Worksite-induced morbidities among truck drivers in the United States

What moves truck drivers? A person-centered perspective on workplace physical activity promotion

Objectives. In developing physical activity (PA) promotion measures in the workplace, individual needs of the target groups must be considered. For this reason, this study aimed to qualitatively identify the individual needs for an increase of PA in truck drivers, representing a neglected working group in terms of PA promotion. Methods. Semi-structured interviews were conducted (N = 19; mean age 50.5 years, SD 11.4 years; 10.5% female). The interview guide was based on the COM-B model to identify needs related to PA behavior in terms of capabilities, opportunities and motivation. The interviews were transcribed and coded by two independent investigators. Results. Altogether, the codes encompassed 395 statements, and the code system contained 14 codes. Three additional codes described further individual needs related to other health behaviors (nutrition, recreation) or external incentives for health interventions. Conclusion. The results reveal a variety of needs that are fundamental to the development of PA-promoting interventions for truck drivers. These needs appear to be closely linked, so a combination of capabilities, opportunities and/or motivation should be considered when developing holistic interventions. An example would be linking automatic motivation and psychological capabilities that encompass motivational techniques combined with information for psychoeducation of truck drivers.

Health Comparisons Between Truck Drivers and the General Population Using the Canadian Community Health Survey

BACKGROUND

This study examined and compared risk factors and health conditions of truck drivers compared with the general Canadian population.

METHODS

This study used the Canadian Community Health Survey consisting of 991 male truck drivers and 29,958 male respondents of the general population.

RESULTS

Compared with the general population, truck drivers were older, less educated, had lower incomes, worked more hours, and were more likely to be widowed/separated/divorced. In addition, truck drivers had significantly higher rates of cardiovascular disease and obesity and were more likely to be sedentary, smoke, drive when fatigued, and eat unhealthy compared with the general population.

CONCLUSIONS

Multicomponent interventions are needed to address the poor lifestyle practices of truckers to reduce the high rates of morbidity.

The Tech4Rest Randomized Controlled Trial: Applying the Hierarchy of Controls to Advance the Sleep, Health, and Well-being of Team Truck Drivers

OBJECTIVE

The aim of the study was to evaluate the effectiveness of interventions to improve sleep, reduce fatigue, and advance the well-being of team truck drivers.

METHODS

In a randomized controlled trial ( k = 24 teams; N = 49 drivers; 61.3% of planned sample), intervention teams were exposed to baseline (3-4 weeks), cab enhancements (active suspension seat, therapeutic mattress; 3-4 weeks), and cab enhancements plus a behavioral sleep-health program (1-2 months). Control teams worked as usual during the same period.

RESULTS

Trends in sleep-related outcomes favored the intervention. Large and statistically significant intervention effects were observed for objectively measured physical activity (a behavioral program target). The discussion of results addresses effect sizes, statistical power, intervention exposure, and work organization.

CONCLUSIONS

Trends, effect sizes, and significant findings in this rare trial provide valuable guidance for future efforts to improve working conditions and outcomes for team drivers.

Factors Associated with Fatigued Driving among Australian Truck Drivers: A Cross-Sectional Study

BACKGROUND

Fatigued driving is one of the leading factors contributing to road crashes in the trucking industry. The nature of trucking, prolonged working time, and irregular sleep patterns can negatively impact drivers' health and wellbeing. However, there is limited research in Australia investigating the impact of demographic, occupational, or lifestyle factors on fatigue among truck drivers.

OBJECTIVE

This cross-sectional study examines the role of demographic, occupational, lifestyle, and other health risk factors associated with fatigue among Australian truck drivers.

METHOD

This study was part of a larger study that used a short online survey with a follow-up telephone survey to capture in-depth information on a wide range of determinants related to truck drivers' physical and mental health outcomes. Fatigue was measured by three questions, including the frequency of fatigue, fatigue management training, and strategies used to combat fatigue. Multivariate regression analysis was used to determine the specific impact of demographics, occupational factors, lifestyle factors, and other health risk factors on fatigue.

RESULTS

In total, 332 drivers completed both the online and telephone surveys; 97% were male, representing drivers from broad age groups and professional experience. The odds of being in the high-risk fatigue group were nearly three times higher in drivers who worked 40-60 h compared to those who worked < 40 h. Poor sleep increased the odds of high-risk fatigue by seventimes (95% CI: 2.26-21.67, p = 0.001). Drivers who reported experiencing loneliness also had double the odds of being at high risk of fatigued driving.

CONCLUSIONS

The increased risk of fatigue in truck drivers is associated with prolonged working hours, poor sleep, and social aspects such as loneliness. Further interventions seeking to reduce driver fatigue should consider the impact of work schedules, the availability of quality sleeping spaces, and the level of social connections.

Drivers with and without Obesity Respond Differently to a Multi-Component Health Intervention in Heavy Goods Vehicle Drivers

Physical inactivity and obesity are widely prevalent in Heavy Goods Vehicle (HGV) drivers. We analysed whether obesity classification influenced the effectiveness of a bespoke structured lifestyle intervention ('SHIFT') for HGV drivers. The SHIFT programme was evaluated within a cluster randomised controlled trial, across 25 transport depots in the UK. After baseline assessments, participants within intervention sites received a 6-month multi-component health behaviour change intervention. Intervention responses (verses control) were stratified by obesity status (BMI < 30 kg/m², n = 131; BMI ≥ 30 kg/m², n = 113) and compared using generalised estimating equations. At 6-months, favourable differences were found in daily steps (adjusted mean difference 1827 steps/day, p < 0.001) and sedentary time (adjusted mean difference -57 min/day, p < 0.001) in drivers with obesity undertaking the intervention, relative to controls with obesity. Similarly, in drivers with obesity, the intervention reduced body weight (adjusted mean difference -2.37 kg, p = 0.002) and led to other favourable anthropometric outcomes, verses controls with obesity. Intervention effects were absent for drivers without obesity, and for all drivers at 16-18-months follow-up. Obesity classification influenced HGV drivers' behavioural responses to a multi-component health-behaviour change intervention. Therefore, the most at-risk commercial drivers appear receptive to a health promotion programme.

Unravelling the Complexity of Irregular Shiftwork, Fatigue and Sleep Health for Commercial Drivers and the Associated Implications for Roadway Safety

Fatigue can be a significant problem for commercial motor vehicle (CMV) drivers. The lifestyle of a long-haul CMV driver may include long and irregular work hours, inconsistent sleep schedules, poor eating and exercise habits, and mental and physical stress, all contributors to fatigue. Shiftwork is associated with lacking, restricted, and poor-quality sleep and variations in circadian rhythms, all shown to negatively affect driving performance through impaired in judgment and coordination, longer reaction times, and cognitive impairment. Overweight and obesity may be as high as 90% in CMV drivers, and are associated with prevalent comorbidities, including obstructive sleep apnea, hypertension, and cardiovascular and metabolic disorders. As cognitive and motor processing declines with fatigue, driver performance decreases, and the risk of errors, near crashes, and crashes increases. Tools and assessments to determine and quantify the nature, severity, and impact of fatigue and sleep disorders across a variety of environments and populations have been developed and should be critically examined before being employed with CMV drivers. Strategies to mitigate fatigue in CMV operations include addressing the numerous personal, health, and work factors contributing to fatigue and sleepiness. Further research is needed across these areas to better understand implications for roadway safety.

A multicomponent structured health behaviour intervention to improve physical activity in long-distance HGV drivers: the SHIFT cluster RCT

Background

Long-distance heavy goods vehicle drivers are exposed to a multitude of risk factors associated with their occupation. The working environment of heavy goods vehicle drivers provides limited opportunities for a healthy lifestyle, and, consequently, heavy goods vehicle drivers exhibit higher than nationally representative rates of obesity and obesity-related comorbidities, and are underserved in terms of health promotion initiatives.

Objective

The aim of this trial was to test the effectiveness and cost-effectiveness of the multicomponent Structured Health Intervention For Truckers (SHIFT) programme, compared with usual care, at both 6 months and 16–18 months.

Design

A two-arm cluster randomised controlled trial, including a cost-effectiveness analysis and process evaluation.

Setting

Transport depots throughout the Midlands region of the UK.

Participants

Heavy goods vehicle drivers.

