Commuting has become a common trend in daily working life due to urbanization. Many people live near cities and travel to the downtown or city center for work. Jakarta, a metropolitan city in Indonesia, serves as a business hub for surrounding areas and is part of JaBoTaBek (Jakarta Bogor Tangerang Bekasi). According to the 2014 JaBoTaBek Commuters Survey, 59.34% of commuters used two-wheeled motorcycles, with 98.49% using this mode of transportation as their primary means of getting around [17].

The significant amount of time spent by the Indonesian population riding motorcycles can be a potential risk factor for the occurrence of musculoskeletal disorders. With the substantial increase in the number and use of two-wheeled motorized vehicles in Indonesia, these disorders can become a significant healthcare burden. One common musculoskeletal disorder experienced by motorbike riders is neck pain. This issue affects urban communities as well as those in educational institutes.

Acute or chronic neck pain can cause discomfort, reduce work productivity, impair driving concentration, and place a significant economic burden on the nation’s health infrastructure [15]. The prevalence and disability associated with neck pain have significantly increased over the past 25 years and are anticipated to continue rising concomitantly with population aging [16]. It is estimated that approximately two-thirds of the global population have experienced neck pain at some point during their lifetime [19]. However, neck pain in educational institution settings seldom gains attention [10].

This educational institution consists of teachers, students, and academic staff. However, the age range of these people in the community is around 20 to 65. If many people have neck pain, several measures to prevent neck pain should be designed and implemented in the university.

Another reason this study was performed is that neck pain is one of the leading causes of disability globally; however, research specific to neck pain is comparatively limited in contrast to studies on lower back pain, despite the frequent correlation between the two. Hence, researchers need to analyze the factors influencing neck pain among productive adult motorbike riders in one center of higher education in a metropolitan city in Jakarta, Indonesia.

The Research Ethics Committee of Universitas Pembangunan Nasional "Veteran" Jakarta has reviewed and approved this Research under ethical certification number 383/X/2023/DEC and the number of ethical approval 383/X/2023/KEP. The entire research process was conducted in accordance with the Helsinki Declaration.

Four hundred seventy-three productive adult motorbike riders (aged 18-64 years) at the university participated by independently completing a research questionnaire. The questionnaire included demographic data, motorcycle riding habits, stress levels, and neck pain information. Stress levels were measured using the Perceived stress scale (PSS)-10 in the Indonesian language, validated and proven reliable for the adult population by Sinaga in 2021 [23]. The PSS-10 questionnaire has been translated to Bahasa Indonesia and tested with Cronbach’s alpha value of 0.81 [14]. Smoking Behaviour was assessed using Brinkman’s index, which calculated the amounts of cigarettes smoked daily multiplied by year experience of smoking and categorized into four smoker categories [1]. Body mass index (BMI) categorization utilizes the Asia-Pacific standard. Neck pain was assessed using the Nordic musculoskeletal questionnaire (NMQ) neck pain section in Bahasa, Indonesia. The NMQ questionnaire has been translated into Bahasa Indonesia, and its validity and reliability have been tested [3].

Data collection took place from October through November 2023. The online questionnaire, in the form of a Google form, was distributed through social media platforms. Population groups unfamiliar with social media and online questionnaires were given a printed version of the questionnaire, distributed randomly. Information was gathered from 473 respondents during the data collection period. After data exclusion and cleaning processes, 421 respondents were included in the study. The exclusion criteria used in the study are presented below in Fig. 1.

This study involved 421 participants, with 16 (3.80%) being faculty members, 45 (10.70%) educational or staff personnel, and the majority, 360 (85.50%), being students. Table 1 depicts the characteristics of the study respondents, while Table 2 displays the proportions of study respondents.

Among productive adult motorcyclists at the university, 62.9% are female, with over half (58.7%) falling within the 18-20 age group, and a significant portion (85.5%) being students. A total of 84.6% of all respondents are unmarried, and 70.1% have completed at least a high school education (SMA)

Regarding BMI classification, 45.6% of the population of productive adult motorcyclists at the sampled university fall into the normal weight category. The majority (86.2%) did not smoke in the last 12 months, and 62.0% engage in infrequent physical activity, exercising only 1-2 times a week for a minimum duration of 30 minutes. A significant portion of respondents (73.4%) has an average daily sleep duration of less than 7 hours. Around 75.5% of productive adult motorbike riders report having a moderate level of stress.

