Background Surveillance of COVID-19 vaccine effectiveness (VE) was extensive upon vaccine introduction; however, it declined after the withdrawal of pandemic status in May 2023. Continued monitoring of updated vaccine formulations is needed to ensure the maintenance of VE in the face of evolving viral strains. Objective The Booster Epidemiological Evaluation of Health, Illness and Vaccine Efficacy (BEEHIVE) study (NCT06065176), a randomized trial with a hybrid design, was developed to assess the real-world VE of the 2023-2024 Pfizer–BioNTech and Novavax COVID-19 vaccine formulations targeting the XBB.1.5 SARS-CoV-2 variant. Methods This study was designed to enroll approximately 1500 participants aged ≥18 years from the Salt Lake City, Utah, area who had previously received ≥2 doses of an authorized messenger RNA (mRNA)–based COVID-19 vaccine but had not received a dose of the 2023-2024 formulation. The study used a randomized, hybrid design comprising 2 blinded groups assigned to receive the 2023-2024 formula of either the Novavax COVID-19 vaccine or the Pfizer–BioNTech COVID-19 vaccine and a nonrandomized, observational control group of volunteers who chose not to receive a 2023-2024 vaccine dose during the study. Follow-up lasted 24 weeks and included symptom surveys and self-administered COVID-19 antigen testing, both occurring weekly. The primary aim was to compare VE (defined as prevention of symptomatic SARS-CoV-2 infection) between study-vaccinated participants and the control group. The secondary aim was to determine the relative VE of the Pfizer–BioNTech mRNA and Novavax 2023-2024 COVID-19 vaccines. Secondary objectives included assessing how the number of previous COVID-19 vaccinations impacted VE of the 2023-2024 COVID-19 vaccines; identifying predictors and associated factors for asymptomatic versus symptomatic infection and/or prolonged or severe illness; examining factors associated with post–COVID-19 conditions; and evaluating participants’ knowledge, attitudes, and practices related to COVID-19 vaccination. Participant engagement was maintained via online and text-based reminders and surveys, as well as researcher follow-up. Results Participants were recruited from November 2023 through March 2024, with 452 and 457 participants randomized to the Novavax and Pfizer–BioNTech vaccine groups, respectively, and 279 participants enrolled in the control group. SARS-CoV-2 variants from the XBB, JN.1, KP.2, and KP.3 lineages were in circulation in the United States and the Utah region during data collection. The study ended on September 9, 2024, with results expected to be published in 2026. Conclusions Data from this study will provide valuable real-world VE data for a dose of the Novavax COVID-19 vaccine or the Pfizer–BioNTech COVID-19 vaccine after an mRNA-based COVID-19 primary series. Trial Registration ClinicalTrials.gov NCT06065176; https://www.clinicaltrials.gov/study/NCT06065176 International Registered Report Identifier (IRRID) RR1-10.2196/80858

OBJECTIVE:Assess employers' use of information from government sources during the coronavirus disease 2019 pandemic. METHODS:Virtual interviews with employers from 28 US companies in 9 National Occupational Research Agenda sectors. Transcribed interviews were thematically coded and analyzed using MaxQDA24. RESULTS:All but 3 companies relied on the Centers for Disease Control and Prevention as their primary source for policy decisions and workforce communications, supplementing this with information from state and local health agencies, OSHA, trade and professional associations. Half of the respondents asked additional experts to interpret guidance for their industry, and all but a few modified available materials to share with their workforce. National Occupational Research Agenda sectors were not effective for audience segmentation. Perception of worksite transmission was loosely aligned with preference for and confidence in information sources. CONCLUSION:Employers want industry-tailored information during a public health emergency; providing that remains a challenge.

