World at work: truck drivers

Allard J van der Beek1,2

The road haulage industry employs millions ofworkers worldwide and most of them are maletruck drivers (or lorry drivers in British English).Generally, truck drivers are poorly educated andhave low socio-economic status. Nonetheless, truckdriving is associated with freedom and adventure,and the job is appreciated for the autonomy that itgives. However, several hazards have beenmentioned in the literature. The aim of this paper isto give an overview of: (1) the tasks and activitiesof truck drivers; (2) the hazards of the truck driver ’sjob; and (3) measures to protect truck drivers.Before doing so, however, a general description ofthe different types of truck drivers is provided.Although all truck drivers spend a substantial

part of their working day behind the wheel, theyare not a homogeneous group as the remainingtasks can differ enormously from one driver toanother. Hence, it is useful to categorise truckdrivers, which has been done in different ways.First, truck drivers can be classified according todriving distance, ranging from local deliverydrivers with dozens of different addresses to callto each day to long-distance drivers with journeysof more than 1 day. Generally the proportion ofworking time spent driving increases and theamount of time loading and unloading decreaseswith longer distances. Large countries, such asAustralia and the USA, tend to have relativelymore long-distance drivers.Second, truck drivers are often grouped by the

(type of) product they transport or by the methodof transport. The (type of) product can be the keyfactor in occupational exposures. For instance,transport of hazardous chemical materials increasesthe driver ’s risk of being exposed to these chem-icals, and transport of animals or flowers mightinvolve exposure to certain biological hazards.However, the (type of) product does not havea consistent relationship with the hazards of thejob, since the same product can be transportedseveral times. For instance, goods can be trans-ported from a harbour to warehouses in large seacontainers, distributed from the warehouse toshops on pallets, and delivered from the shop tocustomers as packed goods. Truck drivers can alsobe classified according to these methods of trans-port, which overlap to some extent with the typeof product, since certain products are likely to betransported in a particular way (eg, petrol intankers, or sand in dump trucks). Although largeamounts of cargo are still being transported bytraditional methods (eg, as packed goods), more andmore containers, pallets or wheeled cages are beingused. This unitisation offers opportunities to useaids and appliances, thereby reducing the hazardsof the job. The use of sea containers has led to truckdrivers not having to load and unload cargo them-

selves anymore. In contrast, the use of pallets andwheeled cages sometimes results in truck driversmanually pushing and pulling large loads.

TASK AND ACTIVITIES OF TRUCK DRIVERSThe most obvious task of truck drivers is drivingthe vehicle. The constant need to observe traffic,read the instruments in the cab and keep movinghour after hour according to an often tight scheduleintensifies the driver ’s mental workload. Given thedifferences between driver categories, the propor-tion of working time spent behind the wheel rangesfrom less than 50% to almost 100%.1 2 In additionto driving, most truck drivers have to load andunload. The method of transport combined withthe availability of appropriate aids largely deter-mines the truck driver ’s activities during loadingand unloading. For instance, wheeled cages involvea great deal of pushing and pulling, whereas packedgoods are more often manually lifted and carried.Although bulk cargo is pumped mechanically intoand out of the truck, this involves the lifting,carrying and dragging of a hose before loading andunloading.3

The task of loading and unloading is notrestricted to moving cargo from storage into thecargo compartment and vice versa. The driver isusually responsible for opening and closing thecargo compartment as well as checking the load forstability, which might involve fastening or rear-ranging goods inside the cargo compartment.Even if a truck driver picks up a fully loaded truckand merely has to drive it, paper and administrativework remain to be done. The work of the truckdriver also often includes supporting tasks (eg,cleaning, maintenance and repair) concerning thetruck, cargo compartment or mechanical handlingdevices. Normally, these duties do not take long,but they are often performed at the end of a longworking day. Furthermore, commercial interactionwith customers may be required. This extension ofresponsibilities can be positive for truck drivers, butif these tasks become a major element of the job,then drivers may experience this as too psych-osocially demanding. Finally, waiting before loadingor unloading was found to take, on average,three quarters of an hour per day in long distancedrivers, who experienced these waiting periods asvery stressful.4

HAZARDS OF THE JOBSeveral hazards are associated with prolongedperiods of driving. Hence, many studies havefocused on work hours, fatigue and sleep depriva-tion as causing impaired alertness or the driver tofall asleep behind the wheel resulting in trafficaccidents and road-related fatalities.2 5e7 However,

