Occupational and off-work recovery predictors of heat-related illness among farmworkers in California: Insights including gender-related differences

BACKGROUND: Farmworkers in the United States are exposed to extreme heat and demanding physical labor, placing them at increased risk for heat-related illnesses (HRI). This study examined individual, occupational, and household factors associated with self-reported HRI among men and women farmworkers in Imperial Valley, California. METHODS: This cross-sectional study used a convenience and snowball sampling approach to recruit agricultural workers through a local community organization. Participants were administered an in-person interview on their experience with HRI and potential risk factors. A multivariate regression analysis was conducted to identify variables related to HRI. RESULTS: From 300 participants, 119 (39.7%) experienced HRI, defined as reporting at least three HRI symptoms. In the multivariate regression analysis, HRI odds were significantly increased in women (aOR: 2.36, 95%CI: 1.35-4.15), in those reporting heat-related sleep problems (aOR: 3.25, 95%CI: 1.50-7.02), face covering use (aOR: 1.94, 95%CI: 1.09-3.45) and those working more than 5 days per week (aOR: 2.19, 95%CI: 1.23-3.91). Older age had a modest association with lower odds of HRI (aOR: 0.98, 95%CI: 0.96-0.99) and more than one break per day (aOR: 0.59, 95%CI: 0.35-1.00, p = 0.053) was associated with marginally lower HRI odds. CONCLUSIONS: As climate change continues to intensify occupational heat exposure among agricultural workers, interventions should extend beyond purely workplace-focused efforts and address cumulative exposure, non-occupational factors and structural constraints. Report of heat-related sleep problems has been associated with HRI relatively recently. Future research should establish the occupational, structural, and biological pathways contributing to the increased HRI odds for women farmworkers.