BACKGROUND:Real-world vaccine effectiveness (VE) and relative VE (rVE) data of protein-based and mRNA COVID-19 vaccines against symptomatic SARS-CoV-2 infections inform policy recommendations and reinforce public confidence. The study aim was to assess the safety and VE of the 2023-2024 protein-based and mRNA COVID-19 vaccines (XBB.1.5) in a real-world setting. METHODS:The single-site, pragmatic BEEHIVE clinical trial was conducted among participants aged ≥18 years from the Salt Lake City, Utah, area, who had previously received ≥2 mRNA COVID-19 vaccines, from November 17, 2023, through September 9, 2024. Randomized participants received a protein-based or mRNA COVID-19 vaccine in a double-blind manner. An unblinded, nonrandomized comparator control group that did not receive a study vaccine was also enrolled. The primary aim measured VE between the randomized and comparator groups. The secondary aim was to measure rVE between the 2 vaccine platforms. In the modified intention-to-treat (mITT) analysis, VE and rVE were estimated using a proportional-hazards model for symptomatic infections confirmed by weekly self-administered rapid antigen tests (RATs) over 24 weeks, adjusted for covariates. Reactogenicity and treatment-emergent adverse events (TEAEs) were recorded. RESULTS:Randomized cohorts (N = 909; protein-based, n = 452; mRNA, n = 457) were largely well-balanced with some differences in baseline covariates versus the comparator group (n = 279), mostly age-related. The mITT population had 142 RAT-confirmed symptomatic SARS-CoV-2 cases with an adjusted VE of 43.6% (95% CI, 18.3-61.0); rVE (protein-based vs mRNA) was -26.7% (90% CI, -78.6% to 10.1%) and did not reach statistical significance. Safety and reactogenicity were comparable to previously reported findings, with no serious study vaccine-related TEAEs, myocarditis/pericarditis, hospitalization, or death. CONCLUSIONS:This is one of the earliest real-world trials evaluating the VE of the 2023-2024 COVID-19 vaccines (XBB.1.5). These results suggest that both protein-based and mRNA vaccines are well-tolerated and significantly reduce the risk of symptomatic SARS-CoV-2 infections.

Introduction Substance use disorders (SUDs) among healthcare workers, legal professionals, and pilots pose risks to public safety and professional performance. Physician health programs (PHPs), lawyer assistance programs (LAPs), and the Human Intervention Motivational Study (HIMS) program for pilots aim to address these challenges through structured referral, treatment, and monitoring. PHPs and LAPs operate through state-based programs with guidance from national organizations such as the Federation of State Physician Health Programs (FSPHP) and the Commission on Lawyer Assistance Programs (CoLAP). In contrast, HIMS follows a standardized federally regulated model. Despite shared goals, no prior study has systematically compared these distinct frameworks. Methods Using the READ (Ready, Extract, Analyze, Distill) framework for document analysis, this study reviewed best practice guidelines from FSPHP and CoLAP alongside publicly available HIMS materials to compare treatment referral, monitoring/aftercare expectations, and return-to-work policies. Results All three programs emphasize rehabilitation and confidentiality but differ in structure. FSPHP guidelines provide detailed recommendations for evaluation, monitoring, and reintegration; HIMS materials outline evaluation and recertification requirements and associated monitoring expectations; and CoLAP offers flexible guidance that emphasizes support and early intervention. Adherence to the guidelines is not well documented at the state or organizational levels, underscoring variability within professions. Conclusion This study compares the FSPHP, CoLAP, and HIMS guidelines, offering insights into standardizing aftercare, monitoring, and return-to-work policies for safety-sensitive professionals. Aligning state and organizational level programs more closely with national guidance may enhance accountability, improve equity, and reinforce public safety.

Background/Objectives: We aimed to assess the impact of updates in the 2024 AMA Guides to the Evaluation of Permanent Impairment, Sixth Edition, on spine and pelvis impairment ratings compared to the 2008 Sixth Edition and to investigate potential correlations with legislative, judicial, and economic factors. Methods: Nineteen clinical vignettes focused on spine and pelvis conditions were analyzed by two expert evaluators, comparing the impairment ratings derived from both editions. Results: Following the spine and pelvis impairment rating procedures from each edition, the 2024 impairment values showed a high correlation and statistical equivalence to those derived from the 2008 methods. Conclusions: The AMA Guides Sixth Edition 2024 update for spine and pelvis impairments offers enhanced diagnosis-based impairment tables and more transparent processes, improving efficiency while preserving the accuracy, validity, and reliability of previous editions.