1Department of Public andOccupational Health, EMGOInstitute for Health and CareResearch, VU UniversityMedical Center, Amsterdam,The Netherlands2Body@Work, Research Centerfor Physical Activity, Work andHealth, TNO VUmc, Amsterdam,The Netherlands

Correspondence toProfessor Allard van der Beek,Department of Public andOccupational Health, EMGOInstitute for Health and CareResearch, VU UniversityMedical Center, Van derBoechorststraat 7, NL-1081 BTAmsterdam, The Netherlands;a.vanderbeek@vumc.nl

Published Online First17 October 2011

Occup Environ Med 2012;69:291e295. doi:10.1136/oemed-2011-100342 291

World at Work

group.bmj.com on December 19, 2014 - Published by http://oem.bmj.com/Downloaded from

several other physical, chemical, ergonomic and psychosocialhealth hazards can be identified. These will be discussed afterthose related to hours of work.

Hours of work and safetyTruck drivers worldwide tend to work (very) long hours.7e9 It iswell known that long working hours are associated with adversehealth effects, such as cardiovascular disease, diabetes, disabilityretirement, subjectively reported physical health, subjectivefatigue, and physiological changes in cardiovascular and immu-nological parameters.10 11 Chronic sleeping problems are notuncommon in truck drivers due to irregular and long workinghours.5 12 The point-prevalence of obstructive sleep apnoea wasfound to be around 15% among truck drivers.13e15 Moreover,prolonged driving results in impaired concentration and reducedalertness, longer reaction time, and feelings of fatigue ordrowsiness.12 As a result, falling asleep while driving occursrelatively often. Late night/early morning is the time of greatestvulnerability to sleep or sleep-like states.5 In a sample of 593long-distance truck drivers, McCartt et al found out that almosthalf had ever fallen asleep while driving their truck and one outof four reported that they had fallen asleep in the past year.6

More than 30% of 160 short-distance drivers reported recentlyfalling asleep at the wheel.7 It is evident that falling asleep whiledriving can cause a road accident involving the driver alone orthird parties. Given the size and weight of trucks, this oftenresults in severe injuries or even fatalities among other roadusers. However, it has also been documented that truck driversinvolved in accidents are relatively often seriously or even fatallyinjured themselves.16 Participation in moderately heavy loadingand unloading was found to increase the severity of fatigue ifpreceded and followed by long periods of driving, and todiminish performance on parameters concerning steering andlane tracking.17 However, participation in such physical workseemed to have temporary beneficial activation effects in driversof relatively short distances.

A fatigue-related hazard is that long-distance truck driversoften use psychostimulants, such as amphetamine, to help themstay awake and maintain their extensive work schedule.18 19 Thiswas more likely for drivers experiencing problems managingfatigue, for drivers on a payment-by-result or contingency-payment basis, and for younger, less experienced drivers.18

Apart from safety hazards during driving, injuries resultingfrom slipping, tripping and falling have been reported to occurwith entry to or exit from the vehicle.20 Also, safety hazards canbe present when truck drivers load and unload their cargo.21 Forinstance, the driver can be accidentally hit by another motorisedvehicle, such as a forklift truck; fast moving forklift trucks arefrequently used in warehouses where truck drivers load andunload their cargo.

Physical and chemical hazardsThe most important physical and chemical hazards duringdriving are exposure to whole-body vibration, noise, climaticfactors, diesel exhaust and carbon monoxide.

Whole-body vibration combined with prolonged sitting ina static posture is a well-known risk factor for back strain intruck drivers. Exposure largely depends on characteristics such asthe type and condition of the road, the type and age of the truck,seating and the suspension system.22 23 However, whole-bodyvibration may no longer be an important risk factor. On the onehand, there is convincing scientific evidence that whole-bodyvibration is a risk factor for low back pain, sciatic pain anddegenerative changes in the spine, including lumbar interverte-

bral disc disorders.24 25 On the other hand, however, improvedseating and suspension systems result in exposure levels that areless harmful than those in the past.25 26

Excessive exposure to truck and traffic noise can lead tohearing loss, particularly in older drivers who previously drovenoisy trucks. Recently, noise exposure was found to exceed thecurrent threshold when driving with the radio on and thedriver ’s side window open.27

