{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,11]],"date-time":"2026-05-11T12:12:21Z","timestamp":1778501541029,"version":"3.51.4"},"reference-count":21,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2026,5,10]],"date-time":"2026-05-10T00:00:00Z","timestamp":1778371200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Healthcare"],"abstract":"<jats:p>Background\/Objectives: Global climate change has increased occupational heat exposure, posing significant risks to outdoor workers. Automotive maintenance workers face high temperatures, radiant heat from machinery, and physically demanding tasks; however, their awareness and preventive behaviors regarding heat-related illness remain insufficiently understood. This study examined heatstroke awareness and preventive behaviors among automotive maintenance workers in Japan. Methods: A cross-sectional web-based survey was conducted among 371 automotive maintenance workers. Self-reported heat-related illness experience was assessed based on subjective judgment without formal medical diagnosis. Associations between heat-related illness experience and behavioral, physical, and health-related factors were analyzed using chi-square tests with Bonferroni correction and multivariable logistic regression. Results: Approximately 39.6% of participants reported experiencing heat-related illness during summer work. In multivariable analysis, headache (OR: 2.66, 95% CI: 1.25\u20135.64), dizziness (OR: 2.06, 95% CI: 1.12\u20133.80), obesity (OR: 1.86, 95% CI: 1.06\u20133.27), and lower self-perceived health (OR: 2.19, 95% CI: 1.36\u20133.55) were independently associated with heat-related illness experience. Some preventive behaviors, including wearing cooling garments and frequent hydration, showed associations in the multivariable analysis; however, these findings should be interpreted with caution due to possible reverse causation, small cell sizes, and residual confounding. Conclusions: Behavioral and individual health-related factors, particularly symptom recognition and self-perceived health, are associated with heat-related illness experience among automotive maintenance workers. Interventions focusing on early symptom awareness, risk perception, and self-monitoring may be important components of workplace-based heat illness prevention. Future studies incorporating objective environmental and physiological measurements are needed to clarify causal relationships.<\/jats:p>","DOI":"10.3390\/healthcare14101293","type":"journal-article","created":{"date-parts":[[2026,5,11]],"date-time":"2026-05-11T10:50:52Z","timestamp":1778496652000},"page":"1293","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Heatstroke Awareness and Preventive Behaviors Among Automotive Maintenance Workers in Outdoor Environments: A Cross-Sectional Study in Japan"],"prefix":"10.3390","volume":"14","author":[{"given":"Chieko","family":"Yodawara","sequence":"first","affiliation":[{"name":"Graduate School of Life and Health Sciences, Chubu University, 1200 Matsumoto-cho, Kasugai-shi 487-8501, Japan"},{"name":"Department of Nursing, Nagoya University of Arts and Sciences, 4-1-1 Sannomaru, Naka-ku, Nagoya-shi 460-0001, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yoko","family":"Iio","sequence":"additional","affiliation":[{"name":"Department of Lifelong Sports and Health Sciences, College of Life and Health Sciences, Chubu University, 1200 Matsumoto-cho, Kasugai-shi 487-8501, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4004-429X","authenticated-orcid":false,"given":"Harumi","family":"Ejiri","sequence":"additional","affiliation":[{"name":"Department of Nursing, College of Life and Health Sciences, Chubu University, 1200 Matsumoto-cho, Kasugai-shi 487-8501, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Saimi","family":"Yamamoto","sequence":"additional","affiliation":[{"name":"Graduate School of Life and Health Sciences, Chubu University, 1200 Matsumoto-cho, Kasugai-shi 487-8501, Japan"},{"name":"Department of Early Childhood Education, College of Contemporary Education, Chubu University, 1200 Matsumoto-cho, Kasugai-shi 487-8501, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hana","family":"Kozai","sequence":"additional","affiliation":[{"name":"Department of Food and Nutritional Sciences, College of Bioscience and Biotechnology, Chubu University, 1200 Matsumoto-cho, Kasugai-shi 487-8501, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8470-6806","authenticated-orcid":false,"given":"Mamoru","family":"Tanaka","sequence":"additional","affiliation":[{"name":"Department of Food and Nutritional Sciences, College of Bioscience and Biotechnology, Chubu University, 1200 Matsumoto-cho, Kasugai-shi 487-8501, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Manato","family":"Seguchi","sequence":"additional","affiliation":[{"name":"Graduate School of Life and Health Sciences, Chubu University, 1200 Matsumoto-cho, Kasugai-shi 487-8501, Japan"},{"name":"Support for Pioneering Research Initiated by the Next Generation (SPRING), Chubu University, 1200 Matsumoto-cho, Kasugai-shi 487-8501, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8706-0705","authenticated-orcid":false,"given":"Morihiro","family":"Ito","sequence":"additional","affiliation":[{"name":"Graduate School of Life and Health Sciences, Chubu University, 1200 Matsumoto-cho, Kasugai-shi 487-8501, Japan"},{"name":"Department of Lifelong Sports and Health Sciences, College of Life and Health Sciences, Chubu University, 1200 Matsumoto-cho, Kasugai-shi 487-8501, Japan"},{"name":"Department of Biomedical Sciences, College of Life and Health Sciences, Chubu University, 1200 Matsumoto-cho, Kasugai-shi 487-8501, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,5,10]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"42539","DOI":"10.1007\/s11356-022-19718-6","article-title":"A review of the global climate change impacts, adaptation, and sustainable mitigation measures","volume":"29","author":"Abbass","year":"2022","journal-title":"Environ. Sci. Pollut. Res. Int."