OBJECTIVE:To determine the ease of use, accuracy, consistency, reliability, and reproducibility for rating lower limb conditions when transitioning to the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides) Sixth Edition 2024 developed using the RAND/UCLA modified Delphi Appropriateness Method compared with the AMA Guides Sixth Edition 2008. METHODS:Three physician experts and four premedical students completed two rounds of impairment ratings using methods from the AMA Guides Sixth Edition 2008 versus the AMA Guides Sixth Edition 2024. Impairment values and completion times for each method were compared across groups. RESULTS:For experts, the average time to complete an impairment rating was 4.1 minutes using the AMA Guides Sixth Edition 2024 compared with 16.7 minutes using the AMA Guides Sixth Edition 2008, maintaining 100% accuracy and reliability for both methods. Premedical students averaged 5.3 minutes with the AMA Guides Sixth Edition 2024 and 24.0 minutes with the AMA Guides Sixth Edition 2008, showing increased accuracy, consistency, reliability, and reproducibility with AMA Guides 2024. CONCLUSION:The AMA Guides Sixth Edition 2024 represents a notable advancement in impairment evaluation, offering a more efficient, accurate, and reliable system for lower limb impairment assessments. This update not only benefits healthcare providers and patients but also sets a new standard in occupational health by preserving the accuracy, consistency, reliability, and reproducibility of impairment ratings while streamlining the evaluation process.

Background/Objectives: This study aims to assess the ease of use, accuracy, consistency, reliability, and reproducibility in evaluating spine and pelvis conditions when transitioning from the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides) Sixth Edition 2008 to the newly updated Sixth Edition 2024. Methods: Two rounds of impairment ratings were performed by a team consisting of three physician experts and four premedical students, focusing on a comparison between the 2008 and 2024 editions of the AMA Guides. The analysis included both the impairment values generated and the time taken to complete assessments with each version. Results: For the expert group, the mean duration required to complete an impairment rating was 5.0 min with the AMA Guides 2024, compared to 15.4 min using the AMA Guides 2008, with both editions achieving 100% accuracy and reliability. The premedical students demonstrated similar improvements, averaging 8.4 min per rating with the 2024 edition versus 26.4 min with the 2008 edition. The AMA Guides 2024 yielded enhanced accuracy, consistency, reliability, and reproducibility. Conclusions: The AMA Guides Sixth Edition 2024 represents a significant advancement in impairment evaluation, particularly for spine and pelvis assessments. This updated edition introduces a more streamlined and time-efficient process while preserving the accuracy, consistency, and reproducibility essential to high-quality impairment ratings. By enhancing clarity and standardization, it sets a new standard in occupational health, offering a reliable framework that supports both clinical assessment and administrative oversight.

Background/Objectives: This study examines the effect of the 2024 update to the AMA Guides to the Evaluation of Permanent Impairment, Sixth Edition, on lower limb impairment determinations in comparison to the 2008 edition. It also explores the broader influence of these changes on regulatory, economic, and adjudicative considerations relevant to physician application and interpretation. Methods: Two experienced evaluators independently reviewed 23 standardized lower limb case scenarios, applying both the 2008 and 2024 methodologies. Each assessment was based solely on clinical history, physical examination findings, and diagnostic test results. Impairment values were then calculated and analyzed for consistency across editions. Results: The 2024 lower limb impairment framework produced outcomes that closely mirrored those of the 2008 edition, with intraclass correlation coefficients of 0.9962 for the lower limb and 0.9951 for whole-person impairment, underscoring the strong consistency between editions. Conclusions: The revised 2024 edition for lower limb assessment enhances procedural clarity and integrates improved diagnosis-based impairment tools without disrupting prior impairment values. These refinements are intended to improve utility for clinical and nonclinical stakeholders, ensuring reliable evaluations while minimizing systemic disruption.

The US construction industry is plagued by high rates of accidents, injuries, and fatalities. Workers in small construction firms are particularly at risk, as these companies have limited resources to implement safety protocols and provide safety training to their employees. In addition to the physical toll, workplace injuries have been linked to mental health problems such as anxiety, depression, and burnout. This study surveyed 234 employees at construction companies with 20 or fewer employees to determine whether employees at small construction firms report increased levels of anxiety and depression compared to a national sample of workers. The study also explored the issue through the lens of safety climate, or the shared perception of employees regarding how much their organization values their safety at a moment in time, specifically examining whether employees at small firms who perceive better safety climates report lower levels of anxiety, burnout, and depression than those who perceive worse safety climates. There was a statistically significant increase in levels of anxiety and depression among the survey participants compared to the national worker sample, as well as a statistically significant decrease in burnout, anxiety, depression, and intention to quit among participants who perceive a higher versus lower safety climate. The findings underscore the urgent need for interventions to support the mental health of workers in small construction firms, as well as the importance of safety climate as a means to improve worker mental and physical health in the construction industry.

