examine the pandemic’s impact on the transit workforce and society at large. For this review, the panel’s two cochairs, three of the panel members, and an expert on transit labor management relationships provided input (via video conferencing). Materials for the transit worker survey in Chapter 3 were informed by a webinar on healthy work assessment tools organized by the Healthy Work Campaign, a public health campaign focused on raising awareness about the health impacts of work stress. Information was collected from interactions with the cochairs and panel members on recent and ongoing best-practice efforts to augment the health and welfare of transit workers in different parts of the country.

Special efforts were made to identify and review related publications by TRB, including TCRP, NCHRP, and ACRP syntheses and research reports. As part of the practice scan, website searches involving FTA, APTA, CTAA, National Rural Transit Assistance Program, TransitCenter.org, Transit Advisory Committee for Safety (TRACS) reports, METRO magazine, Mass Transit magazine, and various transit agencies were conducted to identify resources and practices. In addition to identifying toolkits and best practices, the scan provided a better understanding of federal policies related to the public transit workforce as well as labor-management issues.

The following list provides some key observations from the review of existing literature.

• Frontline transit workers experience a range of difficulties in the work environment. In a survey of transit agencies, 81% of operators reported experiencing verbal threats, intimidation, or harassment; 60% reported spitting; 38% reported projectiles thrown at buses; and 26% reported objects thrown inside buses. Lack of access to restrooms, constrained workstations, sedentary nature of work, long work hours, and communication issues also affect the mental health of bus operators. One study found that 85% of bus operators experience pain in at least one area of their body.
• Person under train (PUT) incidents are a serious issue affecting the mental health of train operators (as well as transit police and other emergency workers). These incidents can occur because of accidents, suicides, or homicides, and studies show that up to 30% of transit operators experience post-traumatic stress disorder (PTSD) after PUT incidents and assaults.
• COVID-19 affected transit agencies and workers profoundly, making it even more difficult for agencies to recruit and retain frontline workers, such as operators. During the first 15 months of the pandemic, almost 50,000 public transit workers in the United States were infected by the virus, and 478 of them died. In 2020, 65% of agencies cut services, 32% eliminated routes, and 15% reduced days of service. In the first year of the pandemic, the number of bus operators may have decreased by as much as 19%.
• Two empirical studies examined the effects of COVID-19 on transit workers’ mental health and well-being. Both studies identified the need for an adequate supply of personal protective equipment (PPE) to reduce workers’ stress. However, more studies on other COVID-19-related improvements sought by workers are needed.
• Few programs about mental health are available to transit workers. A survey of transit agencies showed that only half of all agencies offered programs and services for promoting workers’ health and wellness, and only about 30% of small agencies did so. In addition to the limited availability of programs, workers often do not seek such services for reasons like organizational practices, management leadership style, or an atmosphere of distrust. Bureaucratic practices, such as requiring substantial paperwork, also serve as deterrents.
• Almost all reviewed studies suggest that trust and cooperation are needed between management and union representatives for the success of agency-provided programs and services to promote workers’ health and well-being.
• Despite the high need for mental health programs for transit workers, there is a shortage of research focused on this issue. As a result, transit agencies lag behind other workplaces and organizations in this area. In fact, several workplace reviews of studies beyond public transit identified multiple treatment programs that can improve mental health and resilience in the workplace.

• Proactive resilience training for workers to prepare for adverse situations is notably absent in the public transit literature. However, such training is common in other professions.
• The review of research methodology revealed that most past TCRP studies have involved a survey of transit agencies rather than transit workers. However, several academic research studies have conducted surveys to examine how work conditions affect transit workers’ health and well-being.
• The available surveys of transit workers were either initiated or supported by unions. The mode of survey and dissemination techniques varied. Because it can be difficult to reach transit workers, all surveys used convenience sampling. This non-probability sampling method does not guarantee proportional representation.

In addition to studies looking at mental health and wellness, Transit Workforce Shortage Synthesis Report (APTA, 2023) also presented ongoing challenges related to the workforce shortage. This study summarized research findings on the root causes and potential solutions for the shortage of transit operators and mechanics. APTA conducted research that examined the cause of the shortage by surveying 190 transit agencies, interviewing 18 of those agencies, and surveying over 1,300 transit operation workers. The following list includes some of the main survey findings about agencies’ and workers’ views on the shortage.

• Transit workers and agency management have different perceptions of the pressures on operations workers. Operations workers and agency management both ranked assault and harassment lower among reasons for quitting. However, current—and especially former—operations workers ranked it substantially higher than the agency management respondents.
• Transit workers feel unsupported by agency staff and management. Current and former transit workers felt unsupported by their supervisors, and they believe their agencies were not responsive enough when they had concerns. Responses suggest there is room for agencies to support workers more when they face challenges on the job.
• Pay, work schedule, and agency responsiveness are seen as key to retaining and attracting workers. According to current transit workers, increasing pay and providing better work schedules are the most effective ways to retain employees. In addition, former workers emphasize listening to (and acting on) employees’ concerns, increasing pay, and improving worker safety as the top strategies.
• Building agency culture and improving morale are important tools for retaining workers. Organizations where workers are engaged, recognized, and acknowledged and have clear pathways for growth are attractive to current employees and prospective hires. Creating a supportive working environment that facilitates growth is especially important as agencies attempt to hire a younger generation of workers.