Intervention

The 6-month SHIFT programme included a group-based interactive 6-hour education session, health coach support and equipment provision [including a Fitbit® (Fitbit Inc., San Francisco, CA, US) and resistance bands/balls to facilitate a ‘cab workout’]. Clusters were randomised following baseline measurements to either the SHIFT arm or the control arm.

Main outcome measures

Outcome measures were assessed at baseline, with follow-up assessments occurring at both 6 months and 16–18 months. The primary outcome was device-measured physical activity, expressed as mean steps per day, at 6-month follow-up. Secondary outcomes included device-measured sitting, standing, stepping, physical activity and sleep time (on any day, workdays and non-workdays), along with adiposity, biochemical measures, diet, blood pressure, psychophysiological reactivity, cognitive function, functional fitness, mental well-being, musculoskeletal symptoms and work-related psychosocial variables. Cost-effectiveness and process evaluation data were collected.

Results

A total of 382 participants (mean ± standard deviation age: 48.4 ± 9.4 years; mean ± standard deviation body mass index: 30.4 kg/m2 ± 5.1 kg/m2; 99% male) were recruited across 25 clusters. Participants were randomised (at the cluster level) to either the SHIFT arm (12 clusters, n = 183) or the control arm (13 clusters, n = 199). At 6 months, 209 (54.7%) participants provided primary outcome data. Significant differences in mean daily steps were found between arms, with participants in the SHIFT arm accumulating 1008 more steps per day than participants in the control arm (95% confidence interval 145 to 1871 steps; p = 0.022), which was largely driven by the maintenance of physical activity levels in the SHIFT arm and a decline in physical activity levels in the control arm. Favourable differences at 6 months were also seen in the SHIFT arm, relative to the control arm, in time spent sitting, standing and stepping, and time in moderate or vigorous activity. No differences between arms were observed at 16–18 months’ follow-up. No differences were observed between arms in the other secondary outcomes at either follow-up (i.e. 6 months and 16–18 months). The process evaluation demonstrated that the intervention was well received by participants and that the intervention reportedly had a positive impact on their health behaviours. The average total cost of delivering the SHIFT programme was £369.57 per driver, and resulting quality-adjusted life-years were similar across trial arms (SHIFT arm: 1.22, 95% confidence interval 1.19 to 1.25; control arm: 1.25, 95% confidence interval 1.22 to 1.27).

Limitations

A higher (31.4%) than anticipated loss to follow-up was experienced at 6 months, with fewer (54.7%) participants providing valid primary outcome data at 6 months. The COVID-19 pandemic presents a major confounding factor, which limits our ability to draw firm conclusions regarding the sustainability of the SHIFT programme.

Conclusion

The SHIFT programme had a degree of success in positively impacting physical activity levels and reducing sitting time in heavy goods vehicle drivers at 6-months; however, these differences were not maintained at 16–18 months.

Future work

Further work involving stakeholder engagement is needed to refine the content of the programme, based on current findings, followed by the translation of the SHIFT programme into a scalable driver training resource.

Trial registration

This trial is registered as ISRCTN10483894.

Funding

This project was funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 10, No. 12. See the NIHR Journals Library website for further project information.

Musculoskeletal Disorders Associated with Occupational Driving: A Systematic Review Spanning 2006–2021

Several occupations require workers to spend long periods of time driving road vehicles. This occupational task is associated with musculoskeletal disorders. The purpose of this review was to collate, synthesize, and analyze research reporting on musculoskeletal disorders associated with occupational driving, in order to develop a volume of evidence to inform occupational disorder mitigation strategies. A systematic search of academic databases (PubMed, EBSCO host, CINAHL, SPORTDiscus, and Web of Science) was performed using key search terms. Eligible studies were critically appraised using the Joanna Briggs Institute critical appraisal checklists. A Cohen’s kappa analysis was used to determine interrater agreement between appraisers. Of the 18,254 identified studies, 25 studies were selected and appraised. The mean critical appraisal score is 69% (range 38–100%), with a fair level of agreement (k = 0.332). The studies report that musculoskeletal disorders, most commonly lower back pain, is of concern in this population, particularly in truck, bus, and taxi drivers. Risk factors for these occupations include long hours in a sitting position, years in the profession, vehicle ergonomics, and vibration.

The effectiveness of the Structured Health Intervention For Truckers (SHIFT): a cluster randomised controlled trial (RCT)

BACKGROUND

Long distance heavy goods vehicle (HGV) drivers exhibit higher than nationally representative rates of obesity, and obesity-related co-morbidities, and are underserved in terms of health promotion initiatives. The purpose of this study was to evaluate the effectiveness of the multicomponent 'Structured Health Intervention For Truckers' (SHIFT), compared to usual care, at 6- and 16-18-month follow-up.

METHODS

We conducted a two-arm cluster RCT in transport sites throughout the Midlands, UK. Outcome measures were assessed at baseline, at 6- and 16-18-month follow-up. Clusters were randomised (1:1) following baseline measurements to either the SHIFT arm or usual practice control arm. The 6-month SHIFT programme included a group-based interactive 6-h education and behaviour change session, health coach support and equipment provision (Fitbit® and resistance bands/balls to facilitate a 'cab workout'). The primary outcome was device-assessed physical activity (mean steps/day) at 6 months. Secondary outcomes included the following: device-assessed sitting, physical activity intensity and sleep; cardiometabolic health, diet, mental wellbeing and work-related psychosocial variables. Data were analysed using mixed-effect linear regression models using a complete-case population.

RESULTS

Three hundred eighty-two HGV drivers (mean ± SD age: 48.4 ± 9.4 years, BMI: 30.4 ± 5.1 kg/m², 99% male) were recruited across 25 clusters (sites) and randomised into either the SHIFT (12 clusters, n = 183) or control (13 clusters, n = 199) arms. At 6 months, 209 (55%) participants provided primary outcome data. Significant differences in mean daily steps were found between groups, in favour of the SHIFT arm (adjusted mean difference: 1008 steps/day, 95% CI: 145-1871, p = 0.022). Favourable differences were also seen in the SHIFT group, relative to the control group, in time spent sitting (- 24 mins/day, 95% CI: - 43 to - 6), and moderate-to-vigorous physical activity (6 mins/day, 95% CI: 0.3-11). Differences were not maintained at 16-18 months. No differences were observed between groups in the other secondary outcomes at either follow-up.

CONCLUSIONS

The SHIFT programme led to a potentially clinically meaningful difference in daily steps, between trial arms, at 6 months. Whilst the longer-term impact is unclear, the programme offers potential to be incorporated into driver training courses to promote activity in this at-risk, underserved and hard-to-reach essential occupational group.

TRIAL REGISTRATION

ISRCTN10483894 (date registered: 01/03/2017).

Physical Activity, Sedentary Time, and Cardiometabolic Health in Heavy Goods Vehicle Drivers

OBJECTIVE

Physical inactivity, prolonged sitting, and unhealthy dietary habits are common in Heavy Goods Vehicle (HGV) drivers. These factors increase risk of long-term health conditions.

METHODS

329 HGV drivers across 25 UK depots completed a health assessment, including questionnaire completion, and objectively measured anthropometrics, blood biomarkers, physical activity (PA), and sedentary behavior.

RESULTS

The sample demonstrated a high-risk cardiometabolic health profile. 88.1% were overweight or had obesity, and 11.9% had pre-diabetes or diabetes. 28.3% had hypertension, 83.6% had clinically elevated circulating low-density lipoprotein-cholesterol concentrations (>2mmol/l), and 66.6% had high total cholesterol levels (>4mmol/l). On workdays drivers accumulated 12 hours/day of sitting, 1.7 hours/day of light PA, and 9.8 mins/day of moderate-to-vigorous PA. Associations between light PA and cardiometabolic markers were observed.

CONCLUSION

This sample presents high levels of inactivity, overweight, and obesity, and unhealthy cardiometabolic health profiles.

Smoking and obesity among long-haul truck drivers in France

INTRODUCTION

This study examines the health status of long-haul truck drivers (LHTDs) and more specifically smoking and obesity, in France.

