Identifying factors associated with physical therapy use versus non-use among injured workers with back pain in Washington State.

BACKGROUND: There is little information about predictors of physical therapy (PT) use among injured workers with back pain. The primary objective of this study is to investigate the associations between PT use and baseline factors not routinely captured in workers' compensation (WC) data. METHODS: We conducted a secondary analysis using the Washington State Workers' Compensation Disability Risk Identification Study Cohort, which combines self-reported surveys with claims data from the Washington State Department of Labor and Industries State Fund. Workers with an accepted or provisional WC claim for back injury between June 2002 and April 2004 were eligible. Baseline factors for PT use were selected from six domains (socio-demographic, pain and function, psychosocial, clinical, health behaviors, and employment-related). The outcome was a binary measure for PT use within 1 year of injury. Bivariate and multivariable logistic regression models were conducted to evaluate the associations between PT use and baseline factors. RESULTS: Among the 1370 eligible study participants, we identified 673 (49%) who received at least one PT service. Baseline factors from five of the six domains (all but health behaviors) were associated with PT use, including gender, income, pain and function measures, injury severity rating, catastrophizing, recovery expectations, fear avoidance, mental health score, body mass index, first provider seen for injury, previous injury, and several work-related factors. CONCLUSION: We identify baseline factors that are associated with PT use, which may be useful in addressing disparities in access to care for injured workers with back pain in a WC system.

Occupational heat-related illness in Washington State: A descriptive study of day of illness and prior day ambient temperatures among cases and clusters, 2006-2021.

BACKGROUND: Insufficient heat acclimatization is a risk factor for heat-related illness (HRI) morbidity, particularly during periods of sudden temperature increase. We sought to characterize heat exposure on days before, and days of, occupational HRIs. METHODS: A total of 1241 Washington State workers' compensation State Fund HRI claims from 2006 to 2021 were linked with modeled parameter-elevation regressions on independent slopes model (PRISM) meteorological data. We determined location-specific maximum temperatures (Tmax,PRISM ) on the day of illness (DOI) and prior days, and whether the Tmax,PRISM was ≥10.0°F (~5.6°C) higher than the average of past 5 days ("sudden increase") for each HRI claim. Claims occurring on days with ≥10 HRI claims ("clusters") were compared with "non-cluster" claims using t tests and χ2 tests. RESULTS: Seventy-six percent of analyzed HRI claims occurred on days with a Tmax,PRISM ≥ 80°F. Claims occurring on "cluster" days, compared to "non-cluster" days, had both a significantly higher mean DOI Tmax,PRISM (99.3°F vs. 85.8°F [37.4°C vs. 29.9°C], t(148) = -18, p < 0.001) and a higher proportion of "sudden increase" claims (80.2% vs. 24.3%, χ2 [1] = 132.9, p < 0.001). Compared to "cluster" days, HRI claims occurring during the 2021 Pacific Northwest "heat dome" had a similar increased trajectory of mean Tmax,PRISM on the days before the DOI, but with higher mean Tmax,PRISM. CONCLUSIONS: Occupational HRI risk assessments should consider both current temperatures and changes in temperatures relative to prior days. Heat prevention programs should include provisions to address acclimatization and, when increases in temperature occur too quickly to allow for sufficient acclimatization, additional precautions.

Intensity of physical therapy services: Association with work and health outcomes in injured workers with back pain in Washington State.

