Health and Wellness Programs for Commercial Drivers (2007)

Below is the uncorrected machine-read text of this chapter, intended to provide our own search engines and external engines with highly rich, chapter-representative searchable text of each book. Because it is UNCORRECTED material, please consider the following text as a useful but insufficient proxy for the authoritative book pages.

21.1 Background From 1995 to 2006, the U.S. Department of Transporta- tion’s (U.S. DOT’s) FMCSA conducted a concentrated program of research and outreach education on commercial motor vehicle (CMV) driver alertness, fatigue, health, well- ness, and fitness. Initially, the primary emphasis of those initiatives was on “driver fatigue.” More recently, FMCSA shifted emphasis toward commercial driver health, wellness, and fitness. There are at least five reasons for this renewed emphasis on driver health and wellness. 1. In 2002, FMCSA and the American Transportation Research Institute (ATRI) began a trucking industrywide outreach training program called Gettin’ in Gear (Roberts and York 2000; Krueger and Brewster 2002; Brewster and Krueger 2005). This Gettin’ in Gear wellness program was developed after FMCSA and ATRI trained commercial trucking officials for 5 years on driver fatigue, using a train-the-trainer course titled Mastering Alertness and Managing Driver Fatigue (O’Neill et al. 1996; Brewster and Krueger 2005). The Gettin’ in Gear wellness course was then offered in combination with the Mastering Alertness course from October 2002 through 2006. The combination of the two courses has been attended by hundreds of repre- sentatives from trucking companies across the country and all industry sectors. Attendees are helped to under- stand that a lifestyle focused on health, wellness, and fit- ness can be viewed as a precursor to overall driver safety consciousness, with a belief that commercial drivers and their employers adopting a wellness lifestyle will have a greater likelihood of enacting proper fatigue manage- ment both at the corporate and at the individual driver level (Krueger and Brewster 2002; Krueger et al. 2002; Brewster and Krueger 2005). The demand for FMCSA and ATRI offering these educational courses (both driver fatigue and wellness) has continued unabated in the trucking industry for the past 5 years, and the demand is increasing now that wellness training of drivers is expected as part of FMCSA rulemaking on new entrant training. 2. The commercial intercity bus and motorcoach communi- ties are also interested and motivated regarding driver wellness programs. This synthesis is meant to assist in their efforts. 3. Driver health and wellness topics are being identified by leading transportation companies as key areas for main- taining continued corporate leadership, for continually improving safety records, decreasing health care and workers’ compensation costs, and insurance premiums; for increasing employee morale and job satisfaction; and for improving retention of valued “healthy drivers” (Husting 2005; Husting and Biddle 2005). Proactive companies are adapting various elements of driver well- ness programs into corporate operations, thereby making employee wellness part of their overall corporate culture of excellence. 4. The July 2004 federal court case vacated the 2003 hours-of- service (HOS) rules which took effect for the trucking industry in January 2004. In so doing, the court case raised additional questions about the health of commercial drivers, bringing the topic of driver health to the forefront. Amidst the requirements of the modified HOS rules of August 2005, commercial carriers now are expected to include wellness programs and training as part of their safety and operational management regimens. In February 2006, the continuation of the federal court case regarding trucking HOS rekindled the debate regarding driver health and wellness issues. 5. The National Transportation Safety Board (NTSB) urged FMCSA to place more emphasis on health and wellness of commercial drivers, and also to update medical qualifica- tion standards for CMV drivers. FMCSA currently has C H A P T E R 1 Introduction