Perpetually Adverse Work Conditions for Transit Workers

While COVID-19 added a new layer of adverse working conditions for frontline transit workers, they were already exposed to difficult workplace conditions. Numerous studies have documented these perpetual adverse conditions and their effects on mental health, physical health, and performance, as well as family and personal life. Although all frontline transit workers—including maintenance workers, schedulers, and supervisors—can encounter difficult or hazardous work conditions, barring a few studies (e.g., Bacharach et al., 2005), most existing literature has exclusively focused on the working conditions of bus operators and rail or subway operators. Because of the differences between these studies, work-related adversities experienced by bus operators and train operators are discussed in two separate sections.

time to use restrooms, if any are available, because of tight schedules. In a survey of transit officials and frontline workers at transit agencies operating both bus and rail systems, 29% of respondents reported that access to restrooms was one of the most serious issues, and another 46% reported that it was a significant issue (Gillespie and Sarles, 2020). Among bus operators who took the survey, 48% reported lack of access to restrooms along the route, whereas 38% reported experiencing the issue at layovers. Gillespie and Sarles (2020) noted that transit officials recognize the seriousness of the issue, but lack of funding often prevents the provision of additional restrooms.

Adverse Conditions for Train Operators and Others

While the bulk of literature on mental health among bus operators focuses on the effects of assaults, one of the primary foci of the literature on mental health among train operators is the exposure to violent accidents and death by suicide from train, often referred to as person under train (PUT) incidents. According to FRA’s trespassing dashboard data, there were 539 fatalities in the United States in 2019 from trespassing incidents (FRA, n.d.), out of which 278 (52.6%) were death by suicide (FRA, 2020). Similarly, after analyzing data from the NYC subway system for the years 1990 to 2003, Gershon et al. (2008) found that 51.3% of the 668 fatalities over that period were death by suicide, 47.2% were accidental, and 1.5% were homicides. According to a recent report in the New York Post (Klein, 2022), 47 people died from PUT incidents involving New York subway trains during the first eight months of 2021, which means there were approximately six fatalities per month that involved subway trains in NYC. With such a high rate of PUT incidents, subway operators in New York likely experience extremely high rates of anxiety, fear, and uncertainty while working. Although railway-related fatalities are common worldwide, PUT fatalities are more problematic in the United States than in other high-income countries. For example, only 17% of railroad-related fatalities in the European Union were due to trespassing, whereas trespassing accounted for 43% of such fatalities in the United States (Topel, 2019).

Although much of the literature on the impact of PUT incidents has focused on train operators, it is worth noting that such incidents also have adverse effects on other frontline workers, such as medical emergency personnel and law enforcement personnel attending to such incidents. Media reports about shootings on NYC buses and subway trains, homicides in subway stations, and so on bear testimony to the frequent exposure to violent events endured by the public and frontline transit workers as well as other frontline workers. Some of the adverse effects experienced by bus operators, such as long work hours, difficult work schedules, and exposure to chemicals and fumes, can also be experienced by workers operating trains and working at train stations.

Finally, acts of terrorism also pose a significant risk to the physical and mental health of transit workers and other frontline workers. For example, through a survey of New York City Transit workers, Tapp et al. (2005) found significant health effects caused by dust inhalation from the World Trade Center (WTC) terrorist attack in 2001. Specifically, the study found that transit workers in the dust cloud at the time of the WTC collapse had a significantly higher risk of persistent lower respiratory and mucous membrane symptoms, depressive symptoms, and PTSD symptoms compared to those not exposed to the dust cloud. However, among exposed workers, transit workers were not at any higher risk than non-transit workers to experience PTSD, depression, or lower respiratory symptoms.

Effects of Adverse Conditions on Workers’ Health and Well-Being

Transit workers experience a host of physical and mental health issues, which are often interrelated (e.g., fatigue and sleep problems). Yet, because many reviewed studies have focused on either mental or physical health—but not both—the effects of adverse work conditions on transit workers are discussed separately in two subsections. A third subsection is included to discuss

other types of effects, such as absenteeism and productivity loss, that are often consequences of mental and physical health impacts. It should be noted that the effects of adverse work conditions on transit workers’ health were derived from reviewed studies, but they were not always scientifically designed observational studies. Rather, the effects were often derived from surveys of transit officials or transit workers. Thus, they are referred to as “potential effects” rather than “effects.”

Potential Effects on Mental Health

Frontline transit workers are exposed to a range of potentially traumatic events, including suicide attempts; death by suicide; workplace violence, such as physical and verbal assault; witnessing or involvement with accidents; and robbery (Bender et al., 2016). In a review of 27 studies, Tse et al. (2006) mentioned several psychological effects of adverse work conditions for bus operators, including depression, anxiety, PTSD, and behavioral outcomes such as substance misuse. The study further mentions that bus riders assaulted at work often develop PTSD. Alcohol and drug use are commonly reported as coping strategies in response to occupational pain or aches and sleep problems. Based on past studies, Gillespie et al. (2014) similarly contended that fatigue and sleep disorders are common among transit workers because of the nature of their work.

