key: cord-0685524-nr9k7hf2 authors: Lemke, Michael Kenneth; Apostolopoulos, Yorghos; Sönmez, Sevil title: Syndemic frameworks to understand the effects of COVID-19 on commercial driver stress, health, and safety date: 2020-05-23 journal: J Transp Health DOI: 10.1016/j.jth.2020.100877 sha: 720b38be5940656a68fd797afe4dc832f603ac34 doc_id: 685524 cord_uid: nr9k7hf2 INTRODUCTION: U.S. commercial drivers are entrenched in a stressogenic profession, and exposures to endemic chronic stressors shape drivers’ behavioral and psychosocial responses and induce profound health and safety disparities. To gain a complete understanding of how the COVID-19 pandemic will affect commercial driver stress, health, and safety over time, and to mitigate these impacts, research and prevention efforts must be grounded in theoretical perspectives that contextualize these impacts within the chronic stressors already endemic to profession, the historical and ongoing forces that have induced them, and the potentially reinforcing nature of the resulting afflictions. METHODS: Extant literature reveals how an array of macro-level changes has shaped downstream trucking industry policies, resulting in stressogenic work organization and workplace characteristics. Emerging evidence suggests that the COVID-19 pandemic exacerbates existing stressors and introduces novel stressors, with potentially exacerbatory impacts on health and safety disparities. RESULTS: As COVID-19 exerts an array of multi-level stressors on commercial drivers, syndemic frameworks can provide the appropriate theoretical lens to guide research and prevention. Syndemic frameworks can provide the grounding to allow foregoing commercial driver COVID-19 research to transcend the limitations of prevailing research frameworks by contextualizing COVID-19 stressors holistically within the complex system of endemic chronic stressors and interrelated health and safety afflictions. Syndemic-informed prevention efforts can then be implemented that simultaneously tackle multiple afflictions and the macro-level forces that result in the emergence of commercial drivers’ health and safety disparities over time. CONCLUSIONS: The impacts of the COVID-19 pandemic on commercial drivers cannot be adequately understood or acted upon in isolation from the endemic chronic stressors and interrelated health and safety disparities that characterize the profession. Instead, commercial driver COVID-19 research and prevention needs syndemic frameworks to holistically understand the impacts of COVID-19 on commercial driver stress, health, and safety, and to identify high-leverage preventive actions. 1 ABSTRACT 1 Introduction 2 U.S. commercial drivers are entrenched in a stressogenic profession, and exposures to endemic 3 chronic stressors shape drivers' behavioral and psychosocial responses and induce profound 4 health and safety disparities. To gain a complete understanding of how the COVID-19 pandemic 5 will affect commercial driver stress, health, and safety over time, and to mitigate these impacts, 6 research and prevention efforts must be grounded in theoretical perspectives that contextualize 7 these impacts within the chronic stressors already endemic to profession, the historical and 8 ongoing forces that have induced them, and the potentially reinforcing nature of the resulting 9 afflictions. Extant literature reveals how an array of macro-level changes has shaped downstream trucking 12 industry policies, resulting in stressogenic work organization and workplace characteristics. 13 Emerging evidence suggests that the COVID-19 pandemic exacerbates existing stressors and 14 introduces novel stressors, with potentially exacerbatory impacts on health and safety disparities. As COVID-19 exerts an array of multi-level stressors on commercial drivers, syndemic 17 frameworks can provide the appropriate theoretical lens to guide research and prevention. 18 Syndemic frameworks can provide the grounding to allow foregoing commercial driver 19 research to transcend the limitations of prevailing research frameworks by contextualizing 20 COVID-19 stressors holistically within the complex system of endemic chronic stressors and 21 interrelated health and safety afflictions. Syndemic-informed prevention efforts can then be 22 implemented that simultaneously tackle multiple afflictions and the macro-level forces that result 23 in the emergence of commercial drivers' health and safety disparities over time. The impacts of the COVID-19 pandemic on commercial drivers cannot be adequately understood 26 or acted upon in isolation from the endemic chronic stressors and interrelated health and safety 27 disparities that characterize the profession. Instead, commercial driver COVID-19 research and 28 prevention needs syndemic frameworks to holistically understand the impacts of COVID-19 on 29 commercial driver stress, health, and safety, and to identify high-leverage preventive actions. that the current pandemic simultaneously exacerbates existing stressors and introduces novel 44 stressors, 6 with potentially profound consequences that may exacerbate disparities. However, to 45 gain a complete understanding of how the COVID-19 pandemic will affect commercial driver 46 stress, health, and safety over time -and to be able to ascertain how to best take action to 47 mitigate these impacts -research and prevention efforts must be grounded in theoretical 48 perspectives that contextualize these impacts within the chronic stressors already endemic to 49 profession, the historical and ongoing forces that have induced them, and the potentially 50 reinforcing nature of the resulting afflictions. Thus, using U.S. long-haul truck drivers as an 51 illustrative example, we advocate for using syndemic frameworks to guide research and 52 prevention regarding the effects of the COVID-19 pandemic on commercial driver stress, health, 53 and safety. home for weeks at a time, which effectively makes their worksites their "homes" for prolonged 77 periods of time. 12 As a result, drivers are particularly dependent on the amenities available in 78 these locales; however, these environments are notorious for lacking medical services or 79 5 opportunities for physical activity and healthy eating. 2, 11, 13 The mandatory prolonged periods 80 away from family and friends, exacerbated by scheduling and financial pressures, lead to chronic 81 social isolation 3,11,14 that is compounded by a pervasive lack of respect for LHTD that is manifest 82 through their numerous daily interactions with general public and, due to inherent job 83 requirements to act as a boundary spanner, customers, dispatchers, and even the government. 11 These multi-level chronic stressors often induce detrimental behavioral and psychosocial 85 responses by LHTD and significantly contribute to their excessive health and safety disparities. There is a dearth of empirical investigation into the impacts of the COVID-19 pandemic 98 on commercial drivers, including LHTD, which is due to both the recency of this public health As the COVID-19 pandemic exerts an array of multi-level stressors on commercial 142 drivers, researchers need an adequate 'lens' through which to view these dynamically complex 143 relationships and how they may induce multiple interrelated health and safety outcomes. Instead, commercial driver COVID-19 research and prevention needs syndemic frameworks to 198 provide the appropriate theoretical lens to holistically understand the impacts of COVID-19 on 199 commercial driver stress, health, and safety and to identify high-leverage preventive actions. Occupational outlook handbook: Heavy and tractor-trailer 207 truck drivers. US Department of Labor long-haul truck drivers: Work environment, physical health, and healthcare access Work strain, social isolation and 214 mental health of long-haul truckers. 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The Lancet • Major policy changes have rendered commercial driving a stressogenic profession • Commercial drivers' chronic stress exposures induce health and safety disparities • COVID-19 likely increases drivers' chronic stress exposures and worsens disparities • Commercial driver COVID-19 research should be grounded in syndemic frameworks • Syndemic-informed COVID-19 prevention for drivers would be holistic and multi-level Financial Disclosure: The Authors did not receive any specific funding for this work