The influence of stimulants on truck driver crash responsibility in fatal crashes

Associations among Health Status, Occupation, and Occupational Injuries or Diseases: A Multi-Level Analysis

PURPOSE

The present study used a hierarchical generalized linear model to explore the effects of physical and mental health and occupational categories on occupational injuries and diseases.

METHODS

The data were obtained from the Registry for Beneficiaries of the 2002-2013 National Health Insurance Research Database. The benefit categories involved adults with occupational injuries and diseases. Six major occupational categories and 28 subcategories were used. The main analysis methods were binary logistic regression (BLR) and hierarchical generalized linear model (HGLM).

RESULTS

After adjustment for relevant factors, the three major occupation subcategories most likely to develop occupational injuries and diseases were Subcategory 12 "employees with fixed employers" of Category 1 "civil servants, employees in public or private schools, laborers, and self-employed workers"; Subcategory 2 "employees in private organizations" of Category 1; and "sangha and religionists" of Category 6 "other citizens." Conditions such as mental disorders and obesity increased the risk of occupational injuries and diseases.

CONCLUSION

A portion of the occupational categories had a higher risk of occupational injuries and diseases. Physical and mental health issues were significantly correlated with occupational injuries and diseases. To the authors' knowledge, this is the first study to use HGLM to analyze differences in occupational categories in Taiwan.

Meta-analytic study on substance intake and work-related accidents calls for attention to bio-psycho-social factors

Accidents at work are a major concern because of their social and economic impact. The causes are highly variable and often linked to risk behaviors that could be avoided, of which substance use is a prime example. The aim of this paper was to meta-analytically review the scientific literature on substance intake and its link to work-related accidents. From an initial pool of 19954 papers, we considered a final sample of 27 clustered in three groups according to substances class (alcohol, recreational drugs, medicines). Despite different pharmacological effects, substances consumed for recreational purposes significantly increased the risk of work-related accidents (odds ratio: alcohol 1.78, recreational drugs 1.47), whereas medicines did not: however, these results require caution due to the heterogeneity of the included studies and suspected publication bias. While bio-psycho-social factors could have helped to understand this association, selected studies neglected both the variegated effects and the root causes of recreational substance consumption. Future studies and interventions should consider these complexity factors to transcend the mere description of the phenomenon.

Driving Fine and its Relationship with Dangerous Driving Behaviour Among Heavy Vehicle Drivers

Context

There is a significant difference between actual and existing statistics of traffic fines; since some invisible fines and most of the visible traffic violations cannot be recorded by traffic officers. Therefore, dealing with driving fines and road fatalities is considered an important issue in social and public management worldwide.

Aims

Explore the factors associated with unsafe behaviors and getting traffic fines among a sample of Iranian heavy-vehicle professional drivers.

Settings and Design

The present cross-sectional study was conducted in Iran, from February 2019 to September 2020.

Methods and Material

This study used the driver behavior questionnaire (DBQ), demographic and driving characteristics, the number of fines, and structural equation modeling. Also, in this study 320 professional drivers participated.

Statistical Analysis Used

This article used structural equation modeling for Statistical analysis.

Results

The results of structural equation modeling analysis indicated that the data fit well with the theoretical model proposed in this study. The number of fines was directly predicted by both demographic and driving characteristics and risky driving behaviors. A significant relationship was observed between, driving hours, driving experience, and smoking, respectively, with a mistake, slip, and risky violation. There was a negative correlation between education and all four sub-scales of risky driving behaviors.

Conclusions

In order to reduce traffic fines, training courses on increasing attention and precision in drivers' observations and judgments are useful. The courses can decrease traffic violations by trying to change beliefs, attitudes, and social norms. It is therefore helpful to understand the ways to change the drivers' attitudes.

