Occupational Health Risks at Truck Stops: Evaluating Service Gaps and Safety Needs for Long-Haul Drivers

Abstract

Interest in improving roadside services for long-haul truckers’ health, safety, and well-being has led to an effort to describe the services offered at truck stop/rest areas. This study aimed to describe services offered in truck stop and rest areas and to determine, based on what was available, their implications for the health of long-haul truck drivers. A systematic and structured direct observation of thirteen truck stop and rest areas was undertaken within one state in the US on a major north–south interstate highway from October 2023 to June 2024. The categories of services observed included food, physical activity, rest, personal hygiene and health, and safety. A descriptive analysis of the data was performed. Seventeen visits were carried out in 13 truck stop and rest areas. All sites offered paved parking areas, with lighting and signage; 92% offered internet access; more than 85% offered food, safety, and personal hygiene services; 69% offered laundry services; 54% had a convenience store and hotel nearby; and 15% had green/natural areas with benches. The services offered at the truck stop and rest areas in this study meet the basic needs of food, personal hygiene, and safety of truckers and can serve as lessons for other states and countries to consider.

1. Introduction

Living and working conditions are social determinants of health. The environment influences healthy behavior choices and can have repercussions on people’s well-being and health [1]. In the road transport sector, every day, thousands of long-haul truck drivers (LHTDs) drive hundreds of kilometers transporting feedstock, goods, and essential products. These workers are often away from home for several days and need to use stop and rest areas to access food, personal hygiene, and rest services [2,3,4].

Thus, the stop and rest areas, in addition to offering basic services for trucks, are fundamental to the safety, wellbeing, and health of LHTDs [2,5]. Often, truck stop and rest areas are located near highways, in gas stations, and are considered public spaces, which do not always present the necessary structure to meet the safety and health needs of LHTDs [2,6,7,8]. The literature shows that the main challenges faced by LHTDs are related to the availability of parking spaces [6], which highlights the importance of expanding the opportunities for stopping and resting [4,6,9,10,11] as well as space for basic needs, including eating with the availability of healthy options [2,4,5,8,12], adequate space for physical activity [3,4,13], and tables and chairs for rest and socialization [9,14].

In view of the importance of the environment for people’s health [1], given the gap identified in the literature on the availability and implications of services offered in the stop and rest areas in the health and well-being of LHTDs [3,13], and since no studies on the subject were located along the major north–south highway in the state of Oregon, US, it is considered relevant and innovative to describe the services offered in the stop and rest areas and discuss their influences on the well-being and health of LHTDs to promote reflection and support policies that bring effective solutions to this global problem, as evidenced by studies from the US [6,8,9,10,12,13], Canada [4], Spain [11], Germany [14], Australia [2], South Africa [3], and Brazil [8]. This study aimed to describe the services offered in truck stop and rest areas and their implications for the health of long-haul truck drivers.

2. Materials and Methods

This qualitative descriptive study consisted of a direct, systematic, and structured observation of strategically selected sites from the Oregon Department of Transportation list of truck stop and rest areas along the major north–south highway in the state of Oregon, US. Qualitative description allows the investigation of a phenomenon of interest in a natural environment [15,16]. Because only public areas were observed, and it was not human subject research, there was no need for review by an institutional review board.

2.1. Research Team

The observation was carried out by two female field researchers. The first author is a visiting researcher from Brazil who was aiming to conduct this transnational research study in Brazil and the US. Her knowledge of the services offered at stop and rest areas was based on the literature and experience in the development of qualitative and quantitative studies with long-haul truck drivers in Latin America. The second author is a female Brazilian student of anthropology, on an internship abroad (in the US), with experience in the development of qualitative and observation studies. The third and fourth authors are American researchers with experience in LHTDs, the transportation environment, American culture, and expertise in the occupational health and mental health of workers. An additional male researcher (not listed as an author) observed and recorded the personal hygiene services of men’s restrooms and bathrooms.

2.2. Design of the Study

Qualitative descriptive research is a qualitative approach that allows the investigator to use multiple case purposive sampling over time through detailed, in-depth data collection involving multiple sources of information (e.g., observations, audiovisual material, and reports) and reports a description and case-based themes [15]. To ensure unbiased results, the methodology was selected specifically to avoid influence from site managers or owners and to enhance data reliability through multiple strategies.