BACKGROUND: Associations between the intensity of physical therapy (PT) treatments and health outcomes among individuals with back pain have been examined in the general population; however, few studies have explored these associations in injured workers. Our study objective was to examine whether intensity of PT treatments is positively associated with work and health outcomes in injured workers with back pain. METHODS: We conducted a secondary analysis of prospective data collected from the Washington State Workers' Compensation (WC) Disability Risk Identification Study Cohort (D-RISC). D-RISC combined survey results with WC data from the Washington State Department of Labor and Industries. Workers with a State Fund WC claim for back injuries between June 2002 and April 2004 and who received PT services within the first year of injury were eligible. Intensity of PT treatment was measured as the type and amount of PT services within 28 days from the first PT visit. Outcome measures included work disability and self-reported measures for working for pay, pain intensity, and functional status at 1-year follow-up. We conducted linear and logistic regression models to test associations. RESULTS: We identified 662 eligible workers. In adjusted models, although the intensity of PT treatment was not significantly associated with work disability at 1-year follow-up, it was associated with lower odds of working for pay, decreased pain intensity, and improved functional status. CONCLUSIONS: Our findings suggest that there may be small benefits from receiving active PT, manual therapy, and frequent PT treatments within 28 days of initiating PT care.

"When people see me, they know me; they trust what I say": characterizing the role of trusted sources for smoke risk communication in the Okanogan River Airshed Emphasis Area.

INTRODUCTION: As wildfire smoke events increase in intensity and frequency in the Pacific Northwest, there is a growing need for effective communication on the health risks of smoke exposure. Delivery through a trusted source or intermediary has been shown to improve reception of risk communication messages. This is especially salient in rural and tribal communities who may be hesitant to trust information from state and federal agency sources. This study aims to identify and characterize trusted sources for smoke risk information in the Okanogan River Airshed Emphasis Area (ORAEA), a rural region of North Central Washington state that is heavily impacted by smoke from wildfires and prescribed fire. METHODS: The research team conducted a qualitative study using data collected through key informant interviews and focus groups to assess the role of various sources and intermediaries in disseminating smoke risk information. We used a consensual coding approach in NVivo Qualitative Analysis Software to sort data into preliminary categories, which were grouped into themes using a thematic analysis approach. We used member checking and iterative feedback processes with local project partners throughout the project to ensure credibility of results. RESULTS: Through the analysis, we identified three themes characterizing trusted sources for smoke risk communication in the ORAEA. These themes were: (1) local and tribal sources of information are perceived as more trustworthy than state and federal government sources, (2) trustworthiness is determined by an evaluation of multiple factors, in particular, perceived credibility, quality of information, and relationship with the source, and (3) conservative political ideology and perceived parallels with COVID-19 communication influence perception of trust. Within each theme, we identified several sub-themes, which contributed additional nuance to our analysis. CONCLUSION: This study provides insights into which sources of information are trusted by rural and tribal community members in the ORAEA and why. Results from our study emphasize the importance of relationships and collaboration with local and tribal partners in smoke risk communication. In this paper, we discuss implications for state and federal agency practitioners and present recommendations for how to work with local and tribal partners on smoke risk communication.

The effect of the participatory heat education and awareness tools (HEAT) intervention on agricultural worker physiological heat strain: results from a parallel, comparison, group randomized study.

BACKGROUND: Farmworkers are at risk of heat-related illness (HRI). We sought to: 1) evaluate the effectiveness of farmworker Spanish/English participatory heat education and a supervisor decision-support mobile application (HEAT intervention) on physiological heat strain; and 2) describe factors associated with HRI symptoms reporting. METHODS: We conducted a parallel, comparison group intervention study from May-September of 2019 in Central/Eastern Washington State, USA. We used convenience sampling to recruit adult outdoor farmworkers and allocated participating crews to intervention (n = 37 participants) and alternative-training comparison (n = 38 participants) groups. We measured heat strain monthly using heart rate and estimated core body temperature to compute the maximum work-shift physiological strain index (PSImax) and assessed self-reported HRI symptoms using a weekly survey. Multivariable linear mixed effects models were used to assess associations of the HEAT intervention with PSImax, and bivariate mixed models were used to describe factors associated with HRI symptoms reported (0, 1, 2+ symptoms), with random effects for workers. RESULTS: We observed larger decreases in PSImax in the intervention versus comparison group for higher work exertion levels (categorized as low, low/medium-low, and high effort), after adjustment for maximum work-shift ambient Heat Index (HImax), but this was not statistically significant (interaction - 0.91 for high versus low/medium-low effort, t = - 1.60, p = 0.11). We observed a higher PSImax with high versus low/medium-low effort (main effect 1.96, t = 3.81, p < 0.001) and a lower PSImax with older age (- 0.03, t = - 2.95, p = 0.004), after covariate adjustment. There was no clear relationship between PSImax and the number of HRI symptoms reported. Reporting more symptoms was associated with older age, higher HImax, 10+ years agricultural work, not being an H-2A guest worker, and walking > 3 min to get to the toilet at work. CONCLUSIONS: Effort level should be addressed in heat management plans, for example through work/rest cycles, rotation, and pacing, in addition to education and other factors that influence heat stress. Both symptoms and indicators of physiological heat strain should be monitored, if possible, during periods of high heat stress to increase the sensitivity of early HRI detection and prevention. Structural barriers to HRI prevention must also be addressed. TRIAL REGISTRATION: ClinicalTrials.gov Registration Number: NCT04234802 , date first posted 21/01/2020.