A systematic review of factors associated with illegal drug driving

Drug driving is a serious problem worldwide that can increase the risk of road crashes. This systematic review seeks to identify factors associated with drug driving (i.e., driving after consuming drugs other than alcohol) to highlight gaps in existing knowledge and inform the design of more effective countermeasures. A search of the literature was conducted for the period January 1, 2005 to July 31, 2021 using six different databases. The search protocol followed PRISMA guidelines and was registered in PROSPERO (#CRD42021234616). Studies that met inclusion criteria compared drug drivers with either non-drug drivers, alcohol-only drivers or drug drivers from an earlier time period, to identify factors specifically associated with drug driving, rather than common to all drivers. Two hundred and nineteen publications met the inclusion criteria and were included within the review. Based on the findings, a logic model was developed that presents the factors associated with drug driving. Various sociodemographic, psychosocial and legal factors emerged as the main factors associated with illegal drug driving. At the sociodemographic and psychological levels, drug drivers were more likely to be single, young males who often drive after using cannabis and who score high on sensation-seeking and impulsivity scales. The key social factor found to be associated with drug driving was peer acceptance/disapproval of the behaviour. At the legal level, the review suggested that the effectiveness of current enforcement approaches to drug driving vary among jurisdictions around the world due to differences in the level of perceived certainty of apprehension and the chances of punishment avoidance. Future research into the anticipated and actual rewards for drug driving is needed to inform the development of more effective countermeasures.

A Systematic Review on the Role of Substance Consumption in Work-Related Road Traffic Crashes Reveals the Importance of Biopsychosocial Factors in Prevention

Objective: Since many jobs imply driving, a relevant part of all road traffic crashes (RTC) is related to work. Statistics considering all crashes suggest that they are significantly associated with consumption of substances, but the root causes are not yet clear. The objective of the present paper was to systematically review the scientific literature concerning substances consumption and work-related RTC. We queried the PubMed and Scopus electronic databases according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Articles were included if they reported all necessary data and survived a quality assessment. We selected a final sample of 30 articles from an initial pool of 7113. As hypothesized, taking any of the considered substances was found to increase the risk of work-related RTC. Descriptive statistics on work-related RTC showed a higher average positivity rate for medicines (14.8%) than for alcohol (3.02%) and drugs (0.84%). Interestingly, the impact of some medications found an unconvincing explanation in the mere occurrence of side effects, and it suggests that psychosocial and/or medical conditions could be better predictors of RTC. We therefore propose an intervention and prevention model that also considers biopsychosocial factors, for which further studies are needed in future research.

The Chronic Oral Administration of Clobenzorex or Amphetamine Decreases Motor Behavior and Induces Glial Activation in the Striatum Without Dopaminergic Degeneration

Described as amphetamine-like due to their structural and stimulant similarities, clobenzorex is one of the five most-commonly used drugs in Mexico for the treatment of obesity. Various studies have shown that amphetamines induce dopaminergic neurotoxicity and neuroinflammation in the striatum, symptoms which are associated with motor damage. For this reason, the present study aimed to evaluate the effect of chronic clobenzorex administration on motor behaviors, TH immunoreactivity, gliosis, and the neurodegenerative process in the striatum and substantia nigra pars compacta (SNpc). The present research was conducted on three experimental groups of male Wistar rats: the vehicle group, the amphetamine group (2 mg/kg), and the clobenzorex group (30 mg/kg). All groups were subject to oral administration every 24 h for 31 days. Motor activity and motor coordination were evaluated in the open field test and the beam walking test, respectively. The animals were euthanized after the last day of treatment to enable the extraction of their brains for the evaluation of tyrosine hydroxylase (TH) levels, the immunoreactivity of the glial cells, and the neurodegeneration of both the striatum and SNpc via amino-cupric-silver stain. The results obtained show that amphetamine and clobenzorex administration decrease motor activity and motor coordination in the beam walking test and cause increased gliosis in the striatum, while no significant changes were observed in terms of immunoreactivity to TH and neurodegeneration in both the striatum and SNpc. These results suggest that the chronic administration of clobenzorex may decrease motor function in a manner similar to amphetamine, via the neuroadaptive and non-neurotoxic changes caused to the striatum under this administration scheme.

A systematic review of statistical models and outcomes of predicting fatal and serious injury crashes from driver crash and offense history data

BACKGROUND

Expenditure on driver-related behavioral interventions and road use policy is often justified by their impact on the frequency of fatal and serious injury crashes. Given the rarity of fatal and serious injury crashes, offense history, and crash history of drivers are sometimes used as an alternative measure of the impact of interventions and changes to policy. The primary purpose of this systematic review was to assess the rigor of statistical modeling used to predict fatal and serious crashes from offense history and crash history using a purpose-made quality assessment tool. A secondary purpose was to explore study outcomes.