2.2.1. Direct Observation

Direct observation was chosen as a methodology to explore how services are offered, the dynamics and context, as well as the interactions of drivers and consumption of services. This methodology allows the researcher to act as an attentive spectator, seeking to see and record the maximum occurrence of the phenomena under study [17].

2.2.2. Photography

Photography was used because it is full of symbolism and brings to light cultural and social models of an era, social class, and cultural class [18]. It also favors obtaining data that support the analysis, enable initiative for the implementation of the changes, and validate data obtained by other techniques [19]. The photographs are also “good to think” because they reveal values and motivations implicit in the cultural practice of self-representation [20]; they also prompt people to think about the socio-cultural and environmental factors that influence the health of long-haul truck drivers. The manuscript was prepared according to the COREQ criteria checklist (Consolidated Criteria for Reporting Qualitative Research) [21].

2.3. Study Setting and Period

The truck stop and rest areas in Oregon are like truck stop and rest areas in other states [6]. Truck stops in the US are primarily owned by large national companies [22] and, therefore, are similar or consistent across the US. According to the Oregon Department of Transportation (ODOT) [23], the state of Oregon has 39 rest areas and 62 stop and rest areas located on Interstate 5 (I-5) and Interstate 84 (I-84), which are the two main interstates. I-5 has 15 rest areas run by ODOT that provide basic bathroom services and parking for rest in rural areas and 26 stop and rest areas run by private companies offering fuel, food, hygiene, and other services in urban areas [23]. I-5 is the longest of the interstates in Oregon, running north and south through Oregon between Washington state to the north and the state of California to the south.

Data collection occurred between October 2023 and June 2024; data included observations of services offered at 13 stop and rest areas of LHTDs on the I-5 interstate highway (I-5), in the state of Oregon, US, at the following exits: 24, 30, 33, 76, and 99 and 119, 148, 199, 238, 263, 278 (two locations), and 307 (Figure 1).

The truck stop and rest areas were chosen as part of the list of truck stop and rest areas provided by the Oregon Department of Transportation (ODOT/no date) at https://www.oregon.gov/odot/mct/pages/oregon-truck-stops.aspx (accessed on 15 August 2023). Four truck stop and rest areas were visited twice, and 13 of them had at least one observation, totaling 17 observation visits, with an average duration of two hours and twenty minutes per location. Most observations were carried out during the day, and only one truck stop and rest area observation was carried out during the day and at night. There were 1556 parking spaces in total, with an average of 120 parking spaces per location, ranging from 5 to 300 parking spaces for trucks [23].

2.4. Literature Review and Conceptual Definitions

The authors used an author-developed observation tool to collect data. For the initial construction of the tool, a literature review revealed constructs that would frame the observations: (1) food, (2) personal hygiene and health, (3) physical activity, (4) rest, and (5) safety [24]. These items were then refined, defined, and described using the literature and Medical Subject Heading (MeSH) terms [8] (

Table 1. Concepts of services observed in the truck stop and rest areas (Oregon, 2024).

Service	MeSH Term	Concept
Food	Diet (diet)	Regular method of eating food and drink adopted by a person or animal.
Personal hygiene and health	Hygiene	Science that deals with the implementation and maintenance of health of the individual and the group. It includes procedures, conditions, and practices that lead to health.
	Occupational Health	Promotion and maintenance in the highest degree of the physical, mental, and social well-being of workers in all occupations; prevention among workers of occupational diseases caused by their working conditions; protection of workers in their labors, from the risks resulting from adverse health factors; placement and conservation of workers in occupational environments adapted to their physiological and psychological skills.
Physical activity	Exercise	Usually regular physical activity, performed with the intention of improving or maintaining physical fitness or health. It is different from physical exertion and is focused mainly on physiological and metabolic responses to energy use.
Rest	Rest	Freedom of activity.
Safety	Safety	No exposure to danger and protection against the occurrence or risk of injury or loss. It suggests optimal precautions in the workplace, in the street, in the home, etc., and includes personal safety as well as property safety.

Source: MeSH (Medical Subject Headings) terms [8]. (https://www.ncbi.nlm.nih.gov/mesh/ accessed on 5 August 2023).

).