Based on their motorcycle riding habits, the open face helmet is the most commonly used, accounting for 65.6% of the total respondents. The majority (85.5%) use continuously variable transmission/automatic scooters for their daily commute. About 38.5% ride motorcycles for 1-2 hours per day, and 48.0% cover distances of 10-40 km/day. Approximately 42.8% of respondents wear glasses in their daily activities. Out of the total respondents, two-thirds or 67.0% have experienced neck pain in the last year. The relationship and correlation of existing risk factors for neck pain among productive adult motorcyclists can be observed from Table 3.

The bivariate analysis in Table 4 shows the factors associated with neck pain among productive adult motorcyclists. It indicates a significant relationship between the respondents’ occupation and age and the occurrence of neck pain. Additionally, occupation/position and marital status show a significant but very weak correlation with neck pain among productive adult motorcyclists. The data is further analyzed using logistic regression. The primary factors influencing neck pain among productive adult motorcyclists are occupation and average daily sleep duration. Meanwhile, the confounding factors are age, marital status, and daily commuting distance.

Adult motorcyclists who sleep less than 7 hours a day are 1.774 times more likely to experience neck pain compared to those who sleep more than 7 hours a day, after accounting for age, marital status, and daily driving distance. The 95% confidence interval (CI) for this likelihood is 1.094-2.875. In our university settings, educators and lecturers who ride motorcycles are 3.940 times more likely to experience neck pain compared to student motorbike riders, after controlling for age, marital status, and daily driving distance. The 95% CI for this likelihood is 1.193-13.007.

In the logistic regression analysis conducted, the Nagelkerke R Square value obtained is 0.061 (Table 5). This means that the combined (simultaneous) contribution of all independent variables to the dependent variable is 6.1%. The p-value obtained in the calibration test of the Hosmer and Lemeshow model is 0.200. This indicates that the generated model has good calibration because the p-value is >0.05. The model is capable of predicting the probability of someone experiencing neck pain.

Furthermore, the model’s discriminatory ability is assessed using the ROC method with statistical testing software. The discriminative ability test produces the curve shown in Fig. 2. The obtained p-value is less than 0.05, which indicates that the model can discriminate better than random chance. The AUC result is 0.620, with a 95% CI of 0.563-0.676 and a standard error of 0.029 (see Table 6). In conclusion, the generated model exhibits present but weak discriminative ability [6].

This study found that gender is not a risk factor significantly influencing neck pain in productive adult motorbike riders. This aligns with previous research that also examined neck pain in motorcycle riders [2], Gender is not a significant risk factor for neck pain complaints among motorbike riders. Another study that sampled a broader population did not find a significant relationship between gender and neck pain [11].

In this study, age had a significant relationship with neck pain in productive adult motorbike riders. This aligns with theories suggesting that aging is one of the most influential factors in musculoskeletal disorders. With increasing age, degenerative anatomical changes occur due to muscle, ligament, joint, annulus fibrosis, and human neck anatomy wear and tear [22].

The study found that age was a confounding variable. Age is correlated with occupation/position, which is a key risk factor for predicting neck pain in productive adult motorbike riders in Indonesia. Additionally, the results of this study support the theory proposed by Kazeminasab et al. [20], which suggests that age influences neck pain complaints due to anatomical, strength, and stability changes in the neck as a part of the aging process.

The study resulted that the last educational level was also found not to have a significant relationship with lower back pain, as indicated by Makkiyah et al. [23] and Diallo et al. [7].

However, the findings of this study differ from the research by Genebra et al. [11], which found a significant relationship between the last educational level and neck pain in the general population. This difference is explained by the lower educational level in the general population correlating with occupations involving repetitive movements [11]. Meanwhile, the population in educational institutions, particularly in metropolitan areas, has relatively homogeneous daily occupations compared to the general population.

In previous research, a study on a broad target population found that divorced individuals had a significantly higher prevalence of experiencing neck pain [11]. The study linked divorced status with higher stress levels and lower income in that population. However, marital status was not found to be a significantly influencing factor for neck pain in this study. This can be explained by assessing the percentage of the sampled population, where respondents with married and divorced statuses are almost entirely composed of educators/staff and lecturers.

The marital status group also has a close relationship with the age group. Respondents with married status are dominated by the age group above 25 years old, while those unmarried are dominated by the age group below 25 years old. Therefore, marital status can be considered as a confounding or intervening factor due to multicollinearity. This conclusion aligns with the studies conducted by Kazeminasab et al. [20] and Makkiyah et al. [23], which found no significant relationship between marital status and musculoskeletal disorders.

