Health promotion of long-haul truck drivers and their families.

OBJECTIVES: to describe the development of a Health Information and Communication Technology for the health care of long-haul truck drivers and their families. METHODS: this is a description of the development of an Information and Communication Technology, developed from March to September 2023, following the systematization of the experience in five steps: 1) starting point, 2) initial questions, 3) recovery of the lived process, 4) background reflection, and 5) arrival points. RESULTS: the technology called "Work-Family Balance," electronically available, presents resources for the health care of long-haul truck drivers. It is anchored in studies on the health of long-haul truck drivers, notes from the International Labor Organization, the Strategic Action Plan for Confronting Chronic Diseases and Non-Communicable Diseases in Brazil, 2021-2030, and the Declaration by the International Association of Family Nursing. FINAL CONSIDERATIONS: the theoretical improvement of nursing can potentially improve the health care of long-haul truck drivers, prevent Chronic Non-Communicable Diseases, and promote work-life balance to achieve the goals of Agenda 2030.

Understanding health needs of professional truck drivers to inform health services: a pre-implementation qualitative study in a Canadian Province.

OBJECTIVES: Long-haul truck drivers experience multiple challenges, including increased health risks. A large percentage of professional truck drivers (PTDs) suffer from numerous chronic physical health conditions such as obesity, hypertension, diabetes, heart disease, sleep disorders, etc.) as well as poor mental health and social challenges. Furthermore, this population experiences numerous barriers related to accessing health care services including primary care and resources to improve their health. PTDs living in rural and remote areas are at higher risk. The objective of this study is to understand the views of PTDs and the trucking industry on health and personalized healthcare interventions and services. METHODS: In-depth semi-structured interviews were conducted with twenty-six individuals with contextual knowledge and experience in the trucking ecosystem, to better understand the needs, expectations, and preferences of PTDs based in New Brunswick (Canada), related to their health (physical, mental, and social). Analysis of the audiotape recording was conducted using thematic content analysis. RESULTS: Three major themes emerged from the qualitative analysis describing PTDs' health needs, existing health and preventive services, as well as recommendations for personalized healthcare interventions and services to be implemented: (1) "My life as a trucker!" Understanding needs and challenges, (2) "Taking care of myself, do you think it is easy while you're on the road?" Describing drivers and motivators for better health, and (3) "Can you hear what we need?" Translating needs into recommendations for tailored health services and preventative services. CONCLUSION: A highly demanding work environment and lack of timely access to integrated primary care negatively affect PTDs' health. Results of this study shed light on how to tailor primary care to improve its responsiveness and adequacy to PTDs' needs and realities. PTDs-sensitive integrated services, including multicomponent interventions (health education, coaching for lifestyle changes, and social support), are still lacking within the New Brunswick health system.

Long-Haul Truck Drivers' Perceptions of Truck Stops and Rest Areas: Focusing on Health and Wellness.

The work and life routine of long-haul truck drivers (LHTDs) involve the use of truck stops and rest areas to meet their basic human needs. These extensions of their workspaces on the road do not always offer adequate physical structures and services that drivers need for optimal health. This study aimed to evaluate long-haul truck drivers' perceptions of food services, safety, physical activity, rest, and personal hygiene offered at truck stops and rest areas, as well as the correlation between these perceptions and sociodemographic, health, and work conditions variables. A cross-sectional, quantitative, and descriptive study was conducted with long-haul truck drivers from the southern region of Brazil. For data collection, a sociodemographic questionnaire and a Likert scale on food, rest, personal hygiene, safety, and physical activity services offered at truck stops and rest areas along Brazilian roads from March to August 2023 were used. The data were analyzed with simple frequency descriptive statistics. The sample consisted of 175 long-haul truck drivers. Out of these, 70.29% declared that the services of the truck stops and rest areas were charged; more than half (53.59%) of the professionals evaluated the rest service as "good" or "excellent"; the food services were "good" or "excellent" for 42.24% of the drivers. The spaces for physical activities were the worst evaluated as "bad" or "terrible" by 41.61%, followed by bathroom services (28.42%) and safety (34.24%). Rest and feeding services had better evaluations, while the services of bathroom, safety, and physical activity presented worse evaluations. Variables such as nationality, weekly working days, and marital status presented positive significance and influenced drivers' perceptions of the services offered at truck stops and rest areas. Drivers who were Brazilian and worked more than five days a week negatively evaluated the services of rest (p = 0.018), safety [0.020], physical activity (0.003), and bathrooms (0.020). In addition, the physical activity services were better evaluated by single drivers than married drivers. These findings suggest that the work conditions and nationality may influence LHTDs' perceptions of services and structures of truck stops and rest areas. These findings may reflect a lack of investments and support efforts to improve basic services such as personal hygiene, a safe environment, and physical exercises, which are fundamental to the health of the workers and aimed at reducing vulnerability and a sedentary lifestyle and meeting the basic human needs of LHTDs.