In a systematic review of international studies that mostly focused on train operators but also included one study on bus operators, Carey et al. (2021) noted a high prevalence of PTSD, major depressive disorder, and anxiety disorders among transit operators. The reviewed studies examined workers’ mental health immediately after critical incidents, such as PUT incidents and assaults. PTSD was found to be more common than the other two types of disorders, ranging between 0.73% and 29.9%, followed by depression, ranging between 0.05% and 16.3%, and anxiety disorders, ranging from 1.3% to 13.9%. In a systematic review of studies that only looked at train or subway operators after critical incidents, Clarner et al. (2015) found that 0.7% to 17% of operators experienced PTSD, 1% to 26% experienced persistent depression, 1.3% to 2.8% experienced major depressive episodes, and 0.5% to 1.3% experienced panic disorder. Moreover, Looi et al. (2009) found brain-level differences between transit workers with and without work-related PTSD.

Although cases involving trespasser suicides, accidents, and assaults may have longer-term effects on transit workers than minor events, Gillespie and Sarles (2020) noted that even a lack of adequate access to restrooms could have adverse psychological effects, such as fear, anger, and humiliation. In an observational study involving a small number of bus operators in Stockholm, Sweden, Rydstedt et al. (1998) found that operators’ stress levels increased when assigned to routes with new features but decreased to normal after some time, indicating that assigning operators to drive in different circumstances can acutely raise work-related stress.

Other minor psychological effects of the work environment—such as operators’ job strain, stress, and lack of control—have been discussed in numerous other studies, including Gomez-Ortiz et al. (2018), Poulsen et al. (2007), and Rydstedt et al. (1998). According to Rydstedt et al., work conditions associated with stress include machine-paced work, low social support from colleagues and supervisors, rotating shift work or irregular hours, contradictory work demands, role overload, and unhealthy working conditions, all of which are common concerns for public transportation operators. The lack of job control is also cited as a major contributor to stress among bus drivers, since they have little control over the pace of their work and must balance several different duties throughout their workday. Urban bus driving is also characterized by high levels of risk, where the failure to meet work demands can have serious or, in some instances, fatal consequences. Furthermore, high exposure to traffic congestion has also been shown to cause heightened psychophysiological stress. All of these conditions are common examples of stress factors on public transportation workers that can have serious long-term cardiovascular effects.

and Volume 2: User Guide (CASE and TRA, 2018a; CASE and TRA, 2018b) found that assaults against transit operators resulted in lost work time, damaged employee morale and productivity, and increased worker compensation payments, medical expenses, lawsuits, and liability costs. Similarly, a survey conducted by Nakanishi and Fleming (2011) found that violence against operators was significantly associated with increases in injury-related claims, absenteeism, and union grievances, and it diminishes productivity.

In many other studies, authors have discussed secondary effects of the mental health and physical health impacts of transit workers’ adverse work conditions. For example, Tse et al. (2006) contended that mental and physical health effects on transit workers lead to higher rates of absenteeism and labor turnover and a greater propensity for accidents. Gomez-Ortiz et al. (2018) found that accident propensity was associated with operators’ physical health issues, whereas Gillespie and Sarles (2020) proposed that mental distress from inadequate restroom access could increase accident propensity. Gertler et al. (2002) suggested that fatigue from an adverse work environment might cause accidents and productivity loss. Several other studies also mention absenteeism and productivity loss as consequences of adverse work conditions for transit workers (Ragland et al., 1998; Kompier and Di Martino, 1995; Kompier et al., 2000; Davis, 2004; and Stoloff et al., 2020). Finally, Bacharach et al. (2005) suggested that certain adverse work conditions of transit workers, such as shift work and long work hours, can cause conflicts between work and family.

Although the reviewed literature has been restricted to public transit, numerous studies beyond transit show that work-related mental health issues, such as PTSD, can have serious impacts on productivity, absenteeism, and an employer’s return on investment (ROI). Stergiopoulos et al. (2011) and Pieper et al. (2019) are two examples of such studies. Stergiopoulos et al. studied the effects of eye movement desensitization and reprocessing (EMDR) treatments on public transit workers with PTSD. Results showed that 12 of the 20 patients who received treatment no longer fulfilled the criteria for PTSD at 35 months, and 10 of those 12 patients had returned to full working capacity, improving worker retention. Economic analyses of work-related health interventions by Pieper et al. found that interventions for management of depression in the workplace were “economically successful” and highlighted the potential cost-effectiveness of mental health interventions and web-based programs.

Ways to Address Adverse Work Conditions

FTA administers a national transit safety program and compliance oversight process that applies to all transit agencies and workers. The agency offers transit safety and crime prevention oversight and guidance as well as mental health resources, including access to a mental health toolkit from the U.S. Department of Labor. In 2018, FTA published the Public Transportation Agency Safety Plan (PTASP) Final Rule, requiring public transportation systems that receive federal funds to develop safety plans, including processes and procedures to implement Safety Management Systems. The PTASP went into effect in 2019. FTA also regulates drug and alcohol use policies for transit operators with the intent of reducing accidents. In addition, the agency started the Transit Workforce Center in 2021, the first technical assistance center for transit workforce development. The center focuses on the workforce development needs of urban, suburban, tribal, and rural public transportation entities, with an overarching mission to assist the industry as it recruits, hires, trains, and retains a diverse workforce. (More information about the Transit Workforce Center can be found at www.transitworkforce.org.) FTA also maintains a website focused on mental health resources for transit workers: www.transit.dot.gov/regulations-and-programs/safety/mental-health-resources.