METHODS

Only studies that used observational data and presented a statistical model of crash prediction from offense history or crash history were included. A quality assessment tool was developed for the systematic evaluation of statistical quality indicators across studies. The search was conducted in June 2019.

RESULTS

One thousand one hundred and five unique records were identified, 252 full texts were screened for inclusion, resulting in 20 studies being included in the review. The results indicate substantial and important limitations in the modeling methods used. Most studies demonstrated poor statistical rigor ranging from low to middle quality. There was a lack of confidence in published findings due to poor variable selection, poor adherence to statistical assumptions relating to multicollinearity, and lack of validation using new data.

CONCLUSIONS

It was concluded that future research should consider machine learning to overcome correlations in the data, use rigorous vetting procedures to identify predictor variables, and validate statistical models using new data to improve utility and generalizability of models.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42019137081.

Use of Alcohol Mixed with Energy Drinks Increases the Prevalence of Driving Violations among Brazilian Truck Drivers

Background: The use of alcohol mixed with energy drinks (AmED) has been reported to be associated with a variety of unsafe driving practices. Truck drivers are vulnerable to driving violations, particularly because of their engagement in drug use. The use of AmED among these professionals remains unknown. Aim: To estimate the prevalence of AmED use and its association with driving violations among truck drivers. Methods: 684 drivers were recruited in Sao Paulo, Brazil. The use of drugs was reported. Drivers were split into three groups: (a) alcohol abstainers (AA); (b) alcohol-only users (AO); and (c) users of AmED. Intergroup comparisons were performed by polynomial logistic regression (the reference category was AO). We also performed Poisson regression analysis to obtain the prevalence ratio; the significance level was stipulated at 5%. Results: The prevalence of drivers reporting the use of AmED was 16.8%. Users of AmED (a) were younger, (b) were less experienced drivers, (c) had a heavier pattern of alcohol use, (d) used illicit drugs more frequently, and (e) had poorer sleep quality than AO subjects. A higher prevalence of drivers who had arguments or fights while driving (PR = 1.71) and of drivers who drove unbelted (PR = 1.66) ingested AmED than of AO subjects. Conclusions/importance: The use of AmED increased the prevalence of driving violations beyond the risks commonly attributed to alcohol use. We suggest additional investments in preventative measures based on the beverage category and a revision of the work organization of truck drivers to reduce their health and social risks.

Trends in the use of psychoactive substances by truck drivers in São Paulo State, Brazil: A time-series cross sectional roadside survey (2009-2016)

OBJECTIVE

Truck drivers represent a group that is susceptible to the use of stimulant substances to reduce the symptoms of fatigue, which may be caused by a stressful and exhausting work environment. The use of psychoactive substances may increase the risk for involvement in road traffic crashes. Previous studies have demonstrated that amphetamine, cocaine, and cannabis are the 3 main drugs used by Brazilian truck drivers. We studied the prevalence of amphetamine, benzoylecgonine (indicating use of cocaine), and Δ-9-tetrahydrocannabinol-9-carboxylic acid (THC-COOH; indicating use of cannabis) in urine samples from truck drivers in the state of São Paulo, Brazil, using the same methodology during 8 years (2009-2016).

METHODS

Samples were collected during a health program supported by the Federal Highway Police. Toxicological analyses were performed using immunoassays and gas chromatography-mass spectrometry.

RESULTS

The total prevalence of illicit drugs was 7.8%. Benzoylecgonine was the most prevalent substance (3.6%), followed by amphetamine (3.4%) and THC-COOH (1.6%). We found the highest drug prevalence in 2010 (11.3%) and the lowest in 2011 (6.1%). We could detect a slight change in the pattern of stimulant use: until 2010, amphetamine was the most prevalent substance; however, in 2011 benzoylecgonine became the most frequently detected substance. This lasted until 2015, probably due to changes in Brazilian legislation regarding appetite suppressants; the most common one is metabolized to amphetamine.

CONCLUSION

These data show that the use of psychoactive substances by truck drivers in Brazil did not decrease during the study period. This reinforces the need for further preventive measures to reduce drug use among drivers, which could lead to a decrease in traffic crashes in Brazil.