Truck drivers are consistently found to have a higher incidenceof and mortality from lung cancer than controls.28 29 It seemslikely that exposure to diesel exhaust contributes to thisincreased risk.30 Occupational exposure to diesel exhaust alsoseems to increase the risk of bladder cancer.31e33 High dieselexhaust levels are found in cities and at loading terminals,although long-distance drivers are not highly exposed in theirtruck cabs.28 The literature does not allow for firm conclusionsabout chemical hazards, since exposure assessment in mostepidemiological studies on, for instance, work-related cancer isbased on job title rather than actual measurements of exposure.The retrospective cohort study of Garshick et al is an exceptionas they used measurements of exposure to vehicle exhaust.28

They reported an increased risk of lung cancer mortality fortrucking industry workers with regular exposure to vehicleexhaust. Furthermore, it was found that local drivers had higherexposure to dust than long-distance drivers, who showed nodifference compared with a control group.34 The reason for thiswas probably that the local drivers spent more time in pollutedareas and were more exposed during loading and unloading.Likewise, petrol tanker drivers were found to be exposed topetrol vapours during loading and unloading.35

Nowadays, more and more trucks have air-conditioningsystems to control the cab temperature, so that fewer driversthan in the past are exposed to high temperatures while driving.However, three out of four truck drivers were reported to besignificantly affected by climatic factors while loading andunloading.8 Exposure to climatic changes could cause truckdrivers to be prone to colds or influenza. It is assumed thatexposure to repeated changes in temperature and otherdemanding climatic factors might also be associated withmusculoskeletal symptoms. However, this association has notbeen confirmed in truck drivers.36

Ergonomic hazardsThese days, the ergonomic design of the cab is close to optimalfor driving. However, many truck drivers also live in the cab forseveral days in a row. The cab’s sleeping compartment is oftensmall, which might contribute to the sleeping problems ofdrivers. As stated above, most truck drivers also load and unloadcargo. The driver ’s low back is hypothesised to be at risk ofmechanical damage while loading and unloading after driving, asback muscles may have been fatigued due to exposure to whole-body vibration during the drive.37 According to these authors,trunk muscle fatigue results in increased coupled torques andmuscles that overcompensate for unexpected loads. Severalauthors concluded that truck drivers who, in addition to driving,perform physically demanding loading and unloading activities,run a higher risk of musculoskeletal symptoms than otherprofessional drivers.8 38 39 In general, musculoskeletal symptomsare the most prevalent health problem among truck drivers. Inthe year prior to investigation, almost two thirds of truck drivershad had low back symptoms, while shoulder, neck and kneesymptoms were mentioned by about one third.9 40 Anotherstudy showed somewhat lower 12-month prevalences: two outof three truck drivers reported symptoms in the musculoskeletal

292 Occup Environ Med 2012;69:291e295. doi:10.1136/oemed-2011-100342

World at Work

group.bmj.com on December 19, 2014 - Published by http://oem.bmj.com/Downloaded from

system, with low back symptoms occurring most frequently,followed by shoulder symptoms and knee symptoms (45%, 26%and 24%, respectively).8

Psychosocial hazardsAs mentioned above, the job is appreciated for the autonomythat it gives. However, with the introduction of ’just-in-timedelivery’, transportation planning has become tighter, oftenleading to serious time pressure and decreased decision latitudefor the driver. Significantly more professional drivers (including75% of truck drivers) than referents had a working environmentthat was characterised by high demands, low decision latitudeand low social support.41 Hence, it is not surprising that a studyamong package truck drivers concluded that job stress isa psychological health hazard for these drivers.42 The psycho-social hazards for local delivery drivers are somewhat differentfrom those for long-distance truck drivers. In general, timepressure is caused by unrealistic delivery schedules related to thenumber of unloading stops for local delivery drivers, while it iscaused by unrealistic driving schedules combined with longwaiting times to drop off or pick up loads for long-distance truckdrivers. The recent widespread introduction of on-boardcomputer systems appears to have impaired the driver ’spsychosocial work environment and his job attitude evenfurther.43 It is expected that recent technological developmentsin global positioning will also expand the influence of computersin most countries. The road haulage industry is also becomingmore and more competitive from a business point of view.