METHODS

A total of 373 French and other LHTDs were randomly interviewed at six highway rest stops. Variables recorded were self-reported sociodemographic characteristics (age, gender, marital status, and nationality), behavioral variables (consumption of sodas, daily exercise, smoking status), weight and height. Body mass index (BMI) was also calculated. Statistical analysis was conducted using chi-squared analysis and multiple logistic ordinal regression models (MLR) were developed.

RESULTS

The mean age was 43.4 and the largest proportion (41.2%) of respondents were aged 40–50 years. Most respondents were French (70.3%), married (73.8%) and did not report having an active exercise routine (66.0%). Almost two-thirds of the drivers consumed daily 1–2 sodas (34.2%) or 3–4 sodas (33.2%). Based on the BMI, respondents were divided into normal (34.3%), overweight (39.8%), obese (19.5%) or morbidly obese (9.4%) categories. The mean BMI was 27.9 kg/m² and 51.1% of LHTDs were current or active smokers. MLR analysis revealed that French LHTDs were more likely (OR=3.04; 95% CI: 1.62–5.69) to have a normal BMI compared to other drivers. Smokers were significantly more likely than non-smokers (OR=2.12; 95% CI: 1.26–3.58) to have an above normal BMI.

CONCLUSIONS

These results confirm that French and other LHTDs are at high risk of non-communicable diseases. They also highlight the need to address the health risks associated with smoking and obesity among LHTDs using multifaceted strategies.

Attenuated cardiovascular reactivity is related to higher anxiety and fatigue symptoms in truck drivers

Depression and anxiety have been linked with reduced stress-induced cardiovascular reactivity (CVR), which could be indicative of autonomic dysregulation. Less is known about the association between work-related fatigue and CVR. Truck drivers experience high levels of depression, anxiety, and fatigue, with repeated psychophysiological stressors on the road, yet little is known about the effects of these conditions on their CVR. Three hundred eighty six truck drivers completed the Hospital Anxiety and Depression Scale (HADS) and the Occupational Fatigue Exhaustion/Recovery Scale (OFER-15). Systolic (SBP) and diastolic (DBP) blood pressure and heart rate (HR) were measured at rest and during a stressor protocol to measure CVR. Multivariate regression analyses were used to determine relationships between variables and adjusted for nine key covariates. Higher symptoms of persistent fatigue were related to a reduced SBP reactivity (β = -.236, p = .009) and reduced DBP reactivity (β = -.257, p = .005), whereas there was a positive trend between acute fatigue and DBP reactivity (β = .169, p = .052). Higher symptoms of anxiety were related to a reduced SBP reactivity (β = -.164, p = .016). This study demonstrated in a population of truck drivers that both anxiety and persistent fatigue were related to an attenuated SBP reactivity in a combined model, whereas there was a positive trend between acute fatigue solely and DBP reactivity. These novel findings may have serious implications for cardiovascular disease risk in truck drivers, and future research should attempt to establish the causal effect of these associations and the underlying physiological mechanisms.

Incidence of acute myocardial infarction in the workforce: Findings from the Occupational Disease Surveillance System

BACKGROUND

Increased risks of acute myocardial infarction (AMI) may be attributable to the workplace, however, associations are not well-established. Using the Occupational Disease Surveillance System (ODSS), we sought to estimate associations between occupation and industry of employment and AMI risk among workers in Ontario, Canada.

METHODS

The study population was derived by linking provincial accepted lost-time workers' compensation claims data, to inpatient hospitalization records. Workers aged 15-65 years with an accepted non-AMI compensation claim were followed for an AMI event between 2007 and 2016. Adjusted Cox proportional hazard models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for each industry and occupation group, compared to all other workers in the cohort. Sex-stratified analyses were also performed.

RESULTS

In all, 24,514 incident cases of AMI were identified among 1,502,072 Ontario workers. Increased incidence rates of AMI were found across forestry (HR 1.37, 95% CI 1.19-1.58) and wood processing (HR 1.50, 1.27-1.77) job-titles. Elevated rates were also detected within industries and occupations both broadly related to mining and quarrying (HR 1.52, 1.17-1.97), trucking (HR 1.32, 1.27-1.38), construction (HR 1.32, 1.14-1.54), and the manufacturing and processing of metal (HR 1.41, 1.19-1.68), textile (HR 1.41, 1.07-1.88), non-metallic mineral (HR 1.30, 0.82-2.07), and rubber and plastic (HR 1.42, 1.27-1.60) products. Female food service workers also had elevated AMI rates (HR 1.36, 1.23-1.51).

CONCLUSION

This study found occupational variation in AMI incidence. Future studies should examine work-related hazards possibly contributing to such excess risks, like noise, vibration, occupational physical activity, shift work, and chemical and particulate exposures.

Time in Nature Associated with Decreased Fatigue in UK Truck Drivers

Heavy goods vehicle (HGV) driving is recognised as a highly hazardous occupation due to the long periods of sedentary behaviour, low levels of physical activity and unhealthy food options when working. These risk factors combine with shift work and concomitant irregular sleep patterns to increase the prevalence of fatigue. Fatigue is closely linked with stress and, subsequently, poor physiological and psychological health. In parallel, a wealth of evidence has demonstrated the health and wellbeing benefits of spending time in nature. Here, we sought to examine whether spending time in nature was associated with lower levels of fatigue, anxiety and depression in HGV drivers. 89 long-distance drivers (98.9% male, mean ± SD age: 51.0 ± 9 years, body mass index: 29.8 ± 4.7 kg/m²) participating in a wider health promotion programme reported time spent in nature (during and before the Covid-19 pandemic) and symptoms of occupational fatigue, depression and anxiety. After controlling for covariates, truck drivers who visited nature at least once a week exhibited 16% less chronic fatigue prior to the pandemic, and 23% less chronic fatigue and 20% less acute fatigue during the pandemic. No significant differences were observed for either anxiety or depression. As fatigue has a range of physical and mental health sequelae, we propose that increased exposure to natural settings may make a valuable contribution to interventions to promote the health and wellbeing of this underserved group.

Prevalence and clusters of modifiable cardiovascular disease risk factors among intra-city commercial motor vehicle drivers in a Nigerian metropolitan city

Background

Commercial motor vehicle drivers (CMVDs) have worst health profiles among different occupations, yet the presence of clusters of cardiovascular disease (CVD) risk factors in this group have not been described in a resource-limited setting.

Objectives

The prevalence of CVD risk factors and the clusters among CMVDs was evaluated.

Design

A cross-sectional descriptive study.

Setting

Four motor parks in three local government areas of Ibadan city, Nigeria.

Participants

Consented and conveniently sampled 152 intra-city CMVDs aged ≥ 18 years.

Main outcome measures

Prevalence of CVD risk factors (hypertension, diabetes, high triglyceride, low HDLc, high waist-hip ratio, central obesity, physical inactivity, smoking, alcohol, and overweight/obesity) and their clusters were determined.

Results

All participants were male from 20 – 77 years old. Most of the CMVDs were physically inactive (80, 52.6%), take alcohol (78, 51.3%), and few smokes (35, 12.4%). The prevalence of hypertension, diabetes, hypertriglyceridemia, obesity, and central obesity were 36.2%, 5.9%, 23.7%, 4.6%, and 5.3%, respectively. Four clusters of CVD risk factors in the CMVDs with the prevalence of 36.2%. 33.5%, 17.1% and 13.2% were identified with significant differences (p<0.05) in the risk factors.

Conclusion

The prevalence of diabetes, obesity, central obesity, and smoking was low while the prevalence of hypertension and hypertriglyceridemia was moderate among the CMVDs, but the prevalence of alcohol intake and physical inactivity were high. Four distinct clusters of CVD risk factors were observed among the drivers.

Funding

The study was self-funded.

Working nights and lower leisure-time physical activity associate with chronic pain in Southern African long-distance truck drivers: A cross-sectional study

Background

In South Africa, the trucking industry employs over 70,000 people and the prevalence of chronic pain in this occupational group was reported at 10%. We investigated factors associated with chronic pain in truck drivers including mental health, physical activity, and sleep, as no study has done so.