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

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

Truck drivers' traffic accidents in the State of São Paulo: prevalence and predictors

Abstract The mortality rate of traffic accidents (TA) is high in Brazil. Trucks are the second category of motor vehicles most often involved in TA. However, few studies have addressed the issue of TA among these professionals. The study aimed to estimate the prevalence of TA and their predictors in a sample of 684 truck drivers recruited in the state of São Paulo during 2012 and 2013. We requested participants to answer a research instrument on their personal and occupational data and their involvement in TA and traffic violations. A logistic regression model was developed to identify TA predictors. Almost 11% of the respondents suffered at least one TA in that timeframe. We identified the following TA predictors: having few years of experience as professional drivers (OR = 1.86; CI 95% = 1.05-3.38; p = 0.036); receiving some traffic tickets (OR = 1.91; CI 95% = 1.04-3.66; p = 0.043) and working more than 12 hours daily (OR = 1.84; CI 95% = 1.04-3.24; p = 0.034). Given those results, we suggest the development of a joint action among all the involved social stakeholders in order to negotiate truck drivers' work organization aiming at reducing behaviors that may lead to traffic accidents.

Multiple Conditions Increase Preventable Crash Risks Among Truck Drivers in a Cohort Study

OBJECTIVE

This study aims to quantify the crash risk for truck drivers with multiple comorbid medical conditions, after adjusting for confounders.

METHODS

This retrospective cohort of 38,184 drivers evaluated concomitant medical conditions and subsequent crash data between January 1, 2005, and October 31, 2012. Hazard ratios (HRs) and 95% confidence intervals (95% CIs) were calculated for any cause and preventable crashes of varying severity.

RESULTS

Drivers with three or more medical conditions had a significantly increased risk of preventable Department of Transportation (DOT) reportable crashes (HR = 2.53, 95% CI = 1.65 to 3.88) and preventable crashes with injuries (HR = 2.23, 95% CI = 1.09 to 5.31) after adjustment for covariates. Similarly, adjusted HRs were 2.55 (95% CI = 1.37 to 4.73) for any cause DOT-reportable crashes and 3.21 (95% CI = 1.18 to 8.75) for any cause crashes with injuries.

CONCLUSIONS

Having three concomitant medical conditions may be a statistically significant risk factor for preventable and any cause DOT-reportable crashes and crashes with injuries.

Uso contínuo de medicamentos e condições de trabalho entre motoristas de caminhão

Resumo Os motoristas de caminhão têm sido pouco explorados quanto aos problemas de saúde que os acometem e, principalmente, quanto ao seu perfil de consumo de medicamentos. Este estudo teve o objetivo de determinar o uso contínuo de medicamentos, por motoristas de caminhão, e identificar as características profissionais associadas. Para a sua realização, conduziu-se um estudo transversal com motoristas de caminhão estacionados no Pátio de Triagem do Porto de Paranaguá, Paraná, Brasil. Realizou-se uma entrevista com obtenção de dados socioeconômicos, problemas de saúde, condições de trabalho e uso contínuo de medicamentos. Dos motoristas avaliados (n = 665), 21,1% referiram utilizar algum medicamento continuamente, com destaque para o captopril (10,7%), metformina (10,3%), omeprazol (6,2%) e sinvastatina (6,2%). Motoristas com dezesseis anos ou mais de experiência profissional (RP 1,67; IC 95% 1,11-2,51), proprietários do próprio caminhão (RP 1,38; IC 95% 1,03-1,86) e que não possuíam vínculo empregatício formal (RP 1,49; IC 95% 1,11-2,00) apresentaram maior prevalência de uso contínuo de medicamentos. Observa-se que algumas condições de trabalho têm importante papel do uso contínuo de medicamentos pelos motoristas de caminhão.

Differences in state drug testing and reporting by driver type in U.S. fatal traffic crashes

INTRODUCTION

Driving under the influence of drugs, including marijuana, has become more prevalent in recent years despite local, state, and federal efforts to prevent such increases. The Fatality Analysis Reporting System (FARS) is the primary source of drugged driving data for fatal crashes in the United States but lacks the completeness required to calculate unbiased estimates of drug use among drivers involved in fatal crashes.

METHODS

This article uses the 2013 FARS dataset to present differences in state drug testing rates by driver type, driver fault type, and state-level factors; discusses limitations related to analysis and interpretation of drugged driving data; and offers suggestions for improvements that may enable appropriate use of FARS drug testing data in the future.

