Transportation, Warehousing, and Utilities

Participating core and specialty programs: National Center for Productive Aging and Work

Federal agencies, trade associations, labor organizations, employers, owner/operators, and researchers use NIOSH information to reduce cardiovascular disease among transportation, warehousing and utilities workers.

NOTE: Goals in bold in the table below are priorities for extramural research.

  Health Outcome Research Focus Worker population* Research Type
A Cardiovascular disease Best type of interventions to address the risk factor of obesity Long-haul truck drivers, short-haul truck drivers, bus and transit, rail, maritime, couriers and messengers Intervention
B Cardiovascular disease Best communication methods to decrease risk factors, tailoring interventions from other sectors Long-haul truck drivers InterventionTranslation
C Cardiovascular disease Work organization best practices (e.g., sleep and fleet management) Workers with non-standard work arrangements, long-haul truck drivers, short-haul truck drivers, bus and transit, rail, maritime, couriers and messengers Basic/etiologic


D Cardiovascular disease and other heat-related illnesses Work organization best practices to prevent heat stress Utilities and warehousing workers Intervention

*See definitions of worker populations

Activity Goal 1.13.1 (Basic/Etiologic Research): Conduct basic/etiologic research to better understand relationship between work organization factors and cardiovascular disease among TWU workers.

Activity Goal 1.13.2 (Intervention Research): Conduct studies to develop and assess the effectiveness of interventions to decrease cardiovascular disease risk factors among TWU workers.

Activity Goal 1.13.3 (Translation Research): Conduct translation research to understand barriers and aids to implementing cardiovascular risk factor interventions among TWU workers.


Obesity is a risk factor for chronic disease that manifests itself in health conditions such as metabolic syndrome, cardiovascular disease, obstructive sleep apnea, and diabetes; premature death and disability; increases in health care costs; lost productivity; and social stigmatization [NIH 1998; Thompson et al. 1999; Martin and Church 2009]. It has also been noted that a higher prevalence of hyperlipidemia and hypertension is found in overweight and obese individuals. An estimated 34.2% of all TWU workers are obese [NIOSH 2013], 21.1% have hypertension [NIOSH 2013] and 6.1% have cardiovascular disease (CVD) [Helmkamp et al. 2013]. Obesity is related to multiple medical factors as well as increasing numbers of conditions which may, for example, limit a commercial motor vehicle driver’s driving certification [Thiese et al. 2015]. Psychological stressors and the work demands of TWU workers create special challenges: tasks may be sedentary in nature, limited options may be available for where and when to eat while working or resting away from home, sleep periods may often be less than the 7-9 hours daily recommended, and work arrangements may be non-standard [Hirschkowitz et al. 2015]. Thirty-eight percent of TWU workers indicate less than 7 hours of sleep in a 24-hour period [CDC 2012], 66.7 percent of TWU workers did not meet CDC guidelines for physical activity [Helmkamp et al. 2013], and 31.1% report work-life interference [NIOSH 2015]. Twenty seven point eight percent of TWU workers work more than 48 hours per week compared to 18.7% of the U.S. work force and 35.7 percent work non-standard shift, compared to 26.6% of the U.S. workforce [NIOSH 2010]. Seventeen point four percent of TWU workers report frequent night work [NIOSH 2015]. Other psychological stressors occur because of the increasingly common nontraditional employer-employee relationships TWU workers with non-standard work arrangements account for 15.9% of employees [Violanti et al. 2009, Katz and Krueger 2016]. The cardiovascular system has an important role in thermoregulation, as warm blood is circulated from the core to the skin during heat transfer to the environment. However, heat stress and factors like dehydration, can lead to cardiovascular strain, resulting in heat-related illnesses [Wilson et al. 2014, NIOSH 2016].  Severe heat-related illness may cause permanent damage to the organs, including the heart. One study found that males with heat-related illness were at an increased risk of death from cardiovascular disease and ischemic heart disease [Wallace et al. 2007].