Using social security number to identify sub-populations vulnerable to the health impacts from extreme heat in Florida, U.S.

BACKGROUND: Some socioeconomically vulnerable groups may experience disproportionately higher risk of extreme heat illness than other groups, but no study has utilized the presence/absence of a social security number (SSN) as a proxy for vulnerable sub-populations. METHODS: This study focused on the warm season from 2008 to 2012 in Florida, U.S. With a total number of 8,256,171 individual level health outcomes, we devised separate case-crossover models for five heat-sensitive health outcomes (cardiovascular disease, dehydration, heat-related illness, renal disease, and respiratory disease), type of health care visit (emergency department (ED) and hospitalization), and patients reporting/not reporting an SSN. Each stratified model also considered potential effect modification by sex, age, or race/ethnicity. RESULTS: Mean temperature raised the odds of five heat-sensitive health outcomes with the highest odds ratios (ORs) for heat-related illness. Sex significantly modified heat exposure effects for dehydration ED visits (Males: 1.145, 95 % CI: 1.137-1.153; Females: 1.110, 95 % CI: 1.103-1.117) and hospitalization (Males: 1.116, 95 % CI: 1.110-1.121; Females: 1.100, 95 % CI: 1.095-1.105). Patients not reporting an SSN between 25 and 44 years (1.264, 95 % CI: 1.192-1.340) exhibited significantly higher dehydration ED ORs than those reporting an SSN (1.146, 95 % CI: 1.136-1.157). We also observed significantly higher ORs for cardiovascular disease hospitalization from the no SSN group (SSN: 1.089, 95 % CI: 1.088-1.090; no SSN: 1.100, 95 % CI: 1.091-1.110). CONCLUSIONS: This paper partially supports the idea that individuals without an SSN could experience higher risks of dehydration (for those 25-45 years), renal disease, and cardiovascular disease than those with an SSN.

Heat illness data strengthens vulnerability maps.

