultural and linguistic barriers to care. To improve health outcomes in this vulnerable population, a tailored approach is necessary. Increasing access to primary care improves health status, particularly in minority populations living in poverty. Health fairs with screenings, referrals, and case management by health workers have been shown to increase health care uptake. Taxi HAIL builds upon the successful, ongoing work of the Immigrant Health and Cancer Disparities (IHCD) Service at Memorial Sloan-Kettering Cancer Center (MSKCC) with taxi drivers to address their overwhelming health risks. Our work with drivers in NYC has highlighted their significant underuse of health care services, high rates of overweight, abdominal obesity, and undiagnosed and untreated hypertension. We have developed and implemented a multifaceted intervention, an occupationally tailored worksite screening health fair with case management, which has facilitated health care access and reduced health risk. However, this approach is costly. Taxi drivers, while facing tremendous health risk, also have notable potentially health promoting assets within their own taxi driver communities. In our NIMDH-funded R24 project, Taxi Network, 10 percent of NYC taxi drivers participating in a health fair intervention were teachers and several were physicians in their home country. Drivers, through their existing social networks, constantly exchange information about traffic, food vendors, cricket and soccer games, and home country news. They are highly networked by telephone, presenting a potentially powerful, inexpensive resource for health promotion and systems linkage. This project will use a three arm cluster randomized controlled trial to compare the effectiveness of the proposed Taxi HAIL interventions on increasing the proportion of drivers with a Usual Primary Care Provider, the Primary Outcome. These interventions incorporate a worksite screening health fair intervention (Arm 1), with navigation case management in Arm 2, and a mobile messaging health care reminder system (`Mobile Technology') and telephone-based peer support (`Taxi health Improvement Promoters' or `TIPs') in Arm 3. We will also assess the interventions' incremental costs. Secondary Outcomes include changes in: Health Access Barriers, Blood Pressure Control, BMI, and Waist Circumference.
Taxi HAIL responds to a pressing need in an extremely marginalized population at great risk, New York City taxi drivers, and triangulates a body of compelling prior work to unify key evidence garnered through diverse methodologies on their needs, assets, and tailored approaches to overcome their health risks. Taxi HAIL is the first program of its kind in the U.S. to develop an intervention that is tailored to the specific needs and culture of this large, vulnerable population, reachable through their occupational structures. By harnessing existing social networks and assets found in the driver community to respond to community-identified health needs and priorities, the Taxi HAIL program has the potential to significantly shift the paradigm of health care delivery and prevention activities for the driver population in New York City, and across the nation in key metropolitan areas (Chicago, San Francisco, Washington DC, etc).
| Mirpuri, Sheena; Gill, Pavan; Ocampo, Alex et al. (2018) Discrimination and Health Among Taxi Drivers in New York and Toronto. J Community Health 43:667-672 |