2.5. Instruments and Procedures for Data Collection

The observation tool provided a table with dichotomous items (e.g., restaurant, fast food, shower, and or laundry) and open questions (e.g., What are the positive points that promote truck driver well-being or negative points of the stopping and resting area?) regarding the services offered in truck stop and rest areas. The tool was pilot tested at two sites and then was refined and finalized for the study. In addition to the observation tool, researchers took photographs of the services offered and wrote handwritten notes in a notebook to record observations in the observed environments. We collected Google Earth images (earth.google.com/web/) of the identified places (truck stop or rest areas) to identify the organization of the stops and rest areas before each visit. For data processing, the information collected was entered in an Excel file, and the photographs were stored in a researcher’s personal file. As a criterion of validity, saturation was used as a criterion, achieved when the data begin to repeat itself. The criterion of reliability was that of reflexivity, performing self-reflection during field work, from the consciousness of different perspectives and cultures. The researchers have experience with US and Brazilian cultures, an understanding about the reality of truck stop and rest areas, and experience with quantitative and qualitative interviews and observations of LHTDs in the US and Brazil.

2.6. Data Analysis

The data collected were recorded in a Word spreadsheet and in the notebook, containing the researcher’s perceptions about the observed services, which were used to support the thematic description and understanding of the results of this study. For analysis, descriptive statistics were used to evaluate the data of 17 completed tools from 13 truck stops visited; 961 photos taken, an average of 56 in each truck stop and nearby, and 11 photos per item evaluated (food, physical activity, rest, personal hygiene and health, and security); and 51 pages of field notes, with an average of 3 pages per truck stop visited. The data were analyzed using the Statistical Analysis Software (SAS, version 9.4), based on a database created using the Excel application. The data were described using absolute and percentage frequency tables.

3. Results

We conducted 17 service observation visits at 13 truck stop and rest areas that are all public and located on Interstate 5, in Oregon, US. The services observed were food, physical activity, rest, personal hygiene and health, and safety. The truck stop and rest areas visited offered five restaurants (another one restaurant has been closed since the COVID-19 pandemic), 14 fast food restaurants, two food trucks, and 11 self-serve, prepared, ready to eat food areas; 11 had sugary drink vending machines, and 11 had fresh fruits. All 13 places visited offered paved parking areas, with lighting and signage; 92% offered internet access; 92% (12) had a fuel station; 84% (11) offered at least one convenience store; more than 85% offered food, safety, and personal hygiene services; 69% had a laundry service, 54% had a lounge area in the convenience store and hotel nearby; 15% had a green area with benches; and one location offered Automatic External Defibrillator (AED). We identified a lack of space for physical activity, common space for meals, and access to health services (

Table 2. Services offered at the stop and rest areas located on Interstate 5, Oregon, USA, 2024.

Item	N	%
Food
1- Healthy foods (fresh fruits, vegetables and salads, boiled eggs, and chilled natural sandwiches)	11	85
2- Healthy drinks (water, natural juice, milk, tea, coffee, yogurts)	11	85
3- On-site restaurant with tables and chairs	11	85
4- Restaurant nearby	11	85
5- Availability of public space for meals with tables and chairs	03	23
Physical activity
1- Availability of gym for physical exercise	00	00
2- Space for hiking	00	00
Rest
1- Internet access	12	92
2- Rest area with sofa and TV (lounge)	07	54
3- Hotels on site or nearby	07	54
4- Green area with benches, chair for rest, and/or tables	02	15
Personal hygiene and health
1- Bathroom equipped with toilet, sink, soap, paper, and mirror	11	85
2- Bathroom with shower	11	85
3- Commercialization of products for personal hygiene and or pharmaceuticals	11	85
4- Public laundry service	09	69
5- External cardiac defibrillator	01	8.0
6- Health services	01	8.0
Security
1- Road with signs informing the stopping place	13	100
2- There is a parking area with lighting	13	100
3- Paved parking lot	13	100
4- Exclusive fueling station for trucks	12	92
5- Parking for the truck separated from the passenger cars	12	92
6- Fire extinguishers	12	92
7- Full-time operation (24 h/7 days of the week)	11	85
8- Parking with ramp for accessibility	11	85

N = Number of stopping and resting places; % = percentage.

).