Methods

Southern African male, long-distance truck drivers were recruited at truck stops in Gauteng and Free State Provinces, South Africa (n = 614). Chronic pain was defined as pain present for at least the last three months. Depressive symptoms were assessed with the Patient Health Questionnaire-9, post-traumatic stress disorder with the Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5), exposure to traumatic events with the Life Events Checklist-5 (LEC-5) and daytime sleepiness with the Epworth Sleepiness Scale. Sleep quality was measured on a four-point Likert scale. Leisure-time physical activity was measured using the Godin-Shephard leisure-time physical activity questionnaire. Associations between these factors, demographic factors and chronic pain were investigated.

Results

Multivariate analysis showed that working ≥ 2 nights/week (OR = 2.68, 95% CI = 1.55–4.68) was associated with chronic pain and physical activity was protective (OR = 0.97, 95% CI 0.95–0.98). In an exploratory analysis, greater depressive symptoms (p = 0.004), daytime sleepiness (p = 0.01) and worse sleep quality (p = 0.001) was associated with working ≥ 2 nights/week. Lower leisure-time physical activity was associated with worse sleep quality (p = 0.006), but not daytime sleepiness or depressive symptoms (p>0.05).

Conclusions

There is a clear relationship between working nights and activity levels, and chronic pain, sleep quality, and depression in truck drivers.

Cardiometabolic risk factors and mental health status among truck drivers: a systematic review

OBJECTIVE

This study aimed to systematically review and summarise the literature on cardiometabolic risk factors, lifestyle health behaviours and mental health status of truck drivers globally to ascertain the scale of these health concerns.

DESIGN

Systematic review reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

DATA SOURCES

PubMed, Scopus, PsycINFO and Web of Science were searched in January 2019 and updated in January 2020, from the date of inception to 16 January 2020.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

Papers were included if they (1) reported independent data on truck drivers, (2) included quantitative data on outcomes related to cardiometabolic markers of health, mental health and/or health behaviours, (3) were written in English and (4) were published in a peer-reviewed journal. Grey literature was ineligible for this review.

DATA EXTRACTION AND SYNTHESIS

One reviewer independently extracted data and assessed methodological quality using a checklist based on the National Heart, Lung and Blood Institute Quality Assessment tool. 20% were independently assessed for eligibility and quality by a second reviewer. Due to heterogeneity of the outcomes, results were narratively presented.

RESULTS

3601 titles and abstracts were screened. Seventy-three studies met the inclusion criteria. Truck driving is associated with enforced sedentarism, long and irregular working hours, lack of healthy foods, social isolation and chronic time pressures. Strong evidence was observed for truck drivers to generally exhibit poor cardiometabolic risk profiles including overweight and obesity, hypertension, hypercholesterolaemia, high blood glucose, poor mental health and cigarette smoking.

CONCLUSIONS

Improving truck driver health is vital for the longevity of the trucking industry, and for the safety of all road users. The workplace plays a vital role in truck driver health; policies, regulations and procedures are required to address this health crisis.

PROSPERO REGISTRATION NUMBER

CRD42019124499.

Bridging the Gaps in Health Service Delivery for Truck Drivers of India Through Mobile Medical Units

Background:

Truck drivers in India suffer from many lifestyle-related health problems. Providing primary health care services to truck drivers is essential to improve their overall health and well-being. This paper reports the findings of a community-based mobile medical unit program providing nonemergency and basic primary care services to truck drivers along the major highways of India. Piramal Swasthya Management and Research Institute launched this community-based mobile medical unit program, in partnership with Shriram Transport Finance Corporation Limited (STFCL).

Materials and Methods:

The paper describes the program model, its coverage, the sociodemographic profile, and common health morbidities of the truck drivers availing the program services. 2-year routine program data (April 2017 to March 2019) were accessed and analyzed.

Results:

A total of 1,167,210 number of unique truck drivers availed the program services during the reference period, of which 61,331 had complete data. The majority of truck drivers were male (99.1%) and just a few women (0.88%) and transgender (0.003%). The mean age was 45.5 years ± 10.91 and nearly half (49%) were in the productive age group (31–45 years). Noncommunicable and other chronic diseases (34.74%), musculoskeletal problems (24.17%), communicable diseases (14.52%), oral cavity-related problems (1.23%), and other minor ailments (17.77%) were the major consultation categories.

Conclusion:

Truck drivers in India have significant health morbidities. Providing primary health care services to truck drivers through mobile medical units is a step toward achieving universal health coverage.

Risk Factors for Depressive Symptoms in Long-Haul Truck Drivers

Work-related stress is a salient risk factor for depression. While long-haul truck drivers (LHTDs) face a myriad of occupational pressures and demands, little research has examined predictors of depressive symptoms in this occupational group. The purpose of this study was to identify predictors of depressive symptoms in LHTDs. A cross-sectional study was used to examine depressive symptoms, health and working conditions in a sample of 107 LHTDs (mean age of 50.7 ± 12.3; 95.6% were men) at truck stops from five Western Canadian cities. The findings show that 44% of LHTDs reported symptoms of depression in the past 12 months. Severe work-related stress, the use of psychiatric medications and broken sleep were significant predictors of depressive symptomology accounting for 41% of the variance. The findings suggest that LHTDs experience a host of occupational stressors that are embedded within the transportation industry that may increase the risk for depressive symptoms. Mental health promotion efforts that improve sleep quality, decrease work-related demands and pressures, and increase the use of psychiatric medication may reduce rates of depressive symptoms among LHTDs.

Food choice patterns of long-haul truck drivers driving through Germany, a cross sectional study

Background

Long-haul truck drivers are exposed to unfavorable working conditions affecting their health but information on truck drivers travelling through Europe is missing. The study aimed to describe the populations' characteristics and food choice patterns while working compared with eating patterns at home, taking weight status into account.

Methods

A cross-sectional survey using questionnaires in 12 languages conducted at two truck stops in Germany.

Results

Among 404 truck drivers of 24 nationalities, only 24% were normal weight while 46% were considered overweight and 30% obese. In regards to their health, more than half reported that they smoked and 32% reported at least one chronic disease. 37% ate their meals often or always at truck stops, while 6% never did so. The most common food items brought from home were fruits (62%) followed by sausages (50.6%), sandwiches (38.7%), self-cooked meals (37%), sweets (35.4%), and raw vegetables (31%). Bivariate analyses revealed differences in food choices during work and at home with more sausages, energy drinks and soft drinks, and canned foods eaten during trips. Fresh vegetables, legumes and fish were more often chosen at home. Available food appliances in trucks appeared to be associated with food choice patterns. Interestingly, food choice patterns and food preparation did not differ significantly across weight categories.

Conclusions

The working conditions of professional truck drivers make a healthy lifestyle difficult to follow and appear to influence food choices while working. Particular effort should be taken to improve food choice patterns, food preparation and purchasing possibilities during trips.

Cluster randomised controlled trial to investigate the effectiveness and cost-effectiveness of a Structured Health Intervention For Truckers (the SHIFT study): a study protocol

INTRODUCTION

Heavy goods vehicle (HGV) drivers exhibit higher than nationally representative rates of obesity, and obesity-related comorbidities, in comparison to other occupational groups. Their working environments are not conducive to a healthy lifestyle, yet there has been limited attention to health promotion efforts. We have developed a Structured Health Intervention For Truckers (the SHIFT programme), a multicomponent, theory-driven, health-behaviour intervention targeting physical activity, diet and sitting in HGV drivers. This paper describes the protocol of a cluster randomised controlled trial designed to evaluate the effectiveness and cost-effectiveness of the SHIFT programme.

METHODS AND ANALYSIS

HGV drivers will be recruited from a logistics company in the UK. Following baseline measurements, depots (clusters) will be randomised to either the SHIFT intervention or usual-care control arm (12 clusters in each, average cluster size 14 drivers). The 6-month SHIFT intervention includes a group-based interactive 6-hour education session, worksite champion support and equipment provision (including a Fitbit and resistance bands/balls to facilitate a 'cab workout'). Objectively measured total daily physical activity (steps/day) will be the primary outcome. Secondary outcomes include: objectively measured light-intensity physical activity and moderate-to-vigorous physical activity, sitting time, sleep quality, markers of adiposity, blood pressure and capillary blood markers (glycated haemoglobin, low-density lipoprotein-cholesterol, high-density lipoprotein-cholesterol). Self-report questionnaires will examine fruit and vegetable intake, psychosocial and work outcomes and mental health. Quality of life and resources used (eg, general practitioner visits) will also be assessed. Measures will be collected at baseline, 6 and 12 months and analysed according to a modified intention-to-treat principle. A full process evaluation and cost-effectiveness analysis will be conducted.

