Dr. Wan-chin Kuo investigates social determinants of health to improve truck drivers’ well-being
By Lisa Fields
Criss-crossing the country in a big rig for a living makes it challenging for truck drivers to consistently eat healthily, exercise and get enough restful sleep. Assistant Professor Wan-chin Kuo, PhD’19, RN, is hoping to change that, using behavioral data and biomarkers to improve the health profile of truck drivers.
“We think about the social-ecological model, that health is not just dictated by our choice of health behaviors,” Kuo says. “We never think how our work might potentially influence our health later on. My curiosity is, if there is a link, how can we mitigate that?”
Truck drivers are often sedentary and work during late-night hours. They’re also at increased risk of hypertension, high cholesterol, and diabetes. Kuo and her research team have been gathering data about the daily habits of truck drivers to better understand how social determinants of health impact their cardiometabolic health. The researchers are examining the drivers’ behaviors at work and at home to get a more complete picture of their lives. They’re also developing digital interventions, including an app, to help truck drivers maintain or improve their cardiometabolic health.
For years, Kuo has had an interest in studying truck drivers, construction workers, and other laborers who perform physically demanding work, often at odd hours. Her academic curiosity was inspired by the career choices of the men in her family.
“My dad, uncle, and grandfather were industrial workers in mechanical shops, fixing things from large trucks to smaller vehicles when I was growing up,” Kuo says. “They wanted to demonstrate that they were strong, but you could see their work environment was harsh.”
Portrait of a Truck Driver
Work conditions for truck drivers can be particularly grueling. Many drivers spend several days per week away from home. They drive alone, often at night, when fewer vehicles are on the road. They sit for hours at a time and may have scant opportunities for physical activity. If they don’t plan their meals ahead of time, they may be stuck eating fast food along their route. And they may choose the convenience of sleeping in their truck cab rather than the comfort of a hotel bed.
“Their salary is based on how far they drive, so they don’t want to waste time when they are working,” Kuo says. “However, there are federal regulations limiting driving, because resting is very important.”
Assembling an Interdisciplinary Team
Kuo has built a team of professors and students who help her gather truck drivers’ health data and develop health interventions. She leads them through her research lab, the Metabolic Environment Targeting Age Reversal (METAR) Lab. METAR is housed in the School of Nursing, but the professors and students who work with her are from varied disciplines, including engineering, kinesiology, nursing, information science, computer science, marketing, and biology.
“UW–Madison is amazing, because professors from different departments like to collaborate,” Kuo says. “When I wanted to do research about truck drivers and construction workers, I reached out to Dr. James Schauer in Civil Engineering, who studies the effects of air pollution on health. We reached out to Dr. Tony McDonald in Industrial Engineering; some of his research is focused on truck drivers, fatigue, and how that affects driving.”
Finding the Right Truck Drivers
The most effective way for the research team to interact with truck drivers, Kuo has found, is to attend Wisconsin Motor Carriers Association (WMCA) community events. It isn’t feasible to invite drivers to campus because of their regimented routes and nontraditional work hours, and because the parking lots can’t accommodate tractor-trailers.
At WMCA events, Kuo and her team introduce themselves as researchers who are interested in health topics that truck drivers care about. They connect with drivers who want to participate in their research.
“It requires us to build trust between the researchers and participants,” Kuo says. “We listen to their wisdom, experiences, and challenges. It takes time, but it’s very helpful.”
Truck drivers who participate complete an anonymous survey about their work behaviors, lifestyle habits, and cardiometabolic health.
Drivers who become more deeply involved in the research agree to be interviewed in person or through video calls. Some consent to a finger-prick test, providing biomarker data. They may choose to wear a smartwatch and an air-quality monitor for four days – two work days, two off days – to record their sleep duration, daily step count, heart rate and more. During that four-day period, they use an app that periodically prompts them to recount what they’ve eaten during the previous four hours, providing researchers with key data.
“This gives us more precise information about what they eat, compared to the survey asking them to think about how many fruits and vegetables they ate in the past week,” Kuo says.
While speaking with business owners at WMCA events, Kuo has learned that many companies are invested in their truck drivers’ health. Most companies place refrigerators in their truck cabs, so drivers can bring healthy food from home. Some companies send truck drivers with poor sleep habits for sleep studies; if they’re diagnosed with sleep apnea, the company pays for a continuous positive airway pressure (CPAP) machine. Some companies reimburse truck drivers for gym memberships, encouraging them to stay active. But the companies’ good intentions are not always fully realized.
“A lot of the drivers say, ‘I really want to exercise at the gym, but after work, at home, I finally can spend time with my family, so I do not go,’” Kuo says.
Using Driver Data to Deliver Solutions
Because truck drivers are focused on reaching their destinations quickly, they may not take long enough breaks for exercise. Kuo and her team take details like this into consideration when they create interventions to encourage healthier outcomes.
“As nurses, when we say, ‘exercise more, eat healthy,’ we want to know how that actually looks in real life,” Kuo says. “The essence that our lab tries to address is that if we can make an environment one where making healthy choices is the default setting, then they don’t need to deliberate how and where to exercise or what food to buy and where to buy it.”
Kuo’s team uses truck drivers’ heart-rate data to understand their stress levels.
“We think heart-rate variability is a new way to measure stress in these populations, beyond asking, ‘On a scale of one to five, how stressed are you?’” Kuo says. “We know that when we are under stress, our behavior changes. That means, ‘I know I need to eat healthy, but when I have stress, I don’t prioritize that anymore.’”
The interventions that Kuo and her team are creating for their app consider what truck drivers could realistically fit into their schedules, based on the data they’ve compiled.
“We know that asking them to do one hour of exercise is really challenging, so I talked with Dr. Keith Knurr in Physical Therapy, and we broke it down,” Kuo says. “How does spreading it throughout the day look, during available times, for 10 or 20 minutes of exercise? The truck drivers talked to us about motivation. How can we embed motivation or gamification into this app?”
Members of Kuo’s team, including Kinesiology students, have performed truck-environment simulations to create interventions tailored to the spaces that truck drivers regularly inhabit, to increase the chances of drivers exercising when they aren’t driving.
“In a semi-truck sleeping berth, how does that space allow you to do stretching or weightlifting, so you are not exercising outside your truck during your break?” Kuo says. “If they cannot drive because of loading, unloading or logistics, they cannot walk outside, because it is dangerous, with moving vehicles.”
Trucking Toward the Future
Kuo’s initial research on truck drivers has raised questions that she’d like to investigate further, about loneliness and its effect on mental health, as well as challenges that different driver populations face.
“It’s a predominantly Caucasian industry, but we know there are minorities working in the industry – how can we reach them?” Kuo says. “And recruiting female truck drivers for research is very difficult, so we are thinking about ways to involve this group and create an intervention tailored to their needs.”
Kuo hopes that her research findings about truck drivers may have applications for workers in other industries with similar work habits. For example, truck drivers sit for the majority of their workday; so do many office workers.
“Some of the interventions we are trying to introduce probably could be modified into another, longer-sitting job,” Kuo says.
Kuo and her team are still gathering data and fine-tuning their app. Once the app is ready for distribution, Kuo hopes it will help truck drivers adopt healthier habits and improve their heart health.
“When we have a self-sustainable product, I hope everyone in the industry will use it in Wisconsin and beyond,” Kuo says. “It’s important to let the communities we study benefit from our research findings.”
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