Other agencies have developed additional reports to address adverse work conditions, both for frontline transportation employees and the general working population. The World Health

Organization (WHO) (2022) produced guidelines on mental health at work that elaborate on the interconnection between mental health and work and include recommendations on organizational interventions and training, among other topics. The U.S. Surgeon General’s Workplace Mental Health & Well-Being page (U.S. Surgeon General, 2022b) stated that 76% of U.S. workers reported at least one symptom of a mental health condition, and 84% of workers said their workplace conditions contribute to at least one mental health challenge. In addition, The U.S. Surgeon General’s Framework for Workplace Mental Health and Well-Being (U.S. Surgeon General, 2022a) established five essentials for workplace mental health and well-being: protection from harm; opportunity for growth; connection and community; mattering at work; and work–life harmony.

Only two studies could be identified that empirically examined the effects of COVID-19 on transit workers (Gershon et al., 2021; Rice et al., 2021). One recommendation common to both studies is for transit agencies to provide an adequate amount of PPE to frontline workers. Gershon et al. (2021) further suggested procedural changes in the provision of service, whereas Rice et al. (2021) emphasized workplace assessments, enhanced safety information, and communication with frontline workers about structural changes made (e.g., health and safety personnel hired).

Beyond COVID-19-specific recommendations, several studies have recommendations for how to improve transit workplace environments to promote employee wellness. Notably, while there are operator training programs designed to avoid potentially hostile situations, little work has focused on proactive resilience programs to buffer the effects of adverse situations. Thus, the first subsection discusses potential measures to reduce adverse events, such as PUT incidents and assaults, and thereby reduce the chance that transit workers will be exposed to adverse conditions. In the second subsection, a discussion is provided on proactive resilience programs based on literature from other workplaces and occupational groups. In the third subsection, a discussion is provided on typical transit practices for enhancing the wellness of transit workers, such as employee assistance programs (EAPs). Finally, the fourth subsection is an overview of the barriers to improving transit workers’ mental health and well-being.

Improving Workplace Environment

The reviewed literature covers a variety of methods to improve workplace environments and mitigate transit workers’ risk of exposure to adverse conditions. For example, a project to build physical platform barriers between subway trains and waiting passengers in three NYC Metropolitan Transit Authority stations is underway to reduce the probability of exposure of subway operators and other frontline workers to PUT incidents, such as accidents, deaths by suicide, and homicide. The total cost of the project is estimated to be $100 million (Deliso, 2022). This review showed that potentially less-expensive measures—such as identifying people on the platform who are at risk of suicide through real-time closed-circuit television (CCTV) surveillance (Mishara et al., 2016); identifying locations of trespassing and suicide incidents (Botha et al., 2014); and identifying season, time of day, and so on for railway suicides (Uittenbogaard and Ceccato, 2015)—may also reduce train operators’ risk of exposure to PUT incidents. Furthermore, decreasing this risk would reduce operators’ chances of experiencing PTSD, depression, anxiety, and other mental health symptoms and disorders.

Likewise, Operation Lifesaver is a nonprofit organization working to improve rail safety and save lives in and around rail crossings through education, and FTA’s TRACS completed Trespass and Suicide Prevention Final Report (2021) on rail trespassing and suicide prevention. The report’s recommendations include, among others, providing targeted funding for comprehensive post-fatality support programs for transit employees; developing standard suicide and trespassing prevention signage; using detection technologies to identify rail trespassing hotspots; and building low-cost physical barriers and signage around railroad rights-of-way.

agencies were most lacking regarding the last two components (i.e., employee recognition and rewards, organizational trust).

• Strong leadership, management, and organizational commitment to safety;
• Employee/union shared ownership and participation;
• Effective safety communication;
• Proactive use of safety data, key indicators, and benchmarking;
• Organizational learning;
• Consistent safety reporting and investigation for prevention;
• Employee recognition and rewards; and
• High level of organizational trust.

TCRP Report 174 provided several suggestions for improving transit agencies’ safety culture. However, perhaps the most important takeaway is the need for transit management to take primary responsibility and collectively work with employee leaders to develop a road map.

Although the literature on improving workplace environments within the public transit context is varied, several studies highlight the effectiveness of certain approaches. For example, Cavallari et al. (2021) showed that increasing the predictability of work schedules and reducing the work intensity of transportation workers can reduce burnout. Based on a review of 24 peer-reviewed articles, Lindberg and Vingård (2012) concluded that the workplace environment is healthy when there are chances for collaboration and teamwork, potential for growth and development, and recognition and employee involvement; when leaders are positive, accessible, and fair; when there are opportunities for autonomy and empowerment; when communication is clear; and when the physical work environment is safe.

Reducing the Impact of Adverse Environments

Several studies were found that cover treatment of PTSD and other mental illnesses, including a small, primarily randomized control study to examine the effect of EMDR (Hogberg et al., 2007). This study involved 24 public transit workers who were experiencing PTSD after PUT incidents and assaults. After treatment, the study found that 67% of the EMDR group and 11% of the control group no longer met the criteria for PTSD.

Health-promoting programs already provided by many transit agencies, as discussed in the next subsection, can help workers cope with day-to-day adverse conditions in the workplace. Although evaluations of such programs are rare, studies beyond the realm of public transit show that certain components of similar programs—such as mindfulness training—are highly effective in mitigating workers’ anxiety and stress. Because existing transit agency programs are highly relevant to this research, they are discussed in a later section.

