Many of the interview participants focused on how the physical work environment (e.g., the truck cab, truck stops, distribution centers) impacted health behaviors. There are limited healthy food choices available when the drivers are on the road. Truck stops consist mostly of fast-food restaurants with limited fruit and vegetable options. In addition, the few healthy options available (e.g., fruit, vegetables, water) are also expensive: “It’s cheaper to grab a soda and a bag of chips rather than a bottle of water or a Gatorade and a salad or a thing of fruit. You spend $3 versus $6. You do that twice a day, five days a week, that adds up for truck drivers.” [Instructor, 7]. The students also recognized the lack of healthy food choices at the truck stops. However, they also mentioned how the individual drivers need to resist the pressure of their physical environment by setting personal goals and planning: “It really depends on what my priorities are during my off time… Am I going to be intentional with the way I eat? Am I going to say no to the truck stop junk food and instead be prepared and have stuff that’s not going to be [fast food].” [Student, 12]

In addition to the costs and lack of access to healthy food choices at truck stops, other factors play a role. For example, the location of the truck stops where 18-wheelers can park is limited. These trucks fit either in truck stops, rest areas, or truck-only rest areas, all of which can be used for overnight parking during mandatory driving breaks. However, truck-only rest areas provide a place for drivers to park but do not have food options available. Other rest areas may have vending machines, but there is limited space for parking the larger trucks. These rest areas are also located away from cities or grocery stores, where a greater range of food options may be available. Some drivers may have refrigerators and/or microwaves in their cabs, but not all employers allow these appliances. Even if a driver wanted to take the time to go to a restaurant or grocery store, 18-wheelers do not fit and are also not allowed to park at most restaurants and grocery stores: “The only places we can get trucks into, 99% of them is all fast food. There’s no real sit-down restaurants or no way to get anything to eat. Then if you got to buy the stuff at truck stops, it costs you three times as much if you went to the grocery store to buy it. But you can’t get trucks into a grocery store.” [Driver, 5]

The physical work environment also impacts other health behaviors including physical activity and sleep. Due to the mobile, yet sedentary nature of work, all participants stated that long-haul truck drivers do not get enough physical activity. According to the participants, the daily schedule and the areas where they can park limit the drivers’ ability to exercise. The instructors and drivers emphasized that rest areas do not provide a setting conducive to exercise due to the location of the rest areas that are often closer to the highway with no walking trails or sidewalks. The supervisors and drivers specifically mentioned that truck-only rest stops are places only to park trucks, and they do not have areas to walk or exercise: “The availability of a place to actually get some exercise. Maybe they’re at a place where they pretty much have to stay in their truck and can’t get out and really do anything. So that would limit their exercise, going for a walk or something like that.” [Supervisor, 4] Again, the students indicated that the driver needs to be motivated to exercise and maintain their health regardless of their location and schedule. The students stated that when they start driving, they planned to engage in physical activity every day even when they were parked at truck stops or rest areas: “Suppose we get 11 hours a day. Most people, most our drivers, …, are supposed to exercise. Maybe every day, 30 minutes, 25 minutes. That’s the best thing.” [Student, 11]

Sleep is also impacted by the location of these rest stops. Participants in all groups mentioned that truck stops and rest areas are usually located directly off the highway in areas with a high flow of traffic and a lot of noise. The drivers stated that some companies will rent parking spots at distribution centers off the highway for drivers to park their trucks. This can provide a quieter place to sleep, however, these sites may have trucks parked from several different companies, which leads to traffic holdups when all the drivers are trying to get on the road in the morning or when drivers are trying to exit their parking spots. This can dissuade drivers from utilizing them: “The distribution center is a really crowded, small place. Our company has bought 3 parking spots at this center. I came in this morning at 4:15 am. And when I got in my truck, I was pinned in, and I couldn’t get out.” [Driver, 7]. The students also identified the perceived impact of the work demands on sleep and the long-term health of the drivers. They suggested that trucking companies provide motel rooms for drivers so they do not have to sleep in the truck cab: “I feel everybody should get a room, you know. Just because you do not get to sleep comfortably in the cab. Having a good bed to sleep on. That definitely works you know. Cause you don’t want to wake up with a sore neck, messed up back.” [Student, 2]