3.1. Food

Food services were observed for whether or not they provided meals and the types of food and beverages marketed. The space for dining with tables and chairs was usually in fast-food restaurants, which were little frequented during the day; however, the restaurant of a service observed at night showed greater use. Even in places that run 24 h a day/7 days per week, fast-food restaurants generally were open from 7 a.m. until 10 p.m. We observed a lack of common spaces to have a meal, without the obligation to buy the meal in a restaurant or fast-food restaurant. Three venues offered spaces outside the restaurants. Of these, one offered tables and chairs in the lounge room for dining, and two others offered tables and chairs outside, one in a natural area and the other in the establishment’s courtyard, close to the convenience store and parking lot. Among the types of foods offered, in general, there was the availability of fresh and refrigerated foods such as sandwiches, salads, fruits, yogurt, and other foods, such as boiled eggs. In addition to these food choices, other ultra-processed food options such as sausages, hot dogs, cakes, instant noodles, pizzas, and ice cream were widely available and seemingly frequently purchased. The drinks that were offered were water, teas, coffee, milk, natural and isotonic juices, energy drinks, and beer (Figure 2). Microwaves in places for drivers to be able to warm their food brought from home or prepared in their trucks were not found (microwaves were available for use for food purchased at the convenience stores). Ice was available for purchase for food and beverage conservation. No drivers were observed preparing their meal in the truck.

3.2. Physical Activity

Truck stop and rest areas lacked adequate space for physical activity. No one offered public or private gym rooms, and free areas signposted for walking safely were not observed. In only one stop and rest area, there was a poster recommending care to drivers while hiking nearby.

3.3. Personal Hygiene and Health

Most of the rest rooms/bathrooms at truck stop and rest areas had sufficient lighting; most had doors, toilets, sinks, hot and cold water, soap, toilet paper, mirrors, hand dryers, trash cans, and sharps boxes. The rest rooms/bathrooms were generally clean and suitable for use. When the shower service is available, when purchasing a shower, clients receive a password that is announced from a speaker service when it is ready to be used; showers cost, on average, USD 18.00 per use. Laundry services, when available, had washing and drying machines; however, not all offered spaces with a chair for the driver to wait, and none of them had baskets to remove clothes from the machines, whose service cost on average USD 3.00 per load of laundry. Hygiene and health care items, such as basic medicines (band-aids, pain relievers), were available for purchase. Only one truck stop and rest area offered a health service for toxicological tests, which was open Monday to Saturday; only one other truck stop had an automatic external defibrillator (DEA), and this was located near the entrance of the convenience store (Figure 3).

3.4. Rest

Rest options, when available, were limited to TV rooms (lounges) located in convenience stores and hotels, but hotels and/or motels, when available, were often nearby but not on the grounds of the truck stop or rest areas. In general, hotels were within eight miles north or south of the highway. One truck stop and rest area offered a cinema, nearby the hotel, and a restaurant that had games and puzzles. One truck stop and rest area had a green area with benches and tables for dining and resting, and another restaurant contained benches with tables, in an unshaded location outside the convenience store, close to the parking lot (Figure 4).

3.5. Safety

Most locations were open 24 h per day, seven days per week. The highway had signs on the road that indicated the locations of truck stop and rest areas. The parking areas and the truck fuel stations are separate from the areas for passenger cars. One truck stop and rest area had private security, with uniformed, identified employees, with a security company car circulating on site. All the sites had paved parking, with signage on the pavement of the truck parking space, and they had lighting. Some sites were partially surrounded by walls and/or fences, in general, at the back of the parking lots. Video cameras were observed only in convenience stores; accessibility ramps and fire extinguishers were also observed in most truck stop and rest areas. Activity in truck stop and rest area parking lots was greatest in the late afternoons and early evenings, which generated some congestion on the highway. Internet access is generally easy, using local Wi-Fi (Figure 5).

3.6. Other Services

The description of positive and negative items for the well-being and health of drivers marketed at the truck stop and rest areas provides an overview of the other services available. ATMs, computers, printers, and scanner services were all available, as well as maps, GPS, safety clothes, and personal protective equipment (PPE), and products for trucks like pots, electric kettles, vacuum cleaners, oil, fluids, lubricants, and fire extinguishers were available for purchase. Other electronic products that were available for purchase included books, cell phone chargers, headsets, smartphone holders, and general services such as luggage storage, stamps and mail box photos for passports; truck services such as truck mechanics and truck scales; and pet services such as a fenced green area for pets and a bath area for pets. These could be considered positive promoters of the welfare of drivers. However, it is common to observe other services that could be considered harmful to the health and/or safety of drivers, such as cigarettes and alcoholic beverages that are available for sale, and services like gambling (e.g., lottery tickets), which were categorized as negative (Figure 6).