Continuing time pressure in combination with long workinghours may cause severe fatigue, leading to the driver beingoverworked and resulting in psychosocial problems such asanxiety, depression and aggression. A recent prospective cohortstudy elegantly showed that work-related fatigue also resultedin an increased risk of sick leave. High baseline scores on a scaleassessing the need for recovery after work, which reflects theextent to which workers have difficulties recovering adequatelyfrom fatigue after their working day, predicted sick leave duringa 2-year follow-up period.44

Truck drivers’ mental load resulting from prolonged drivingaffects their bodily functions. Vivoli et al found that the urinaryexcretion rates of both catecholamines, epinephrine andnorepinephrine, were related to poor driving conditions, such asfog.45 The excretion rate of epinephrine was significantly relatedto state-anxiety scores. In general, prolonged driving may resultin feelings of discomfort, local stiffness and pain, irritation, ortension and stress. In a later study among Dutch short-distancedrivers, the working day excretion rates of epinephrine andespecially norepinephrine were higher than those found in earlierstudies among professional drivers.46 Moreover, they reportedthat insufficient recovery took place after work had ended.Sustained physiological activation after work is associated withsomatic pathology, psychosomatic complaints and sleepingproblems, and this association was confirmed among theseDutch short-distance drivers as the excretion rate of epinephrineafter work was related to psychosomatic complaints.47

Other hazardsTruck drivers’ unhealthy lifestyle is probably the best known‘hazard’ of the job. Truck drivers had a greater likelihood of eversmoking than workers with other job titles in the road haulageindustry,48 and smoking is one of the strongest risk factors forlung cancer. Irregular eating in combination with an unbalanceddiet often results in digestive disorders. Backman found that35% of a group of 287 bus drivers and 346 truck drivers reported

stomach symptoms, with this percentage being similar for bothtypes of drivers.49 Compared with a control group of 52 indus-trial workers, 26 bus and 26 truck drivers had higher mean valuesfor serum cholesterol, serum triglycerides and blood pressure,50

indicating a higher risk of coronary heart disease. In anotherstudy, none of these variables differed significantly betweenprofessional drivers, 75% of whom were truck drivers, andreferents.41 However, this study did find a higher score ona cardiovascular risk index for these drivers in comparison withthe referents, due to high fat consumption, high daily tobaccoconsumption, low leisure-time physical activity and a highstrain working situation. It should be stressed that the popula-tion in these studies consisted of 25%e50% of professional busdrivers and not specifically truck drivers. However, a recentlyconducted, large study showed elevated risk among truck driversfor several lifestyle-related diseases except alcohol-relateddiseases.51 Also, working as a truck driver was found to bestrongly associated with hospital treatment for obesity as wellas with diabetes.51 It was concluded that truck drivers may havediseases related to an energy imbalance (ie, energy intake greaterthan energy output). Furthermore, two studies demonstratedthat truck drivers have an increased risk of cardiovasculardisease.52 53 However, one of those studies stated that theincreased risk of myocardial infarction seemed to be explained byindividual rather than lifestyle factors.52

Finally, among long-distance truck drivers in African andAsian countries, a sexually promiscuous lifestyle paired witha disregard for safe sex practices has been identified as a healthhazard.54 55 This risky behaviour not only increases the drivers’own risk of sexually transmitted diseases, but was also consid-ered to be crucial in spreading sexually transmitted diseases andHIV infection in these parts of the world.

MEASURES TO PROTECT WORKERSA reduction in working hours might reduce truck drivers’ work-load, improve the chances of proper recovery after work anddiminish the risk of traffic accidents. However, it should bestressed that this recommendation is not yet evidence based.Moreover, the epidemiological literature has not consistentlyshown a doseeresponse relationship between number of hoursworked and adverse health outcomes. Still, the association withroad accidents is beyond doubt and measures to eliminate verylong working hours should be implemented. However, this iseasier said than done, since these measures are not very practi-cable in the road haulage industry. The obvious problem is thatboth transport companies and truck drivers benefit financiallyfrom long working hours. Transport companies only earn incomeif the truck is transporting goods from one place to another. Truckdrivers earn (much) higher salaries if they work longer hours.However, different strategies can be used to improve workinghours. The first strategy targets the truck drivers themselves.Drivers’ attitudes towards working 60 h or more per week mightchange if they were aware of the adverse health effects forthemselves and other road users. Although truck drivers canrecover from fatigue while driving, it should be stressed thatdriving and its required attention hinders proper recovery.Therefore, drivers are advised to take more short breaks, inparticular if they feel fatigued. More flexible approaches tomanaging the scheduling of deliveries as well as improved driverawareness of early signs of fatigue are prerequisites for thisrecommendation.56 The second strategy targets the transportcompany. Improved cooperation between the company’s opera-tions department and drivers might help decrease working hoursand encourage short breaks. The company should certainly not