Potential solutions promoting healthy eating proposed by all groups focused primarily on the individual rather than the employer. For example, instead of purchasing food at truck stops, many mentioned bringing food from home or creating a “personal meal plan”. In addition to meal planning, drivers and instructors stated that they personally bought a microwave and refrigerator for their truck where they could store food and then cook it. Students also discussed the advantages of having a healthy meal plan and stated that they plan to prepare meals for the road when they start driving. While a meal plan could be a healthy option, the participants also discussed issues related to maintaining the plan. For example, they are home only for a few days each month, and most of their time would be spent on preparing meals instead of spending time with their family. Employer-level solutions referenced by participants included workplace incentive programs that could motivate drivers to engage in healthy behaviors and providing a separate room to allow sleep and rest when they are done with their hours at work.

Work Evaluation and Experience includes support at work, job demands (e.g., time constraints, long hours of work), and an individual’s job satisfaction. Good communication with one’s supervisor, particularly about the work conditions, was identified as important: “So, if you have good communication, that helps your employment. And it goes both ways, management and driver.” [Instructor] Particularly for new drivers, who may have unrealistic expectations about the work conditions and their ability to engage in healthy behaviors: “The students that I was training, they had no idea on how long they were going to be out once they got into their first truck. They didn’t know if they were going to be over the road [long-haul truck driving] or they didn’t know what all came in that. The expectations of the students and the company needs to be clearer.” [Instructor, 4]

Drivers indicated that conditions of work such as long work hours, time constraints, and regulations impacted their health behaviors. A major factor identified by participants in all groups was time constraints. Federal regulations in the United States allow drivers to work a 14-hour day, which includes a maximum of 11 hours driving. After this, they are required to take 10 hours off. During the workday drivers are transporting loads from one location to another and often the loads are time-sensitive, which means the load needs to make it to a specific location at a given time. This pressure to complete the job during this time frame also reduces the ability of drivers to engage in physical activity or get enough sleep and promotes the consumption of fast food: “Well I think just the fact that, DOT regulations, they can have 14 hours of work a day. And that 10 hours is time they need to shower, eat, talk to their family, sleep. They’re trying to fit a lot into that time, and they may not have the energy or just the allotment of time to exercise.” [Supervisor, 2] The drivers mentioned that the daily schedule and time-sensitive loads sometimes forces them to wake up early and work without enough sleep, “… sometimes go without sleep to get the loads delivered on time.” [Driver, 4]

One driver suggested companies could use an incentive program to promote healthy behaviors: “And I think something that company should do is maybe have an incentive to pay you to go out and walk, or do something like that, you know? They’re not getting their exercise. They’re extremely unhealthy…” [Driver, 5] Additionally, technology could be used to address driver concerns, including work conditions that impact health, in a timely manner: “There is a driver retention app that some companies use to address issues quickly because drivers aren’t always going to tell you what their problem is but they’ll type it on their app. Developing an app for your company and making things as digital as possible. So I think it’s just trying to stay ahead of technology and how to best utilize that to make their jobs easier, make them more comfortable, making sure that their truck is set up the right way.” [Supervisor, 2] Providing drivers with a single point of contact is another way to increase a driver’s job satisfaction, which can impact their health behaviors: “We’re trying to give them more attention in terms of giving them a driver manager so they kind of have one point of contact and somebody who can address all their needs.” [Supervisor, 2]

The Workplace Policies and Culture domain encompasses organizational policies, industry regulations, and tangible benefits (e.g., pay, health insurance). All participants discussed how industry regulations that allow 14-hours of work contribute to unhealthy behaviors among drivers, limiting their time to take breaks, exercise and eat healthy food: “I can drive my 11 hours and that’s it. I’m done. But I can’t go nowhere, because I got to sit there for another six hours or until the clock restarts. So, then you lay there and try to sleep and you can’t. Then when it is time to go you don’t feel like going, because you’ve not been sleeping, and you don’t want to get up.” [Driver, 1] Drivers also mentioned that despite the sedentary nature of the job, truck driving leads to fatigue due to whole-body vibration and the need for constant vigilance while driving.