BACKGROUND: Previous extreme heat and human health studies have investigated associations either over time (e.g. case-crossover or time series analysis) or across geographic areas (e.g. spatial models), which may limit the study scope and regional variation. Our study combines a case-crossover design and spatial analysis to identify: 1) the most vulnerable counties to extreme heat; and 2) demographic and socioeconomic variables that are most strongly and consistently related to heat-sensitive health outcomes (cardiovascular disease, dehydration, heat-related illness, acute renal disease, and respiratory disease) across 67 counties in the state of Florida, U. S over 2008-2012. METHODS: We first used a case-crossover design to examine the effects of air temperature on daily counts of health outcomes. We employed a time-stratified design with a 28-day comparison window. Referent periods were extracted from ±7, ±14, or ± 21 days to address seasonality. The results are expressed as odds ratios, or the change in the likelihood of each health outcome for a unit change in heat exposure. We then spatially examined the case-crossover extreme heat and health odds ratios and county level demographic and socioeconomic variables with multiple linear regression or spatial lag models. RESULTS: Results indicated that southwest Florida has the highest risks of cardiovascular disease, dehydration, acute renal disease, and respiratory disease. Results also suggested demographic and socioeconomic variables were significantly associated with the magnitude of heat-related health risk. The counties with larger populations working in farming, fishing, mining, forestry, construction, and extraction tended to have higher risks of dehydration and acute renal disease, whereas counties with larger populations working in installation, maintenance, and repair workers tended to have lower risks of cardiovascular, dehydration, acute renal disease, and respiratory disease. Finally, our results showed that high income counties consistently have lower health risks of dehydration, heat-related illness, acute renal disease, and respiratory disease. CONCLUSIONS: Our study identified different relationships with demographic/socioeconomic variables for each heat-sensitive health outcome. Results should be incorporated into vulnerability or risk indices for each health outcome.

Promoting Early, Safe Return to Work in Injured Employees: A Randomized Trial of a Supervisor Training Intervention in a Healthcare Setting.

Purpose Supervisors in the healthcare sector have the potential to contribute to disability prevention in injured employees. Published data on the evaluation of return to work (RTW) interventions aimed at direct supervisors are scarce. We sought to determine the effect of a brief audiovisual supervisor training module on supervisor RTW attitudes and knowledge. Methods A parallel-group study, using equal randomization, comparing the training module intervention to usual practice in healthcare supervisors at a quaternary care hospital was conducted. Differences between groups in changes in RTW attitude and knowledge survey question scores between baseline and 3 months were assessed using the Mann-Whitney U test. The Benjamini-Hochberg-Yekutieli procedure was used to control for false discovery rate and generate adjusted p values. Results Forty supervisors were allocated to the intervention group and 41 to the usual practice group. Attitude and knowledge scores for most questions improved between baseline and immediately after intervention administration. Comparing intervention (n = 33) and usual practice groups (n = 37), there was a trend toward greater increase between baseline and 3 months follow-up in agreement that the supervisor can manage the RTW process (U = 515, adjusted p value = 0.074) and in confidence that the supervisor can answer employees' questions (U = 514, adjusted p value = 0.074) in the intervention group, although these findings were not statistically significant. Conclusions The training intervention may have provided the initial tools for supervisors to navigate the RTW process in collaboration with others in the RTW community of practice. A larger study with longer follow-up is needed to confirm results.

Plasma polychlorinated biphenyl concentrations and immune function in postmenopausal women.

BACKGROUND: Polychlorinated biphenyl (PCB) exposure has been associated with non-Hodgkin lymphoma in several studies, and the immune system is a potential mediator. OBJECTIVES: We analyzed associations of plasma PCBs with immune function measures. We hypothesized that higher plasma PCB concentrations are associated with lower immune function cross-sectionally, and that increases in PCB concentrations over a one year period are associated with decreases in immune function. METHODS: Plasma PCB concentrations and immune function [natural killer (NK) cell cytotoxicity and PHA-induced T-lymphocyte proliferation (PHA-TLP)] were measured at baseline and one year in 109 postmenopausal overweight women participating in an exercise intervention study in the Seattle, Washington (USA) area. Mixed models, with adjustment for body mass index and other potential confounders, were used to estimate associations of PCBs with immune function cross-sectionally and longitudinally. RESULTS: Associations of PCBs with immune function measures differed across groups of PCBs (e.g., medium- and high-chlorinated and dioxin-like [mono-ortho-substituted]) and by the time frame for the comparison (cross-sectional vs. longitudinal). Higher concentrations of medium- and high-chlorinated PCBs were associated with higher PHA-TLP cross-sectionally but not longitudinally. The mean decrease in 0.5 µg/mL PHA-TLP/50.0 pmol/g-lipid increase in dioxin-like PCBs over one year was 51.6 (95% confidence interval 2.7, 100.5; P=0.039). There was no association between plasma PCBs and NK cytotoxicity. CONCLUSIONS: These results do not provide strong evidence of impaired cellular immunity from PCB exposure. Larger longitudinal studies with greater variability in PCB exposures are needed to further examine temporal associations of PCBs with immune function.