Occup Environ Med 2012;69:291e295. doi:10.1136/oemed-2011-100342 293

World at Work

group.bmj.com on December 19, 2014 - Published by http://oem.bmj.com/Downloaded from

encourage driving while tired. For delivery drivers and short-distance drivers, companies might consider having two 8-h shiftswith separate drivers. In this way, the truck will be even moreproductive than in a situation where one driver works long hours.The disadvantage with two shifts, however, is that most truckdrivers do not like to share ‘their ’ truck with a colleague. For long-distance drivers, two-up driving combined with overnight restappeared to be the most successful strategy for managing fatigueacross the trip.57 Other company strategies might be to replacetruck drivers at certain points, comparable to airline pilots. Again,this would mean that truck drivers would not drive ‘their ’ truckanymore. The third strategy targets national authorities, such asministries of transport, who should take more serious actionagainst those violating regulations governing driving hours. Thereis scientific evidence that compliance with regulations requiresspecific intervention approaches towards truck drivers.58 Obvi-ously, newly implemented regulations should not increasefatigued driving, as was found in a study evaluating new federalrules regulating the working hours of interstate truck drivers inthe USA.59

It is recommended that trucks be equipped with properseating and suspension systems in order to lessen harmfulexposure to whole-body vibration; there are indications thattoday ’s systems can keep exposure levels below internationalstandards. Likewise, air-conditioning systems can eliminateexposure to high cab temperatures while driving. Local deliverydrivers, with or without air-conditioning systems, should beencouraged to drive with the windows closed to decreaseexposure to traffic noise, diesel exhaust and dust as much aspossible. Furthermore, the use of electric forklift trucks isrecommended at loading terminals.

From an ergonomic point of view, much can and should bedone to improve the loading and unloading process. A widerange of manually operated wheeled equipment is available andthe most appropriate handling aid should be chosen. The designof the handling aid should be appropriate for the goods beingloaded or unloaded and the driver performing the task. The mostimportant design feature is a proper handle height. For example,while pushing sack barrows the trunk of many drivers needs tobe flexed because the handles are too low. Properly designedhandles can easily prevent poor posture, which in this exampleof the sack barrow requires a lower and an upper handle. Theformer is angled backwards to tilt the barrow prior to movingoff, and the latter is located at a much more comfortable heightto push while moving. Furthermore, the wheels of manuallyoperated cages and hand forklifts should be better maintained.Obstacles at the workplace such as misaligned floors, kerbs,thresholds or slopes should be removed and the floor shouldregularly be cleared of rubbish because wheeled cages and handforklifts are difficult to move over any but the smoothest floors.Electric hand forklifts should be made available to make theloading and unloading of pallets easier. Suitable electric equip-ment is very important for the loading and unloading of wheeledcages. When properly designed these aids should be able toconsiderably decrease the forces required while pushing andpulling the cages. Also the cargo compartment can be improvedergonomically. For instance, a rolling floor was developed tomove packed goods automatically in and out of the cargocompartment. This floor, on an average day, decreased thefrequency of lifting/lowering of packed goods by 24%, thefrequency of handling goods below knee level by 79%, and thefrequency of entering the cargo compartment by 45%.60 Also,the unloading process was reduced by 8 min, which can beconsidered as an increase in productivity.

Educational programmes should be used to improve the life-style of truck drivers. These health promotion programmes canbe targeted at smoking cessation, improved nutritional balanceand/or increased daily physical activity. For instance, a recentlifestyle intervention was implemented at a Swedish truck stopaiming at the hard-to-reach risk group of professional drivers.61

Nutritional analysis showed a better balance of fat, calories,carbohydrates and protein (per 100 g) in the dishes chosen bydrivers after the intervention. Furthermore, drivers had anincreased awareness of the healthier alternatives on offer andchose these alternatives. More recently, truck drivers alsoreported that they would choose healthy foods if available andappetising,62 indicating that truck stop restaurants should offerhealthier meal options to improve drivers’ lifestyle.Finally, there is evidence for the efficacy of an HIV prevention

programme in Asia.63 Hence, it is recommended that suchprogrammes be further developed, enabling optimal feasibility atrelatively low economic cost,64 after which large-scale imple-mentation of the resulting HIV prevention programme shouldbe considered.

Competing interests None.

