摘要：Objectives. To evaluate the effectiveness of the Safety and Health Involvement For Truckers (SHIFT) intervention with a randomized controlled design. Methods. The multicomponent intervention was a weight-loss competition supported with body weight and behavioral self-monitoring, computer-based training, and motivational interviewing. We evaluated intervention effectiveness with a cluster-randomized design involving 22 terminals from 5 companies in the United States in 2012 to 2014. Companies were required to provide interstate transportation services and operate at least 2 larger terminals. We randomly assigned terminals to intervention or usual practice control conditions. We assessed participating drivers (n = 452) at baseline and 6 months. Results. In an intent-to-treat analysis, the postintervention difference between groups in mean body mass index change was 1.00 kilograms per meters squared ( P < .001; intervention = −0.73; control = +0.27). Behavioral changes included statistically significant improvements in fruit and vegetable consumption and physical activity. Conclusions. Results establish the effectiveness of a multicomponent and remotely administered intervention for producing significant weight loss among commercial truck drivers. Nearly 70% of US freight travels on a truck at some point. 1 From this perspective, the men and women who operate large commercial trucks are the backbone of the tangible goods economy. However, the welfare of this workforce is in jeopardy. Obesity is twice as prevalent among US truck drivers compared with the general population (69% vs 31%). 2 Regulated medical conditions associated with obesity, such as uncontrolled hypertension, may disqualify drivers from working. In addition to creating stressful precarious employment, obesity and associated sleep disorders 3 place drivers at personally imperceptible—yet very real—increased risk of crash involvement. To illustrate, new truck drivers with class II or III obesity (World Health Organization criteria) have greater than 50% higher odds of crash involvement during their first 2 years. 4 Obstructive sleep apnea roughly doubles drivers’ crash risk. 5 Large truck crashes, although more rare per vehicle mile traveled than those involving personal vehicles, are 20% to 55% more likely to result in a fatality. 6 Thus, improving the well-being, health, and safety of commercial truck drivers is a public health priority. Diverse multilevel interventions are needed to reduce obesity hazards and support weight loss among commercial truck drivers. Obesogenic factors in trucking include long work hours, prolonged sitting, unfavorable sleeping conditions, prevalent calorie-dense foods, and limited access to whole foods and safe places to walk. Evaluations of corporate health programs for drivers are typically limited to brief case studies. 7 Peer-reviewed evaluations of body weight management interventions among truck drivers (or among samples including truck drivers) identified in our literature search included 2 uncontrolled pilot studies, 8–10 3 studies with nonrandomly selected control groups, 11–13 and 2 randomized controlled trials. 14,15 Three of these interventions produced mean or median within-group weight loss greater than 3 kilograms. 8,10,15 Only 1 of these more effective approaches, a 12-month lifestyle counseling intervention implemented with Scandinavian truck and bus drivers, 15 was established as effective with a randomized controlled design. The Safety and Health Involvement For Truckers (SHIFT) intervention model involves evidence-based tactics amenable for implementation with isolated workers, including weight-loss competition, behavior and body weight self-monitoring, computer-based training, and motivational interviewing. 16–19 In the previously referenced SHIFT pilot study, the intervention produced significant within-group mean weight loss of −3.5 kilograms (7.8 lb). 8 However, the lack of a control group and small sample prevent strong conclusions about effectiveness. To address the public health need and research gaps, we conducted a randomized controlled trial of SHIFT with US truck drivers.