Although some studies suggest training programs could reduce operators’ risk of aggression due to disputes, it is rare for such studies to discuss proactive resilience training programs that prepare workers for hostile work environments. For example, in TCRP Synthesis 93, Nakanishi and Fleming (2011) mentioned that nearly all bus operators received training on customer relations, conflict mitigation, and diversity, whereas only 33% received training on self-defense. There was no mention of resilience training.

A large body of literature (outside of public transit) shows the benefits of such proactive resilience training. The number of studies on such resilience training programs is large enough to allow Robertson et al. (2015) to review 14 studies and Joyce et al. (2018) to undertake a meta-analysis involving 11 randomized trial studies.

Proactive resilience programs typically instill problem-solving skills, self-efficacy, optimism, self-regulation, emotional awareness, flexibility, empathy, and healthy relationships with others

(Robertson et al., 2015). These programs can be thought of as mental health “prep” programs to help build individuals’ resilience and ability to cope with distress. Such programs have been used to prepare intensive-care nurses, college students, cancer survivors, youth workers, radiologists, immigrants, physicians, military officers, police officers, educators, entrepreneurs, and general office workers (Robertson et al., 2015; Joyce et al., 2018). No explicit mention of transit workers was found in the reviewed literature on proactive resilience training.

Perhaps the most well-known resilience training program in the United States is the Master Resilience Trainer program developed at the University of Pennsylvania to train military personnel (Reivich et al., 2011). The program uses validated concepts from positive psychology—such as identifying strengths, cultivating gratitude, and improving relationships—to enhance cognitive and social skills. Another well-known and popular program is the READY (Resilience and Activity for every DaY) program, which enhances positive emotions, cognitive flexibility, social support, life meaning, and active coping (Burton et al., 2010). The program has been successfully used in numerous circumstances, including workplaces with diverse characteristics.

In addition to teaching how to prepare for and effectively encounter hostile environments, resilience training programs also teach empathy and healthy relationships, which can make them beneficial not only to frontline transit workers but also to managerial staff who make organizational decisions.

Typical Health and Wellness–Promoting Practices of Transit Agencies

At the time of writing, no comprehensive review of transit agencies’ health and wellness programs has been published since TCRP Synthesis 52: Transit Operator Health and Wellness Programs, released two decades ago (Davis, 2004). Based on a survey of 14 transit agencies and 6 case studies, the synthesis included the following findings.

• A program’s success depends on management and union support.
• Some health and wellness programs are visible, but others are not.
• Some agencies have health and wellness committees, but others have personnel attached to health and wellness. In some agencies, health and wellness personnel have other responsibilities, limiting their time and effort in this area.
• Most health and wellness programs are organizationally linked with other programs, such as safety, benefits, and workers’ compensation. This practice allows health and wellness programs to maintain a higher profile.
• Although agencies often have annual operating plans, goals, and objectives, program evaluations are rare. Assessment of participant satisfaction is the most common method for program evaluation.

The synthesis also revealed that “health education, exercise, stress management, employee assistance, nutrition, smoking cessation, maintaining mental health, cardiovascular disease prevention, and disease management programs” were the most common endeavors undertaken by wellness programs (Davis, 2004, p. 2). In a subsequent TCRP study, TCRP Report 169: Developing Best-Practice Guidelines for Improving Bus Operator Health and Retention, a survey of U.S. and Canadian transit agencies and unions showed that only 50% of agencies had ongoing workplace health-promotion programs, which was lower than the percentage (63%) reported by the Kaiser Foundation for all types of employers at that time (Gillespie et al., 2014). The report authors also noted that transit agencies’ health-promoting programs were sporadic, and only one-third of small agencies had health-promoting programs compared to 50% for all agencies.

Because of the scarcity of recent reviews of transit agencies’ wellness programs or EAPs, a preliminary investigation into the components of wellness programs was conducted through searches of transit agency websites. The following list includes a few examples.

interventions focused on individual workers rather than workplace structure or procedures may be more effective at reducing mental health distress. In a review of 30 studies on workplace psychological aggression, Pacheco et al. (2021) concluded that workers need support from supervisors, managers, and coworkers for a workplace to be healthy and aggression-free. Useche et al. (2021) and Bacharach et al. (2005) similarly showed the importance of supervisor support and peer support in reducing job stress.

Steps taken by transit agencies beyond health-promoting programs can also be beneficial for workers. However, very little literature is available on efforts by transit agencies in that regard. In a study involving transit agencies from several countries that was published more than 20 years ago, Kompier et al. (2000) showed that health-promoting courses and activities were considered highly effective, but improving communication and creating new workgroup structures were also effective.

Barriers to Improving Mental Health and Well-Being

Although several review studies, some involving meta-analysis of scientifically conducted empirical studies, show definitive positive effects of employer-provided health and wellness programs, there are many barriers to treatment, participation, and access to benefits.

