Study design, participants and procedure

This study was a descriptive cross-sectional study among a self-selected convenient sample of FIFO workers of a large Western Australian mining company. All FIFO workers were invited to participate in the study during a COVID-19 screening program the mining company organised for its FIFO workers (N = 9,301) from May to November 2020. During the period, 1200 of the workers voluntarily opted to participate in the study and 768 (64%) of them responded by providing valid data to be included as the final sample for the study.

A structured online questionnaire, drawing on validated scales, e.g., [42, 43] and previous literature, e.g., [34, 44], was formulated by the authors and pre-tested. Participants anonymously completed the online questionnaire (set up in Redcap data capture tool), from May and November 2020. Participants’ recruitment and online data collection procedures have been described in detail elsewhere [45]. All participants provided an informed written consent before taking part in the study. The Curtin University Human Research Ethics Committee provided the ethics approval for this study (Approval reference number: HRE2020-0180).

Measures

Participants provided information on socio-demographic characteristics (age, gender: participants identified as either male or female) and three health-related behaviours comprising alcohol intake, smoking, and physical activity since COVID-19 public health and social restrictions actions including working from home and social distancing started. Data collection was conducted between May to November 2020. In January 2020, the initial case of COVID-19 was recorded in Australia and by March 2020, various COVID-19 restrictions and lockdown measures were in place, up until May 2020 when restrictions began to ease [46]. The various COVID-19 related control measures including periodic lockdowns, social distancing, testing, mask wearing and quarantines have since continued.

Statistical analysis

The STATA version 13 (StataCorp LP, College Station, TX, USA) was used to conduct the data analysis. Continuous variables were presented in mean and standard deviation (±SD) and categorical variables in frequencies and proportions for descriptive purposes. The prevalence (with 95% confidence intervals) of smoking, alcohol consumption and physical activity outcomes for each gender (males and females) were identified. The independent sample t-test for continuous variables and the Pearson’s chi-square test (with post hoc analysis estimating the adjusted residuals and the corresponding p-values for each cell) for categorical variables were conducted to examine the differences between males and females for the behavioural outcomes. Spearman’s rank non-parametric correlations were conducted on health-related behaviours. P-value < .05 was considered statistically significant.

Background characteristics of study participants

The participants were on average aged 44.1±11.8 (range 19–73) years; majority of them (74.7%) were aged more than 34 years. Most participants were of European descent (80.7%), male (82.4%) and the remainder were female (17.6%).

Prevalence of health-related behaviours among participants

Table 1 presents the distribution of health-related behaviours across male and female FIFO workers. Thirty-two per cent of the participants had ever smoked tobacco regularly for 5 days or more for at least a year, with no significant differences between the males and females (32.9% vs 28.1%; χ² = 1.1344, p = .287). Approximately 18% were current smokers, smoking on average 14.8±7.3 cigarettes per day since COVID-19 restrictions started. Although similar current smoker prevalence was found in women (19.3%) and men (17.4%) (χ² = 0.2704, p = .603), male smokers were found to smoke more cigarettes per day than females (15.2±7.0 vs 13.1±7.1; t = 1.3684, p = .174).

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Table 1. Lifestyle behaviours distribution across gender of FIFO workers.

https://doi.org/10.1371/journal.pone.0275008.t001

The majority of participants (74.7%) were current alcohol users, with no significant differences between males and females (75.9% vs 74.1%; χ² = 4.4905, p = .106). About a third of the participants (33.3%) reported consuming alcohol for 1–2 days per week since COVID-19 restrictions started, with statistically similar proportions of males (33.1%) and females (34.0%) consuming alcohol for 1–2 days per week (χ² = 4.6350, p = .327). Overall, 43.6% of the participants (43.3% males and 45.0% females) reported consuming alcohol at a rate of 3–4 standard drinks per day. More males than females indicated consuming more than 4 standard alcohol drinks (20.2% vs 8.0%) per day (χ² = 9.2774, p = .010). A post hoc analysis showed significantly fewer females compared to males to consume more than 4 standard alcohol drinks (adjusted residual = -2.377, p = .018).

About one-third of the participants (34.4%) engaged in inadequate moderate-vigorous exercises/physical activity. Similar proportions of both males and females (33.5% vs 38.5%, χ² = 1.2466, p = .264) reported engaging in inadequate moderate-vigorous exercises/physical activities.

Multiple health-related behaviours and correlation between behaviours

The study found 6.6% of the workers (7.0% males and 5.2% females) indicated all three risky health-related behaviours (smoking, alcohol use and inadequate physical activity), 26.4% (26.7% males and 25.2% females) indicated two of the risky health-related behaviours, 39.7% (39.7% males and 40.0% females) reported only one, and 27.2% reported no-risk behaviours. Overall, about a third of the participants (33.1%) reported 2 or more risky health-related behaviours and there was no statistical difference between males and females reporting 2 or more risk behaviours (33.7% vs 30.4%; p = .699). Twelve per cent of the participants reported a combination of smoking and alcohol consumption at risky levels (more than two standard drinks per day) (Table 2). However, no correlation was found between the number of cigarettes smoked per day and the number of standard drinks intake per day, but the number of cigarettes smoked per day correlated with days of moderate-vigorous physical activity (r = -0.18, p = .009). In addition, there was no correction between the number of standard drinks intake per day and days of moderate-vigorous physical activity (Table 3).