Keep on truckin': how effective are health behaviour interventions on truck drivers' health? A systematic review and meta-analysis.

BACKGROUND: Truck drivers are a vital workforce, but have higher rates of obesity and other chronic diseases than the general population. The occupation's sedentary nature, limited physical activity opportunities and access to healthy food, and irregular sleeping patterns contribute to poor health. This systematic review and meta-analysis aimed to evaluate the effectiveness of interventions on health behaviours and cardiometabolic biomarkers of health in truck drivers. METHODS: A systematic search was conducted in February 2024, and reported according to PRISMA 2020 guidelines. Experimental studies targeting physical activity, sedentary behaviour, sleep, diet, weight loss, drug/alcohol use, and/or smoking were eligible. Two reviewers independently screened and completed data extraction and risk of bias assessment. Data were combined at the study level. Pooled statistics were calculated using mean differences (MD) or standardised mean differences (SMD) for outcomes that were reported in ≥2 studies. Pre- and post-intervention means and standard deviations (SD) for the intervention and control groups were used to compute effect sizes. RESULTS: Nineteen studies (n=2137 participants) were included. Meta-analyses found a small-to-moderate increase in fruit and vegetable consumption (SMD 0.32, p=0.03) with no other significant effects on other outcome variables. CONCLUSIONS: Interventions are moderately effective in increasing truck drivers' fruit and vegetable consumption, but not other outcomes. There is a dearth of research in the driver population compared to other occupational groups. Future interventions should consider workplace and environmental factors to promote the health and wellbeing of truck drivers. TRIAL REGISTRATION: The study protocol was registered on PROSPERO (CRD42021283423).

Global burden of HIV among long-distance truck drivers: a systematic review and meta-analysis.

OBJECTIVES: The purpose of this study was to systematically summarise the empirical evidence on the prevalence of HIV among long-distance truck drivers (LDTDs) from all parts of the world. DESIGN: A systematic review and meta-analysis were conducted. DATA SOURCES: We searched PubMed, ProQuest Central, PubMed Central, Cumulated Index to Nursing and Allied Health Literature and Global Index Medicus to identify relevant information published from 1989 to 16 May 2023. ELIGIBILITY CRITERIA: Peer-reviewed publications of English language reporting on the prevalence of HIV among LDTDs were included. Non-empirical studies like literature reviews were excluded. DATA EXTRACTION AND SYNTHESIS: Using a standardised data abstraction form, we extracted information on study characteristics and HIV prevalence levels. Crude prevalence estimates per 100 participants were computed and later transformed using logit transformation to have them follow a normal distribution. A meta-analysis of prevalences using the random effects model was performed. The I2 statistic was used to quantify the degree of heterogeneity across studies. A subgroup analysis using meta-regression was performed to investigate factors that could explain variability across studies. The Joanna Briggs Institute tools and Newcastle-Ottawa Scale were used to assess the quality of the included studies. To assess the certainty of evidence, the Grading of Recommendations Assessment, Development, and Evaluation approach was used. RESULTS: Of the 1787 articles identified, 42 were included. Most of the included studies were conducted in sub-Saharan Africa (45.23%, n=19) and Asia and the Pacific (35.71%, n=15). The pooled prevalence of HIV was 3.86%, 95% CI (2.22% to 6.64%). The burden of HIV was highest in sub-Saharan Africa at 14.34%, 95% CI (9.94% to 20.26%), followed by Asia and the Pacific at 2.12%, 95 CI (0.94% to 4.7%) and lastly Western, Central Europe and North America at 0.17%, 95% CI (0.03% to 0.82%). The overall heterogeneity score was (I2=98.2%, p<0.001). CONCLUSION: The global burden of HIV among LDTDs is 3.86%, six times higher than that of the general population globally. Compared with other regions, the burden of HIV is highest in sub-Saharan Africa at 14.34%, where it is estimated to be 3% in the general population. Thus, LDTDs endure a disproportionately high burden of HIV compared with other populations. Consequently, more LDTD-centred HIV research and surveillance is needed at national and regional levels to institute tailored preventive policies and interventions. PROSPERO REGISTRATION NUMBER: CRD42023429390.