ETHICS AND DISSEMINATION

Ethical approval was obtained from the Loughborough University Ethics Approvals Sub-Committee (reference: R17-P063). Study findings will be disseminated through publications in research and professional journals, through conference presentations and to relevant regional and national stakeholders via online media and at dissemination events.

TRIAL REGISTRATION NUMBER

ISRCTN10483894.

Psychoactive drug consumption among truck-drivers: a systematic review of the literature with meta-analysis and meta-regression

Few studies have assessed the extent of psychoactive drug consumption in the occupational setting. The trucking sector, in particular, is an important cause for concern, since psychoactive substance use has a relevant impact on the drivers' health and safety, increasing the risk of injuries and traffic accidents, potentially affecting the general public health as well. A systematic review of the literature and meta-analysis was performed in order to provide Occupational Health Professionals and policy-makers with an updated epidemiological perspective regarding this important issue. The results showed a prevalence of overall drug consumption of 27.6% [95%CI 17.8-40.1], particularly high considering illicit CNS-stimulants (amphetamine consumption of 21.3% [95%CI 15.7-28.1], and cocaine consumption of 2.2% [95%CI 1.2-4.1]). It appears that truck-drivers choose stimulant substances as a form of performance enhancing drug, in order to increase productivity. However, chronic and high dose consumption has been shown to decrease driving skills, placing these professional drivers at risk for health and road safety. Further research is required, particularly in Europe, in order to fill the knowledge gap and improve the strength of evidence.

Fatigue in Long-Haul Truck Drivers: A Concept Analysis

The majority of long-haul truck drivers are affected by fatigue. Notably, fatigue impacts not only quality of life, but the risk for human error, thus impacting the safety of our nation’s roads. In 2015, 400,000 trucking accidents occurred with the top driver impairment identified as being “asleep or fatigued.” Yet, the current scientific literature reflects different understandings of the concept of fatigue, hindering synchronized measurement and efforts toward its alleviation. The purpose of this work was to analyze the concept of fatigue in long-haul truck drivers using the Rodgers’ evolutionary method. The physical, cognitive, and emotional dimensions of fatigue are presented.

Sleep and Mental Health in Truck Drivers: Descriptive Review of the Current Evidence and Proposal of Strategies for Primary Prevention

Background: Professional truck drivers (TDs) are exposed to stressful working (and living) conditions and are vulnerable. They report physical and mental health problems and psychological distress more frequently than the general population and their problems can affect safety on the roads. Actions to improve TDs’ health and reduce the risks of (co-)morbidity or unsafe driving are imperative. Methods: The published studies dealing with the TDs’ sleep habits and mental health were reviewed to define the scenario and organize the preventive strategies proposed thus far. Results: Awareness among TDs of the high risk for health and safety due to (often co-existing) untreated sleep and mental health problems is critical. Alcohol and prescribed or illicit drugs are often misused to compensate for depression, anxiety, job strain, fatigue, and social isolation. Polypharmacy and dependence increase the chance of unsafe behaviors on the road. The TDs’ access to healthcare services is scant, and participation in industry-sponsored wellness programs is limited. Conclusions: Primary prevention is a first unavoidable step to deal with sleep and mental health problems. Educational programs, online support and tele-health assessment/monitoring would help improve the well-being, safety and health of professional TDs and increase safety on the road.

Patterns of Harmful Alcohol Consumption among Truck Drivers: Implications for Occupational Health and Work Safety from a Systematic Review and Meta-Analysis

Alcohol consumption is one of the main causes of productivity losses arising from absenteeism, presenteeism, and workplace injuries. Among occupational categories most affected by the use of this substance, truck drivers are subject to risk factors and risky behaviors that can have a serious impact on their health, their work, and the general road safety. The use of alcohol during truck-driving activities is, indeed, an important risk factor for traffic accidents. The present systematic review and meta-analysis aims at synthesizing the literature regarding harmful alcohol consumption patterns among truck drivers in a rigorous way. A ‘binge drinking’ prevalence of 19.0%, 95% confidence interval or CI (13.1, 26.9) was present. An ‘everyday drinking’ pattern rate of 9.4%, 95% CI (7.0, 12.4) was found, while the rate of alcohol misuse according to the “Alcohol Use Disorders Identification Test” (AUDIT)—“Cut down-Annoyed-Guilty-Eye opener questionnaire” (CAGE) instruments was computed to be of 22.7%, 95% CI (14.8, 33.0). No evidence of publication bias could be found. However, there is the need to improve the quality of published research, utilizing standardized reliable instruments. The knowledge of these epidemiological data can be useful for decision makers in order to develop, design, and implement ad hoc adequate policies.

The Association Between Cardiovascular Disease Risk Factors and Motor Vehicle Crashes Among Professional Truck Drivers

OBJECTIVE

This study assesses relationships between the Framingham cardiovascular disease risk (CVD risk) score and prevalence of US Department of Transportation (DOT)-reportable crashes in commercial motor vehicle (CMV) drivers, after controlling for potential confounders.

METHODS

Data were analyzed from CMV drivers (N = 797) in a large cross-sectional study. CVD risk was calculated for each driver. Adjusted odds ratios (ORs) and 95% confidence intervals (95% CIs) between CVD risk and DOT-reportable crashes were calculated.

RESULTS

Drivers in the two highest CVD risk groups had significantly higher likelihood of crash (OR = 2.08, 95% CI = 1.20 to 3.63 and OR = 1.99, 95% CI = 1.05 to 3.77, respectively) after adjusting for confounders. There was a significant trend of increasing prevalence of crashes with an increasing CVD risk score (P = 0.0298).

CONCLUSION

Drivers with a high CVD risk had a higher likelihood of a crash after controlling for confounders.

A retrospective analysis of cardiometabolic health in a large cohort of truck drivers compared to the American working population

BACKGROUND

Truck drivers face many health challenges, including lifestyle, diet, inactivity, stressors, and social support.

METHODS

A repeated cross-sectional analysis compared 88,246 truck drivers with data from (n = 11 918) the National Health and Nutrition Examination Survey (NHANES). Trends over time for body mass index (BMI), high blood pressure, diabetes mellitus, heart disease, and sleep disorders were analyzed, adjusting for potential confounders.

RESULTS

Truck drivers had significantly worsening health metrics between 2005 and 2012 compared to NHANES participants. Truck drivers were significantly more likely to be obese and morbidly obese with prevalence odds ratios (POR) and 95% confidence intervals (95%CI) of 1.99 (1.87, 2.13) and 2.34 (2.16, 2.54), respectively. Measured blood pressure, self-reported high blood pressure, diabetes mellitus, and heart disease all significantly increased. Also, sleep disorders increased among truck drivers from 2005 to 2012 (POR = 6.55, 95%CI 5.68, 7.55).

CONCLUSION

These data suggest disproportionate increases in poor health among truck drivers from 2005 to 2012.

Uptake of health services among truck drivers in South Africa: analysis of routine data from nine roadside wellness centres

BACKGROUND

Long-distance truck drivers are occupationally susceptible to poor health outcomes. Their patterns of healthcare utilisation and the suitability of healthcare services available to them are not well documented. We report on truck driver healthcare utilisation across South Africa and characterise the client population of the clinics serving them for future service development.

METHODS

We analysed anonymised data routinely collected over a two-year period at nine Roadside Wellness Centres. Associations between services accessed and socio-demographic characteristics were assessed using univariable and multivariable logistic regression models.

RESULTS

We recorded 16,688 visits by 13,252 individual truck drivers (average of 1.26 visits/person) who accessed 17,885 services for an average of 1.07 services/visit and 1.35 services/person. The mean age of truck drivers was 39 years. Sixty-seven percent reported being in stable relationships. The most accessed services were primary healthcare (PHC)(62%) followed by HIV (32%). Low proportions (≤6%) accessed STI,TB and malaria services. Most visits were characterised by only one service being accessed (93%, n = 15,523/16,688). Of the remaining 7% of visits, up to five services were accessed per visit and the combination of TB /HIV services in one visit remained extremely low (<1%, n = 14/16,688). Besides PHC services at the beginning of the reporting period, all service categories displayed similar seasonal utilisation trends(i.e. service utilisation peaked in the immediate few months post clinics opening and substantially decreased before holidays). Across all service categories, younger truck drivers, those with a stable partner currently, and those of South African origin were the main clinic attendees. Older truck drivers (≥40 years) were more likely to access TB and PHC services, yet less likely to access HIV and STI services. Those with stable partners were less likely to access STI and TB services but more likely to access malaria and PHC services. South African attendees were more likely to access PHC, while attendees from other nationalities were more likely to access HIV and malaria services.