4. Discussion

Based on the 17 observation visits of food, personal hygiene and health, rest, safety, and physical activity services that are offered to long-haul truck drivers at 13 truck stop and rest areas located on Highway I-5 in the state of Oregon, USA, we determined that most services meet the basic needs of drivers—food, safety, personal hygiene and rest—and their implications for the LHTD’s health, and they can serve as lessons for other countries concerned with offering better working and living conditions to drivers. However, three services—physical activity, food and dining, and health—need further investment and development to better promote the health and well-being of LHTDs. Physical activity services were the most neglected, followed by food services, which, although they were diversified and offered some healthy options, can still improve the availability of and access to nutritional options, as well as provide shared environments with tables and chairs for dining and/or rest in the indoor areas of convenience shop and/or outdoor in green areas. Health promotion materials could be enhanced in these settings because, in terms of health, there is a perceived lack of care services for the prevention and control of chronic diseases that have the potential to prevent years of life lost due to disabilities and deaths.

In truck stop and rest areas that offer at least one convenience store, it is common to offer bathroom services, showers, and advertisements of fresh and ultra-processed foods, drinks (water, juice, milk, tea, energy drinks beer, etc.), internet connection, laundry, and personal hygiene products, basic remedies, condoms, and equipment for trucks. Convenience stores are important for providing safety, rest areas, personal hygiene products and services, food, and room for physical activity and for facilitating communication with family and friends. Therefore, the lack of convenience stores can compromise the health and well-being of long-haul truck drivers, especially considering that significant differences were found in the evaluation of rest, safety, toilets, and physical activity services at the Brazilian truck stops [9].

In the physical activity service, the lack of opportunities for physical activity and exercise is highlighted, since drivers usually drive for many hours at a time, and for safety and other logistical reasons (parking areas for big rigs), LHTDs cannot simply stop in other places to exercise. The realization of the truck stop and rest areas in spaces for health care environment, where LHTDs can use their time for health care, such as engaging in physical activity, in popular gyms and/or hiking trails, first requires public policies that guarantee investments capable of providing structural changes. Previous studies that obtained similar results to the present study demonstrated the need for investments to promote physical activity in the stop and rest areas [12,24,25]. For example, in Brazil, the spaces for the practice of physical activities were perceived as “unavailable” by 27.7% and “bad” or “terrible” by 30.4% of drivers [9]. In addition, they stressed the importance of encouraging the practice of physical activity to combat the sedentary lifestyle of workers, which was 45% [3] and to prevent chronic diseases such as obesity, diabetes mellitus, arterial hypertension, obstructive sleep apnea, stress, fatigue, pain, and anxiety [2,3,9,10,13,26].

Regarding food service and health, it is necessary to consider the facilities and barriers in access to food since the truck stop and rest areas where products are available, or in convenience stores and/or restaurants, which make up the environment where LHTDs buy and/or eat, can influence driver’s wellbeing and health. In this study, we found that convenience stores and/or restaurants offered options of meals that are considered healthy, including whole products, fruits, vegetables, and foods of animal origin, including meats and non-homogenized dairy. However, it is possible that ultra-processed products (sugary and ready-to-eat) are easier, cheaper, and more easily accessible in convenience stores and in fast-food restaurants at truck stops. Additionally, LHTDs work long hours over many days, and preparing meals in trucks is not easy and can be a barrier to healthy behaviors, which endangers the health of LHTDs. Given this context, it is evident that the basic health conditions, involving the space related to the meal environment, the time of preparation and having the meal, the energy used in the preparation of the meal, and the limited opportunities to access healthy foods, may be affected by the organization of the downtime environment and routine work of LHTDs. Previous studies revealed the pattern of food choice by LTHDs while working, showing that 73% preferred to eat food brought from home [14], 88% consumed fewer vegetables than national recommendations, 63% consumed at least one harmful food per day, 65% drank at least one harmful food per day or one can of sugary drink per day, 90% of drivers had high body mass indexes, and 60% were obese [2], and drivers indicated that they would choose healthy foods if available [12]. In Brazil, the drivers perceived the food service as “good” or “excellent” (44.0%), which can be related to the practice of drivers preparing their meals in the kitchen boxes of their trucks [9], and 74.2% spent only a few minutes up to one hour a day to cook and eat [10], reinforcing the economic and human benefits of investing in truck driver nutrition [5].