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Table 2. Combination of risk behaviours across gender.

https://doi.org/10.1371/journal.pone.0275008.t002

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Table 3. Correlations of health-related behaviours.

https://doi.org/10.1371/journal.pone.0275008.t003

Main findings

This study sought to examine the prevalence of health-related behaviours, highlighting the gender differences, during the COVID-19 pandemic among FIFO workers in the mining industry. These common health-related behaviours comprising alcohol intake, smoking and physical activity, contribute substantially to morbidities and mortalities from NCDs [1]. The prevalence of current daily smoking (17.7%) among FIFO workers in our study was slightly higher than the 16% noted in a pre-pandemic study [44]. Our current finding was also higher than the pandemic rate of 10.7–13.4% [49, 50] and pre-pandemic rates (regular smokers: 13% and current smokers: 14.7%) [51] reported in the Australian adult general population. The current study found similar proportions of males and females to be current daily smokers, contrary to that established in the Australian adult general population where a higher rate of current daily smoking during the pandemic was reported in males (12.6%) than in females (8.8%) [52]. FIFO workers in the current study were found to smoke an average of 14.8 cigarettes per day, higher than the 13.2 cigarettes per day reported before the pandemic [53]. Our finding is also higher than the 10.7 cigarettes per day during the pandemic [52] and 12.9 cigarettes per day prior to the pandemic [36] reported among current smokers in the Australian general population. Male FIFO workers smoked more cigarettes per day than females, but difference was statistically insignificant, a trend consistent with that reported in the Australian general population, during the pandemic (men: 11.0, women: 10.4 cigarettes per day) [52] and pre-pandemic (men: 13.1, women: 12.9 cigarettes per day) [54]. An increase in smoking during the COVID-19 pandemic has been reported in the general population [15, 17], which have been linked to the stress caused by the COVID-19 pandemic [55]. Furthermore, FIFO workers are documented to report higher pre-pandemic levels of smoking than in the general population [38] and compared to other industries outside the resource sector [39]. Generally, shift workers report a high prevalence of smoking and a higher number of cigarettes smoked per day than non-shift workers [56]. FIFO workers work on compressed shift patterns of long hours [36], and rotation work in general is associated with high levels of psychological distress [38]. It has been widely documented that job stress increases the likelihood of smoking and the number of cigarettes smoked per day [57], as experiencing high levels of stress may increase the desire to smoke [58]. The COVID-19 pandemic and related preventive measures including restrictions have necessitated longer rosters, self-isolation/quarantine on-and-off sites and limited socialization, exacerbating further the experiences of distress among FIFO workers [59]. In our study, cigarette consumption reported in female FIFO workers were comparable to the pre-pandemic levels reported in the general population. However, studies examining smoking changes during COVID-19 pandemic have found females to be more likely to smoke more during the pandemic [17, 60], as a response to stressful events [30]. Evidence also suggests that females who work long hours, as done in the FIFO work arrangements, are found to be associated with increased levels of smoking [61].

Our study found high proportions of FIFO workers were current alcohol users (74.7%), with no significant differences between males and females. A high proportion of the participants (43.6%) reported consuming alcohol at a rate associated with long-term risk of harm, and about 18% of the workers consumed alcohol at a level exceeding the guideline for short-time risk of harm. While some studies did show an increase in levels of alcohol consumption during the pandemic in the adult general population in Australia [16, 62] with 25.8% of adults exceeding the Australian Adult Alcohol Guideline during the pandemic [63], previous studies have shown comparable higher consumption levels among FIFO and general mining workers during pre-pandemic periods [34, 39, 44]. This is supported by other pre-pandemic studies that have shown that mining workers consume alcohol at a higher rate than other professional industries [39], highlighting a need for further investigation into the cause of the behaviour that appears specific to the mining population [64].

More males (63.5%) than females (53.0%) indicated that they consume alcohol at risky levels. This finding is consistent with the findings made in the general Australian population during the pandemic where more men (33.6%) than women (18.5%) exceeded the national adult alcohol guideline [63]. However, other studies examining alcohol consumption during the pandemic have found females to consume more alcohol per week than males in the general Australian population [16, 65], with the female more likely to come under stress due to increased demands such as having to combine working at home and childcare as a result of lockdowns [16]. The observed differences could be accounted for by the differences in the study samples and measurements used. For instance, FIFO workers during work periods are free from household commitments such as childcare [66]. However, similar trends have been found in pre-pandemic studies among a mining population in Australia where more males (52.8%) than females (31.9%) reported risky or harmful use of alcohol [34, 35] and reported in the general population [67]. The FIFO workforce is mostly males [44] and on average, in the general population men consume more alcohol than women [68]. Furthermore, several other FIFO work characteristics including rotating shift patterns and shifts of more than 12 hours have been indicated to propagate the high and risky levels of alcohol consumption [35]. Additionally, FIFO campsites in Australia have been reported to not prohibit alcohol consumption as drinking is reported as a socialisation tool for workers at the worksite [69, 70]. On the other hand, FIFO workers are said to consume a lot of alcohol during their off-shift/leave periods [53], seen as a sign of freedom from the worksite which comes with some level or full restrictions [71].

