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3 CHAPTER ONE INTRODUCTION BACKGROUND health, wellness, and fitness (Krueger et al. 2007), and TRB CTBSSP Synthesis 15: Health and Wellness Programs for Commercial truck, bus, and motorcoach drivers are expected Commercial Drivers (Krueger et al. 2007b) identified the need to continually maintain full cognitive alertness while driving, for increased research on these topics. While developing the and to sustain safe operating practices on our roadways, nation's second ten-year plan for a National Occupational even during long highway trips. For decades there has been a Research Agenda, the National Institute for Occupational common belief that many drivers in search of countermeasures Safety and Health also identified the need for research to to drowsy driving have taken to ingesting various chemical determine the relationship between the use of chemical sub- substances that might assist them in combating driver fatigue. stances by commercial drivers and any resultant short- and Drivers occasionally may take a variety of psychoactive drugs, long-term health consequences or safety implications of medications, sleep-inducing hypnotics, wakefulness-promoting such practices (National Institute for Occupational Safety stimulants, and a proliferation of other chemicals casually and Health 2010). labeled as dietary and nutritional or health food supplements. Drivers do this to obtain adequate sleep during their off-duty As a result of this heightened attention to commercial drivers hours or to boost their energy and prompt alertness while partaking of chemical substances, this synthesis project was driving. The concern has been whether or not the individual or initiated to provide information on the relationship between interactive and synergistic effects of such chemicals adversely the use of psychoactive chemicals and driver performance, affect their driving alertness, fatigue, performance, or health safety, and health. (Krueger CMV driver fatigue and wellness train-the-trainer experiences, 19962006; Krueger 2003, 2010). OBJECTIVES AND SCOPE Additionally, physicians and other health care providers legitimately prescribe various medications to drivers for treat- There were four principal objectives for this synthesis: ment of diseases, illnesses, and a myriad of medical problems, including insomnia or sleep disorders. Commercial motor 1. To present a synopsis of a sizeable portion of the vehicle (CMV) drivers also may take a wide variety of over- scientific literature on a wide variety of psychoactive the-counter (OTC) medications to self-treat their ailments, chemical substances that sometimes are consumed whether medically diagnosed or not. Drivers are known to by commercial drivers, particularly insofar as the sub- consume medications to alleviate or ameliorate such physio- stances may affect driver performance. logical conditions as allergies, rhinitis, being overweight or 2. To provide an extensive bibliographic reference listing obese, musculoskeletal discomfort, or for a variety of other of published literature on these topics. medical conditions, including attempts at cessation of tobacco 3. To administer a survey questionnaire to a small con- use and smoking. Of particular concern is the belief that even venience sample of medical examiners inquiring about while taking medications to treat ailments some commercial their anticipated actions with respect to their assessment drivers may also ingest various chemicals as contained in of chemical substances pertinent to conduct Commercial nutritional supplements (beverages, food bars, etc.) in an effort Driver Medical Examinations (CDMEs). to boost energy levels, enhance alertness, or combat driver 4. To survey a sampling of motor carrier officials regard- fatigue. ing their company policies about drivers using chemi- cal substances. Two recent TRB publications identifying data gaps in truck and bus safety research determined that science-based This synthesis study identified available information and information is needed to judge how drivers consuming such research needs relating to the use of chemical substances chemical substances affect their own driving alertness and by commercial drivers and is intended to provide up-to-date performance, their sleep hygiene, fatigue management, and information to inform decision making for near-, mid-, and several basic health practices. A TRB Research Circular long-range planning of research and educational outreach (Knipling 2007) presents a chapter on commercial driver programs.