Provenance and peer review Not commissioned; internally peer reviewed.

REFERENCES1. Van der Beek AJ, Frings-Dresen MH. Physical workload of lorry drivers: comparison

of four methods of transport. Ergonomics 1995;38:1508e20.2. Arnold PK, Hartley LR, Corry A, et al. Hours of work, and perceptions of fatigue

among truck drivers. Accid Anal Prev 1997;29:471e7.3. Hedberg GE, Niemi K. Physical and muscular strain in Swedish tanker truck drivers.

Ergonomics 1986;29:817e26.4. Kiegeland P. Anforderungen, Beanspruchung und verkehrsrelevante Einstellungen

von Berufskraftfahrern [Demands, load and traffic relevant attitude of professionaldrivers]. Koln: Verlag TUV Rheinland GmbH, 1990.

5. Mitler MM, Miller JC, Lipsitz JJ, et al. The sleep of long-haul truck drivers. N Engl JMed 1997;337:755e61.

6. McCartt AT, Rohrbaugh JW, Hammer MC, et al. Factors associated with fallingasleep at the wheel among long-distance truck drivers. Accid Anal Prev2000;32:493e504.

7. Sabbagh-Ehrlich S, Friedman L, Richter ED. Working conditions and fatigue inprofessional truck drivers at Israeli ports. Inj Prev 2005;11:110e14.

8. Van der Beek AJ, Frings-Dresen MH, Van Dijk FJ, et al. Loading and unloading bylorry drivers and musculoskeletal complaints. Int J Ind Ergon 1993;12:13e23.

9. Robb MJ, Mansfield NJ. Self-reported musculoskeletal problems amongstprofessional truck drivers. Ergonomics 2007;50:814e27.

10. Van der Hulst M. Long workhours and health. Scand J Work Environ Health2003;29:171e88.

11. Harma M. Workhours in relation to work stress, recovery and health. Scand J WorkEnviron Health 2006;32:502e14.

12. McDonald N. Fatigue, Safety and the Truck Driver. London: Taylor & Francis, 1984.13. Talmage JB, Hudson TB, Hegmann KT, et al. Consensus criteria for screening

commercial drivers for obstructive sleep apnea: evidence of efficacy. J Occup EnvironMed 2008;50:324e9.

14. Lemos LC, Marqueze EC, Sachi F, et al. Obstructive sleep apnea syndrome in truckdrivers. J Bras Pneumol 2009;35:500e6.

15. Braeckman L, Verpraet R, Van Risseghem M, et al. Prevalence and correlates ofpoor sleep quality and daytime sleepiness in Belgian truck drivers. Chronobiol Int2011;28:126e34.

16. Charbotel B, Martin JL, Gadegbeku B, et al. Severity factors for truck drivers’injuries. Am J Epidemiol 2003;158:753e9.

17. Miller JC, Mackie RR. Effects of irregular schedules and physical work oncommercial driver fatigue and performance. In: Oborne DJ, Lewis JA, eds. HumanFactors in Transport Research. London: Academic Press, 1980:127e33.

18. Williamson A. Predictors of psychostimulant use by long-distance truck drivers. AmJ Epidemiol 2007;166:1320e6.

19. Leyton V, Sinagawa DM, Oliveira KC, et al. Amphetamine, cocaine and cannabinoidsuse among truck drivers on the roads in the State of Sao Paulo, Brazil. Forensic Sci Int2012;215:25e7.

20. Nicholson AS, David GC. Slipping, tripping and falling accidents to delivery drivers.Ergonomics 1985;28:977e91.

21. Shibuya H, Cleal B, Mikkelsen KL. Work injuries among drivers in the goods-transport branch in Denmark. Am J Ind Med 2008;51:364e71.

22. Cann AP, Salmoni AW, Eger TR. Predictors of whole-body vibration exposureexperienced by highway transport truck operators. Ergonomics 2004;47:1432e53.

294 Occup Environ Med 2012;69:291e295. doi:10.1136/oemed-2011-100342

World at Work

group.bmj.com on December 19, 2014 - Published by http://oem.bmj.com/Downloaded from

23. Okunribido OO, Magnusson M, Pope M. Delivery drivers and low-back pain: a studyof the exposures to posture demands, manual materials handling and whole-bodyvibration. Int J Ind Ergon 2006;36:265e73.