1. Gillespie et al. (2014) found that only 50% of agencies provide such services—thus, half of all transit workers have no access to mental health services or programs. As noted by the same study, workers from smaller agencies are less likely to have access to such programs.
2. Long work hours and shift work cause fatigue, which can prevent workers from participating in wellness programs and services (Gertler et al., 2002). Said another way, the job itself is so demanding that it can prevent workers from seeking out any services, even if they would be beneficial, due to fatigue and exhaustion.
3. As found by Bance et al. (2014), transit workers are often reluctant to seek treatment or participate in health programs because of an overwhelming amount of paperwork (bureaucracy); negative interaction with management; and personal or household financial constraints. How insignificant operators can feel about their status within transit agencies is revealed in this quote from an interviewee: “I have a badge number and basically I’m a number, I’m part of the system. They want the service out there and that’s about it. As long as those buses are on time” (Bance et al., 2014, p. 7).
4. As Bowles et al. (2017) observed in a study involving semi-structured interviews with transit workers, organizational practices and management leadership style often create an atmosphere of distrust among workers, which in turn can discourage workers from seeking assistance provided by employers.
5. Other factors, such as attrition, turnover, conflict between worker groups, resistance to change, and authoritarian leadership style, can also prevent workers from seeking assistance provided by transit agencies (Kompier et al., 2000).

There has not been much discussion in recent surface transit literature about removing barriers or enhancing the participation of workers in programs and services provided by employers. However, a recent study on airport workers’ participation in similar programs and services, ACRP Synthesis 113: Airport Workforce Programs Supporting Employee Well-Being, is instructive because surface transit workers and airport workers both encounter some of the same issues, such as public-facing work environment, long work hours, and the potential to encounter violent incidents (Alexander et al., 2020). The following two passages about removing barriers to workers’ participation in programs and services provided by employers could also be beneficial to surface transit.

One way to convince transit agency leadership about the positive impact of employer-provided programs and services would be to demonstrate their positive economic impacts, such as any productivity gain or reduction in absenteeism. However, one such effort in TCRP Research Report 217: Improving the Health and Safety of Transit Workers with Corresponding Impacts on the Bottom Line failed to find evidence of reduced absenteeism for four of the five agencies for which data were analyzed (Stoloff et al., 2020). Such results are not necessarily surprising, for two reasons. First, productivity is a secondary benefit, whereas improvement in health and well-being is a primary benefit. The mechanism by which employer-provided programs and services affect workers’ personal well-being, and how that enhanced well-being affects productivity or absenteeism, may not be identifiable by the type of regression model used by Stoloff et al. (2020). Second, if workers do not participate in programs and services provided by employers, one cannot expect them to have positive economic outcomes. Since the relationship between employer-provided programs and services and worker productivity is complex, it may be more sensible to demonstrate the impact of programs and services on personal mental health and well-being. This may also increase workers’ desire for such programs and services and help remove the barriers that prevent workers from seeking and participating in such programs and services.

Impact of COVID-19 on Public Transit

COVID-19 Infection and Mortality Among Public Transit Workers

As of the first week of April 2022, COVID-19 had killed 6.2 million people worldwide and almost 1 million in the United States alone, according to Johns Hopkins University’s COVID-19 website (https://coronavirus.jhu.edu/map.html). The pandemic has had a disproportionately greater impact on the health and well-being of transit workers. Transit workers were declared essential critical infrastructure workers by the federal government and continued to work during initial COVID-19 shutdowns. According to a report by APTA, during the first 15 months of the pandemic (March 2020–May 2021), 48,511 public transit workers in the United States were infected with the coronavirus, and 478 of them died from COVID-19 (Mader, 2021). Tomasi et al. (2021) found that, during the first five months of the pandemic, COVID-19 killed 118 public transit workers in the New York metropolitan area—the first epicenter of the pandemic in the United States. The study also showed that most victims were male (83%) and older (median age of 58). Because of the nature of COVID-19 transmission, vehicle operators (46%) and workers with public contact (57%) represented a disproportionately larger share of the victims. The disproportionately worse health effects of the pandemic on transportation workers seem to be universal: A countrywide analysis by Nafilyan et al. (2021) showed a very high mortality hazard ratio for workers in the United Kingdom, and a very high level of excess deaths was found among transportation workers in California by Chen et al. (2021).

Age-specific COVID-19 mortality data by occupation within the transportation sector could not be located. However, it can be inferred from Tomasi et al. (2021) and a study by the Shared Use Mobility Center (SUMC) (2021) that bus operators might have constituted a disproportionately larger share of victims nationally. (This is because bus operators are typically older than other transportation workers, on average, and older workers experienced disproportionately worse health effects from COVID-19.) For example, the SUMC report showed that the median

age of urban bus operators was 52.1 years in 2020, whereas the median age for all transportation workers was only 42.5 years.

Impact of COVID-19 on Mental Health of Transit Workers

A recent NCHRP/TCRP research report mentioned that a pandemic like COVID-19 affects workers’ confidence, morale, trust, bonds, and stress, as well as personal and household expenditures and income (Matherly et al., 2021). The study did not provide empirical evidence of these effects; however, there are two empirical studies—by Gershon et al. (2021) and Rice et al. (2021)—that specifically addressed the impact of the COVID-19 pandemic on mental health in public transit workers. These studies provided insights not only about variables that could potentially affect the mental health of transit workers but also about survey protocols and questionnaire design, as well as methods of data analysis. Because these studies were far more relevant to the research project, they have been described in more detail than other studies in this report.

Gershon et al. (2021) collected data from 645 transit workers (bus and subway) via random sampling in New York City through convenient sampling in August 2020, approximately five months after the pandemic began. The TWU Local 100 leadership emailed the online survey link to 3,000 workers, stratified by job type. The study provided a detailed description of the 645 workers who responded, including race, ethnicity, gender, and age. It also showed the level of access that sampled workers had to diverse types of PPE.