Near miss road traffic accidents and associated factors among truck drivers in Gamo zone, southern Ethiopia by using a contributory factors interaction model.

Background: Road traffic accidents (RTAs) are among the leading causes of injuries, fatalities, and the resulting increase in financial burdens worldwide. Every year, RTAs cause numerous serious injuries and fatalities in Ethiopia. it is important to understand how prevalent near-miss crash accidents are, and which by definition could have injured the victim but did not result in an actual accident. The determinants of these near-misses are essential in road crash accident reduction strategies. In spite of the fact that near-miss accidents are much more common than actual losses or injuries, very little research has been conducted on them. Thus, this study was intended to assess the near-miss accidents and associated factors among truckers in Gamo zone, southern Ethiopia. Methodology: The community-based cross-sectional study was employed from May 12 to July 10,2022, using a structured interviewer-administered questionnaire. A simple random sampling technique was used to select participants. The data were analyzed using the statistical package for social sciences. A binary and multivariate logistic regression model was used to identify the determinants of near-miss accidents. A statistical significance level was set at p < 0.05. Results: About 72.5% of truckers had experienced near-miss road traffic accidents. The majority of the near-miss accidents were caused by speeding, followed by driving on the wrong side of the road and skidding, 65 (22.6%), 39 (13.5%), and 38 (13.2%), respectively. Driving frequency per week, location of accidents, condition of the road, sleeping status, and weather conditions were significantly associated with near-miss accidents. Conclusion: The prevalence of near-miss accidents is high in the Gamo zone. Being a younger and less educated driver, high driving frequency per week, driving on major roads and junctions, foggy weather, and inadequate sleep all contribute to the occurrence of accidents. Road safety measures that could address these identified factors are required to mitigate potential RTAs.

Risk Factors for Chronic Non-Communicable Diseases of Long-Haul Truck Drivers during the COVID-19 Pandemic: An Integrative Review.

Long-haul truck drivers are responsible for transporting goods valued at millions of dollars of the world economy, and may have their health affected by living and working conditions. This study analyzed and synthesized scientific findings about risk factors for the development of chronic non-communicable diseases in long-haul truck drivers. An integrative literature review was conducted. We identified 23 studies that met the inclusion criteria and evaluated the health of 7363 drivers. The biological risk factors identified were age, gender, race/ethnicity, genetics, and comorbidities, and were considered to be non-modifiable for chronic diseases. The behavioral risks considered to be modifiable were sedentary lifestyle, smoking, alcohol consumption, overweight, diet, stress, anxiety, and unfavorable socioeconomic conditions. Environmental risks involved working conditions such as the following: number of working hours per day, week, and month; time away from home; risk of musculoskeletal injury; and opportunities for rest, hours of sleep, and access to health services. The results were presented in two categories: (1) biological, behavioral, and environmental risks, and (2) general recommendations to promote physical, cognitive, and emotional health. Macro-structural changes are needed to reorganize work and rest, improve access to health services to control modifiable risk factors, and to support behavioral and environmental changes to reduce chronic non-communicable diseases and deaths.

A review of truck driver persona construction for safety management.