Objective: The aim of the study was to assess predictive relationship that cardiovascular disease (CVD) has on work-related shoulder injuries. Methods: This retrospective cohort study quantifies relationships between CVD risk and subsequent incident cases of shoulder-related worker compensation (WC) claims in a large cohort of 34,369 commercial drivers. CVD risk was assessed using an expanded Framingham Risk score. Incident shoulder WC cases were identified. Relative risk (RR), hazard ratio (HR), and their associated 95% confidence intervals (95% CI) were calculated. Results: Significant relationships between CVD risk scores and subsequent shoulder WC claims were observed. Participants in the highest CVD risk were significantly more likely to have a shoulder-related WC claim (RR = 6.70, 95% CI = 2.03, 22.12), after adjustment for age, gender and Body Mass Index. Conclusion: There may be a relationship between CVD risk and shoulder injuries and disorders.

BACKGROUND AND OBJECTIVES:Substance use disorders (SUD) among healthcare professionals threaten both patient safety and workforce stability. Professional health programs (PHPs) aim to support recovery and safe practice reentry, yet outcomes for non-physician professionals remain underexplored. This study assessed return to use and professional outcomes among healthcare professionals monitored through the Utah Professionals Health Program (UPHP), a cohort predominantly composed of non-physician participants. METHODS:A retrospective cohort study used data from 183 UPHP participants with SUD (60.7% nurses) enrolled between 2013 and 2024. The primary outcome was return to use, defined by positive toxicology results or self-report. Logistic regression was used to identify predictors of return to use. RESULTS:Return to use occurred in 48.6% of participants, with the highest incidence (33.9%) in year one. By year five, 81.4% had completed monitoring, and 55.9% were working full-time in healthcare. In adjusted models, age (OR = 0.93 per year, p = .039), duration of SUD before UPHP enrollment (OR = 1.14 per year, p = .004), and injury history (OR = 0.23, p = .017) were significantly associated with return to use. DISCUSSION AND CONCLUSIONS:This non-physician dominant cohort highlights need for early recovery support and profession-specific care. Return to use was most frequent in year one, underscoring the need for intensive early-phase monitoring. Tailored support for injury-related substance use, along with peer support and employment services may improve outcomes. SCIENTIFIC SIGNIFICANCE:Findings provide novel insight into recovery outcomes for non-physician healthcare professionals in a PHP, a group underrepresented in addiction research.

Objective Describe and evaluate methodological improvements in AMA Guides to the Evaluation of Permanent Impairment (Guides) Sixth Edition 2024, including an updated sequential method and enhanced diagnosis-based impairment tables, compared to the Guides Sixth 2008. Methods Three physician experts and 3 premedical students, respectively, completed 2 rounds of impairment ratings using the AMA Guides Sixth 2008 versus 2024 methods. Impairment values and completion times using each method were compared for both groups. Results Time to complete an impairment rating by experts averaged 3.5 minutes using Guides 2024 compared with 13.9 minutes using Guides 2008, with 100% accuracy and reliability for both. Students' time averaged 5.3 and 15.9 minutes, respectively, with increased accuracy and reliability with Guides 2024. Conclusions The Guides Sixth 2024 allowed more efficient impairment ratings while retaining accuracy, consistency, reliability, and reproducibility.

