Heat Safety in the Workplace:Modified Delphi Consensus to Establish Strategies and Resources to Protect U.S Workers

The purpose of this consensus document was to develop feasible, evidence‐based occupational heat safety recommendations to protect the US workers that experience heat stress. Heat safety recommendations were created to protect worker health and to avoid productivity losses associated with occupational heat stress. Recommendations were tailored to be utilized by safety managers, industrial hygienists, and the employers who bear responsibility for implementing heat safety plans. An interdisciplinary roundtable comprised of 51 experts was assembled to create a narrative review summarizing current data and gaps in knowledge within eight heat safety topics: (a) heat hygiene, (b) hydration, (c) heat acclimatization, (d) environmental monitoring, (e) physiological monitoring, (f) body cooling, (g) textiles and personal protective gear, and (h) emergency action plan implementation. The consensus‐based recommendations for each topic were created using the Delphi method and evaluated based on scientific evidence, feasibility, and clarity. The current document presents 40 occupational heat safety recommendations across all eight topics. Establishing these recommendations will help organizations and employers create effective heat safety plans for their workplaces, address factors that limit the implementation of heat safety best‐practices and protect worker health and productivity

Work adaptations insufficient to address growing heat risk for U.S. agricultural workers

The over one million agricultural workers in the United States (U.S.) are amongst the populations most vulnerable to the health impacts of extreme heat. Climate change will further increase this vulnerability. Here we estimate the magnitude and spatial patterns of the growing heat exposure and health risk faced by U.S. crop workers and assess the effect of workplace adaptations on mitigating that risk. We find that the average number of days spent working in unsafe conditions will double by mid-century, and, without mitigation, triple by the end of it. Increases in rest time and the availability of climate-controlled recovery areas can eliminate this risk but could affect farm productivity, farm worker earnings, and/or labor costs much more than alternative measures. Safeguarding the health and well-being of U.S. crop workers will therefore require systemic change beyond the worker and workplace level

A Comparative Assessment of Cooling Center Preparedness across Twenty-Five U.S. Cities

Cooling centers have played a significant role in reducing the risks of adverse health impacts of extreme heat exposure. However, there have been no comparative studies investigating cooling center preparedness in terms of population coverage, location efficiency, and population coverage disparities among different subpopulation groups. Using a catchment area method with a 0.8 km walking distance, we compared three aspects of cooling center preparedness across twenty-five cities in the U.S. We first calculated the percentage of the population covered by a single cooling center for each city. Then, the extracted values were separately compared to the city’s heat indexes, latitudes, and spatial patterns of cooling centers. Finally, we investigated population coverage disparities among multiple demographics (age, race/ethnicity) and socioeconomic (insurance, poverty) subpopulation groups by comparing the percentage of population coverage between selected subpopulation groups and reference subpopulation groups. Our results showed that cooler cities, higher latitude cities, and cities with dispersed cooling centers tend to be more prepared than warmer cities, lower latitude cities, and cities with clustered cooling centers across the U.S. Moreover, older people (≥65) had 9% lower population coverage than younger people (≤64). Our results suggest that the placement of future cooling centers should consider both the location of other nearby cooling centers and the spatial distribution of subpopulations to maximize population coverage and reduce access disparities among several subpopulations

Risk Factors for Heat-Related Illness in Washington Crop Workers

<div><p>ABSTRACT</p><p>Crop workers are at high risk of heat-related illness (HRI) from internal heat generated by heavy physical work, particularly when laboring in hot and humid conditions. The aim of this study was to identify risk factors for HRI symptoms in Washington crop workers using an audio computer-assisted self-interview (A-CASI) instrument that has undergone reliability and validity evaluation. A cross-sectional A-CASI survey of 97 crop workers in Washington State was conducted during the summer of 2013. Potential HRI risk factors in demographic, training, work, hydration, clothing, health, and environmental domains were selected a priori for evaluation. Mixed-effects logistic regression was used to identify risk factors for self-reported symptoms associated with heat strain and HRI (dizziness/light-headedness or heavy sweating) experienced at work in hot conditions. An increase in age was associated with a lower odds of HRI symptoms (odds ratio [OR] = 0.92; 95% confidence interval [CI] = 0.87–0.98). Piece rate compared with hourly payment (OR = 6.20; 95% CI = 1.11–34.54) and needing to walk for more than 3 minutes to get to the toilet, compared with less than 3 minutes (OR = 4.86; 95% CI = 1.18–20.06), were associated with a higher odds of HRI symptoms. In this descriptive study of risk factors for HRI symptoms in Washington crop workers, decreased age (and less work experience), piece rate pay, and longer distance to the toilet were associated with self-reported HRI symptoms. Modifiable workplace factors should be considered in HRI prevention efforts that are evaluated using objective measures in representative working populations.</p></div

Distribution of influenza-like illness (ILI) by occupation in Washington State, September 2009-August 2010.