The trucking industry urgently requires comprehensive methods to evaluate driver safety, given the high incidence of serious traffic accidents involving trucks. The concept of a "truck driver persona" emerges as a crucial tool in enhancing driver safety and enabling precise management of road transportation safety. Currently, the road transport sector is only beginning to adopt the user persona approach, and thus the development of such personas for road transport remains an exploratory endeavor. This paper delves into three key aspects: identifying safety risk characteristic parameters, exploring methods for constructing personas and designing safety management interventions. Initially, bibliometric methods are employed to analyze safety risk factors across five domains: truck drivers, vehicles, roads, the environment, and management. This analysis provides the variables necessary to develop personas for road transportation drivers. Existing methods for constructing user personas are then reviewed, with a particular focus on their application in the context of road transportation. Integrating contemporary ideas in persona creation, we propose a framework for developing safety risk personas specific to road transportation drivers. These personas are intended to inform and guide safety management interventions. Moreover, the four stages of driver post-evaluation are integrated into the persona development process, outlining tailored safety management interventions for each stage: pre-post, pre-transit, in-transit, and on-post. These interventions are designed to be orderly and finely tuned. Lastly, we offer optimization recommendations and suggest future research directions based on safety risk factors, persona construction, and safety management interventions. Overall, this paper presents a safety management-oriented research technology system for constructing safety risk personas for truck drivers. We argue that improving the design of the persona index system, driven by big data, and encompassing the entire driver duty cycle-from pre-post to on-post-will significantly enhance truck driver safety. This represents a vital direction for future development in the field.

What's in drugs freely used by Brazilian truck drivers - "Rebites"? Determination of target and nontarget compounds by high-resolution mass spectrometry and nuclear magnetic resonance.

Highways, the lifeline of the Brazilian economy, transport approximately 75% of the country's economic activity, highlighting its importance. However, professional drivers, accustomed to long daily journeys, make use of tablets widely available in Gas Station, which are known as "Rebites," which could contain a mixture of legal and illegal compounds. Thus, this study aims at the chemical characterization of these through different analytical methods. Initially, we performed a comprehensive screening of compounds present in seven samples collected across the country using high-resolution mass spectrometry (HRMS). The findings revealed caffeine as the main compound, alongside theophylline, lidocaine, and clobenzorex, among others. In the next step, we employ quantitative nuclear magnetic resonance (qNMR) to quantify the caffeine content in the tablets. The results indicated a caffeine concentration ranging between 14% and 31% (m/m), which may imply a daily overdose of this compound from around four tablets. In summary, this investigation provides a chemical characterization of real samples of "Rebites" freely obtained along Brazilian highways. Caffeine emerged as the predominant active compound, with its concentration determined by qNMR analysis. The notable presence of caffeine, combined with other stimulants, depressants, and hallucinogens, underscores the need for strict quality control measures regarding "Rebites" to safeguard public health.

Diesel Engine Exhaust Exposure in Relation to Lung Cancer in Long-Haul Truck Drivers: An Eight-Step Concept Analysis.

BACKGROUND: Long-haul truck drivers (LHTDs) face a number of occupational hazards. One such hazard is exposure to diesel engine exhaust (DEE). However, this concept has yet to be analyzed. To address this gap, a concept analysis was conducted to explore the effects of DEE in relation to lung cancer. METHODS: Walker and Avant's eight-step concept analysis method was utilized: concept selection, analysis purpose, concept uses, defining attributes, model case, borderline case, antecedents and consequences, and empirical referents. PubMed, Scopus, and CINAHL databases were searched for relevant literature. FINDINGS: Diesel engine exhaust was identified as a mixture of gases and particulates that are considered carcinogenic. Defining attributes of DEE for truckers include respiratory effects such as decreased peak flow and increased airway resistance leading to symptoms such as a phlegm-producing cough, eye and throat irritation, exacerbation of asthma symptoms, and allergic responses. The identified level of DEE exposure associated with these attributes is 75 µg EC/m3 for 1 to 2 hours daily or a long-term exposure of 10 µg EC/m3. The conceptual definition of DEE in truckers was illustrated by the attributes, antecedents, consequences, model case, and empirical referents. CONCLUSION: Lung cancer was identified as a significant consequence of occupational DEE exposure for LHTDs. This analysis highlights the need for future research to develop interventions that will safeguard truckers from the adverse health effects of DEE exposure.

Exploring the challenges faced by Dutch truck drivers in the era of technological advancement.