Previous NIOSH obesity TWU surveillance research has focused on long- and short-haul truck drivers, and more efficient methods to monitor obesity among TWU workers are needed. Further NIOSH research on obesity should include intervention and evaluation studies focusing on obesity in commercial drivers as well as other high prevalence occupations. There is a need to evaluate both programmatic and technological approaches so that health guidelines for the TWU sector are supported by scientific evidence. Intervention research to assess the effectiveness of organizational interventions and translation research to understand barriers to drivers in adopting effective interventions is needed. Research should consider cost-effectiveness as well as features of work organization in the TWU sector such as self-employment, time pressures, and other work-related stressors. Because non-standard worker arrangements are understudied but increasingly prevalent, and their determinants and health and safety consequences are poorly understood, basic/etiologic research leading to intervention is needed. Research should also address work organization models for sleep as well as fleet management. Particularly needed are models on the determinants and effects of work arrangements and efforts to improve the taxonomy of work arrangements and their characteristics. Workers and managers show widespread lack of appreciation and knowledge about the importance of sleep health and risks associated with poor sleep and fatigue. The evidence for a link between short sleep and CVD risk factors is an active area of research [Knutson KL et al. 2007]. Translation and intervention research are needed to develop effective administrative controls for management and to understand how to implement them most effectively, as well as how to best communicate the health risks of obesity. Existing approaches are not always accepted among TWU workers. Intervention research is needed to develop better heat prevention work practices that fit into the unique indoor environments of warehouse workers and outdoor environments of utilities workers.

CDC [2012]. Short sleep duration among workers—United States, 2010. MMWR 61(16):281-285.

Helmkamp JC, Lincoln JE, Sestito J, Wood E, Birdsey J, Kiefer M [2013]. Risk actors, health behaviors, and injury among adults employed in the transportation, warehousing, and utilities super sector. Am J Ind Med 56(5S):556-568,

Hirschkowitz M, Whiton K, Albert SM, Alessi C, Bruni O, DonCarlos L, Hazen N, Herman J, Katz ES, Kheirandish-Gozal L, Neubauer DN, O’Donnell AE, Ohayon M, Peever J, Rawding R, Sachdeva RC, Setters B, Vitielljo MV, Ware J, Hillard PJA [2015]. National Sleep Foundation’s sleep time duration recommendations: methodology and results summary. Sleep Health 1(1):40-43,

Katz LF, Krueger AB [2016]. The rise and nature of alternative work arrangements in the United States, 1995-2015. Washington D.C.: National Bureau of Economic Research No. w22667.

Knutson KL, Spiegel K, Penev P, Van Cauter E [2007]. The metabolic consequences of sleep deprivation. Sleep Med Rev 11(3):163-178.

Martin BC, Church TS, Bonnell R, Ben-Joseph R, Borgstadt T [2009]. The impact of overweight and obesity on the direct medical costs of truck drivers. J Occup Environ Med 51(2):180-184.

NIH [1998]. Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults: the evidence report. Washington, DC: U.S. Department of Health and Human Services, National Institutes of Health, NIH Publication No. 98-408,

NIOSH [2010]. National Health Interview Survey 2010 Occupational Health Supplement: transportation, warehousing, and utilities industry profile – Figure 5. Cincinnati, OH: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health.

NIOSH [2013]. Health Behavior Charts: National Health Interview Survey (NHIS), 2004 – 2013. Unadjusted prevalence of obesity among workers by industry. Cincinnati, OH: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health,

NIOSH [2015]. NHIS Occupational Health Supplement (NHIS-OHS). Cincinnati, OH: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health.

NIOSH [2016]. NIOSH criteria for a recommended standard: occupational exposure to heat and hot environments. By Jacklitsch B, Williams WJ, Musolin K, Coca A, Kim J-H, Turner N. Cincinnati, OH: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, DHHS (NIOSH) Publication 2016-106,

Thiese MS, Moffitt G, Hanowski RJ, Kales SN, Porter RJ, Hegmann KT [2015]. Commercial driver medical examinations: prevalence of obesity, comorbidities, and certification outcomes. J Occup Environ Med 57(6):659-665,

Thompson D, Edelsberg J, Colditz G, Bird AP, Oster G [1999]. Lifetime health and economic consequences of obesity. Arch Intern Med 159:2177-2183,

Violanti JM, Andrew ME, Burchfiel CM, Hartley TA, McCanlies E [2009]. Biosocial synergy: stress, cardiovascular disease, and high risk populations. Psychological factors and cardiovascular disorders. Sher l, ed., New York: Nova Science Publishers, Inc., Jan, p 1-31.

Wilson MD, Conroy LM, Dorevitch S {2014]. Occupational stress and subclinical atherosclerosis: a systematic review. Int J Occup Environ Health 20(4):271-280.

Page last reviewed: April 24, 2018