CONCLUSIONS

This utilisation analysis shows that tailored services assist in alleviating healthcare access challenges faced by truck drivers, but it underscores the importance of ensuring that service packages and clinics speak to truck drivers' needs in terms of services offered and clinic location.

US long-haul truck driver work organization and the association with cardiometabolic disease risk

Work organization, including long working hours, irregular work schedules, and job stress, has been associated with increased cardiometabolic disease (CMD) risk for numerous working populations. The purpose of this study was to examine the associations between work hours, work schedules, job stress, and CMD risk for a sample of US long-haul truck drivers (LHTDs). A nonexperimental, descriptive, cross-sectional design was employed to collect survey and anthropometric data from 260 US LHTDs at a major truck stop. The mean BMI was 33.40 kg/m² and mean waist circumference was 114.77 cm. Using logistic regression, researchers found longer work hours, especially greater than 11 hours daily, were associated with increased odds for an extremely high risk of CMD. Results support comprehensive and integrated approaches that address work organization, and in particular long working hours, to reduce drivers' CMD risk.

Cross-sectional surveillance study to phenotype lorry drivers' sedentary behaviours, physical activity and cardio-metabolic health

OBJECTIVES

Elevated risk factors for a number of chronic diseases have been identified in lorry drivers. Unhealthy lifestyle behaviours such as a lack of physical activity (PA) and high levels of sedentary behaviour (sitting) likely contribute to this elevated risk. This study behaviourally phenotyped UK lorry drivers' sedentary and non-sedentary behaviours during workdays and non-workdays and examined markers of drivers cardio-metabolic health.

SETTING

A transport company from the East Midlands, UK.

PARTICIPANTS

A sample of 159 male heavy goods vehicle drivers (91% white European; (median (range)) age: 50 (24, 67) years) completed the health assessments. 87 (age: 50.0 (25.0, 65.0); body mass index (BMI): 27.7 (19.6, 43.4) kg/m²) provided objective information on sedentary and non-sedentary time.

OUTCOMES

Participants self-reported their sociodemographic information. Primary outcomes: sedentary behaviour and PA, assessed over 7 days using an activPAL3 inclinometer. Cardio-metabolic markers included: blood pressure (BP), heart rate, waist circumference (WC), hip circumference, body composition and fasted capillary blood glucose, triglycerides, high-density lipopreotein cholesterol, low-density lipoprotein cholesterol (LDL-C) and total cholesterol (TC) levels. These cardio-metabolic markers were treated as secondary outcomes.

RESULTS

Lorry drivers presented an unhealthy cardio-metabolic health profile (median (IQR) systolic BP: 129 (108.5, 164) mm Hg; diastolic BP: 81 (63, 104) mm Hg; BMI: 29 (20, 47) kg/m²; WC: 102 (77.5, 146.5) cm; LDL-C: 3 (1, 6) mmol/L; TC: 4.9 (3, 7.5) mmol/L). 84% were overweight or obese, 43% had type 2 diabetes or prediabetes and 34% had the metabolic syndrome. The subsample of lorry drivers with objective postural data (n=87) accumulated 13 hours/day and 8 hours/day of sedentary behaviour on workdays and non-workdays (p<0.001), respectively. On average, drivers accrued 12 min/day on workdays and 6 min/day on non-workdays of moderate-to-vigorous PA (MVPA).

CONCLUSION

Lorry drivers demonstrate a high-risk cardio-metabolic profile and are highly sedentary and physically inactive. Interventions to reduce sitting and increase MVPA during breaks and leisure time to improve cardio-metabolic health are urgently needed. Educational programmes to raise awareness about diet and exercise are recommended.

Sleep, Dietary, and Exercise Behavioral Clusters Among Truck Drivers With Obesity: Implications for Interventions

OBJECTIVE

The objectives of the study were to describe a sample of truck drivers, identify clusters of drivers with similar patterns in behaviors affecting energy balance (sleep, diet, and exercise), and test for cluster differences in health safety, and psychosocial factors.

METHODS

Participants' (n = 452, body mass index M = 37.2, 86.4% male) self-reported behaviors were dichotomized prior to hierarchical cluster analysis, which identified groups with similar behavior covariation. Cluster differences were tested with generalized estimating equations.

RESULTS

Five behavioral clusters were identified that differed significantly in age, smoking status, diabetes prevalence, lost work days, stress, and social support, but not in body mass index. Cluster 2, characterized by the best sleep quality, had significantly lower lost workdays and stress than other clusters.

CONCLUSIONS

Weight management interventions for drivers should explicitly address sleep, and may be maximally effective after establishing socially supportive work environments that reduce stress exposures.

Differences in stroke and ischemic heart disease mortality by occupation and industry among Japanese working-aged men

Occupation- and industry-based risks for stroke and ischemic heart disease may vary among Japanese working-aged men. We examined the differences in mortality rates between stroke and ischemic heart disease by occupation and industry among employed Japanese men aged 25–59 years. In 2010, we obtained occupation- and industry-specific vital statistics data from the Japanese Ministry of Health, Labour, and Welfare dataset. We analyzed data for Japanese men who were aged 25–59 years in 2010, grouped in 5-year age intervals. We estimated the mortality rates of stroke and ischemic heart disease in each age group for occupation and industry categories as defined in the national census. We did not have detailed individual-level variables. We used the number of employees in 2010 as the denominator and the number of events as the numerator, assuming a Poisson distribution. We conducted separate regression models to estimate the incident relative risk for stroke and ischemic heart disease for each category compared with the reference categories “sales” (occupation) and “wholesale and retail” (industry). When compared with the reference groups, we found that occupations and industries with a relatively higher risk of stroke and ischemic heart disease were: service, administrative and managerial, agriculture and fisheries, construction and mining, electricity and gas, transport, and professional and engineering. This suggests there are occupation- and industry-based mortality risk differences of stroke and ischemic heart disease for Japanese working-aged men. These differences in risk might be explained to factors associated with specific occupations or industries, such as lifestyles or work styles, which should be explored in further research. The mortality risk differences of stroke and ischemic heart disease shown in the present study may reflect an excessive risk of Karoshi (death from overwork).

•

There are mortality risk differences of stroke and ischemic heart disease in Japan.

•

These risk differences may reflect a risk of Karoshi (death from overwork).

•

Occupation and industry correlated with stroke and ischemic heart mortality risk.

•

Service and mining are high-risk for stroke and ischemic heart disease.

•

Further research is necessary to clarify mechanisms of occupation- and industry-related disparity in mortality risk.

Obesity indices are predictive of elevated C-reactive protein in long-haul truck drivers

BACKGROUND

Obesity rates in long-haul truck drivers have been shown to be significantly higher than the general population. We hypothesized that commercial drivers with the highest levels of general obesity and abdominal adiposity would have higher concentrations of high sensitivity C-reactive protein (CRP), a marker of inflammation.

METHODS

Survey and anthropometric data were collected from 262 commercial drivers. Weight, circumference measures, and blood analysis for CRP (N = 115) were conducted and compared to National Health and Nutrition Examination Survey (NHANES) data. CRP values were non-normally distributed and logarithmically transformed for statistical analyses.

RESULTS

BMI, waist circumference, sagittal abdominal diameter, and CRP were significantly higher than in the general population. Anthropometric indices that included height (BMI, waist-to-height ratio, and sagittal diameter-to-height ratio), were most predictive of CRP values.

CONCLUSIONS

Abdominal obesity is prevalent in commercial vehicle drivers and is an important indicator of the presence of inflammation in this population. Am. J. Ind. Med. 59:665-675, 2016. © 2016 Wiley Periodicals, Inc.