Policies in the trucking industry and a culture that prioritizes customer service over worker well-being impact health behaviors among drivers: “…we are a customer service biz. We have time that we have to maintain. On-time services. On-time pickup. On-time delivery and that’s affecting the actual driver’s wellbeing.” [Supervisor, 1] Specifically, policies that restrict drivers from loading or unloading the freight (e.g., “no touch” policies) were described as having an impact on physical activity. Instructors and the current drivers indicated that most receiving companies do not allow drivers to touch the freight, and drivers are required to sit and wait in the break room or in their cabs until the loading and unloading of the freight is completed. Participants stated that these “no touch” policies limit the physical activity of the drivers. When they are allowed to get out of the cab and move around, the drivers have opportunities to get some physical activity: “Sometimes this job is so demanding, that it doesn’t allow you to get out of the truck. Like I’ll give you an example. We go to a customer, some of these customers will restrict you from even getting out of your truck, or they’ll have you go in the break room and sit there. They won’t allow you to roam or walk on their property or do anything. You end up sitting there waiting for your truck to be unloaded or loaded. And then you’re off and running to the next pickup or delivery, and same thing there.” [Driver, 3]

Another example is a company policy that provides or allows drivers to install refrigerators and microwaves in their trucks. This makes drivers less reliant on fast food as they have a place to store food and heat up meals: “Some companies stay away from putting refrigerators in the trucks. I think that installing a refrigerator and a microwave just offers one less thing that the drivers have to provide or have to go out and purchase in order to do this job.” [Supervisor, 2]

To recruit and retain employees, companies often offer competitive pay and benefits packages (Aryal et al. 2023): “I knew I could make a lot of money doing this.” [Student, 3] Instructors describe how they encourage students to evaluate offers and inquire about benefits before accepting a position. “We encourage them to take a good look. So, there’s a comparison sheet we give them. It is a list of items and as they go through that list, what’s most important to you as a driver. Okay? And then, when the recruiters come in here, or if you’re doing an interview ask those pertinent questions.” [Instructor, 2] Competitive pay and benefits packages are considered important to retain new drivers entering the industry: “I would think a lot of that would be good benefits, a good pay package and good driver benefits, medical insurance definitely, life insurance, dental insurance, and retirement, 401K’s and pensions and things like that.” [Driver, 4]

Health Status considers individual characteristics that impact one’s ability to work and how work conditions affect health. For many drivers, trucking is a second career. These drivers are older, often come from physically demanding industries (e.g., construction), and may have current or chronic health conditions: “…all my life has been strong back, weak-mind jobs whether it be work in stone quarries, bailing hay, picking stones, concrete work. The body has told me I need to slow it out. And, with the money that this industry pays and the opportunities of being able to get into a job that isn’t quite so physical all the time, that’s kind of what’s directed me towards it too.” [Student, 4] However, the sedentary nature of the job can worsen health conditions. Instructors, supervisors, and current drivers indicated that their health was adversely impacted after they started driving: “I started driving [a] truck, I was 250 pounds, I went clear up to 500 pounds. My health went to hell.” [Driver, 3] All participants indicated that health behaviors, primarily diet, were affected by various aspects of the work environment and organizational aspects of the trucking industry, such as long hours of work, time away from the family, and time constraints. “Well, I think just the fact that, I mean DOT regulations, they can have 14 hours of work a day. And that 10 hours is time they need to shower, eat, talk to their family, sleep. They’re trying to fit a lot into that time, and they may not have the energy or just the allotment of time to exercise.” [Supervisor, 2] In contrast, most of the solutions to promote healthy behaviors proposed by all participants focused on the individual. Meal planning and prepping was often discussed as a solution to unhealthy eating on the road: “I used to meal prep. I used to only be home five or six days a month and when I came home, I meal prepped, and I had a fridge in the truck and a microwave or a little oven thing.” [Instructor, 3]

The Home, Community, and Society domain captures intangible factors such as social relationships, and tangible factors including financial security and activities outside of work. Drivers indicated that they did not want to spend their limited hours at home preparing to go back out on the road. “We do have some drivers that pre-make their meals. They’d try and do some preparation but if they’re home on Friday and leaving out on a Sunday, they’re spending a portion of their downtime just preparing to go back out again. Some of them may not want to be slaving over the grill making a healthy meal or packaging up all their meals.” [Supervisor, 2] Furthermore, instructors and current drivers also mentioned the support of their family in maintaining healthy behaviors. Some instructors said that their spouses were more conscious about their health and packed their meal before they left for the road: “Even when I had my own truck, I didn’t have a microwave, but I ate better because my wife prepped everything for me when I left. I probably ate better on the road than I did it at home.” [Instructor, 6]