Introduction: Despite their important role in the economy, truck drivers face several challenges, including adapting to advancing technology. The current study investigated the occupational experiences of Dutch truck drivers to detect common patterns. Methods: A questionnaire was distributed to professional drivers in order to collect data on public image, traffic safety, work pressure, transport crime, driver shortage, and sector improvements. Results: The findings based on 3,708 respondents revealed a general dissatisfaction with the image of the industry and reluctance to recommend the profession. A factor analysis of the questionnaire items identified two primary factors: 'Work Pressure', more common among national drivers, and 'Safety & Security Concerns', more common among international drivers. A ChatGPT-assisted analysis of textbox comments indicated that vehicle technology received mixed feedback, with praise for safety and fuel-efficiency improvements, but concerns about reliability and intrusiveness. Discussion: In conclusion, Dutch professional truck drivers indicate a need for industry improvements. While the work pressure for truck drivers in general may not be high relative to certain other occupational groups, truck drivers appear to face a deficit of support and respect.

Multimodal in-vehicle lighting system increases daytime light exposure and alertness in truck drivers under Arctic winter conditions.

Drowsiness while driving negatively impacts road safety, especially in truck drivers. The present study investigated the feasibility and alerting effects of a daylight-supplementing in-truck lighting system (DS) providing short-wavelength enriched light before, during, and after driving. In a within-participants design, eight truck drivers drove a fully-loaded truck under wintry Scandinavian conditions (low daylight levels) with a DS or placebo system for five days. Subjective and objective measures of alertness were recorded several times daily, and evening melatonin levels were recorded three times per study condition. DS significantly increased daytime light exposure without causing negative side effects while driving. In addition, no negative carry-over effects were observed on evening melatonin and sleepiness levels or on nighttime sleep quality. Moreover, objective alertness (i.e., psychomotor vigilance) before and after driving was significantly improved by bright light exposure. This effect was accompanied by improved subjective alertness in the morning. This field study demonstrated that DS was able to increase daytime light exposure in low-daylight conditions and to improve alertness in truck drivers before and after driving (e.g., during driving rest periods). Further studies are warranted to investigate the effects of daylight-supplementing in-cabin lighting on driving performance and road safety measures.

Risk factors for collisions attributed to microsleep-related behaviors while driving in professional truck drivers.

Sleep-disordered breathing (SDB) is prevalent among professional drivers. Although SDB is a known risk factor for truck collisions attributed to microsleep-related behaviors at the wheel (TC-MRBs), the usefulness of overnight pulse oximetry for predicting TC-MRBs is debatable. This retrospective study assessed the association between overnight pulse oximetry parameters, the Epworth Sleepiness Scale (ESS), and TC-MRBs, confirmed by dashcam footage. This study included 108 matched professional truck drivers (TC-MRBs: N = 54; non-TC-MRBs: N = 54), with a mean age and body mass index of 41.9 ± 11.3 years and 23.0 ± 3.7 kg/m2, respectively. Night-time drivers, 4% oxygen desaturation index (ODI), and nadir oxygen saturation (SpO2) were associated with TC-MRBs (odds ratio [95% confidence interval]: 25.63 [5.88-111.77], p < 0.0001; 2.74 [1.02-7.33], p = 0.045; and 3.87 [1.04-14.39], p = 0.04, respectively). The area under the curve of 4% ODI and nadir SpO2 for TC-MRBs were 0.50 and 0.57, respectively. In conclusion, night-time driving, 4% ODI, and nadir SpO2 were significantly associated with TC-MRBs in professional truck drivers. However, the sensitivity of overnight pulse oximetry parameters to predict TC-MRBs in a real-world application was poor. Therefore, combining subjective and objective assessments such as dashcam video footage may be needed to achieve high accuracy for predicting TC-MRBs among professional truck drivers.

The economic costs and cost-effectiveness of HIV self-testing among truck drivers in Kenya.

