Advisor(s)

Karen Heaton

Committee Member(s)

Chizimuzo Okoli
Jongwha Oh
Peng Li
Stephanie Hammond

Document Type

Dissertation

Date of Award

6-1-2026

Degree Name

Doctor of Philosophy (PhD)

School

School of Nursing

Department

Nursing

Abstract

Long-haul truck drivers (LHTDs) are exposed to a range of occupational hazards and stressors that threaten their health and well-being. These include, but are not limited to, irregular sleep patterns, fatigue, and chronic exposure to diesel engine exhaust (DEE) and tobacco smoke in the confined spaces of truck cabins. Smoking tobacco cigarettes is often used as a coping mechanism for occupational stressors and nicotine dependence, contributing to a high smoking rate among LHTDs (51%) compared to the general population (19%). Collectively, exposure to DEE and tobacco smoke may have a synergistic effect, increasing LHTD’s risk for lung cancer and other respiratory illnesses. Despite existing smoke-free policies among other industries, no federal regulations currently prohibit smoking in trucks, leaving LHTDs vulnerable to extended exposures of first-hand, second-hand, and third-hand smoke. Current gaps in the literature include biomarker-based measurements of nicotine exposure and worker well-being among LHTDs. The purpose of this dissertation was to advance the science of occupational exposures, specifically DEE as a concept and tobacco smoke, and explore their health implications. Three manuscripts were produced: 1) a concept analysis to define DEE exposure as a concept, emphasizing its association with lung cancer risk and potential synergy with tobacco smoke exposure, 2) a narrative review synthesizing the evidence on tobacco smoke exposure in vehicles, highlighting the dangers of SHS smoke exposure in vehicles and the gap among occupational and commercial drivers such as LHTDs, and 3) a cross-sectional study examining nicotine and cotinine uptake in hair to serve as proxy measure of nicotine exposure, also exploring its associations with worker well-being using the NIOSH Worker Well-Being Questionnaire (WellBQ). Collectively, these manuscripts highlight the demand for smoke-free cabin regulations, optimal air-quality controls, and smoking cessation interventions tailored to long-haul trucking, encouraging healthier work environments and well-being among this under-researched population.

Keywords

diesel engine exhaust;long-haul truck drivers;occupational exposures;tobacco smoke exposure;worker well-being

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