As for where LHTDs eat meals, truck stop and rest areas lack common spaces for eating. There are tables in restaurants or fast-food restaurants, but food must be purchased in these businesses. The compromise of space related to the meal environment can affect the well-being and social interaction of LHTDs. Thus, the need for structural changes in the meal space, providing opportunities to adopt healthy behavior by the LHTDs [9], is evident to meet the needs of almost 2/3 of the drivers who mentioned in a previous study that they prefer to bring food from home or to prepare food in the truck’s kitchen, as well as those who reportedly ate at least one meal per day at a truck stop or rest area [14].

Regarding personal hygiene and health services, the availability of bathrooms and showers was present in 85% of observed locations, while laundry services and health services were observed in 69% and 8%, respectively. Anderson et al. (2018) [14] found that the bathroom service is considered very important by 91% of LHTDs, followed by shower service at 61%. Boris (2018) [6] found that 79% of LHTDs are responsible for choosing their stopping places, and in a Brazilian study, it was shown that those who work more than five days a week have a worse perception of bathroom services; the evaluation was rated “average” by 36.6%, followed by “good” or “excellent” by 35.1% [9]. Health services at truck stop and rest areas were limited, which can be a barrier in the prevention of chronic non-communicable diseases such as obesity, diabetes mellitus, and/or arterial hypertension due to difficulty accessing consultations with health professionals. Considering how much time LHTDs spend on the road and at truck stops and rest areas, these environments could serve as locations to promote health care, optimizing LHTDs’ time by allowing for health care visits to be performed during driving rest times at these locations where drivers frequent. Most truck stops and rest areas, however, do not offer health care services. Considering the need evidenced in the conflicts between work schedules and hours of care in health services in 32% of LHTDs, and that 62% performed a follow-up every two years [9], these services would be a benefit to the health of drivers. Lincoln et al. (2018) [25] found that only 6% of truck stop and rest areas had health clinics. Other studies recommended the urgent promotion of access to health services for the prevention of NCDs, either in a face-to-face environment at health clinics, via telehealth, or in online support groups or on-road wellness centers [2,9,13,27,28,29]; however, even then, availability may depend on insurance coverage or the drivers’ willingness to pay for the service. To address the environmental and occupational health risks identified in this study, a multi-level policy approach is essential. Infrastructure improvements at truck stops—such as physical activity areas, health kiosks, and green spaces—require targeted funding. In Oregon, most truck stops are operated by private companies, which presents an opportunity for public–private partnerships to co-finance upgrades. Federal and state transportation and health departments could establish grant programs to support these enhancements. In Brazil, the Unified Health System (SUS) has implemented policies that allow healthcare teams to provide services at alternative times and locations, including truck stops registered with the National Department of Transportation Infrastructure [30]. This model could be adapted in the U.S. through Medicaid waivers or mobile health clinics to improve access for long-haul truck drivers (LHTDs).

The rest services offered internet access, limited space in the rooms with chairs or armchairs and a TV, and hotels that were nearby. In addition, outdoor spaces, green areas, and other interiors with the availability of chairs, tables for games, and small libraries with space for reading and/or social interaction were lacking in most truck stops and rest areas. To meet the basic human needs of sleep and rest, these places can and must provide spaces with outdoor rest environments and convenience stores so that drivers can use their rest time to recover, renew, and recuperate the energies employed while driving. A preview study showed that the rest service in Brazil was rated “good” or “excellent” by more than 50% of drivers, followed by “average” by 29.8% [9]. Others addressed the importance of ensuring that truck stops offer a place of rest or sleep that is quiet, is silent, has temperature control, and has quality air [9,26], and they highlighted the potential of quality of rest in reducing the risk of fatigue, pain, accidents, drowsiness, stress, symptoms of depression, risk of cardiometabolic diseases, and cancer, as well as in the promotion of sleep quality and safety at work [9,10,11,14].

The security service involves parking, and parking spaces are offered free of charge; some truck stop and rest areas offer the option of booking, charging a fee of USD 20.00. Despite the sites offering lighting, a paved area, sign posts, parking, and exclusive fuel stations for trucks, with access ramps for wheelchair users, extinguishers, and internet connection, they still need to ensure the operation of the convenience stores for 24 h, 7 days a week. Previous studies conducted on U.S. highways revealed that 60% of truck stop and rest areas had inadequate lighting in parking areas [25]. In addition, the difficulty in finding secure parking on weekdays [6] and especially at night exposes drivers to the risk of parking in unauthorized locations on the highway at least once a week [7]. More than 70% of drivers would like parking lots for trucks to be separated from those for cars and trailers; LHTDs want parking lots that are better lit and safer, and they want to receive information about parking availability through an app, GPS, radio in vehicle, or another form of communication [6]. In Brazil, the security services were perceived as “bad” or “terrible” by 33.5%, followed by “average” by 35.1%, of LHTDs, related to the organization of the work process and services, urban violence, and the restriction of the opening hours of services at truck stop and rest areas [9].