HIV status awareness is critical for ending the HIV epidemic but remains low in high-HIV-risk and hard-to-reach sub-populations. Targeted, efficient interventions are needed to improve HIV test-uptake. We examined the incremental cost-effectiveness of offering the choice of self-administered oral HIV-testing (HIVST-Choice) compared with provider-administered testing only [standard-of-care (SOC)] among long-distance truck drivers. Effectiveness data came from a randomized-controlled trial conducted at two roadside wellness clinics in Kenya (HIVST-Choice arm, n = 150; SOC arm, n = 155). Economic cost data came from the literature, reflected a societal perspective and were reported in 2020 international dollars (I$), a hypothetical currency with equivalent purchasing power as the US dollar. Generalized Poisson and linear gamma regression models were used to estimate effectiveness and incremental costs, respectively; incremental effectiveness was reported as the number of long-distance truck drivers needing to receive HIVST-Choice for an additional HIV test-uptake. We calculated the incremental cost-effectiveness ratio (ICER) of HIVST-Choice compared with SOC and estimated 95% confidence intervals (CIs) using non-parametric bootstrapping. Uncertainty was assessed using deterministic sensitivity analysis and the cost-effectiveness acceptability curve. HIV test-uptake was 23% more likely for HIVST-Choice, with six individuals needing to be offered HIVST-Choice for an additional HIV test-uptake. The mean per-patient cost was nearly 4-fold higher in HIVST-Choice (I$39.28) versus SOC (I$10.80), with an ICER of I$174.51, 95% CI [165.72, 194.59] for each additional test-uptake. HIV self-test kit and cell phone service costs were the main drivers of the ICER, although findings were robust even at highest possible costs. The probability of cost-effectiveness approached 1 at a willingness-to-pay of I$200 for each additional HIV test-uptake. HIVST-Choice improves HIV-test-uptake among truck drivers at low willingness-to-pay thresholds, suggesting that HIV self-testing is an efficient use of resources. Policies supporting HIV self-testing in similar high risk, hard-to-reach sub-populations may expedite achievement of international targets.

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.

Fatigue at the wheel: A non-visual approach to truck driver fatigue detection by multi-feature fusion.

BACKGROUND: Monitoring of long-haul truck driver fatigue state has attracted considerable interest. Conventional fatigue driving detection methods based on the physiological and visual features are scarcely applicable, due to the intrusiveness, reliability, and cost-effectiveness concerns. METHODS: We elaborately developed a fatigue driving detection method by fusion of non-visual features derived from the customized wristbands, vehicle-mounted equipment, and trip logs. To capture the spatiotemporal information within the sequential data, the bidirectional long short-term memory network with attention mechanism was proposed to determine whether the truck driver was fatigued within a fine-grained episode of one minute. The model was validated using a natural driving dataset with nine truck drivers on real-world roads in Guiyang, China during June and July 2021. RESULTS: Our approach yielded 99.21 %, 84.44 %, 82.01 %, 99.63 %, and 83.21 % in accuracy, precision, recall, specificity, and F1-score, respectively. Compared with the mainstream visual-based methods, our approach outperformed particularly in terms of precision and recall. Photoplethysmogram stood out as the most important feature for truck driver fatigue state detection. Vehicle load, driving forward angle, cumulative driving time, midnight, and recent working hours were found to be positively associated with the probability of fatigue driving, while the galvanic skin response, vehicle acceleration, current time, and recent rest hours had a negative relationship. Specifically, truck drivers were more likely to fatigue when driving at 20-40 km/h, braking abruptly at 5-10 m/s2, with vehicle loads over 70 tons, and driving more than 100 min consecutively. CONCLUSIONS: Our study is among the first to harness the natural driving dataset to delve into the real-life fatigue pattern of long-haul truck drivers without disruptions on routine driving tasks. The proposed method holds pragmatic prospects by providing a privacy-preserving, robust, real-time, and non-intrusive technical pathway for truck driver fatigue monitoring.

Optimization of Forward Collision Warning Algorithm Considering Truck Driver Response Behavior Characteristics.