Our study found about a third of the FIFO workers (34.4%) in this study engaged in inadequate moderate-vigorous exercises/physical activity (less than 2 or more day per week of moderate-vigorous exercises/physical activity), with no significant differences between male and female workers. This is lower than the 40.4% rate of insufficient physical activity reported among FIFO workers in the pre-pandemic periods [39]. The differences in periods between the studies and measures used should be noted; while the current study measured as the number of days per week they usually participate in moderate-to-vigorous-intensity activities, the previous study measured the ‘levels of physical activity during leisure time and work’. However, our current finding is in contrast to the findings of the National Health Survey among the Australian adult population during the pandemic where only 24.5% of adults meet the requirement for sufficient physical activity, with less women than men found to meet the physical activity guidelines (22.3% compared to 27.0%) [72]. Physical activities levels were generally indicated to have reduced in the general population due to COVID-19 restrictions around the world [73], including Australia [15, 74]. Previous studies have indicated a large proportion of FIFO workers engaged in leisure-time physical activities [38] in pre-pandemic periods as compared to other shift workers and work employment [39]. It has been suggested to be linked to the availability of satisfactory recreational facilities and, in some cases, fitness programs/activities for workers at worksites [75]. Further, owing to the fact that the usage of such facilities and participation in recreational activities is suggested to promote social interactions and a sense of belonging among workers [69]. However, COVID-19 restrictions and social distancing measures at both on-sites and at home may have limited social/recreational activities, including the social use of recreational facilities [59].

The study found a high prevalence (42%) of multiple (2 or more) health-related behaviours among both male and female FIFO workers. This is higher than reported in the Australian general population pre-pandemic, where the majority of people (51.1%) engage in one or more health-related behaviours, with 10.6% reporting two or more coexisting behaviours (smoking, alcohol intake and physical inactivity) and where males were more likely to engage in multiple risk behaviours [48]. This result may reflect the high proportions of FIFO workers reporting risky health-related behaviours than reported in the general population [38, 39] and the negative impact of COVID-19 impact of lifestyle behaviours [13, 15]. Differences in findings could also be attributed to the differences in measures of health-related behaviours across studies.

Our study found smoking was correlated with moderate-vigorous physical inactivity and not with alcohol consumption while physical inactivity was not correlated with alcohol consumption. These findings were partly supported by the findings among the Australian general population where physically inactive individuals were more likely to smoke whereas those in their 20s and 40s who smoked were more likely to consume alcohol at risky levels (more than 2 standard drinks per day) [48]. Again, dissimilarities in findings could be accounted for by the disparities in measures of health-related behaviours and the samples among the different studies. The findings of our study emphasise the need for interventions aimed at addressing or modifying health-related behaviours focusing on multiple behaviours, while taking into consideration relationships between behaviours, as against targeting a single behaviour, which is deemed to be more efficient to accomplish greater health benefits and cost-effectiveness [76].

Strength and limitations

This study presents the gender differences in common health-related behaviours and multiple health behaviours among mining workers on FIFO work arrangements for the initial period of the outbreak of the COVID-19 in Australia. The study included relatively a large sample size. Nevertheless, some limitations to the study are noted. As a cross-sectional design study, where the time-based sequence cannot be determined, findings from this study cannot be interpreted with causality. There is the possibility that the prevalence and levels of health-related behaviours reported in the study could be under-or over-estimated because of the use of self-reported data. For instance, substance use is a sensitive social topic and there may also be strict workplace restrictions on their use, which could potentially lead to participants being reluctant to reveal their accurate substance use [34]. The levels of physical activity reported in this study may not accurately reflect the typical moderate/vigorous physical activity levels since the item used to assess physical activity did not identify the number of minutes spent per day engaging in physical activity. The study using convenient sampling could introduce self-selection biases and result in recruiting a sample that may not be representative of the general FIFO work population. Additionally, this study was descriptive and focused on examining the engagement of behaviours and the differences that may exist between men and women; however, other personal and workplace characteristics including FIFO job roles, shift pattern, shift hours, years spent working in FIFO roles could have influenced the health-related behaviours of FIFO workers [34, 35]. Further studies could examine the gender differences of workplace risks factors of behaviours to inform specific and targeted interventions to improve the lifestyle behaviours and health status of FIFO workers. The study included a relatively small number of females, which reflects the FIFO work population, predominantly includes males, and that could bias the observed differences in the study parameters. The study participants were reluctant to report on their educational level, marital status, and occupational roles, leading to several missing data and as such these variables were excluded, which limits the full description of the background characteristics of the study sample. The study included snap shot measures of health-related behaviours during the pandemic with comparisons made to the Australian norms and FIFO workers secondary data; assessing pre-pandemic health-related behaviours may enable for a more direct evaluations of the changes in the levels of behaviours during the pandemic.