Re-evaluating occupational heat stress in a changing climate.

The potential consequences of occupational heat stress in a changing climate on workers, workplaces, and global economies are substantial. Occupational heat stress risk is projected to become particularly high in middle- and low-income tropical and subtropical regions, where optimal controls may not be readily available. This commentary presents occupational heat stress in the context of climate change, reviews its impacts, and reflects on implications for heat stress assessment and control. Future efforts should address limitations of existing heat stress assessment methods and generate economical, practical, and universal approaches that can incorporate data of varying levels of detail, depending on resources. Validation of these methods should be performed in a wider variety of environments, and data should be collected and analyzed centrally for both local and large-scale hazard assessments and to guide heat stress adaptation planning. Heat stress standards should take into account variability in worker acclimatization, other vulnerabilities, and workplace resources. The effectiveness of controls that are feasible and acceptable should be evaluated. Exposure scientists are needed, in collaboration with experts in other areas, to effectively prevent and control occupational heat stress in a changing climate.

Heat-related illness in Washington State agriculture and forestry sectors.

BACKGROUND: We sought to describe heat-related illness (HRI) in agriculture and forestry workers in Washington State. METHODS: Demographic and clinical Washington State Fund workers' compensation agriculture and forestry HRI claims data (1995-2009) and Washington Agriculture Heat Rule citations (2009-2012) were accessed and described. Maximum daily temperature (Tmax) and Heat Index (HImax) were estimated by claim date and location using AgWeatherNet's weather station network. RESULTS: There were 84 Washington State Fund agriculture and forestry HRI claims and 60 Heat Rule citations during the study period. HRI claims and citations were most common in crop production and support subsectors. The mean Tmax (HImax) was 95°F (99°F) for outdoor HRI claims. Potential HRI risk factors and HRI-related injuries were documented for some claims. CONCLUSIONS: Agriculture and forestry HRI cases are characterized by potential work-related, environmental, and personal risk factors. Further work is needed to elucidate the relationship between heat exposure and occupational injuries.

Farmworker-Relevant Heat Exposure in Different Crop and Shade Conditions.

OBJECTIVES: Agricultural workers are at risk of heat-related illness, which is preventable. Few field studies have compared farmworker-relevant heat exposure in different conditions. We examined heat exposure over time in different potential shade and work locations to inform future occupational heat prevention approaches. METHODS: We assessed heat exposure in Eastern Washington State (WA) cherry and grape fields in August 2022. QUESTemp° monitors recorded Wet Bulb Globe Temperature (WBGT) and Black Globe Temperature (BGT) every 10 min from approximately 07:00-14:00 for three days in the center of crop rows (mid-row), under portable shade structures (shade), and in open field (open) locations. Linear mixed effects regression (LMER) models compared WBGT and BGT among field locations. Hourly time-weighted average WBGT and comparisons with occupational exposure limits (OELs) were computed for different hypothetical work-rest cycles during the hottest sampling hours, assuming different worker effort levels, rest locations (mid-row versus shade), and acclimatization statuses. RESULTS: Across all crops and locations during the study period, the mean/SD air temperature was 31°C (88°F)/3.9°C (6.9°F), with a maximum temperature of 39°C (102°F) and a mean/SD relative humidity of 30%/9.6%. LMER models suggested no significant difference in mid-row versus open WBGT but significantly lower WBGT in shade versus open locations for both cherries (main effect -5.14: 95% confidence interval [CI] -6.97,-3.32) and grapes (-6.20: 95%CI -7.73,-4.67), though this difference diminished over the course of the day. BGT was significantly higher in the mid-row than the shade (cherries main effect 14.33: 95%CI 9.52,19.13 and grapes 17.10: 95%CI 13.44,20.75). During the hottest sampling hour, the exceedances of OELs were reduced with assumptions of increased shaded break lengths, reduced effort level, and acclimatization. CONCLUSIONS: Shade canopies, but not the crops studied, provided significant reductions in heat exposure. We observed increased protection from heat assuming longer shaded breaks and reduced effort levels. Results highlight the need for additional field research on the effectiveness, feasibility, and acceptability of different shade types and work-rest cycles to guide employer optimization of best practices for worker protections, including acclimatization before high heat, sufficient shaded rest time, reduced effort levels as the day warms, and avoiding work in peak heat.