24. Bovenzi M, Hulshof CT. An updated review of epidemiologic studies on therelationship between exposure to whole-body vibration and low back pain (1986-1997). Int Arch Occup Environ Health 1999;72:351e65.

25. Lings S, Leboeuf-Yde C. Whole-body vibration and low back pain: a systematic,critical review of the epidemiological literature 1992-1999. Int Arch Occup EnvironHealth 2000;73:290e7.

26. Palmer KT, Griffin MJ, Bendall H, et al. Prevalence and pattern of occupationalexposure to whole body vibration in Great Britain: findings from a national survey.Occup Environ Med 2000;57:229e36.

27. Seshagiri B. Occupational noise exposure of operators of heavy trucks. Am Ind HygAssoc J 1998;59:205e13.

28. Garshick E, Laden F, Hart JE, et al. Lung cancer and vehicle exhaust in truckingindustry workers. Environ Health Perspect 2008;116:1327e32.

29. Corbin M, McLean D, Mannetje A, et al. Lung cancer and occupation: a NewZealand cancer registry-based case-control study. Am J Ind Med 2011;54:89e101.

30. Jarvholm B, Silverman D. Lung cancer in heavy equipment operators and truckdrivers with diesel exhaust exposure in the construction industry. Occup Environ Med2003;60:516e20.

31. Boffetta P, Silverman DT. A meta-analysis of bladder cancer and diesel exhaustexposure. Epidemiology 2001;12:125e30.

32. Manju L, George PS, Mathew A. Urinary bladder cancer risk among motor vehicledrivers: a meta-analysis of the evidence, 1977-2008. Asian Pac J Cancer Prev2009;10:287e94.

33. Dryson E, ’t Mannetje A, Walls C, et al. Case-control study of high risk occupationsfor bladder cancer in New Zealand. J Cancer 2008;122:1340e6.

34. Guillemin MP, Herrera H, Huynh CK, et al. Occupational exposure of truck drivers todust and polynuclear aromatic hydrocarbons: a pilot study in Geneva, Switzerland. IntArch Occup Environ Health 1992;63:439e47.

35. Vainiotalo S, Ruonakangas A. Tank truck driver exposure to vapors from oxygenatedor reformulated gasolines during loading and unloading. Am Ind Hyg Assoc J1999;60:518e25.

36. Van der Beek AJ, Oort-Marburger D, Frings-Dresen MH. The relations betweenwork demands and health effects in lorry drivers: a model tested by means of LISREL.Int Arch Occup Environ Health 1994;66:179e84.

37. Magnusson ML, Wilder DG, Pope MH, et al. Back, shoulder and neck pain inoccupational drivers; a two center screening of long-term exposure. In: Ernst E,Jayson MIV, Pope MH, et al, eds. Advances in idiopatic low back pain. Vienna:Blackwell-MZV, 1993:81e5.

38. Hedberg GE. Epidemiological and ergonomic studies of professional drivers. Arbeteoch Halsa 1987;9:1e76.

39. Magnusson ML, Pope MH, Wilder DG, et al. Are occupational drivers atan increased risk for developing musculoskeletal disorders. Spine 1996;21:710e17.

40. Hedberg GE. The period prevalence of musculoskeletal complaints among Swedishprofessional drivers. Scand J Soc Med 1988;16:5e13.

41. Hedberg GE, Jacobsson KA, Janlert U, et al. Risk indicators of ischemic heartdisease among male professional drivers in Sweden. Scand J Work Environ Health1993;19:326e33.

42. Orris P, Hartman DE, Strauss P, et al. Stress among package truck drivers. Am J IndMed 1997;31:202e10.

43. De Croon EM, Kuijer PP, Broersen JP, et al. Information technology and roadtransport industry: how does IT affect the lorry driver. Appl Ergon 2004;35:313e20.

44. De Croon EM, Sluiter JK, Frings-Dresen MH. Need for recovery after work predictssickness absence: a 2-year prospective cohort study in truck drivers. J PsychosomRes 2003;55:331e9.

45. Vivoli G, Bergomi M, Rovesti S, et al. Biochemical and haemodynamic indicator ofstress in truck drivers. Ergonomics 1993;36:1089e97.

46. Van der Beek AJ, Meijman TF, Frings-Dresen MH, et al. Lorry drivers’ work stressevaluated by catecholamines excreted in urine. Occup Environ Med 1995;52:464e9.

47. Kuiper JI, Van der Beek AJ, Meijman TF. Psychosomatic complaints and unwindingof sympathoadrenal activation after work. Stress Med 1998;14:7e12.