To measure mental health symptoms, Gershon et al. (2021) used the General Health Questionnaire (GHQ-4), a four-item, self-report screener for anxiety and depression symptoms. Logistic regression models were used to predict the likelihood of COVID-19 infection, experiencing fear of COVID-19 infection, and developing any mental health symptoms. It used preexisting medical conditions (Y/N), age (<50/50+), gender, race, Hispanic ethnicity, marital status, number of household members, and household members with chronic illness as common independent or explanatory variables to predict the likelihood of COVID-19 infection. There were not many emergent predictors of virus infection. Instead, the only significant predictor of infection likelihood was the difficulty of acquiring PPE, such that difficulty of obtaining PPE was associated with an increased likelihood of COVID-19 infection. In addition, knowing someone with COVID-19, history of home quarantine, history of COVID-19 infection, public-facing nature of work, difficulty acquiring PPE, and having a plexiglass barrier were associated with greater fear of COVID-19. The presence of physical barriers (such as plexiglass) may contribute to workers’ awareness and concern about viral infection; however, data indicated that signage about social distancing, physical barriers, and fewer passengers were associated with lower work-related fear. The model on mental health symptoms used variables that were mostly similar to those of the COVID-19 infection and fear of COVID-19 infection models, but it included fear of COVID-19 as an additional predictor. Results indicated that people who feared COVID-19 were six times more likely to have anxiety or depression symptoms. One of the study’s conclusions was that transit agencies can reduce fear of a pandemic by providing an adequate amount of PPE and making procedural changes via signage and limiting passenger numbers, which could have a positive effect on mental health.

The study by Rice et al. (2021) involved public transit workers from Oregon. A total of 174 transit workers were recruited for a survey, with assistance from labor unions. Nine transit agencies were approached; four of them participated. Survey respondents were recruited by placing posters in garages and flyers in employee mailboxes, and a union mailing flyers to its members. Of the respondents, 67% were bus operators, whereas the other 33% included rail/streetcar operators, vehicle maintenance workers, facility maintenance workers, administrative support staff, and other support staff.

• Run only drop-off service after reaching capacity;
• Require masks on board vehicles;
• Install mask and hand sanitizer dispensers in vehicles;
• Switch to rear-door boarding;
• Implement the six-feet social distancing rule; and
• Install protective physical barriers between operators and passengers. (Mader, 2021)

Some transit agencies adopted measures to address frontline workers’ needs specifically, including

• Work with labor unions to change schedules (e.g., Port Authority of Allegheny County);
• Allow workers to use special administrative leave instead of sick time (e.g., Port Authority of Allegheny County);
• Approve hazard pay for frontline workers (e.g., Heart of Iowa Regional Transit Authority, New Orleans Regional Transit Authority); and
• Give priority to transit workers for receiving vaccines.

A comparison of national data from the Bureau of Labor Statistics for May 2019 and May 2020 shows that the number of jobs for the occupational category “Bus Drivers, Transit and Intercity” decreased from 179,510 to 162,850, a decrease of approximately 9.3%. For the same period, median annual wages for the occupational category increased from $43,030 to $48,620, an increase of 13% (U.S. Bureau of Labor Statistics, 2020; 2021). These changes reflect the shortage of transit frontline workers in the peri-COVID-19 period, especially bus operators, which has been a concern for many transit agencies. The decrease in bus operators despite the increase in median wages could also demonstrate how wages are not the definitive factor in the decline of frontline transit jobs.

Even media reports now show the difficulties faced by transit agencies in hiring bus operators (Perrero, 2022). A survey conducted by APTA in February 2022 revealed the difficulties that transit agencies experience in hiring frontline workers (Dickens, 2022). Among the 117 transit agencies surveyed, 92% reported having difficulty hiring new employees, especially bus operators; 71% reported having to decrease service level or delay increasing service level because of labor shortage; 52% increased starting pay; 39% implemented referral bonuses; and 17% implemented retention bonuses.

Some information on agency-specific efforts is also available (Thompson, 2021). For example, NJ TRANSIT began to pay sign-on bonuses of $6,000, and Metropolitan Atlanta Rapid Transit Authority (MARTA) began to provide one-time payments of $3,500 to various types of frontline workers (Thompson, 2021). Bonuses can be structured in various ways; for example, sign-on bonuses may be paid in different amounts at different times, such as once at the start of service, again once operators complete their initial training, and again after six months.

As indicated in the APTA survey from February 2022, almost 62% of responding agencies reported having difficulty retaining employees. According to a worker survey that APTA conducted in 2023, many factors contributed to workers quitting, such as (in descending order of importance) work schedules, compensation, “other” working conditions, on-the-job harassment or assault, and concerns over contracting COVID-19 on the job. Difficulty retaining frontline transit workers appears to be the result of multiple factors, with stressors from everyday working conditions being an underlying reason why transit workers are leaving their jobs. If not addressed properly, these everyday stressors can develop into mental health issues with long-term impacts on current and former operators.