Background:Immunogenicity studies suggest that recombinant influenza vaccine (RIV) may provide better protection against influenza than standard-dose inactivated influenza vaccines (SD IIV). This randomized trial evaluated the relative vaccine effectiveness (VE) and immunogenicity of RIV versus SD IIV in frontline workers and students aged 18-64 years. Methods:Participants were randomized to receive RIV or SD IIV and followed for reverse-transcription polymerase chain reaction (RT-PCR)-confirmed influenza during the 2022-2023 influenza season. Sera were collected from a subset of participants before and at 1 and 6 months postvaccination and tested by hemagglutination inhibition for A/H1N1, A/H3N2, B/Yamagata, and B/Victoria and against cell-grown vaccine reference viruses for A/H1N1 and A/H3N2. Results:Overall, 3988 participants were enrolled and vaccinated (25% of the trial sample size goal); RT-PCR-confirmed influenza occurred in 20 of 1963 RIV recipients and 28 of 1964 SD IIV recipients. Relative VE was 29% (95% confidence interval [CI], -26% to 60%). In the immunogenicity substudy (n = 118), the geometric mean titer ratio (GMTR) comparing RIV to SD IIV at 1 month was 2.3 (95% CI, 1.4-3.7) for cell-grown A/H1N1, 2.1 (95% CI, 1.3-3.4) for cell-grown A/H3N2, 1.1 (95% CI, .7-1.6) for B/Victoria, and 1.4 (95% CI, .9-2.0) for B/Yamagata. At 6 months, GMTRs were >1 against A/H1N1, A/H3N2, and B/Yamagata. Conclusions:Relative VE of RIV compared to SD IIV did not reach statistical significance, but RIV elicited more robust humoral immune responses to 2 of 4 vaccine viruses at 1 month and 3 of 4 viruses at 6 months after vaccination, suggesting possible improved and sustained immune protection from RIV. Clinical Trials Registration. NCT05514002.

Objectives The aims of the study are to evaluate how upper limb impairment ratings are affected by updates to the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides) Sixth Edition 2024 compared with the AMA Guides Sixth Edition 2008 and to investigate potential correlations with judicial, legislative, and economic factors. Methods Two expert evaluators reviewed 31 upper limb clinical vignettes from the 2008 and 2024 versions. The impairment ratings for each version were compared. Results After following the impairment ratings steps in each version, the results for 2024 showed no significant differences when compared with the impairment ratings generated using 2008 methods (Cohen’s kappa = 1.00). Conclusions The updated AMA Guides Sixth Edition 2024 with improved, transparent processes and enhanced diagnosis-based impairment tables provides efficiency while retaining the accuracy, validity, and reliability of past versions of the AMA Guides.

Background: Law professionals are understudied, and little is known about their mental health. This cross-sectional study aimed to assess the relationship between the amount of physical activity and depressive symptoms. Methods: A sample of 681 law professionals completed a survey that assessed mental health conditions and activities to promote well-being. Crude and adjusted odds ratios (ORs) and 95% confidence interval (95% CI) were calculated for the relationship between the number of days of an hour or more of physical activity and two levels of depression from the patient health questionnaire-9 (PHQ-9). Results: Law professionals were found to have significantly more depressive symptoms, mild or worse and moderate or worse, when reporting 0 days of physical activity when compared to 7 days, with OR of 6.07 (95% CI 2.55–14.48) and 8.64 (95% CI 1.97–37.82) and adjusted ORs of 3.91 (95% CI 1.58–9.68) and 6.32 (95% CI 1.4–28.33), respectively. A dose response was also noted. Conclusions: There was a statistically significant relationship found between amounts of physical activity and depressive symptoms in law professionals. We recommend future research be conducted to better understand this relationship.

Abstract Introduction The pathophysiological bases of musculoskeletal disorders (MSDs) is/are uncertain, resulting in reduced opportunities for prevention. Methods Nine-year prospective cohort data from 1,224 workers in 3 US states were analyzed. IRBs approved of the protocol. Baseline data included questionnaires, structured interviews, physical examinations, anthropometric measurements, and nerve conduction studies. Job physical factors were individually measured. Monthly follow-ups were conducted. Framingham risk scores were calculated. A priori case definitions were constructed for carpal tunnel syndrome, lateral/medial epicondylopathy, and rotator cuff tendinopathy. Data were also analyzed from a second 8-year prospective cohort of 828 workers for low back pain (LBP) using similar methods. Results Adjusted RRs (including job physical factors) for one or more MSDs increased to 3.90 (95% CI, 2.20, 6.90) among those with 10-year CVD risk scores above 15% and 17.4 (95% CI 3.85, 78.62) among those with 4+ disorders. By contrast with these common upper extremity MSDs, cardiovascular risks did not confer an increased risk for LBP. Discussion Cardiovascular risk factors are strong risk factors for common upper extremity MSDs. The relationships become stronger among those with increasing numbers of MSDs. Data suggest potential microvascular pathophysiology. The magnitude of risks is sufficiently high that confounding appears improbable. These data also suggest if there is a microvascular cause, it does not involve LBP. LBP continues to stand in search of explanatory pathophysiology. Conclusion While job physical factors remain as important modifiable risks, CVD factors are strongly associated with the development of common MSDs, but not LBP. Risks among those with multiple MSDs are considerably stronger.