Healthcare Programmes for Truck Drivers in Sub-Saharan Africa: A Systematic Review and Meta-Analysis

BACKGROUND

Truck drivers have unique health needs, and by virtue of their continuous travel, experience difficulty in accessing healthcare. Currently, planning for effective care is hindered by lack of knowledge about their health needs and about the impact of on-going programmes on this population's health outcomes. We reviewed healthcare programmes implemented for sub-Saharan African truck drivers, assessed the evaluation methods, and examined impact on health outcomes.

METHODS

We searched scientific and institutional databases, and online search engines to include all publications describing a healthcare programme in sub-Saharan Africa where the main clients were truck drivers. We consulted experts and organisations working with mobile populations to identify unpublished reports. Forest plots of impact and outcome indicators with unadjusted risk ratios and 95% confidence intervals were created to map the impact of these programmes. We performed a subgroup analysis by type of indicator using a random-effects model to assess between-study heterogeneity. We conducted a sensitivity analysis to examine both the summary effect estimate chosen (risk difference vs. risk ratio) and model to summarise results (fixed vs. random effects).

RESULTS

Thirty-seven publications describing 22 healthcare programmes across 30 countries were included from 5,599 unique records. All programmes had an HIV-prevention focus with only three expanding their services to cover conditions other primary healthcare services. Twelve programmes were evaluated and most evaluations assessed changes in input, output, and outcome indicators. Absence of comparison groups, preventing attribution of the effect observed to the programme and lack of biologically confirmed outcomes were the main limitations. Four programmes estimated a quantitative change in HIV prevalence or reported STI incidence, with mixed results, and one provided anecdotal evidence of changes in AIDS-related mortality and social norms. Most programmes showed positive changes in risk behaviours, knowledge, and attitudes. Our conclusions were robust in sensitivity analyses.

CONCLUSION

Diverse healthcare programmes tailored to the needs of truck drivers implemented in 30 sub-Saharan African countries have shown potential benefits. However, information gaps about availability of services and their effects impede further planning and implementation of effective healthcare programmes for truck drivers.

Overcoming Barriers in Unhealthy Settings: A Phenomenological Study of Healthy Truck Drivers

We investigated the phenomenon of sustained health-supportive behaviors among long-haul commercial truck drivers, who belong to an occupational segment with extreme health disparities. With a focus on setting-level factors, this study sought to discover ways in which individuals exhibit resiliency while immersed in endemically obesogenic environments, as well as understand setting-level barriers to engaging in health-supportive behaviors. Using a transcendental phenomenological research design, 12 long-haul truck drivers who met screening criteria were selected using purposeful maximum sampling. Seven broad themes were identified: access to health resources, barriers to health behaviors, recommended alternative settings, constituents of health behavior, motivation for health behaviors, attitude toward health behaviors, and trucking culture. We suggest applying ecological theories of health behavior and settings approaches to improve driver health. We also propose the Integrative and Dynamic Healthy Commercial Driving (IDHCD) paradigm, grounded in complexity science, as a new theoretical framework for improving driver health outcomes.

NIOSH national survey of long-haul truck drivers: Injury and safety

Approximately 1,701,500 people were employed as heavy and tractor-trailer truck drivers in the United States in 2012. The majority of them were long-haul truck drivers (LHTDs). There are limited data on occupational injury and safety in LHTDs, which prompted a targeted national survey. The National Institute of Occupational Safety and Health conducted a nationally representative survey of 1265 LHTDs at 32 truck stops across the contiguous United States in 2010. Data were collected on truck crashes, near misses, moving violations, work-related injuries, work environment, safety climate, driver training, job satisfaction, and driving behaviors. Results suggested that an estimated 2.6% of LHTDs reported a truck crash in 2010, 35% reported at least one crash while working as an LHTD, 24% reported at least one near miss in the previous 7 days, 17% reported at least one moving violation ticket and 4.7% reported a non-crash injury involving days away from work in the previous 12 months. The majority (68%) of non-crash injuries among company drivers were not reported to employers. An estimate of 73% of LHTDs (16% often and 58% sometimes) perceived their delivery schedules unrealistically tight; 24% often continued driving despite fatigue, bad weather, or heavy traffic because they needed to deliver or pick up a load at a given time; 4.5% often drove 10miles per hours or more over the speed limit; 6.0% never wore a seatbelt; 36% were often frustrated by other drivers on the road; 35% often had to wait for access to a loading dock; 37% reported being noncompliant with hours-of-service rules (10% often and 27% sometimes); 38% of LHTDs perceived their entry-level training inadequate; and 15% did not feel that safety of workers was a high priority with their management. This survey brings to light a number of important safety issues for further research and interventions, e.g., high prevalence of truck crashes, injury underreporting, unrealistically tight delivery schedules, noncompliance with hours-of-service rules, and inadequate entry-level training.

A Clinical Trial on Weight Loss among Truck Drivers

Background:

The high prevalence of obesity among commercial truck drivers may be related to sedentary nature of the job, lack of healthy eating choices, and lack of exercise. There may be a link between obesity and crash risk, therefore an intervention to reduce obesity in this population is needed.

Objective:

To assess feasibility of a 12-week weight loss intervention for truck drivers with a weight loss goal of 10% of initial body weight.

Methods:

Drivers were selected based on age (≥21 years) and body mass index (≥30 kg/m²). The drivers participated in a before-after clinical trial. The intervention included a 12-week program that provided information on healthy diet and increasing exercise, and telephone-based coaching using SMART goals. Outcomes included change from baseline in reported energy intake, measured weight, waist, hip, and neck circumference, blood pressure, and point of care capillary blood lipids and hemoglobin A1c. Exit interviews were conducted to gain insight into driver opinions on the program features and usefulness. This study was registered with the NIH Clinical Trials Registry, number NCT02348983.

Results:

12 of 13 drivers completed the study. Weight loss was statistically significant (p=0.03). Reported energy (p=0.005), total fat consumption (p=0.04), and saturated fat consumption (p=0.02) intake were also lower after the 12-week intervention. Drivers attributed their weight loss to health coaching and suggested a longer intervention so that they could reach their goal and become accustomed to the changes.

Conclusion:

This weight loss intervention is feasible for this difficult population. Additional research is needed to compare this intervention with a control group.

Mapping U.S. long-haul truck drivers' multiplex networks and risk topography in inner-city neighborhoods

This article illustrates how urban inner-city trucking milieux may influence STI/BBI/HIV acquisition and transmission risks for U.S. long-haul truckers, as well as their social and risk relationships. Using mixed methods, we collected ethnoepidemiological and biological data from long-haul truck drivers and their risk contacts in inner-city trucking milieux in Atlanta, Georgia, United States. Key findings indicate that within the risk-endemic environment of distressed inner-city areas, diverse trucking risk milieux can amplify STI/BBI/HIV risk for multiplex networks of truckers. Inner-city neighborhood location, short geographic distance among risk contacts, and trucker concurrency can potentially exacerbate transmission via bridging higher-risk individuals with lower-risk populations at disparate geographic and epidemiological locations.

Surveying the Impact of Work Hours and Schedules on Commercial Motor Vehicle Driver Sleep

Background

Given the long hours on the road involving multiple and interacting work stressors (i.e., delivery pressures, irregular shifts, ergonomic hazards), commercial drivers face a plethora of health and safety risks. Researchers goal was to determine whether and to what extent long-haul trucker work schedules influence sleep duration and quality.

Methods

Survey and biometric data collected from male long-haul truck drivers at a major truckstop in central North Carolina over a six month period.

Results

Daily hours worked (mean = 11 hours, 55 minutes) and frequency of working over government-mandated daily HOS regulations (23.8% “frequently or always”) were statistically significant predictors of sleep duration. Miles driven per week (mean = 2,812.61), irregular daily hours worked (63.8%), and frequency of working over the daily hour limit (23.8% “frequently or always”) were statistically significant predictors of sleep quality.

Conclusion

Implications of findings suggest a comprehensive review of the regulations and operational conditions for commercial motor vehicle drivers be undertaken.

Prevalence of cardiovascular risk factors among truck drivers in the South of Brazil

BACKGROUND

Truck drivers work under conditions that predispose them to a high prevalence of risk factors for the development of cardiovascular disease (CVD); however, these factors have not been fully evaluated and are not usually considered to be within the scope of health or labor services.