Identification of barriers to the prevention and treatment of heat-related illness in Latino farmworkers using activity-oriented, participatory rural appraisal focus group methods.

BACKGROUND: Heat-related illness (HRI) is an important cause of non-fatal illness and death in farmworkers. We sought to identify potential barriers to HRI prevention and treatment in Latino farmworkers. METHODS: We conducted three semi-structured focus group discussions with 35 Latino farmworkers in the Central Washington, USA area using participatory rural appraisal techniques. Interviews were audio taped and transcribed in Spanish. Three researchers reviewed and coded transcripts and field notes, and investigator triangulation was used to identify relevant themes and quotes. RESULTS: Although the majority of participants in our study reported never receiving formal HRI training, most participants were aware that extreme heat can cause illness and were able to accurately describe HRI symptoms, risk factors, and certain prevention strategies. Four main observations regarding farmworkers' HRI-relevant beliefs and attitudes were identified: 1) farmworkers subscribe to varying degrees to the belief that cooling treatments should be avoided after heat exposure, with some believing that such treatments should be avoided after heat exposure, and others encouraging the use of such treatments; 2) the desire to lose weight may be reflected in behaviors that promote increased sweating; 3) highly caffeinated energy drinks are preferred to increase work efficiency and maintain alertness; and 4) the location of drinking water at work (e.g. next to restrooms) and whether water is clean, but not necessarily chemically-treated, are important considerations in deciding whether to drink the water provided at worksites. CONCLUSIONS: We identified potential barriers to HRI prevention and treatment related to hydration, certain HRI treatments, clothing use, and the desire to lose weight among Latino farmworkers. Strategies to address potential barriers to HRI prevention and treatment in this population may include engineering, administrative, and health education and health promotion strategies at individual, workplace, community, and societal levels. Although farmworkers in our study were able to describe HRI risk factors, reported practices were not necessarily consistent with reported knowledge. Further study of potential knowledge-behavior gaps may uncover opportunities for additional HRI prevention strategies. Farmworkers and employers should be included in the development and evaluation of interventions to prevent HRI.

The Effect of Participatory Heat Education on Agricultural Worker Knowledge.

OBJECTIVES: Farmworkers disproportionately experience preventable adverse health effects from heat exposure. We sought to evaluate the effect of participatory heat education on farmworker knowledge. METHODS: We conducted a parallel, comparison group intervention study to investigate the effectiveness of a Spanish/English participatory, culturally-tailored, heat education-based intervention on farmworker heat knowledge in the Summer 2019. We used convenience sampling to recruit adult outdoor farmworkers from Central/Eastern Washington State, USA. Crews were randomized to receive the intervention (n = 40 participants) versus not receive the intervention (n = 43 participants). We assessed changes in heat knowledge, scored on a scale from 0 to 11, between baseline, immediate post-intervention, and post-season, which was approximately three months after baseline, using the Wilcoxon signed-rank test. We compared differences in knowledge scores from baseline to post-season between groups using analysis of variance. RESULTS: Average knowledge scores improved from 4.6 (standard deviation [sd] 1.5) to 6.3 (sd 2.0) pre to post season in the intervention group (p < 0.001). There was a greater improvement in pre-post knowledge scores in the intervention (average difference 1.6, sd 2.0) versus the comparison group (average difference 0.41, sd 1.7) (p = 0.04). CONCLUSIONS: Participatory heat training was effective in improving farmworker heat knowledge over the course of a summer season. Results of this study will be used to guide heat prevention efforts for farmworkers. TRIAL REGISTRATION: ClinicalTrials.gov Registration Number: NCT04234802.