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"239","DOI":"10.1093\/heapro\/dat027","article-title":"Working in Australia\u2019s heat: Health promotion concerns for health and productivity","volume":"30","author":"Singh","year":"2015","journal-title":"Health Promot. Int."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"46","DOI":"10.3402\/gha.v2i0.2047","article-title":"Workplace heat stress, health and productivity\u2014An increasing challenge for low and middle-income countries during climate change","volume":"2","author":"Kjellstrom","year":"2009","journal-title":"Glob. Health Action"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"91","DOI":"10.2486\/indhealth.2012-0145","article-title":"Health Impacts of Workplace Heat Exposure: An Epidemiological Review","volume":"52","author":"Xiang","year":"2014","journal-title":"Ind. Health"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"11786302261426720","DOI":"10.1177\/11786302261426720","article-title":"Heat Exposure and Health Outcomes in Construction Workers: A Systematic Review and Meta-Analysis","volume":"20","author":"Chattu","year":"2026","journal-title":"Environ. Health Insights"},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"De Sario, M., de\u2019Donato, F.K., Bonafede, M., Marinaccio, A., Levi, M., Ariani, F., Morabito, M., and Michelozzi, P. (2023). Occupational heat stress, heat-related effects and the related social and economic loss: A scoping literature review. Front. Public Health, 11.","DOI":"10.3389\/fpubh.2023.1173553"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1007\/s40572-025-00520-8","article-title":"An Umbrella Review of Systematic Reviews and Meta-Analyses on Occupational Heat Exposure, Health Risks, and Productivity Losses Globally","volume":"13","author":"Nath","year":"2026","journal-title":"Curr. Environ. Health Rep."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"334","DOI":"10.1136\/injuryprev-2016-042204","article-title":"Working in hot weather: A review of policies and guidelines to minimise the risk of harm to Australian workers","volume":"23","author":"McInnes","year":"2017","journal-title":"Inj. Prev."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"86","DOI":"10.5271\/sjweh.3602","article-title":"Association between high ambient temperature and acute work-related injury: A case-crossover analysis using workers\u2019 compensation claims data","volume":"43","author":"McInnes","year":"2017","journal-title":"Scand. J. Work Environ. Health"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"380","DOI":"10.1016\/j.ssci.2018.04.027","article-title":"Are workers at risk of occupational injuries due to heat exposure? A comprehensive literature review","volume":"110","author":"Varghese","year":"2018","journal-title":"Saf. Sci."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"246","DOI":"10.1136\/oemed-2013-101584","article-title":"Association between high temperature and work-related injuries in Adelaide, South Australia, 2001\u20132010","volume":"71","author":"Xiang","year":"2014","journal-title":"Occup. Environ. Med."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Xiang, J.J., Hansen, A., Pisaniello, D., and Bi, P. (2015). Perceptions of Workplace Heat Exposure and Controls among Occupational Hygienists and Relevant Specialists in Australia. PLoS ONE, 10.","DOI":"10.1371\/journal.pone.0135040"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"338","DOI":"10.1136\/oemed-2014-102428","article-title":"Effect of summer outdoor temperatures on work-related injuries in Quebec (Canada)","volume":"72","author":"Smargiassi","year":"2015","journal-title":"Occup. Environ. Med."},{"key":"ref_14","first-page":"357","article-title":"The association between extreme weather conditions and work-related injuries and diseases. A systematic review of epidemiological studies","volume":"52","author":"Bonafede","year":"2016","journal-title":"Ann. Dell\u2019istituto Super. Di Sanita"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1136","DOI":"10.1113\/EP090402","article-title":"Are there sex differences in risk for exertional heat stroke? A translational approach","volume":"107","author":"Giersch","year":"2022","journal-title":"Exp. Physiol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1283","DOI":"10.1139\/apnm-2017-0361","article-title":"Carbohydrate and protein intake during exertional heat stress ameliorates intestinal epithelial injury and small intestine permeability","volume":"42","author":"Snipe","year":"2017","journal-title":"Appl. Physiol. Nutr. Metab."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"331","DOI":"10.1539\/joh.14-0218-OA","article-title":"Risk and preventive factors for heat illness in radiation decontamination workers after the Fukushima Daiichi Nuclear Power Plant accident","volume":"57","author":"Kakamu","year":"2015","journal-title":"J. Occup. Health"},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Morrissey, M.C., Kerr, Z.Y., Brewer, G.J., Tishukaj, F., Casa, D.J., and Stearns, R.L. (2023). Analysis of Exertion-Related Injuries and Fatalities in Laborers in the United States. Int. J. Environ. Res. Public. Health, 20.","DOI":"10.3390\/ijerph20032683"},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Alele, F.O., Malau-Aduli, B.S., Malau-Aduli, A.E.O., and Crowe, M.C. (2020). Epidemiology of Exertional Heat Illness in the Military: A Systematic Review of Observational Studies. Int. J. Environ. Res. Public Health, 17.","DOI":"10.3390\/ijerph17197037"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"431","DOI":"10.1016\/B978-0-444-63912-7.00026-6","article-title":"Obesity and thermoregulation","volume":"156","author":"Speakman","year":"2018","journal-title":"Handb. Clin. Neurol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"615","DOI":"10.1152\/japplphysiol.00906.2015","article-title":"A comparison of thermoregulatory responses to exercise between mass-matched groups with large differences in body fat","volume":"120","author":"Dervis","year":"2016","journal-title":"J. Appl. Physiol. 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