The majority of respondents in this study are students of a metropolitan university. This corresponds to the proportion of the academic community population at the sampled university. In bivariate analysis, this study found a significant relationship between occupation and neck pain among productive adult motorcyclists.

Occupation is one of the primary risk factors of neck pain for adult motorcyclists in our university. Motorcyclists working as lecturers or educators have a 3940 times greater risk (odds ratio, 3.940) of experiencing neck pain compared to those of students. Lecturers and educators are at a higher risk of musculoskeletal disorders due to their occupational characteristics, including lower physical activity, prolonged sitting without lumbar support, and high workplace stress [7,25]. Neck pain among lecturers and educators is also associated with poor posture, as indicated in Indonesia [25]. Professions that involve prolonged sitting or repetitive movements daily have a higher risk of experiencing neck pain [11].

Additionally, occupations such as lecturers and educators are predominantly held by individuals aged over 25 years old, while students are mostly in the age group of 18-21 years old. Previous research by Makkiyah et al. [23] in the year 2023 found that work experience within a certain duration significantly influences lower back pain. This implies that the population of lecturers and educators is at a higher risk of experiencing neck pain and lower back pain.

This study found that BMI does not significantly influence neck pain in productive adult motorcycle riders in Indonesia. The results of this study align with the findings of Arslan et al. [2], who discovered that despite having a positive correlation, the relationship between BMI and neck pain in motorcycle riders is not significant.

Furthermore, the results of this study also contradict similar research findings that investigated lower back pain. BMI is a significant factor influencing lower back pain in those studies [23]. However, it does not hold true for neck pain. The difference in findings can be explained by the anatomical role of lumbar vertebrae, which bear a greater load compared to cervical vertebrae [29]. Hence, it is reasonable that its influence is more significant in lower back pain.

Observing Table 4, among all BMI groups in this study, each has a proportion of neck pain occurrences ranging from 65-68%. This means that productive adult motorcycle riders have relatively equal chances of experiencing neck pain regardless of their BMI categories.

Smoking habits were not found to be significantly associated with neck pain in adult motorcycle riders at our university. About 86.2% of the respondents were non-smokers, while only 13.8% were smokers. Among all respondents, both smokers and non-smokers, the percentage of reported neck pain consistently falls around 66-68%.

The findings of this study contradict prior research that identified smoking as a significant risk factor for neck pain in the general population [5]. Smoking is known to have negative effects on blood vessels, elevate systemic inflammation, and is a factor significantly correlated with musculoskeletal disorders [1,12,13]. However, the results of this study align with several previous studies that also investigated neck pain which found that smoking habits are not a significant influencing factor, such as those conducted by Jahre et al. [18] and Genebra et al. [11].

As many as 84.6% of all respondents among productive-age motorcycle riders in our university engage in physical exercise less than or equal to two times per week. This figure falls short of the recommended regular exercise by the World Health Organization for productive-age adults [31]. In our study indicates that exercise routines do not significantly influence neck pain among productive-age motorcycle riders. This does not align with the previously established theory that regular exercise routines act as a protective factor against musculoskeletal disorders and reduce disabilities in old age [8].

Based on the research findings, it was discovered that productive-age motorcycle riders who sleep less than 7 hours per day have a chance of experiencing neck pain 1.776 times greater than motorcycle riders who sleep more than 7 hours per day. This aligns with the study conducted by Chin et al. [4] in 2021, which found a correlation between sleep duration of less than 7 hours per day and neck pain. Other studies investigating the relationship between daily sleep duration and neck pain have also found similar results, albeit with different categorical boundaries.

However, some other studies have found that the relationship between daily sleep duration and neck pain can be contradictory. Although individuals sleeping less than 7 hours per day have a higher risk of neck pain, this risk does not decrease over time with increased sleep duration. Research by Yang and Tang [32] found that the optimal sleep duration differs between males and females. An increase in sleep duration above 7.48 hours per day does not provide protection against chronic neck pain [32].

This study found that stress levels do not have a significant relationship with neck pain in productive-age motorcycle riders in our university. Stress levels have a very weak, though not significant, negative correlation with neck pain in productive-age motorcycle riders. The results of this study differ from previous theories that posit stress levels as a risk factor for neck pain [5,11].

In this study, stress levels were found to have a negative direction in the Spearman’s rank correlation analysis. This can be interpreted as higher stress levels having a protective factor against the occurrence of neck pain in productive-age motorcycle riders. The results of this study are in stark contrast to many theories that suggest higher stress alters an individual’s perception of pain. This presents an intriguing avenue for further research and examination. Multicollinearity may occur in this study, where a population more susceptible to neck pain (above 25 years old) has lower stress levels compared to those less susceptible.