Pre-surgery disability compensation predicts long-term disability among workers with carpal tunnel syndrome.

BACKGROUND: We sought to identify early risk factors for work disability compensation prior to and after carpal tunnel syndrome (CTS) surgery, and to determine whether pre-surgery disability compensation is associated with long-term disability. METHODS: Washington State workers' compensation administrative data and data from interviews with workers 18 days (median) after submitting new workers' compensation claims for CTS were examined. Baseline risk factors for pre-surgery disability compensation and for long-term disability (>365 days of work disability compensation prior to 2 years after claim filing) were evaluated for workers who underwent CTS surgery and had at least 1 day of disability compensation (N = 670). RESULTS: After adjustment for baseline long-term disability risk factors, workers with pre-surgery disability compensation had over five times the odds of long-term disability. Baseline factors in multiple domains, including job, psychosocial, clinical, and worker pain and function, were associated with both pre-surgery disability compensation and long-term disability. CONCLUSIONS: Risk factors for work disability prior to and after CTS surgery are similar, and early work disability is a risk factor for long-term CTS-related disability. An integrated approach to CTS-related disability prevention could include identifying and addressing combined risk factors soon after claim filing, more efficient use of conservative treatments and appropriate work modifications to minimize early work loss, and, when indicated, timely surgical intervention.

Accuracy of an estimated core temperature algorithm for agricultural workers.

There is a substantial burden of occupational health effects from heat exposure. We sought to assess the accuracy of estimated core body temperature (CBTest) derived from an algorithm that uses sequential heart rate and initializing CBT,1 compared with gastrointestinal temperature measured using more invasive ingestible sensors (CBTgi), among outdoor agricultural workers. We analyzed CBTest and CBTgi data from Washington State, USA, pear and apple harvesters collected across one work shift in 2015 (13,413 observations, 35 participants) using Bland Altman methods. The mean (standard deviation, range) CBTgi was 37.7 (0.4, 36.5-39.4)°C. Overall CBT bias (limits of agreement) was -0.14 (±0.76)°C. Biases ranged from -0.006 to -0.75 °C. The algorithm, which does not require the use of ingestible sensors, may be a practical tool in research among groups of workers for evaluating the effectiveness of interventions to prevent adverse occupational heat health effects.

Workplace Determinants of Depression, Anxiety, and Stress in U.S. Mariners during the COVID-19 Pandemic.

United States (U.S.) mariners continued sailing throughout COVID-19. Many aspects of their work could make them prone to adverse mental health outcomes but research on workplace determinants of their mental health during COVID-19 is limited. Between January and July 2021 an online survey assessed the outcomes of increased depressive symptoms, increased anxiety symptoms, and increased perceived stress in addition to concerns, worries, and experiences when sailing during COVID-19, job satisfaction, and safety climate in n = 1384 U.S. mariners. Demographic measures were also collected. Logistic regression models (for depression and anxiety) and a linear regression model (for stress) were developed. We found that increased COVID-19 concerns and poor self-reported mental health were related to increased odds of likely depression and anxiety and higher stress. Mariners who experienced more adverse experiences aboard a vessel had increased stress and increased odds of depression. Poor sleep quality was also related to increased odds of depression, and poor vessel support/safety culture was related to higher stress. Differences in outcomes were seen by vessel type, age, and credential in regression analyses. Results from this study will help to prioritize interventions to minimize the mental health impacts of COVID-19, and influence evidence-based recommendations to improve the mental health of mariners going forward.