RESULTS

Results showed that state drug testing rates were highest among drivers who died at the scene of the crash (median=70.8%) and drivers who died and were at fault in the crash (median=64.4%). The lowest testing rates were seen among surviving drivers who were not transported to a hospital (median=14.0%) and surviving drivers who were not at fault in the crash (median=10.0%). Drug testing rates differed by state blood alcohol content (BAC) testing rate across all driver types and driver fault types, and in general, states that tested a higher percentage of drivers for BAC had higher drug testing rates.

DISCUSSION

Testing rates might be increased through standardization and mandatory testing policies. FARS data users should continue to be cautious about the limitations of using currently available data to quantify drugged driving. More efforts are needed to improve drug testing and reporting practices, and more research is warranted to establish drug concentration levels at which driving skills become impaired.

Restraint use and risky driving behaviors across drug types and drug and alcohol combinations for drivers involved in a fatal motor vehicle collision on U.S. roadways

Background

While driving impaired is a well-recognized risk factor for motor vehicle (MV) crash, recent trends in recreational drug use and abuse may pose increased threats to occupant safety. This study examines mechanisms through which drug and/or alcohol combinations contribute to fatal MV crash.

Methods

The Fatality Analysis Reporting System (FARS) for 2008–2013 was used to examine drugs, alcohol, driver restraint use, driver violations/errors and other behaviors of drivers of passenger vehicles who were tested for both alcohol and drugs (n = 79,932). Statistical analysis was based on Chi-square tests and multivariable logistic regression. Associations of restraint use and other outcomes with alcohol and drug use were measured by estimated odds ratios (ORs) and 95 % confidence intervals (95 % CIs).

Results

More than half (54.8 %) of the study population were positive for drugs or alcohol at the time of crash. Approximately half of drivers were belted, but this varied from 67.1 % (unimpaired) to 33.0 % (drugs plus alcohol). Compared to the unimpaired, the odds of a driver being unbelted varied: alcohol and cannabis (OR 3.70, 95 % CI 3.44–3.97), alcohol only (3.50,3.36–3.65), stimulants (2.13,1.91–2.38), depressants (2.09,1.89–2.31), narcotics (1.84,1.67–2.02) and cannabis only (1.55,1.43–1.67). Compared to belted drivers, unbelted drivers were over 4 times more likely to die. Driving violations varied across drug/drug alcohol combinations. Speed-related violations were higher for drivers positive for stimulants, alcohol, cannabis, and cannabis plus alcohol, with a more than two fold increase for alcohol and cannabis (2.36, 2.05, 2.71).

Conclusions

Mechanisms through which drugs, alcohol and substance combinations produce increased risks to occupant safety include lowered restraint use and increases in risky driving behaviors, including speeding, lane, passing, turning and signal/sign violations.

Pooling data from fatality analysis reporting system (FARS) and generalized estimates system (GES) to explore the continuum of injury severity spectrum

Fatality Analysis Reporting System (FARS) and Generalized Estimates System (GES) data are most commonly used datasets to examine motor vehicle occupant injury severity in the United States (US). The FARS dataset focuses exclusively on fatal crashes, but provides detailed information on the continuum of fatality (a spectrum ranging from a death occurring within thirty days of the crash up to instantaneous death). While such data is beneficial for understanding fatal crashes, it inherently excludes crashes without fatalities. Hence, the exogenous factors identified as critical in contributing (or reducing) to fatality in the FARS data might possibly offer different effects on non-fatal crash severity levels when a truly random sample of crashes is considered. The GES data fills this gap by compiling data on a sample of roadway crashes involving all possible severity consequences providing a more representative sample of traffic crashes in the US. FARS data provides a continuous timeline of the fatal occurrences from the time to crash - as opposed to considering all fatalities to be the same. This allows an analysis of the survival time of victims before their death. The GES, on the other hand, does not offer such detailed information except identifying who died in the crash. The challenge in obtaining representative estimates for the crash population is the lack of readily available "appropriate" data that contains information available in both GES and FARS datasets. One way to address this issue is to replace the fatal crashes in the GES data with fatal crashes from FARS data thus augmenting the GES data sample with a very refined categorization of fatal crashes. The sample thus formed, if statistically valid, will provide us with a reasonable representation of the crash population. This paper focuses on developing a framework for pooling of data from FARS and GES data. The validation of the pooled sample against the original GES sample (unpooled sample) is carried out through two methods: (1) univariate sample comparison and (2) econometric model parameter estimate comparison. The validation exercise indicates that parameter estimates obtained using the pooled data model closely resemble the parameter estimates obtained using the unpooled data. After we confirm that the differences in model estimates obtained using the pooled and unpooled data are within an acceptable margin, we also simultaneously examine the whole spectrum of injury severity on an eleven point ordinal severity scale - no injury, minor injury, severe injury, incapacitating injury, and 7 refined categories of fatalities ranging from fatality after 30 days to instant death - using a nationally representative pooled dataset. The model estimates are augmented by conducting elasticity analysis to illustrate the applicability of the proposed framework.