3medical review panels updating CMV medical qualifica- tion standards. For details see FMCSA website at www.fmcsa.dot.gov. As a result of this heightened attention to commercial driver health and wellness, FMCSA and the trucking, bus, and safety communities requested the CTBSSP to provide information on the relationship between employee health and wellness programs and the potential for enhancing highway safety in the commercial truck and bus/motorcoach industries. FMCSA is seeking information about experiences, and wellness program models of proactive organizations working to upgrade their employees’ physical and psycho- logical well-being. This report documents some of this information. 1.2 Objectives and Scope There were five principal objectives for this synthesis: (1) to review the literature on truck and bus driver health issues, high- lighting the chief health risks facing commercial drivers; (2) to present an analytical review of literature associating crash cau- sation with functional impairments affecting abilities of CMV drivers to drive safely; (3) to describe elements of employee health and wellness programs that could be made to apply to transportation industry employee health and wellness programs principally aimed at commercial drivers; (4) to conduct a survey of trucking, bus, and motorcoach companies who already have implemented employee health and wellness programs and to document what components of the numerous health and wellness options available are presently being offered to their employees, especially drivers; and (5) to report several case studies of successful employee health and wellness pro- grams in the trucking industry and in the commercial bus and motorcoach communities. Health and wellness case studies are presented to highlight lessons learned, indicating what seems to work well. This synthesis also provides recommendations for implementation of employee health and wellness programs and information and suggestions concerning areas for additional research on this critical issue. This synthesis was conducted to provide up-to-date infor- mation to inform decision making for near-, mid-, and long- range planning of research and educational outreach programs. 1.3 Methodology and Approach of This Synthesis 1.3.1 Driver Health Risks To provide context for the literature review on health and wellness programs for commercial drivers, the most promi- nent health risks facing commercial transportation workers, especially truck and bus/motorcoach operators, are summa- rized first. 1.3.2 Driver Medical Qualifications The current medical qualification standards for commercial drivers are given, for example, Code of Federal Regulations (CFR), Part 391: Qualifications of Drivers, provides medical standards for attaining and retaining certification as a com- mercial driver, entitling one to hold a commercial driver’s license (CDL) and to work in the industry. 1.3.3 Literature Review The principal focus of the literature review is to describe corporate experiences with employee health and wellness programs that help ensure employees are healthy and safe at work. Reports pertaining directly to transportation operators, and in particular to truck and bus/motorcoach operators, are included from such sources as (a) scientific journal articles presenting assessments of employee health and wellness programs, especially those in transportation industries; (b) occupational health and health promotion journals; (c) professional truck and bus/motorcoach industry trade lit- erature; and (d) corporate and professional human resources (HR) literature, wellness magazines, and various Internet- based websites of wellness program providers. Included in this report are additional sources describing or assessing employee health and wellness programs in other industries (i.e., not limited to the transportation community) and program outcomes (e.g., documenting success stories, failures, cost- benefit assessments, and so on). Also provided is a brief analytical review of the emerging body of literature on the influence of health and medical factors on motor vehicle crash involvement associating crash causation with functional impairments. Summarized in this section of the report are recent epidemiological (case- control) studies using violation and crash records, analyzed both retrospectively and prospectively to determine their relationships with functional status for large, representative driver samples. Applications to heavy vehicle operations are emphasized, pointing toward the potential to develop, validate, and demonstrate the administrative feasibility of screening procedures to reliably measure differences in key safe driving abilities in the near term. 1.3.4 Surveys of Employee Health and Wellness Programs This synthesis included two surveys to gain insights into industry experiences with employee health and wellness programs.

4Truck carriers and intercity/charter bus and motorcoach carriers were surveyed regarding experiences with health and wellness programs by means of 1. A survey of truck and bus motor carrier company managers and 2. A survey of truck and bus drivers who work for compa- nies that offer some form of formal or informal health and wellness programs for employees. Two questionnaires were developed (see Appendices A and B); the first for managers (safety and risk managers, driver managers, human resources personnel, and company execu- tives) and the second for drivers. The surveys were distributed via fax, emailed, and posted on ATRI’s Internet website. The survey development and distribution methodology, as well as survey results, are described in detail in Section 3.1. In both the driver and the driver manager surveys, health and wellness programs were defined as a series of ongoing company planned activities intended to improve health and well-being of truck or bus/motorcoach drivers. Bus and Motorcoach Manager Survey. The research team elicited participation by the American Bus Association (ABA) and the United Motorcoach Association (UMA) to survey intercity bus and motorcoach carriers in a manner similar to that described for the trucking industry (see Section 3.1). Commercial Truck and Bus Driver Surveys/Interviews. A convenience sampling of truck and bus drivers, whose com- panies offer health and wellness programs, was also conducted. Drivers surveyed were determined after the companies that have wellness programs were identified and the company’s cooperation elicited to permit drivers to be surveyed. Many of the questions used in the manager and driver surveys were similar to, but modified from, the questions used in the conduct of the survey done for TCRP Synthesis 52 (Davis 2004). It was acknowledged that replicating portions of some of the questions posed to the transit community would allow for comparison between the two transportation industry segments. 1.3.5 Case Studies In select sectors of both the trucking and bus/motorcoach industries, five employee wellness programs are documented as case studies highlighting successful attributes and lessons learned in terms of rationale used for implementing pro- grams, program components, and carrier experience with program results. The descriptive case studies document both successful implementation of innovative employee health and wellness practices and programs. Targets for the case studies were proactive corporations and organizations seeking to upgrade employees’ physical and psychological well-being. The health and wellness program elements and features include formal or informal employee wellness programs, employee health risk assessments, fitness-for-duty evalua- tions, exercise programs, employee assistance programs, mentoring programs, labor-management health and safety committees, nutrition and diet programs, critical incident stress management, smoking cessation programs, disease management programs, health consultant follow-ups with individual employee health coaching, and case management initiatives. Case studies were identified through interactions with the companies surveyed. The company health and wellness pro- grams are described and presented in the form of programs offered and of lessons learned, identifying successes and information gaps, and making recommendations regarding the efficacy of such programs. The research team identified and received approval to describe four key programs in the trucking industry: (1) Schneider National, Inc., (2) JB Hunt, (3) Trucks, Inc., and (4) Waste Management, Inc. Members of the research team previously worked with the first three of these trucking firms on a Truckload Carriers Association audio-conference on driver health and wellness programs (ATRI and TCA 2006). For more information on that audio-conference, see Appendix C. In the interstate bus and motorcoach industry several key companies having health and wellness programs were identi- fied, and a case study on Greyhound Lines, Inc., is provided. The case studies are described in Chapter 4 of this report.