Regarding stress levels, metropolitan universities serves as an educational setting for students and a workplace for lecturers and educators. A study by Ehsani et al. [10], examining factors influencing neck pain among school teachers in Iran, found job satisfaction to be a significant contributing factor. Consistent with that research, Kim et al. [21] also suggested that job satisfaction is a factor that increases the risk of the first episode of neck pain.

Types of motorcycle used does not show a significant relationship with neck pain in productive adult motorcyclists in metropolitan universities. The results of this study contradict previous research that stated manual motorcycle riders have a higher risk of musculoskeletal disorders [12].

Motorcycles with manual transmission and underbone type are often associated with higher musculoskeletal disorders because riders are exposed to engine vibrations, which tend to be more significant [27]. A study by Siagian et al. [27] in the year 2022 also found that exposure to vibrations and the duration of sitting on motorcycles do not have a significant impact on lower back pain. There is no previous research that specifically examines the relationship between exposure to vibrations on motorcycles and neck pain.

Another factor that might influence the relationship between motorcycle type and musculoskeletal disorders in riders is the ergonomics of the motorcycle. One study found discrepancies in the design and size of motorcycle seats concerning the anthropometry of students. These discrepancies were observed in populations using automatic scooters, manual transmission motorcycles, and sport motorcycles [9].

The results of this study also differ from Arslan et al. [2]’s research, where a significant correlation was found between helmet weight and neck pain. In this study, it was found that the correlation direction was positive, although its strength was very weak. This positive correlation direction supports previous research that found a positive correlation between helmet weight and neck pain.

Nevertheless, the use of helmets as a personal protective equipment when riding is regulated by traffic laws in the Republic of Indonesia. Moreover, the protection provided by wearing a helmet during motorcycle riding is crucial in the event of a traffic accident. Regardless of potential musculoskeletal issues, helmet use can save lives and prevent riders from permanent disabilities in the case of an accident [2,30].

In this study, the average daily motorcycle riding duration was found to be a non-significant factor. The results differ from a previous study by Arslan et al. [2], which found a significant relationship between daily travel distance and neck pain in motorcycle riders. An increase in daily riding duration corresponds to an increase in neck pain, aligning with the findings of Arslan et al. [2], although the obtained values were not significant.

The daily driving distance does not show a significant relationship with neck pain in productive adult motorcyclists in metropolitan universities. In the study by Arslan et al. [2], this relationship became significant only for riders covering a daily distance of more than 70 km. Although no significant relationship was found, the daily driving distance has a positively correlated effect on neck pain, as suggested by the theory.

The results of this study align with previous research by Radinda and Rahayu [26], which found that the duration of driving does not influence musculoskeletal complaints in motorcycle riders. The duration of driving is proportional to the daily driving distance but can vary based on average speed and terrain [26].

The use of eyeglasses has a significant relationship with the occurrence of neck pain because improper fitting, size, and refractive errors of glasses can trigger a prolonged flexion or extension posture of the neck [24]. However, this study found results contrary to that theory. The use of eyeglasses was not found to have a significant relationship with the occurrence of neck pain in the population of productive adult motorcycle riders.

Although eyeglass use has been associated with neck pain, other research has found that students with refractive eye disorders, but not corrected properly, have a high risk of musculoskeletal disorders, especially upper back and neck pain, as well as headaches [28]. The use of eyeglasses that leads to neck pain is more commonly associated with the use of incorrect refractive lenses or improper correction.

Research specifically investigating the effects of eyeglass use on neck pain in motorcycle riders is currently lacking as of the writing of this study. Bivariate analysis results indicate no significant relationship between eyeglass use and neck pain in productive adult motorcyclists in metropolitan universities. Additionally, eyeglass use shows a weak positive correlation.

This study found that over two-thirds, of adult motorcyclists at our university experience neck pain at least once within the last 12 months, regardless of their role as students, lecturers, or other staff. The research revealed that age and occupation significantly relate to neck pain among these individuals. Occupation and sleeping less than 7 hours per day were the primary factors contributing to neck pain. Age, marital status, and riding distance were identified as additional factors influencing neck pain among productive adult motorcyclists at our university.

Motorbike riders are encouraged to consistently wear helmets, follow driving regulations, and maintain proper posture while riding. Managing stress levels and ensuring adequate rest, a minimum of 7 hours per day, are also recommended. Those undertaking long-distance motorcycle journeys should maintain proper riding posture, take periodic breaks, and consistently use helmets for safety.