Potential Impacts of Different Occupational Outdoor Heat Exposure Thresholds among Washington State Crop and Construction Workers and Implications for Other Jurisdictions.

Occupational heat exposure is associated with substantial morbidity and mortality among outdoor workers. We sought to descriptively evaluate spatiotemporal variability in heat threshold exceedances and describe potential impacts of these exposures for crop and construction workers. We also present general considerations for approaching heat policy-relevant analyses. We analyzed county-level 2011-2020 monthly employment (Bureau of Labor Statistics Quarterly Census of Employment and Wages) and environmental exposure (Parameter-elevation Relationships on Independent Slopes Model (PRISM)) data for Washington State (WA), USA, crop (North American Industry Classification System (NAICS) 111 and 1151) and construction (NAICS 23) sectors. Days exceeding maximum daily temperature thresholds, averaged per county, were linked with employment estimates to generate employment days of exceedances. We found spatiotemporal variability in WA temperature threshold exceedances and crop and construction employment. Maximum temperature exceedances peaked in July and August and were most numerous in Central WA counties. Counties with high employment and/or high numbers of threshold exceedance days, led by Yakima and King Counties, experienced the greatest total employment days of exceedances. Crop employment contributed to the largest proportion of total state-wide employment days of exceedances with Central WA counties experiencing the greatest potential workforce burden of exposure. Considerations from this analysis can help inform decision-making regarding thresholds, timing of provisions for heat rules, and tailoring of best practices in different industries and areas.

Consistent cooling benefits of silvopasture in the tropics.

Agroforestry systems have the potential to sequester carbon and offer numerous benefits to rural communities, but their capacity to offer valuable cooling services has not been quantified on continental scales. Here, we find that trees in pasturelands ("silvopasture") across Latin America and Africa can offer substantial cooling benefits. These cooling benefits increase linearly by -0.32 °C to -2.4 °C per 10 metric tons of woody carbon per hectare, and importantly do not depend on the spatial extent of the silvopasture systems. Thus, even smallholders can reap important cooling services from intensifying their silvopasture practices. We then map where realistic (but ambitious) silvopasture expansion could counteract a substantial fraction of the local projected warming in 2050 due to climate change. Our findings indicate where and to what extent silvopasture systems can counteract local temperature increases from global climate change and help vulnerable communities adapt to a warming world.

Wildfire, Smoke Exposure, Human Health, and Environmental Justice Need to be Integrated into Forest Restoration and Management.

PURPOSE OF REVIEW: Increasing wildfire size and severity across the western United States has created an environmental and social crisis that must be approached from a transdisciplinary perspective. Climate change and more than a century of fire exclusion and wildfire suppression have led to contemporary wildfires with more severe environmental impacts and human smoke exposure. Wildfires increase smoke exposure for broad swaths of the US population, though outdoor workers and socially disadvantaged groups with limited adaptive capacity can be disproportionally exposed. Exposure to wildfire smoke is associated with a range of health impacts in children and adults, including exacerbation of existing respiratory diseases such as asthma and chronic obstructive pulmonary disease, worse birth outcomes, and cardiovascular events. Seasonally dry forests in Washington, Oregon, and California can benefit from ecological restoration as a way to adapt forests to climate change and reduce smoke impacts on affected communities. RECENT FINDINGS: Each wildfire season, large smoke events, and their adverse impacts on human health receive considerable attention from both the public and policymakers. The severity of recent wildfire seasons has state and federal governments outlining budgets and prioritizing policies to combat the worsening crisis. This surging attention provides an opportunity to outline the actions needed now to advance research and practice on conservation, economic, environmental justice, and public health interests, as well as the trade-offs that must be considered. Scientists, planners, foresters and fire managers, fire safety, air quality, and public health practitioners must collaboratively work together. This article is the result of a series of transdisciplinary conversations to find common ground and subsequently provide a holistic view of how forest and fire management intersect with human health through the impacts of smoke and articulate the need for an integrated approach to both planning and practice.