Transit agencies are struggling to hire and retain frontline workers, despite providing pay raises and other incentives, because of the lived experiences of transit frontline workers during the pan demic, as well as the perception of risk among people who could potentially work as frontline transit employees. As discussed in the 2023 APTA report, transit frontline workers have had to

work in difficult environments since before the pandemic, which contributes to poorer mental and physical health compared to most other occupations. COVID-19 has had a compounding effect on an already adverse work environment, potentially leading to even worse outcomes in terms of health and well-being. However, COVID-19 also seems to provide an opportunity to negotiate a better work environment for frontline transit workers.

With the COVID-19 pandemic’s persistence for over two years, repeated surges affecting millions of people, the emergence of new virus variants (e.g., Delta, Omicron BA.1, Omicron BA.2), and various predictions from the nation’s public health experts as to whether circumstances will ever be like pre-pandemic times, it is difficult to predict how the nature of public transportation in this country will change. A recent report for APTA by Freemark et al. (2021) on post-pandemic travel showed that more transit agencies expect overall ridership to decrease (45% decrease vs. 20% increase), and they expect a substantial reduction in the numbers of white-collar riders and peak-period riders. If these changes materialize, and service revisions are made because of such changes, they could potentially impact the health and well-being of the future transit workforce.

Although COVID-19 made recruiting frontline transit workers more difficult, recruiting and retaining such workers have always been challenging for transit agencies. TCRPReport77:Managing Transit’s Workforce in the New Millennium (McGlothin Davis, Inc., and Corporate Strategies, Inc., 2002) noted that (a) retaining frontline workers is more challenging for larger agencies than smaller agencies, (b) retention is easier when workers are treated with dignity, (c) there is a need for greater joint efforts between agencies and unions through labor-management committees for retaining workers, and (d) agencies must be open to an organizational culture change that prioritizes inclusion, respect, and appreciation.

Literature Review Conclusion

This review began with the perpetually adverse work conditions of transit workers and their effects on workers’ mental health, physical health, and overall well-being. A large number of studies, including some rigorous reviews, showed strong evidence of the adverse effects. For example, there is clear evidence of PUT incidents and assaults negatively impacting train operators’ and bus operators’ mental health. The subsequent review of approaches to reduce exposure to adverse conditions and incidents showed many ways to reduce exposure, including building physical platform barriers at stations. However, such measures are expensive, and they cannot prevent trespassing in areas outside stations (e.g., at level crossings), which is a more serious problem in the United States than other high-income countries. It may be possible to reduce suicides by monitoring individuals through live CCTV; however, the effectiveness of such efforts has not yet been seriously tested.

Several studies on the adverse effects of work environment on bus operators were also reviewed. Although assaults appear to have the gravest consequences, bus operators constantly operate in inconvenient physical spaces and stressful conditions. For example, one study from the Seattle area found that 85% of bus operators suffer from pain in various body parts. Another study from Los Angeles showed that a large proportion of bus operators work significantly longer hours than typical workers. Restroom access is also a serious problem because of the inadequate number of restrooms along bus routes and at layovers. Several suggestions have been made by past studies, including redesign of operator workstations, less stressful schedules, and shorter work hours. Workplace conditions such as restroom access, varying schedules, exposure to COVID-19, and assault contribute to agencies’ ability to retain frontline workers.

The review of transit agencies’ health-promoting programs and services showed that about half of all agencies make such provisions, but only about one-third of small agencies make such provisions. While some agencies provide information about such programs and services on their

websites, many do not. Assessment of programs and services provided by transit agencies for workers has been rare, but a review of the effectiveness of certain components (e.g., mindfulness training) in mainstream studies showed that they may be highly effective in addressing the mental health of workers. Although preparatory training for resiliency is nearly guaranteed for certain demanding professions, such as military personnel and physicians, little evidence was found about such training among transit workers.

It appears from the review that participation by transit workers in health and wellness-promoting programs is often voluntary. The reviewed literature showed that organizational practices and leadership styles of managers often create an atmosphere of distrust among workers. Studies have shown that visible labor-management collaboration, leadership buy-in, and identifying champions among workers are crucial for the success of employer-provided health-promoting programs and services. While a demonstration of economic benefits to transit agencies through productivity gain could be convincing to managers, some suggest managers should not expect short-term economic benefits because the effects of such programs and services are likely to be evident only in the long run.

This literature review included an exploration of the limited number of studies that have been published to date on the effects of COVID-19 on transit workers and transit agencies. The research team found two studies on the effects of COVID-19 on transit workers, and both showed statistically significant adverse effects. Both studies also recommended adequate provision of PPE to transit workers to reduce the pandemic’s impact. The review also showed that the pandemic has had a profound effect on transit ridership, which has led to a great deal of uncertainty about the nature of transit in the future. COVID-19-related research showed that the pandemic has had a significant impact on the transit labor force. Many frontline workers departed because of COVID-19 and restructuring of the overall labor market. Because of the disproportionate effects of the virus on different age groups, it appears that departures have been more common among older workers, who are usually more experienced. It is difficult to predict what the long-term consequences of COVID-19 will be, but managers will have to create better work environments for frontline workers if the current labor shortage continues.

One of the primary objectives of this review was to assess how past studies conducted outreach with transit agencies and what analytical methods researchers used in quantitative studies. The review showed that most TCRP studies conducted outreach with transit agencies rather than interacting directly with transit workers, but many other studies involved direct interaction with workers. These interactions were mostly conducted through surveys, but in some cases, semi-structured interviews were also conducted. Finally, the review showed that the statistical models used in past studies are conventional.