Occupational conditions and the risk of the use of amphetamines by truck drivers

OBJECTIVE To test whether the occupational conditions of professional truck drivers are associated with amphetamine use after demographic characteristics and ones regarding mental health and drug use are controlled for.METHODS Cross-sectional study, with a non-probabilistic sample of 684 male truck drivers, which was collected in three highways in Sao Paulo between years 2012 and 2013. Demographic and occupational information was collected, as well as data on drug use and mental health (sleep quality, emotional stress, and psychiatric disorders). A logistic regression model was developed to identify factors associated with amphetamine use. Odds ratio (OR; 95%CI) was defined as the measure for association. The significance level was established as p < 0.05.RESULTS The studied sample was found to have an average age of 36.7 (SD = 7.8) years, as well as low education (8.6 [SD = 2.3] years); 29.0% of drivers reported having used amphetamines within the twelve months prior to their interviews. After demographic and occupational variables had been controlled for, the factors which indicated amphetamine use among truck drivers were the following: being younger than 38 years (OR = 3.69), having spent less than nine years at school (OR = 1.76), being autonomous (OR = 1.65), working night shifts or irregular schedules (OR = 2.05), working over 12 hours daily (OR = 2.14), and drinking alcohol (OR = 1.74).CONCLUSIONS Occupational aspects are closely related to amphetamine use among truck drivers, which reinforces the importance of closely following the application of law (Resting Act ("Lei do Descanso"); Law 12,619/2012) which regulates the workload and hours of those professionals. Our results show the need for increased strictness on the trade and prescription of amphetamines in Brazil.

Association of sleep habits with accidents and near misses in United States transportation operators

OBJECTIVE

To explore sleep risk factors and their association with adverse events in transportation operators.

METHODS

Self-reported sleep-related behaviors were analyzed in transportation operators (drivers, pilots, and rail operators) aged 26 to 78 years who completed the National Sleep Foundation's 2012 "Planes, Trains, Automobiles, and Sleep" survey. Regression analyses were used to assess the associations of various sleep-related variables with the combined outcome of self-reported accidents and near misses.

RESULTS

Age- and body mass-adjusted predictors of accidents/near misses included an accident while commuting (odds ratio [OR] = 4.6; confidence interval [CI], 2.1 to 9.8), driving drowsy (OR = 4.1; CI, 2.5 to 6.7), and Sheehan Disability Scale score greater than 15 (OR = 3.5; CI, 2.2 to 5.5). Sleeping more than 7 hours nightly was protective for accident/near misses (OR = 0.6; CI, 0.4 to 0.9).

CONCLUSION

Recognized risk factors for poor sleep or excessive daytime sleepiness were significantly associated with self-reported near misses and/or accidents in transportation operators.

Association between travel length and drug use among Brazilian truck drivers

OBJECTIVE

To investigate whether the use of the stimulants amphetamines and cocaine by truck drivers in Brazil was related to travel length.

METHODS

Truck drivers were randomly stopped by the Federal Highway Police on interstate roads in Sao Paulo State during morning hours from 2008 to 2011 and invited to participate in the project "Comandos de Saúde nas Rodovias" (Health Commands on the Roads). Participants were asked about the use of drugs, travel distance, and age, and gender was recorded. Samples of urine were collected and analyzed for amphetamine, benzoylecgonine (a metabolite of cocaine), and carboxytetrahydrocannabinol (THC-COOH; a metabolite of cannabis) by immunological screening and quantification by gas chromatography-mass spectroscopy.