48. Jain NB, Hart JE, Smith TJ, et al. Smoking behavior in trucking industry workers. AmJ Ind Med 2006;49:1013e20.

49. Backman AL. Health survey of professional drivers. Scand J Work Environ Health1983;9:30e5.

50. Hartvig P, Midttun O. Coronary heart disease risk factors in bus and truck drivers:a controlled cohort study. Int Arch Occup Environ Health 1983;52:353e60.

51. Dahl S, Kaerlev L, Jensen A, et al. Hospitalization for lifestyle related diseases inlong haul drivers compared with other truck drivers and the working population atlarge. Work 2009;33:345e53.

52. Bigert C, Gustavsson P, Hallqvist J, et al. Myocardial infarction among professionaldrivers. Epidemiology 2003;14:333e9.

53. Robinson CF, Burnett CA. Truck drivers and heart disease in the United States,1979-1990. Am J Ind Med 2005;47:113e19.

54. Ntozi JP, Najjumba IM, Ahimbisibwe F, et al. Has the HIV/AIDS epidemic changedsexual behaviour of high risk groups in Uganda? Afr Health Sci 2003;3:107e16.

55. Rao KS, Pilli RD, Rao AS, et al. Sexual lifestyle of long distance lorry drivers in India:questionnaire survey. BMJ 1999;318:162e3.

56. Adams-Guppy J, Guppy A. Truck driver fatigue risk assessment and management:A multinational survey. Ergonomics 2003;46:763e79.

57. Feyer AM, Williamson A, Friswell R. Balancing work and rest to combat driverfatigue: an investigation of two-up driving in Australia. Accid Anal Prev1997;29:541e53.

58. Poulter DR, Chapman P, Bibby PA, et al. An application of the theory of plannedbehaviour to truck driving behaviour and compliance with regulations. Accid Anal Prev2008;40:2058e64.

59. McCartt AT, Hellinga LA, Solomon MG. Work schedules of long-distance truckdrivers before and after 2004 hours-of-service rule change. Traffic Inj Prev2008;9:201e10.

60. Verschoof S, Kuijer PP, Frings-Dresen MH. Does a rolling floor reduce the physicalwork demands and workload, and increase the productivity of truck drivers handlingpacked goods? Appl Ergon 2005;36:595e600.

61. Gill PE, Wijk K. Case study of a healthy eating intervention for Swedish lorry driver.Health Educ Res 2004;19:306e15.

62. Whitfield Jacobson PJ, Prawitz AD, Lukaszuk JM. Long-haul truck drivers wanthealthful meal options at truck-stop restaurants. J Am Diet Assoc 2007;107:2125e9.

63. Lau JT, Tsui HY, Cheng S, et al. A randomized controlled trial to evaluate the relativeefficacy of adding voluntary counseling and testing (VCT) to informationdissemination in reducing HIV-related risk behaviors among Hong Kong male cross-border truck drivers. AIDS Care 2010;22:17e28.

64. Kumar SG, Dandona R, Schneider JA, et al. Outputs and cost of HIV preventionprogrammes for truck drivers in Andhra Pradesh, India. BMC Health Serv Res2009;9:82.

PAGE fraction trail=4.75

Occup Environ Med 2012;69:291e295. doi:10.1136/oemed-2011-100342 295

World at Work

group.bmj.com on December 19, 2014 - Published by http://oem.bmj.com/Downloaded from

World at work: truck drivers

Allard J van der Beek

doi: 10.1136/oemed-2011-10034217, 2011

2012 69: 291-295 originally published online OctoberOccup Environ Med 

http://oem.bmj.com/content/69/4/291Updated information and services can be found at:

These include:

References #BIBLhttp://oem.bmj.com/content/69/4/291

This article cites 60 articles, 8 of which you can access for free at:

serviceEmail alerting

box at the top right corner of the online article. Receive free email alerts when new articles cite this article. Sign up in the

CollectionsTopic Articles on similar topics can be found in the following collections

(820)Other exposures (16)OEM World at work

Notes

http://group.bmj.com/group/rights-licensing/permissionsTo request permissions go to:

http://journals.bmj.com/cgi/reprintformTo order reprints go to:

http://group.bmj.com/subscribe/To subscribe to BMJ go to:

group.bmj.com on December 19, 2014 - Published by http://oem.bmj.com/Downloaded from