METHODS

An observational cross-sectional study was conducted on 250 long-distance truck drivers; the drivers were all male and were aged 18-60 years. The clinical evaluation consisted of an assessment of social habits and demographic data and an evaluation of risk factors for CVD at 3 time points separated by a one-week interval. To assess the associations with risk factors were used univariate and multivariate analysis. The suitability of the final model fit was assessed via the Hosmer-Lemeshow test. The significance level was set at 5%.

RESULTS

Among all of the subjects, the prevalence of physical inactivity was 72.8%; consumption of alcoholic beverages, 66.8%; routine use of some type of stimulant during work activities, 19.2%; and smoking, 29%. Only 20.8% had a healthy weight, and 58.2% had an abdominal circumference greater than 102 cm. A diagnosis of arterial hypertension was confirmed in 45.2%, and abnormal glucose levels were detected in 16.4%. Although some of the truck drivers were aware of these conditions, most were not taking specific medications. The logistic regression analysis shows that the odds of hypertension and abnormal glucose levels were increased in truck drivers with abdominal obesity. Age and the family history of premature CVD also increased the chances of hypertension and the abnormal blood glucose levels were related to II or III grade obesity.

CONCLUSION

Long-distance truck drivers showed a high prevalence of a cluster of cardiovascular risk factors; these risk factors make the drivers highly susceptible to the development of CVD. The associated risk factors, low compliance with drug treatment, and unique features of this profession suggest that traditional precautions are not sufficient to change this scenario.

Obesity and other risk factors: the national survey of U.S. long-haul truck driver health and injury

BACKGROUND

Drivers of heavy and tractor-trailer trucks accounted for 56% of all production and nonsupervisory employees in the truck transportation industry in 2011. There are limited data for illness and injury in long-haul truck drivers, which prompted a targeted national survey.

METHODS

Interviewers collected data during 2010 from 1,670 long-haul truck drivers at 32 truck stops across the 48 contiguous United States that were used to compute prevalence estimates for self-reported health conditions and risk factors.

RESULTS

Obesity (69% vs. 31%, P < 0.01) and current smoking (51% vs. 19%, P < 0.01) were twice as prevalent in long-haul truck drivers as in the 2010 U.S. adult working population. Sixty-one percent reported having two or more of the risk factors: hypertension, obesity, smoking, high cholesterol, no physical activity, 6 or fewer hours of sleep per 24-hr period.

CONCLUSION

Survey findings suggest a need for targeted interventions and continued surveillance for long-haul truck drivers.

Obesity prevalence by occupation in Washington State, Behavioral Risk Factor Surveillance System

Introduction

Data that estimate the prevalence of and risk factors for worker obesity by occupation are generally unavailable and could inform the prioritization of workplace wellness programs. The aims of this study were to estimate the prevalence of obesity by occupation, examine the association of occupational physical activity and a range of health behaviors with obesity, and identify occupations in which workers are at high risk of obesity in Washington State.

Methods

We conducted descriptive and multivariable analyses among 37,626 employed Washington State respondents using the Behavioral Risk Factor Surveillance System in odd numbered years, from 2003 through 2009. We estimated prevalence and prevalence ratios (PRs) by occupational groups adjusting for demographics, occupational physical activity level, smoking, fruit and vegetable consumption, and leisure-time physical activity (LPTA).

Results

Overall obesity prevalence was 24.6% (95% confidence interval [CI], 24.0–25.1). Workers in protective services were 2.46 (95% CI, 1.72–3.50) times as likely to be obese as workers in health diagnosing occupations. Compared with their counterparts, workers who consumed adequate amounts of fruits and vegetables and had adequate LTPA were significantly less likely to be obese (PR = 0.91; 95% CI, 0.86–0.97 and PR = 0.63; 95% CI, 0.60–0.67, respectively). Workers with physically demanding occupational physical activity had a lower PR of obesity (PR = 0.83; 95% CI, 0.78–0.88) than those with nonphysically demanding occupational physical activity.

Conclusion

Obesity prevalence and health risk behaviors vary substantially by occupation. Employers, policy makers, and health promotion practitioners can use our results to target and prioritize workplace obesity prevention and health behavior promotion programs.

Morbidity profile of long distance truck drivers in Hyderabad city, India

CONTEXT

Truck drivers in India suffer from multiple health problems related to their long travelling and inadequate rest hours.

AIMS

The objective was to study the health problems and risk factors in a sample of truck drivers in Hyderabad city.

MATERIALS AND METHODS

A cross-sectional study was conducted during June 2011 among 59 truck drivers from a transport company, who were interviewed using a pretested proforma and examined by trained investigators. Lab results and medical consultations were provided the following day. Results were analyzed using Microsoft Access software.

RESULTS

The mean age of truck drivers was 28.46 ± 9.3 years. 54% suffered from low backache, 16.95% from visual problems, 45.76% had hypertension, 8.47% had anemia and 30.51% had high-risk body mass index. The prevalence of risk factors for metabolic disorders was lower compared to the general population.

CONCLUSION

Proper road and job policies for truck drivers should be framed, aiming at subjecting them for periodic health evaluations to detect the diseases early.

Examining the impact of opioid analgesics on crash responsibility in truck drivers involved in fatal crashes

INTRODUCTION

Commercial motor vehicle (CMV) drivers, particularly drivers of large trucks continue to be a population of concern regarding traffic safety despite the reduction in large truck crash rates over the past decade. Medication and drug use while driving is one important risk factor for large truck crashes. Work-related exposures, such as vibration, manual handling and poor ergonomics contribute to an increased risk for injuries and chronic conditions and are common reasons for opioid analgesic (OA) use by CMV truck drivers. The objectives of this study were to examine the role of OA use in CMV truck drivers involved in fatal crashes by: (a) generating prevalence estimates of OA use; (b) documenting the relationship between OA use and crash responsibility.

METHODS

Case-control study using logistic regression to compare Fatality Analysis Reporting System (1993-2008) record of one or more crash-related unsafe driver actions (UDAs--a proxy measure of responsibility) between drivers with a positive drug test and drivers with a negative drug test for OA, controlling for age, other drug use, and driving history.

RESULTS

The annual prevalence of OA use among all CMV drivers of large trucks involved in fatal crashes did not exceed 0.46% for any year in the study period and mostly ranged between 0.1 and 0.2%. Male truck drivers using OA had greater odds of committing an UDA (OR: 2.80; 95% CI: 1.64; 4.81). Middle-aged users had greater odds than younger or older users.

CONCLUSION

The results of our study indicate that the presence of OAs is associated with greater odds of committing an UDA. This association may have implications for the commercial transport industry and traffic safety. However, the limited prevalence of OA use is encouraging and further research is needed to address the limitations of the study.

Risk factors, health behaviors, and injury among adults employed in the transportation, warehousing, and utilities super sector

BACKGROUND

The TWU super sector is engaged in the movement of passengers and cargo, warehousing of goods, and the delivery of services. The purpose of this study is to describe employee self-reported personal risk factors, health behaviors and habits, disease and chronic conditions, and employer-reported nonfatal injury experiences of workers in the TWU super sector.

METHODS

National Health Interview Survey (NHIS) data for 1997-2007, grouped into six morbidity and disability categories and three age groups, were reviewed. Demographic characteristics and prevalence estimates are reported for workers in the TWU super sector and the entire U.S. workforce, and compared with national adult population data from the NHIS. Bureau of Labor Statistics employer-reported TWU injury data from 2003 to 2007 was also reviewed.

RESULTS

An average of 8.3 million workers were employed annually in the TWU super sector. TWU workers 65 or older reported the highest prevalence of hypertension (49%) across all industry sectors, but the 20% prevalence is notable among middle age workers (25-64). TWU workers had the highest prevalence of obesity (28%), compared to workers in all other industry sectors. Female TWU workers experienced the highest number of lost workdays (6.5) in the past year across all TWU demographic groups.

CONCLUSIONS

Self-reported high proportions of chronic conditions including hypertension and heart disease combined with elevated levels of being overweight and obese, and lack of physical activity-particularly among TWUs oldest workers-can meaningfully inform wellness strategies and interventions focused on this demographic group. Am. J. Ind. Med. 56:556-568, 2013. © 2012 Wiley Periodicals, Inc.