RESULTS

Current use of amphetamine, cocaine, and cannabis was reported by 5.7%, 0.7%, and 0.3% of the truck drivers, respectively. Amphetamine, benzoylecgonine, and THC-COOH were found in urine samples from 5.4%, 2.6,% and in 1.0% of the drivers, respectively. There was a significant association between the positive cases for amphetamine and reported travel length; 9.9% of urine samples from drivers who reported travel length of more than 270 km were positive for amphetamine, and 10.9% of those drivers reported current use of amphetamines. In most cases, appetite suppressants containing amphetamines had been used, but the purpose was most often to stay awake and alert while driving. Truck drivers with travel length of more than 270 km had significantly higher odds ratio (OR) for having a urine sample that was positive for amphetamine when adjusted for age as confounding factor (OR = 9.41, 95% confidence interval [CI], 3.97-22.26). No significant association was found between the use of cocaine or cannabis and travel length.

CONCLUSION

Truck drivers who reported driving more than 270 km had significantly higher frequencies of urine samples positive for amphetamine and reported significantly more frequent current use of amphetamines than those who reported shorter driving distances.

The culpability of drivers killed in New Zealand road crashes and their use of alcohol and other drugs

Over a period of five years, blood samples were taken from 1046 drivers killed as a result of a motor vehicle crash on New Zealand roads. These were analysed for the presence of alcohol and a range of both illicit drugs and psychoactive medicinal drugs. Driver culpability was determined for all crashes. The control group of drug- and alcohol-free drivers comprised 52.2% of the study population. Drivers positive for psychoactive drugs were more likely to be culpable (odds ratio (OR) 3.5, confidence interval (CI) 95% 2.4-5.2) than the control group. Driver culpability exhibited the expected positive association with alcohol use (OR 13.7, 95% CI 4.3-44) and with combined alcohol and cannabis use (OR 6.9, 95% CI 3.0-16). There was only a weak positive association between cannabis use (with no other drug) and culpability (OR 1.3, CI 95% 0.8-2.3). Furthermore, the OR for drivers with blood tetrahydrocannabinol (THC) concentrations greater than 5 ng/mL was lower (OR 1.0, CI 95% 0.4-2.4) than drivers with blood THC concentrations less than 2 ng/mL (OR 3.1, CI 95% 0.9-10). This is inconsistent with results reported by other studies where a significant increase in crash risk was found with blood THC levels greater than 5 ng/mL. In this study, there were very few drivers who had used a single drug, other than cannabis or alcohol. Therefore, from this study, it is not possible to comment on any relationship between opioid, stimulant or sedative drug use and an increased risk of being killed in a crash for the drivers using these drugs. The results from a multivariate analysis indicate that driver gender, age group and licence status, (P=0.022, P=0.016, P=0.026, respectively), the type of vehicle being driven (P=0.013), the number of vehicles in the crash (P<0.001), the blood alcohol concentration of the driver (P<0.001) and the use of any drug other than alcohol and cannabis (P=0.044), are all independently associated with culpability.

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

INTRODUCTION

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

METHODS

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

RESULTS

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

CONCLUSION

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

Psychoactive substance use by truck drivers: a systematic review

The aim of this study was to summarise the scientific evidence on the prevalence of psychoactive substance use and on the factors associated with their intake among truck drivers. A systematic review was performed in the databases PubMed, Scientific Electronic Library Online, Latin American and Caribbean Health Sciences, and Cochrane and 36 cross-sectional studies were identified with quantitative results about the use of psychoactive substances by truck drivers. Out of these, 28 were carried out in countries with large land areas and 23 obtained their information through self-reporting. The most frequently studied substances were alcohol (n=25), amphetamines (n=17), marijuana (n=16) and cocaine (n=13). The prevalence of the use of these substances greatly varied: alcohol (0.1-91.0%); amphetamines (0.2-82.5%), marijuana (0.2-29.9%), cocaine (0.1-8.3%). The frequency of substance use was lower in studies that investigated the presence of these substances in biological samples than in those based on self-reported use. In 12 studies that evaluated factors associated with the intake of psychoactive substances, the following stood out: younger age, higher income, longer trips, alcohol consumption, driving in the night shift, travelling interstate routes, long or short sleep, fewer hours of rest, little experience of the driver, connection with small and medium sized companies, income below levels determined by labour agreements, productivity-based earnings and prior involvement in accidents. The frequency of psychoactive substance use by truck drivers seems to be high, although that greatly varies according to the type of substance and the method of collecting the information. The use of these substances was mainly associated with indicators of poor working conditions.