Among the other services considered, some positives are services of mechanics and the commercialization of products for health, safety, books, and electronics, such as electric pots that facilitate the preparation of food in the kitchens of the truck. A previous study showed that the kitchens of the trucks were equipped with refrigerators, 62% had gas pots, and 8% had microwaves, and these allow LHTDs to prepare meals more often in their trucks and less often in truck stop and rest areas [14]. On the other hand, the lack of fresh foods such as fruits and salads at affordable prices and the appeal of ultra-processed, hypercaloric, and sugary foods, cigarettes, and alcoholic beverages are negative and do not support the health of LHTDs.

Limitations

This study is subject to several limitations that may influence the generalizability of its findings. First, observational bias may have occurred due to the subjective nature of field notes and the researchers’ interpretations of service quality and usage. Although efforts were made to standardize observations, the presence of researchers may have influenced behaviors at some sites. Second, most observations were conducted during daytime hours, which may not fully capture the nighttime conditions or service availability, which are particularly relevant for long-haul truck drivers who often operate during off-peak hours. For example, some fast-food restaurants were closed at night despite the truck stop operating 24/7, potentially limiting access to food and rest services. Third, the geographic scope was limited to 13 truck stop and rest areas along Interstate 5 in Oregon. While this corridor is a major route, the findings may not reflect conditions in other regions of the U.S. or in Brazil, where infrastructure, ownership models, and public health policies differ significantly. Future studies should expand the geographic coverage and include nighttime observations to provide a more comprehensive assessment.

5. Conclusions

This findings from this study describe an evaluation of services offered by 13 truck stop and rest areas located on Highway I-5, in the state of Oregon, USA, that revealed a wide range of services related to the food, personal hygiene and health, rest, safety, and physical activity of LHTDs and the implications that these services have on the health of LHTDs. In general, services seemed to meet the basic needs of LHTDs; however, two could be improved (e.g., opportunities for physical activities and health-promoting environments and services), with structural changes and public policies aimed at improving the opportunities for healthy behaviors of LHTDs. Only 15% of the locations offered green areas with benches, and only one unit had an Automated External Defibrillator (AED), reflecting the lack of basic support for health emergencies.

Among the services that can promote health, the spaces for physical activity and health services and the food service, food options, and environment for meals and rest could be improved. Physical activity services lack spaces for exercise with the limited availability of popular gyms and/or areas appropriate for walking to reduce the health risks of LHTDs and to prevent chronic non-communicable diseases such as obesity, diabetes mellitus, and arterial hypertension. In addition, there is a need to provide access to health services in the places of stopping and resting to meet the health needs of LHTDs. Regarding food service, despite the availability of healthy foods, their access needs to be encouraged and facilitated, with a greater availability of fruits and salads, a reduction in the cost of healthy products, and a reorganization of the food preparation space in the truck and the work routine being alternatives that can change the consumption pattern and decrease the intake of ultra-processed products that are rich in sodium and trans and saturated fat. There is a need for common environments to eat meals and to rest, which both promote social interaction and well-being.

Based on these findings, we provide the following recommendations: (1) expanding green areas with basic infrastructure for outdoor rest; (2) increasing the availability of AEDs for emergency response; (3) installing physical activity areas (e.g., short walking trails, stretching equipment); (4) creating common spaces for meals; and (5) implementing structural changes supported by public policies aimed at promoting the health and well-being of LHTDs.

The information presented in this study may be used to improve the services offered at driver rest stops, considering the importance of taking care of the health and well-being of LHTDs and, consequently, the global economy. To strengthen future research directions, studies could explore the impact of truck stop services on specific health outcomes among long-haul truck drivers, such as cardiovascular risk, sleep quality, and dietary patterns. Longitudinal designs or mixed-method approaches combining direct observation with driver interviews or wearable health monitoring could provide deeper insights. Additionally, comparative studies across different regions—such as between Oregon and other U.S. states, or between Brazil and other Latin American countries—would help assess how policy, infrastructure, and cultural factors influence service availability and driver well-being.