Background: To determine the impacts of statewide coronavirus disease 2019 (COVID-19)-related public health and social measures (PHSMs) and attempted pandemic mitigation measures on years of potential life lost (YPLL). Methods: The “openness score” of each state during the COVID-19 pandemic was obtained using two open-source sites, the Multistate openness score and the Wallethub openness score. These scores combined various PHSMs, such as restrictions on gatherings and closing various types of businesses. Using data from the Centers for Disease Control and Prevention (CDC) Wonder database, the differences in prepandemic (2017-2019) and pandemic excess mortality were calculated in terms of YPLL and then compared to the openness scores using univariate regression modeling. Results: States that instituted more restrictive PHSMs as measured by openness scores failed to experience reductions in YPLL. On the contrary, there were trends toward statistical significance associating greater YPLL with the institution of more stringent PHSMs (p = 0.109 and p = 0.080 for Multistate and Wallethub, respectively). Discussion: This study suggests restrictive PHSMs were ineffective for improving mortality in this pandemic and trended toward increasing mortality in the younger population, presumably from other, non-COVID-19 causes.

Background. Data are limited on whether vaccination reduces post COVID conditions (PCCs) risk after less severe nonhospitalized coronavirus disease 2019 (COVID-19). This study assessed whether COVID-19 vaccination protected against PCCs in persons with mild initial infections during Delta and Omicron variant predominance. Methods. This study utilized a case-control design, nested within the HEROES-RECOVER cohort. Participants aged >= 18 years with test-confirmed severe acute respiratory syndrome coronavirus disease 2 (SARS-CoV-2) between 28 June 2021 and 14 September 2022 were surveyed for PCCs, defined by symptoms lasting >4 weeks after initial infection. Cases self-reported PCCs and controls self-reported no PCCs. The exposure was messenger RNA (mRNA) COVID-19 vaccination (2 or 3 monovalent doses). Odds of PCCs among vaccinated and unvaccinated persons were compared with logistic regression. Results. Of 936 participants, 23.6% reported PCCs and 83.2% were vaccinated. Participants who received 3 vaccine doses had lower odds of PCC-related gastrointestinal, neurological, and other symptoms compared to unvaccinated participants (adjusted odds ratio [95% confidence interval]: 0.37 [.16-.85], 0.56 [.32-.97], and 0.48 [.25-.91], respectively). Conclusions. COVID-19 vaccination protected against development of PCCs among persons with mild infection during both Delta and Omicron variant predominance, supporting vaccination as an important PCCs prevention tool.

Excess health and safety risks of commercial drivers are largely determined by, embedded in, or operate as complex, dynamic, and randomly determined systems with interacting parts. Yet, prevailing epidemiology is entrenched in narrow, deterministic, and static exposure-response frameworks along with ensuing inadequate data and limiting methods, thereby perpetuating an incomplete understanding of commercial drivers' health and safety risks. This paper is grounded in our ongoing research that conceptualizes health and safety challenges of working people as multilayered "wholes" of interacting work and nonwork factors, exemplified by complex-systems epistemologies. Building upon and expanding these assumptions, herein we: (a) discuss how insights from integrative exposome and network-science-based frameworks can enhance our understanding of commercial drivers' chronic disease and injury burden; (b) introduce the "working life exposome of commercial driving" (WLE-CD)-an array of multifactorial and interdependent work and nonwork exposures and associated biological responses that concurrently or sequentially impact commercial drivers' health and safety during and beyond their work tenure; (c) conceptualize commercial drivers' health and safety risks as multilayered networks centered on the WLE-CD and network relational patterns and topological properties-that is, arrangement, connections, and relationships among network components-that largely govern risk dynamics; and (d) elucidate how integrative exposome and network-science-based innovations can contribute to a more comprehensive understanding of commercial drivers' chronic disease and injury risk dynamics. Development, validation, and proliferation of this emerging discourse can move commercial driving epidemiology to the frontier of science with implications for policy, action, other working populations, and population health at large.