Forward collision warning (FCW) systems have been widely used in trucks to alert drivers of potential road situations so they can reduce the risk of crashes. Research on FCW use shows, however, that there are differences in drivers' responses to FCW alerts under different scenarios. Existing FCW algorithms do not take differences in driver response behavior into account, with the consequence that the algorithms' minimum safe distance assessments that trigger the warnings are not always appropriate for every driver or situation. To reduce false alarms, this study analyzed truck driver behavior in response to FCW warnings, and k-means clustering was adopted to classify driver response behavior into three categories: Response Before Warning (RBW), Response After Warning (RAW), and No Response (NR). Results showed that RBW clusters tend to occur at long following distances (>19 m), and drivers applied braking before the warning. In RAW clusters, deceleration after warning is significantly more forceful than before warning. NR clusters occur at short distances, and deceleration fluctuates only slightly. To optimize the FCW algorithm, the warning distance was divided into reaction distance and braking distance. The linear support vector machine was used to fit the driver reaction distance. The long short-term memory method was used to predict braking distance based on each of the three response scenarios: R2 was 0.896 for RAW scenarios, 0.927 for RBW scenarios, and 0.980 for NR scenarios. Verification results show that the optimized truck FCW algorithm improved safety by 1 % to 5.1 %; accuracy reached 97.92 %, and the false alarm rate was 1.73 %.

Self-reported sleep tendency poorly predicts the presence of obstructive sleep apnea in commercial truck drivers.

BACKGROUND AND OBJECTIVES: Drowsy driving increases the risk of motor vehicle crashes in those with untreated obstructive sleep apnea (OSA). Although previous studies indicated that excessive daytime sleepiness (EDS) might not predict OSA, they were not conclusive due to their small study sizes or restricted participants to sleep clinic patients. The overall objective was to determine whether self-reported EDS can be used for case identification of OSA among commercial truck drivers. METHODS: Commercial truck drivers (N = 19,699) were screened for OSA-related symptoms. EDS was determined using the Epworth Sleepiness Scale (ESS) ≥ 11 and all participants completed the home sleep apnea test using a type 4 portable monitor to derive the respiratory event index (REI). Regression analyses were used to characterize the association between EDS and REI. RESULTS: EDS was associated with OSA severity (p for trend <0.001). The sensitivity and specificity values of EDS for identifying moderate-to-severe OSA (REI ≥15 events/hour) were 0.10 and 0.93, respectively, and 0.48 and 0.71 if BMI ≥25 kg/m2 was added. Those using BMI ≥25 kg/m2 with OSA-related signs yielded the best sensitivity and specificity of 0.77 and 0.50, which were not improved by the addition of EDS. CONCLUSIONS: Despite the associations between EDS and OSA severity and between OSA and lethal crash, case-identification of OSA using the ESS in commercial truck drivers is poor. Thus, OSA screening strategy may need a special approach, including a hierarchical combination of screening tools (Swiss Cheese Model approach), and incorporation of home sleep apnea testing.

Program Evaluation of Fit to Pass®, a Remotely Accessible Health Promotion Program for Commercial Motor Vehicle Truck Drivers.

BACKGROUND: Chronic health conditions are highly prevalent among truck drivers due to many unique occupational and environmental stressors. Health promotion programs are shown to be effective in improving truck driver health outcomes; however, there is no research on whether such programs can increase the length of a driver's Department of Transportation (DOT) medical certificate. The purpose of this quality improvement project was to evaluate Fit to Pass (FTP), a remotely accessible health promotion program available for truck drivers on improved health outcomes and increased DOT medical certificate length. METHOD: Program evaluation included an evaluation of the FTP coaching guide against evidence-based practice guidelines. An analysis of a limited dataset of 22 truck driver records examined the effectiveness of the program in achieving improved health outcomes and increased medical certification length. FINDINGS: A review of the literature revealed three major themes: (a) motivational interviewing to increase driver intention and self-efficacy; (b) mobile health care technology to connect hard-to-reach truck drivers; and (c) effectiveness of structured multicomponent health promotion programs. After participation in FTP, truck drivers experienced a mean decrease in weight and body mass index (BMI) of 4.6 lbs and 1.3 kg/m2, respectively. The lengths of initial DOT medical certificates were compared with DOT medical certificates received at the time of recertification (post-FTP). Only eight participants had the potential for improvement in certificate length. Of those, three truck drivers achieved an increased DOT medical certificate length at the time of recertification. CONCLUSION/APPLICATIONS TO PRACTICE: FTP offers tailored and comprehensive health coaching for truck drivers using current evidence-based practice guidelines to educate and reinforce healthy lifestyle habits. Analysis of a limited dataset revealed a mean decrease in BMI and a trend of increased DOT medical certification lengths after participation in FTP; however, further research with larger sample sizes is recommended.