We aim to estimate the prevalence of influenza-like illness (ILI) by occupation and to identify occupations associated with increased ILI prevalence.Between September 2009 and August 2010, the Centers for Disease Control (CDC) included questions on ILI symptoms on the Behavioral Risk Factor Surveillance System (BRFSS). Washington State collects the occupation of all employed BRFSS respondents. ILI prevalence and prevalence ratios (PR) were calculated by occupational group.There were 8,758 adult, currently employed, non-military respondents to the Washington BRFSS during the study period. The ILI prevalence for all employed respondents was 6.8% (95% Confidence Interval (95% CI) = 6.1, 7.6). PRs indicated a lower prevalence of ILI in Technicians (PR = 0.4, 95% CI = 0.2, 0.9) and Truck Drivers (PR = 0.2, 95% CI = 0.1, 0.7) and higher prevalence in Janitors and Cleaners (PR = 2.5, 95% CI = 1.3, 4.7) and Secretaries (PR = 2.4, 95% CI = 1.1, 5.4).Some occupations appear to have higher prevalence of ILI than others. These occupational differences may be explained, in part, by differing levels of social contact with the public or contact with contaminated surfaces at work, or by other occupational factors such as stress or access to health care resources

Demographics and vaccination rate by occupation in the Washington State employed population, BRFSS data, September 2009 to August 2010.

<p>Note. n.e.c. = not elsewhere classified; all data were weighted to account for BRFSS sampling design.</p>a<p>The n for the vaccination status question was 6,139.</p

Influenza like illness (ILI) prevalence ratios by select occupation and characteristics, Washington State employed population, BRFSS September 2009 to August 2010.

<p>Note. CI = confidence interval; PR = prevalence ratio; n.e.c. = not elsewhere classified; bold font indicates significance at p<0.05; all data were weighted to account for BRFSS sampling design; reference group for the ‘all occupations’ column, and for each row, is composed of those in that category in all occupations with ≤70 respondents.</p>a<p>The original n for the vaccination status question was 6,139.</p

Differences between the reference group and the aggregate 29 selected occupations.

<p>Note. CI = confidence interval; all data were weighted to account for BRFSS sampling design.</p>a<p>The number of respondents for the vaccination status question was 6,139.</p

Prevalence of Influenza like illness (ILI) by occupation and select characteristics, Washington State employed population, BRFSS September 2009 to August 2010.

<p>Note. CI = confidence interval; n.e.c. = not elsewhere classified; all data were weighted to account for BRFSS sampling design; results for categories with <50 respondents are not reported.</p>a<p>The number of respondents for the vaccination status question was 6,139.</p

The multi-level heat education and awareness tools [HEAT] intervention study for farmworkers: Rationale and methods

Background: The burden of adverse health effects from heat exposure is substantial, and outdoor workers who perform heavy physical work are at high risk. Though heat prevention interventions have been developed, studies have not yet systematically evaluated the effectiveness of approaches that address risk factors at multiple levels. Objective: We sought to test the effectiveness of a multi-level heat prevention approach (heat education and awareness tools [HEAT]), which includes participatory training for outdoor agricultural workers that addresses individual and community factors and a heat awareness mobile application for agricultural supervisors that supports decisions about workplace heat prevention, in the Northwest United States. Design: We designed the HEAT study as a parallel, comparison, randomized group intervention study that recruited workers and supervisors from agricultural workplaces. In intervention arm crews, workers received HEAT training, and supervisors received the HEAT awareness application. In comparison arm crews, workers were offered non-HEAT training. Primary outcomes were worker physiological heat strain and heat-related illness (HRI) symptoms. In both worker groups, we assessed HRI symptoms approximately weekly, and heat strain physiological monitoring was conducted at worksites approximately monthly, from June through August. Discussion: To our knowledge, this is the first study to evaluate the effectiveness of a multi-level heat prevention intervention on physiological heat strain and HRI symptoms for outdoor agricultural workers. Trial registration: ClinicalTrials.gov Registration Number: NCT04234802